Early change of thyroid hormone concentration after 131I treatment in patients with solitary toxic noudule

In spite of extensive use of 131I for treatment hyperthyroidism, the results of early outcome are variable. To test whether 131 I induced necrosis causing clinical aggravation of hyperthyroidism and increasing the free thyroid Hormone concentration in the serum of patients with solitary nodule not pretreated with antithyroid drugs. Thirty consecutive patients were treated with 925 MBq 131 I. Serum concentration of thyrotropin [SH] free thyroxine [fT4], free triiodothyronine [fT3], Thyroglobuline [Tg], and interleukin-6 [IL-6] were measured A'lure and after application of 131 I. After application of 131 I no clinical worsening I was observed. FT4 and fT3 concentration did not change significantly within the first five days, whereas both of them significantly decreased after 12 days [p<0.0001]. Slight and clinically irrelevant increase in the level of the two thyroid innones was observed in 9 patients. Furthermore, we observed a prolonged increase in Tg concentration and a transient [iirrease in IL-6 concentration. Neither evidence of any clinical aggravation hyperthyroidism nor any significant increase in thyroid inrmone concentration by 131 I induced necrosis of thyroid cells was found. Therefore, the application of 131 I may be concidered as a safe and effective treatment for patients with typerthyroidism due to toxic adenoma.

Three basic patterns of changes in serum thyroid hormone levels in graves' disease during the one-year period after radioiodine therapy

Was to clarify the characteristic patterns of the thyroid hormonal changes in Graves' disease during the one-year period after [131]I therapy considering that few serial hormonal data during this period are available in the literature. The levels of serum T[3], T[4] and FT[4] before and during one year were plotted as a function of time in 86 therapy courses of 70 patients without subsequent antithyroid or steroid therapy. 35 euthyroid, 6 hypothyroid and 29 hyperthyroid states were obtained during one year after therapy. Although individual patients had individual hormonal changing patterns, 3 common basic patterns were observed from baseline to one month [early] and thereafter [late], respectively. The early patterns were a decrease in 54 [77%], a minimum change in 8 [11.5%] and an increase in 8 [11.5%]. The late patterns were a stable state after an initial decrease with a bottom followed by an increase [valley pattern] in 47 [67%], a stable state after an initial increase with a peak followed by a decrease with a bottom and a subsequent re-increase [mountain pattern] in 12 [17%] and a late stable state after a gradual slow decrease without an obvious bottom near or till one year [downhill pattern] in 11 [16%]. The bottom level and the degree of hormonal recovery from the bottom determined the stable euthyroid, hypothyroid or hyperthyroid state in 49 [86%] of 59 with the valley or mountain pattern. Most of the bottom levels [81%] and transient abnormal changes including transient hypothyroidism [93%, 13/14], peak or hyperthyroidism [85%, 11/13] and euthyroidism [67%, 10/15] appeared within 6 months. The posttherapeutic stable euthyroid, hypothyroid or hyperthyroid state could be judged from the hormonal patterns in 57% [39/68] from 2.5 to 6 months, in 18% [12/68] from 6 to 9 months and in 25% [17/68] thereafter. Although the changes in thyroid hormones are not constant in Graves' disease during one year after [131]I therapy, there are three basic patterns; valley, mountain and downhill patterns from one month after therapy. The post-therapeutic stable state can be judged by the hormonal level recovered from the bottom in most patients

Percutaneous cannulated screws fixation in displaced intracapsular fractures of the femoral neck

The results of percutaneous cannulated screws fixation in 20 patients with displaced intracapsular femoral neck fractures were evaluated. 15 patients [75%] had partially displaced fractures [Garden III] and 5 patients [25%] had completely displaced fractures [Garden IV]. The mean age of the patients was 42 years [range 22 to 60 years]. The mean duration of follow-up was two years. Closed reduction was successfully done in all patients using Whitman maneuver and under image control. Cases with failed closed reduction were excluded from the study. All patients were evaluated on the basis of both clinical and radiological examinations. No patient died or had a wound infection during stay in the hospital. There was non-union of the fracture in two patients [10%] and healing of the fracture in 18 patients [90%]. The final results were graded as excellent in 12 patients [60%], good in 6 patients [30%], fair in one patient [5%], and poor result in another patient [5%]. Avascular head necrosis developed in 2 patients [10%], both had Garden type IV fracture. Another one patient [5%] with fracture [Garden III united in varus although she was functionally classified as good. Percutaneous cannulated screws fixation of intracapsular femoral neck fractures could offer a safe, simple, and effective procedure with good union and low rate of morbidity and mortality

post-exercise to peak exercise systolic blood pressure ratio: a new marker of myocardial Ischaemia

