ABSTRACT
Thyroglossal duct cyst is the most common congenital anomaly of thyroid gland development. However, papillary carcinoma is described only in 1-2 percent of cases and the clinical appearance is indistinguishable from a benign thyroglossal duct cyst. We report two females aged 15 and 27years consulting for a cervical mass. In both, a solid cystic lesion was found and excised using the Sistrunk procedure. The biopsy disclosed a papillary carcinoma in both. The postoperative evolution of both patients was uneventful.
Subject(s)
Adolescent , Adult , Female , Humans , Carcinoma, Papillary/pathology , Thyroglossal Cyst/pathology , Thyroid Neoplasms/pathology , Biopsy, Fine-Needle , Carcinoma, Papillary/surgery , Diagnosis, Differential , Lymphatic Metastasis , Submandibular Gland Neoplasms/secondary , Submandibular Gland Neoplasms/surgery , Thyroglossal Cyst/surgery , Thyroid Neoplasms/surgery , Tongue Neoplasms/secondary , Tongue Neoplasms/surgeryABSTRACT
El manejo profiláctico de los linfonodos regionales en melanoma maligno es un tema controversial. En la actualidad, se reconoce la utilidad de la identificación del primer linfonodo de drenaje a la lesión (ganglio centinela) para definir la conducta respecto a la linfadenectomía profiláctica. La identificación de este ganglio se realiza con los mejores resultados, utilizando la cintigrafía asociada a la tinción con azul de metileno en el intraoperatorio. Se evaluaron nueve pacientes, seis mujeres y tres hombres, con un promedio de edad de 48 años, con lesiones en estadio I y II distribuidas topográficamente de la siguiente forma: extremidad inferior 4, extremidad superior 1, torso 2 y cabeza y cuello 2. Los resultados iniciales del estudio demuestran la validez y la aplicabilidad de la técnica, la que puede producir cambios significativos en el manejo de estos pacientes. El escaso número de pacientes, impide obtener conclusiones con significación estadística en este momento del estudio
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Ganglia/pathology , Melanoma/surgery , Lymphatic Metastasis/pathology , Biopsy/statistics & numerical data , Radionuclide Imaging/statistics & numerical dataABSTRACT
Background: There is not much evidence about the usefulness of digoxin or enalapril in the treatment of heart failure due to mitral insufficiency. Aim: to compare digoxin and enalapril in the treatmen of heart failure due to mitral insufficiency. Patients and methods: Patients with mitral insufficiency, in sinus rhythm, with a heart failure grade II or III and with echocardiographic left ventricular dilatation were eligible for the study. They received sequentially, during 12 weeks each, digoxin 0.25 mg/day or enalapril in doses up to 20 mg/day, with a washout in-between period of 2 weeks. The order of the sequence was determined randomly. At the start and end of treatment, functional class according to NYHA and maximal exercise tolerance in the treadmil were assessed and a color Doppler echocardiogram was done to measure ventricular dimensions, function and degree of mitral insufficiency. Results: Nine patients on enalapril and 12 on digoxin improved their functional capacity. Digoxin improved exercise time in 76ñ168 sec (p= 0.022), whereas this change was not significant with enalapril (38ñ158 sec; p= 0.2). With enalapril treatmen, ventricular diastolic dimensiondecreased from 59.3ñ8.1 to 58ñ9.3 mm and the area of mitral insufficiency decreased from 8.1ñ3.5 to 6.6ñ3.1 cm2. Digoxin did not induce any significant echocardiographic change. Conclusions: In these patients, digoxin and enalapril improved functional class. Digoxin improved exercise time and enalapril reduced ventricular dimensions and mitral insufficiency
Subject(s)
Humans , Male , Female , Enalapril/pharmacokinetics , Digoxin/pharmacokinetics , Heart Failure/drug therapy , Mitral Valve Insufficiency/complications , Echocardiography , Clinical ProtocolsABSTRACT
