[ incidence of subclinical thyroid dysfunction and it's natural course in the Tehranian adults]

The aim of this study was to determine the incidence of thyroid dysfunction and the natural course of subclinical thyroid disorders in the Tehranian community. All individual >/= 20 years, who participated during the first to third phases [6 years, 7 months], of the [Tehran Lipid and Glucose Study] and provided the relevant data were included in this study. Both Tpo-Ab and TSH were measured. In 808 TPO-Ab negative individuals who were not taking any thyroid and anti-thyroid drugs and without a history of thyroid disease, thyroid surgery, goiter and thyroid nodules, mean, median, 2.5, 5, 95, 97.5 percentile TSH were determined. On the basis of 2.5 and 97.5 percentile, normal reference range for TSH was 0.4- 5.8 micro u/mL. In those, whose TSH fell outside the reference range, T3, T4 and T3 uptake were measured and FTI was calculated. In the first stage, 1065 women and 693 men had normal thyroid tests. After 6.7 years the incidence of clinical hypothyroidism was 0.28 in 1000 women and 0.21 in 1000 men, subclinical hypothyroidism was 11.59 in 1000 women and 4.69 in 1000 men, clinical hyperthyroidism was 1.4 in 1000 women and 0.21 in 1000 men, subclinical hyperthyroidism was 5.72 in 1000 women and 3.62 in 1000 men. In this period, increasing positivity of TPO-Ab from 15.9 to 17.7% in women was significant. [P=0.06] In the first stage 8 women had subclinical hypothyroidism, 5 still did on follow-up, one was normal, and one was diagnosed with clinical hypothyroidism. The remaining one was hyperthyroid on levothyroxin. Two women with subclinical hyperthyroidism in the first stage were normal in follow-up, without any treatment. In the first stage 2 men had subclinical hypothyroidism, and in follow-up, one was same, while the other was diagnosed with clinical hypothyroidism. Normal range of TSH was 0.4-5.8 micro u/mL in the Tehranian community. There was significant increase of the frequency of subclinical thyroid disorders in both genders and frequency of clinical hyperthyroidism and TPO-Ab positive in women. Compared to clinical thyroid disorders, the incidence of subclinical thyroid disorders, was more significant

[Myocardial 99m Tc-MDP uptake on the bone scintigraphy in the hemodialysis-associated amyloidosis:a case report]

Amyloidosis is characterized by an abnormal extracellular deposition of amyloid in different organs, where it usually causes some type of dysfunction. Its cause is unknown. Five different types of amyloidosis have been described according to the underlying disease; immunoglobulin amyloidosis, familial amyloidosis, senile systemic amyloidosis, secondary amyloidosis and hemodialysis-associated amyloidosis. We report a case of hemodialysis-associated amyloidosis in a 56-year-old man that radionuclide imaging demonstrated intense uptake of Tc-99m MDP within the myocardium. The diagnosis of amyloidosis was established by analysis of aspirated abdominal fat, although other non- invasive modalities didn't reveal any positive findings. The first clue to the possible presence of amyloidosis in this case was provided by the radionuclide bone scan performed, which revealed intense tracer uptake in the heart suggesting amyloid deposit. We conclude that in cases of extraosseous accumulation of Tc-99 MDP especially as a diffuse pattern of myocardial uptake, a diagnosis of amyloidosis should be considered, in an appropriate clinical setting

Baclofen in maintenance treatment of opioid dependence: a randomized double-blind clinical trial with placebo-controlled

This project was aimed to evaluate the efficacy of baclofen in keeping opioid dependents in maintenance treatment and in reduction of their opioid use. It also assessed its superiority over placebo. In this double blind experimental study, 40 patients with the diagnosis of opioid dependence [DSM- IV based criteria] were inserted randomly in two groups following the detoxification phase. In one group, 20 patients took baclofen [60 mg daily in three divided doses] and in the other one, 20 patients took placebo for a total of 12 weeks. The primary measuring factors included retention of patients in maintenance treatment and positive urine analysis. The project's data were analyzed via statistical Mann-Whitney and chi-square tests. The retention of patients in treatment was significantly more in baclofen group than the placebo group. baclofen group patients exhibited less opioid withdrawal and depressive symptoms than the placebo group. There were no significant differences between the two groups in terms of the rate of positive urine analysis, intensity of craving for opioid use, medication side effects, and the average days of opioid and alcohol consumption during treatment. Baclofen is considerably superior to placebo in keeping the patients in treatment and also in reduction of opioid withdrawal and depressive symptoms

Dystrophic calcinosis cutis and SLE: the bone scan pattern [case report]

A 21 years old woman presented with a history of SLE and skin lesions on the arms, trunk, and abdomen. The left gluteal region was ulcerated and painful and occasionally extruded a chalky white material. The patient referred from rheumatology department for osteomyelitis assessment. On physical examination the patient had hard, nontender lesions on the proximal arms, lower abdomen and lower back. She had painful, hyper pigmented bullae, plaques, erosions and ulcer on her hands, arms, thighs, knees and especially left gluteal region. All laboratory results including BUN, Cr, Ca, Ph, LFT, were normal except for ESR which was increased. Left gluteal skin biopsy reveals homogenized and sclerotic collagen in the lower dermis with scattered foci of calcification, consistent with calcinosis cutis. The whole body bone scan shows diffuse extra osseous calcification mainly in the arms, lower trunk and thighs. The X-ray findings revealed multiple foci of calcification in the soft tissue compartment of the arms and lower trunk. Focal areas of increased uptake in the ribs and right humerus secondary to osteoporosis and truma were noticed. Calcinosis cutis is a rare presentation of SLE. It is usually seen in CRF and due to electrolyte impairment .In this report however, a case of SLE is presented with extensive calcinosis but normal renal function and lack of any electrolyte imbalance