To assess the usefulness of the post-exercise [recovery] to the peak exercise systolic blood pressure ratio [RSBP/PSBP] in the diagnosis of coronary heart disease [CHD], 100 patients [94 M and 6 F, mean age 49 +/- 8.7 yrs] were examined by ECG exercise test and coronary angiography. The series was divided into 3 groups: group I [40 pts, mean age 51 +/- 6.8 yrs] symptomatizing by typical chest pain but depicting nonspecific ST-T changes in the resting ECG; group II[40 pts, mean age 51.5 +/- 7.8 yrs] either known to have CHD in the form of a previous documented myocardial infarction, or preliminarily presenting a very high index of suspicion of CHD in the form of typically ischaemic ST-T changes in the resting ECG; and group III [20 pts, mean age 44 +/- 7.2 yrs] presenting with atypical chest pain but without resting ECG changes whatsoever. In group I, coronary angiography displayed single vessel disease [I VD] in 24 pts [60%], two-vessel disease [2VD] in 13 pts [32.5%] and triple vessel disease [3VD] in 3 pts [7.5%]; in group II, 23 pts [57.5%] had 1VD, 15 pts[375%] had 2VD and 2 pts [5%] had 3VD, whereas all patients in group III were proven to have normal coronary arteries. The duration of exercise test was significantly longer in group III than in both groups I and II. Patients in group III achieved a significantly higher level of maximal SBP than those of groups I and II [p = 0.0104]. An abnormal RSBP/PESBP ratio was defined as recovery SBP to peak exercise SBP ratio > 1, 0.9 and 0.8 at 1, 2 and 3 minutes of recovery respectively. An abnormal ratio was disclosed by 35 pts [87.5%] of group 1, 37 pts [92.5%] of group II and 3 pts [15%] of group III. On the other hand, chest pain during exercise testing occurred in 26 pts [65%] of group I, 28 pts [70%] of group II and 6 pts [30%] of group III. Significant ST-T displacement during exercise testing was developed in 23 pts [57.5%] of group I, 26 pts [65%] of group II and 4 pts [20%] of group III [these ST-T alterations were only typically ischaemic in the first 2 groups]. The RSBP/PSBP ratio has successfully detected CHD with a sensitivity of 85%, specificity of 70%, positive predictive value of 90%, negative predictive value of 68% and diagnostic accuracy of 85%: The sensitivity of exercise-induced chest pain in detecting CHD was only 67% the specificity was 70% positive predictive value 90% negative predictive value 35% and diagnostic accuracy 68% whereas the sensitivity, specificity, positive predictive value negative predictive value and diagnostic accuracy of exercise induced ST changes in the detection of CHD were 61%, 70%, 90%, 34% and 65% respectively. For combined ST changes and chest pain the sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy were 90%, 72%, 93.5%, 70% and 88% respectively. It is noteworthy that 85% of patients with 1VD, 88% of those with 2VD and 100% of those. with 3VD have displayed an abnormal RSBP/PSBP ratio. Thus, the RSBP/PSBP ratio supercedes either exercise-induced angina or ST changes in the sensitivity of detection of CHD. Nevertheless, the combination of exercise angina and ST changes is more sensitive than the RSBP/PSBP in detecting CHD. The ratio exhibited a diagnostic accuracy in identifying patients with CHD that is comparable to ST changes and chest pain. Moreover, the RSBE/PSBP correlated well with the severity of CHD. The ratio is not, however, meant to replace the classical hallmarks of myocardial ischaemia during ECG stress testing, it might be rather perceived as an adjunct to those classical time-honoured criteria

Clinical value of local treatment in patients of bacterial otitis externa

This study aimed to demonstrate the effects of local treatment with or without systemic antibiotics after the classification of cases of otitis externa [OE] into mild, moderate and severe according to the findings seen in the clinical examination and complaints of the patients. The results showed that the predisposing factors for OE were swimming [30%], local trauma [25%], ear washing [12%], allergy [10%], diabetes [6%] and unknown etiology [17%]. The bacteriologic results showed pure aerobic bacterial growth in 56%, pure fungal growth in 18%, mixed growth of both in 24% and no growth in 2%. Anaerobic bacterial growth was obtained in 20% of the cases. Mildly and moderately severe cases of bacterial OE gave a good response to topical applications only; while, severe cases needed systemic antibiotics