Carcinoma papilar esclerosante difuso del tiroides: comunicación de dos casos / Diffuse sclerosing papillary thyroid carcinoma: report of two cases

Unlike classical papillary carcinoma, diffuse sclerosing papillary thyroid carcinoma presents as a diffuse goiter with a discretely irregular surface, associated to hypo or hyperthyroidism, specially in young women. We report two women aged 41 and 23 years old with this disease, one with normal thyroid function and the other with hyperthyroidism. It is concluded that diffuse sclerosing papillary thyroid carcinoma must be suspected in patients with rapidly growing goiter with irregular surface or diffuse minute calcifications, specially in the presence of hypo or hyperthyroidism. Fine needle aspiration is a good diagnostic procedure

Función tiroidea en una población con aporte extra de yodo / Thyroid function in a population with an extra iodine intake

Background: After 20 years of iodine salt fortification, the prevalence of goiter has decreased significantly in the rural area of Pirque, central Chile. In this location, equipment has been installed that efficiently and economically adds 0.5 mg of elemental iodine per liter of water to render it potable. Aim: To study thyroid function and urinary iodine excretion in scbool age cbildren of this zone, after two years of extra iodine intake. Material and methods: One hundred thirty four children aged 6 to 12 years old were examined. In 56 randomly chosen children a morning urine sample was obtained to measure iodine excretion. In 45 children without goiter, a blood sample was obtained to measure TSH and thyroxin. Results: In nine cbildren (7 percent) a diffuse goiter was found. Median urinary iodine excretion was 158 ug/dl. Thyroxin and TSH levels were within normal limits (8.4Ý1.1 ug/dl and 2.2Ý1.5 uU/ml respectively). During the period of iodine water supplementation there were 47 births in the zone. All newborns had normal TSH values and none had goiter. Conclusions: When present results are compared with the period before water iodination (when the prevalence of goiter was 9.6 percent and mean urinary iodine excretion was 57.6 ug/dl), it can be concluded that extra iodine intake in this rural population has not caused additional thyroid problems

Prevalencia de bocio en escolares de la zona de Pirque: efecto de la yodación de la sal / Prevalence of goiter in school children at Pirque: effects of salt iodination

Twenty years ago, Pirque was a zone with a goiter prevalence of 39 percent, to assess the effects of salt iodination on the prevalence of goiter, school age children from 4 public schools of Pirque, were examined, following WHO criteria for the diagnosis of goiter. Urinary iodine excretion was also measured. Five hundred ninety one males and 298 females aged 12.1ñ2.5 years were examined. Fifty seven children (9.6 percent) had goiter. In 53, the goiter was grade I and in 4, grade II. No sex differences were observed. Minimal and median urinary iodine excretion values were 12.6 and 57.6 ug/dll respectively. In conclusion, goiter prevalence dropped from 39 to 10 percent. The fact that iodine intake is over minimal recommendations, underscores the effectiveness of salt iodination

Infiltración adiposa difusa de la glándula tiroides asociada a amiloidosis en un paciente con insuficiencia renal crónica / Diffuse fatty infiltration of the thyroid gland associated to amyloidosis in a patient with chronic renal failure

We report a 26 years old male with secondary amyloidosis and chronic renal failure who consulted due to rapidly growing goiter associated with coarseness and dysphagia. Serum levels of thyroid hormones and TSH were normal and a neck CT scan showed a big mass in the anterior lateral regions, thet compressed neighboring structures. The patient was subjected to a total thyroidectomy and the pathological study revealed a diffuse fatty and amyloid infiltration of the thyroid gland. There was no evidence of malignancy

Presentaciones inhabituales de infecciones del tracto urinario en 6 casos / Unusual presentation of urinary tract infections in 6 cases

Urinary tract infections may have different clinical presentations that may range from asymptomatic bacteriuria to purulent collections and severe sepsis. We report 6 diabetic patients, 3 presenting with a renal carbuncle and 3 with an emphysematous pyelonephritis. All required medical and surgical treatment and had a good evolution. Two carbuncles were caused by beta-hemolitic type B streptococcus. This is the second notification of this agent as causative of renal abscesses, probably reaching the kidney through hematogenous dissemination from cutaneous foci

Septicemia por streptococcus pneumoniae: análisis de 40 casos / Septicemia by streptococcus pneumoniae: analysis of 40 cases

Sepsis due to streptococcus pneumoniae has a high mortality. We report a retrospective review of 40 episodes of S pneumonia sepsis in adult patients during a two yaer period in a general hospital, that represented 11,3 percent of all sepsis observed in such hospital. Ninety two percent of infections were community acquired and in 95 percent, the portal of entry was the respiratory tract. 85 percent of patients had at least one risk factor such as alcohol abuse, unconsciousness of chronic pulmonary disease. Nine patients had suppurative complications (empyema in 4 cases, spontaneous bacterial peritonitis in 2, septic arthritis in 2 and meningitis in 1 case) and 12 (30 percent) died. The potential benefit of antipneumococcal vaccine as prevention should be considered in high risk subjects

Intoxicación aguda por tiroxina en niños / Acute poisoning with thyroxine in children

Dos niñas de 5 y 14 años de edad ingresaron al hospital 4 y 8 h después de haber ingerido dosis estimadas de L-tiroxina de 72 ug*kg. En ambas pacientes la concentración sérica de T4 estaba elevada al ingresar (19 y 20 ug/dl) y las dos eran asintomáticas. Ellas fueron tratadas con Ipodato de sodio, 3 g por vía oral cada 72 h, con el propósito de bloquear la conversión de T4 a T3. Las concentraciones séricas de T4 aún permanecían elevadas 10 días después (8 y 16 ug/dl), pero las de T3 descendieron a 60 ug/dl y se mantuvieron bajo este nivel, dentro de las primeras 48 h de iniciado el tratamiento. Los pacientes, en estos casos, pueden no presentar síntomas de intoxicación, sino hasta después de 24 h de producida la ingestión; por este motivo deben ser admitidos y tratados sistemáticamente en el hospital. El Ipodato es el tratamiento de elección

Síndrome de Cushing: problemas de diagnóstico y tratamiento en 27 casos / Cushing syndrome: diagnosis and treatment in 27 patients

Problems of diagnosis and treatment were analyzed in 27 patients with Cushing syndrome (25 confirmed by anatomic findings) followed for a mean fo 50 months. The etiology was Cushing disease in 14 (52%), suprarenal tumor in 9 (33%) and ectopic secretion of ACTH in 4(15%). Determination of plasma cortisol levels at 4PM or 11 PM was a highly sensitive test for the presence of this syndrome (100%). High resolution computed tomography was considerably more effective than conventional X ray studies of the sella in patients with Cushing disease (42 vs 20%. Treatment has been totally effective in all patients with bening suprarenal lesions. Cure was obtrained in 64% of patients with pituitary lesions and 0% of patients with Cushing syndrome associated to malignancy