The benefits of digoxin in patients with atrial fibrillation may be reduced due to its limited effect on atrioventricular conduction. The aim of this work was to compare digoxin and etanolol on functional class, resting and exercise heart rate and exercise capacity in patients with atrial fibrillation. Thirteen subjects with this condition, normal echocardiographic left ventricular function and size, a resting heart rate less than 80 beats/min and with no contraindication for beta blocker or digoxin use, were studied. Patients were randomly assigned to receive initially digoxin 0.25 mg. o.d. or atenolol 100 mg o.d. in a double blind fashion. The doses were sdjusted to obtain a heart rate between 60 and 80 beats-min at the end of the first week of treatment. After 2 weeks of treatment, outcomes were assessed, patients were left without treatment for one week and crossed over to the other drug after that. Resting heart rates achieved with digoxin and atenolol were similar (67ñ11 and 65ñ23 beats/min respectively). However, maximal exercise heart rates and maximal exercise time were higher during digoxin treatment (166ñ23 vs 135ñ27 beats/min and 9.95ñ1.68 vs 8.5ñ2 min respectively). NYHA functional class deteriorated in 3 patients receiving atenolol. We conclude that atenolol achieves a better control of heart rate during exercise but also reduces maximal exercise capacity
Subject(s)
Humans , Female , Male , Adult , Middle Aged , Atenolol/pharmacology , Digoxin/pharmacology , Atrial Fibrillation/drug therapy , Heart Function TestsABSTRACT
Due to differences in treatment effect in studies on the effectiveness of digoxin in patients with congestive heart failure in sinus rhythm, a cross-over placebo-controlled randomized double blind clinical trial was performed. Thirty one patients, without previous treatment with digoxin, in New York Heart Association (NYHA) functional class II to IV, with a dilated left ventricle and/or ventricular systolic dysfunction were included. Patients received digoxin, adjusted for blood levels, or placebo, during an 8 week period, prior to crossing over to the other treatment for another 8 weeks. The order of tretments was randomly allocated. Outcome measurement were performed at the end of each 8 week period. Digoxin, compared with placebo, improved NYHA class, 6,9 por ciento vs 41.4 por ciento (p=0.013) and increased the treadmill exercise time, 406 ñ 204 s vs 484 ñ 185 s (p=0.003). During the digoxin treatment the left ventricular and systolic diameter was reduced from 52.9 ñ 8.9 to 50.1 ñ 9.7 mm (p=0.009). No significant difference was observed in the left ventricular end diastolic diameter (LVED) of the left ventricle and in a estimation of quality of life. In conclusion, digoxin treatment produced a significant improvement in functional capacity, exercise time and left ventricular performance
Subject(s)
Humans , Male , Female , Middle Aged , Digoxin/pharmacology , Heart Failure/drug therapy , Placebos/administration & dosage , Quality of Life , Echocardiography , Cardiomyopathy, Dilated/drug therapy , Vital Capacity/drug effects , Ergometry , Coronary Disease/drug therapy , Digoxin/administration & dosage , Digoxin/blood , Hemodynamics , Aortic Valve Insufficiency/drug therapy , Mitral Valve Insufficiency/drug therapy , Heart SoundsABSTRACT
Se estudió la utilidad clínica del test de TRH por vía nasal. Luego de la obtención de muestras basales se administró una dosis de 1 mg de TRH en cada fosa nasal y tanto la respuesta hiposifisiaria (TSH y PRL) como tiroidea (T4) a los 30 y 60 min. fueron analizadas en 12 pacientes, 6 normales 6 portadores de una Tiroiditis Crónica con disminución de la reserva Tiroidea. El grupo control presentó un peak de TSH a los 30 min que no superó los 25 uUl/ml (13.7 ñ 2.9 u Ul/ml) y de PRL de 68.9 ñ 4.3 ng/ml. Los 6 pacientes con una Tiroiditis Crónica, la respuesta TRH fue claramente mayor con un valor máximo de TSH de 43.5 ñ 4.4 uUl/ml y de PRL de 112 ñ 8 ng/ml a los 30 min. Se concluye que la administración de TRH por vía nasal es capaz de inducir una respuesta hipofisiaria tanto de los tirotropos como en los lactotropos, similar a la que se observa con TRH endovenoso