Cholestasis secondary to hyperthyroidism in Graves disease: report of one case / Colestasia en un paciente con hipertiroidismo por enfermedad de Graves: informe de un caso

ABSTRACT Hyperthyroidism can induce elevation in several liver function tests including aminotransferases, alkaline phosphatases and, less frequently, serum bilirubin. These alterations are usually mild and asymptomatic. We report a 26 year-old male presenting with palpitations, progressive jaundice, choluria and generalized itching. Laboratory tests were compatible with hyperthyroidism and a mild elevation of bilirubin, alkaline phosphatases and gamma glutamyl transpeptidase. A liver biopsy showed portal hepatitis with canalicular cholestasis. The patient was treated temporarily with glucocorticoids, cholestyramine and betablockade. Thereafter, he was treated with radioactive iodine, after which serum bilirubin decreased steadily until normalization in ten weeks.

El hipertiroidismo puede producir elevación de aminotransferasas, fosfatasas alcalinas y, menos frecuentemente, de bilirrubina sérica. Habitualmente, estas alteraciones son leves y asintomáticas. Reportamos un hombre de 26 años con hipertiroidismo secundario a enfermedad de Basedow-Graves, que debutó con un cuadro colestásico, inicialmente estudiado por sospecha de patología hepática autoinmune que incluyó biopsia hepática. Posteriormente, se diagnosticó hipertiroidismo que fue tratado con glucocorticoides, colestiramina y beta bloqueo como puente a terapia definitiva con radioyodo. La evolución mostró disminución progresiva hasta la normalización de bilirrubina sérica.

In properly selected patients with differentiated thyroid cancer, antithyroglobulin antibodies decline after thyroidectomy and their sole presence should not be an indication for radioiodine ablation

ABSTRACT Objective Our objective was to evaluate the trend of antithyroglobulin antibodies (TgAb) during follow-up of patients with differentiated thyroid cancer (DTC) treated without RAI, as well as their role in the risk of recurrence. Subjects and methods This was a prospective, descriptive study. A total of 152 consecutive patients with DTC treated in a single institution undergoing total thyroidectomy without RAI and followed for a median of 2.3 years (0.5-10.3) were divided in two groups: TgAb(-) (n = 111) and TgAb(+) (n = 41). Patients were classified according to AJCC 7th and 8th editions, as well as to their risk of recurrence and response to treatment categories. Results Both groups, TgAb(-) and TgAb(+), were similar regarding patient and tumor characteristics. At the end of follow-up, 90 (59.2%), 57 (37.5%), 3 (2%) and 2 (1.3%) patients achieved excellent, indeterminate, biochemically incomplete and structurally incomplete response, respectively. The risk of structural recurrence was similar in both groups (TgAb[-] 0.9% vs. TgAb[+] 2.4%, p = 0.46). In the TgAb(+) group, TgAb became negative in 10 (24.4%), decreased ≥ 50% without negativization in 25 (60.9%), decreased < 50% in 4 (9.8%) and remained stable or increased in 2 (4.9%) cases. The only incomplete structural response had increasing TgAb during follow-up. Conclusions In properly selected patients with DTC, TgAb concentration immediately after total thyroidectomy should not mandate RAI ablation, and their trend during follow-up may impact the risk of recurrence.

Papillary thyroid microcarcinoma: characteristics at presentation, and evaluation of clinical and histological features associated with a worse prognosis in a Latin American cohort

ABSTRACT Objective We aimed to describe the presentation of papillary microcarcinoma (PTMC) and identify the clinical and histological features associated with persistence/recurrence in a Latin American cohort. Subjects and methods Retrospective study of PTMC patients who underwent total thyroidectomy, with or without radioactive iodine (RAI), and who were followed for at least 2 years. Risk of recurrence was estimated with ATA 2009 and 2015 classifications, and risk of mortality with 7th and 8th AJCC/TNM systems. Clinical data obtained during follow-up were used to detect structural and biochemical persistence/recurrence. Results We included 209 patients, predominantly female (90%), 44.5 ± 12.6 years old, 183 (88%) received RAI (90.4 ± 44.2 mCi), followed-up for a median of 4.4 years (range 2.0-7.8). The 7th and 8th AJCC/TNM system classified 89% and 95.2% of the patients as stage I, respectively. ATA 2009 and ATA 2015 classified 70.8% and 78.5% of the patients as low risk, respectively. Fifteen (7%) patients had persistence/recurrence during follow-up. In multivariate analysis, only lymph node metastasis was associated with persistence/recurrence (coefficient beta 4.0, p = 0.016; 95% CI 1.3-12.9). There were no PTMC related deaths. Conclusions Our series found no mortality and low rate of persistence/recurrence associated with PTMC. Lymph node metastasis was the only feature associated with recurrence in multivariate analysis. The updated ATA 2015 and 8th AJCC/TNM systems classified more PTMCs than previous classifications as low risk of recurrence and mortality, respectively.

A diachronic view of the net longshore sediment drift during the Late Holocene at the Jequitinhonha River delta, Brazil, using numerical modeling

Using numerical modeling, this work estimates sediment dispersion patterns caused by the incidence of waves in five distinct coastline contours of the Jequitinhonha River delta plain during the Late Holocene. For this study, a wave cliate odel based on the construction of ave refraction diagras relative to the current boundary conditions as defined and assumed to be valid for the five coastlines. Numerical modeling from the refraction diagrams was carried out considering the angle of incidence and wave height along the coastline. This work has allowed us to reproduce past and current patterns of net longshore sediment drift defined by a conceptual model developed from the integration of sediment cores, aerial photograph interpretation, C14 datings and geomorphic indicators of longshore drift. These results show that, on average, current wave conditions in the east-northeastern Brazilian region seem to have remained characteristically the same from approximately 5100 years BP until the present time. This type of information can be important when attempting to simulate possible future situations in terms of the long-term general behavior of the east-northeastern Brazilian coastal region.

O presente trabalho apresenta uma estimativa, por modelagem numérica, dos padrões de dispersão de sedimentos causados pela incidência de ondas em cinco distintos contornos de linhas de costa da planície deltaica do Rio Jequitinhonha durante o Holoceno Tardio. Para isso, um modelo de clima de ondas baseado na construção de diagramas de refração de onda, em função das condições de contorno atuais, foi definido e assumido ser válido para as cinco linhas de costa. A modelagem numérica, a partir dos diagramas de refração, foi feita considerando o ângulo de aproximação e a altura da onda ao longo da linha de costa. O trabalho permitiu reproduzir os padrões pretéritos e atuais da deriva litorânea efetiva de sedimentos, definidos por um modelo conceitual desenvolvido a partir da integração de testemunhos de sedimentos, interpretação de fotos aéreas e datações de C14, bem como por indicadores geomórficos de deriva. Estes resultados mostram que, em média, em relação à região leste-nordeste brasileira as condições de onda atuais parecem ter permanecido com as mesmas características desde aproximadamente 5.100 anos A.P. até o tempo atual. Esse tipo de informação pode ser importante para tentativas de simulação de possíveis situações futuras em termos do comportamento genérico de longa duração das regiões costeiras leste-nordeste brasileira.

Deficit of sand in a sediment transport model favors coral reef development in Brazil

This paper shows that the location of the shoreface bank reefs along the northeastern and eastern coasts of Brazil, in a first order approximation, seem to be controlled by the deficit of sediment in the coastal system. The sediment transport pattern defined by a numerical modeling of wave refraction diagrams, representing circa 2000 km of the northeastern and eastern coasts of Brazil, permitted the regional-scale reproduction of several drift cells of net longshore sediment transport. Those drift cells can reasonably explain the coastal sections that present sediment surplus or sediment deficit, which correspond, respectively, to regions where there is deposition and erosion or little/no deposition of sand. The sediment deficit allows the exposure and maintenance of rocky substrates to be free of sediment, a favorable condition for the fixation and development of coral larvae.

Este trabalho mostra que a localização dos recifes de coral ao longo dos litorais leste e nordeste do Brasil, em uma aproximação de primeira ordem, parece ser controlada pelo déficit de sedimentos no sistema costeiro. O padrão de transporte de sedimentos definido por modelagem numérica a partir de diagramas de refração de ondas, representando cerca de 2000 km dos litorais leste e nordeste do Brasil, permitiu a reprodução, em escala regional, de várias células de deriva litorânea efetiva de sedimentos. Essas células de deriva podem razoavelmente explicar os segmentos costeiros que representam superávit, ou deficit de sedimentos que correspondem, respectivamente, a regiões onde existe deposição e erosão ou pouca/nenhuma deposição de areia. O deficit de sedimentos propicia a exposição e manutenção de substratos rochosos livres de sedimento, uma condição favorável para a fixação e desenvolvimento das larvas de coral.

Utilidad de la programación temporal del marcapaso en modo VVT para el tratamiento de las taquicardias ventriculares repetitivas / Usefulness of the temporary pacemaker programming to the VVT mode in the treatment of recurrent ventricular tachicardia

Se presenta el caso de un paciente, varón de 59 años, intervenido de prótesis de Björk en posición aórtica y comisurotomía mitral, con mala función ventricular y episodios repetidos de taquicardia ventricular (TV), a pesar del tratamiento anti-arrítmico con amiodarona. El estudio electrofisiológico (EEF) puso de manifiesto que la TV por reentrada cedía con extraestímulos (EE) aplicados en el apex del ventrículo derecho . Fuera de los episodios de TV, el paciente se mantenía con arritmia completa por fibrilación auricular, con frecuencias ventriculares medias lentas. Se implantó marcapaso Medtronic Spectrax 5985, multiprogramable, con posibilidad de programar a modo VVT y con períodos refractarios efectivos (PRE) programables cortos (220mseg). Durante las crisis de TV el MP se programaba temporalmente a modo VVT con PRE de 220 mseg y a través de estimulación torácica por medio del estimulador de electrofisiología se conseguían interrumpir las crisis de TV con EE (2 ó 3) sincronizados. Gracias al mecanismo de disparo ("triggered", la estimulación tóracica obliga al buscado disparo del marcapasos, que de este modo funcional igual que un estimulador externo de electrofisiología, siempre que se tengan en cuenta sus PRE y mantegan adecuados los umbrales de percepción y estimulación