ABSTRACT
Una de las complicaciones más importantes asociada la cirugía de tiroides y paratiroides es la parálisis de las cuerdas vocales secundaria a la lesión del nervio laríngeo recurrente. La parálisis del nervio laríngeo recurrente inducida por anestésicos locales es una rara complicación con muy pocos casos publicados.Las técnicas patrón para el examen de las cuerdas vocales son la fibrolaringoscopia flexible y la videoestrobolaringoscopia. Sin embargo, estas técnicas son caras, y frecuentemente se asocian con dolor y malestar para los pacientes. Considerando estas desventajas, la ecografía laríngea transcutánea es una alternativa en pacientes que se someten a cirugía de tiroides y paratiroides.Presentamos un caso en el que se diagnosticó ecográficamente una parálisis bilateral transitoria de las cuerdas vocales tras la infiltración local de 10mL de mepivacaína al 2% administrada para la revisión de la herida quirúrgica por un hematoma subcutáneo ocurrido después de una paratiroidectomía subtotal.(AU)
One of the most important complications associated with thyroid and parathyroid surgery is vocal cord paralysis due to a recurrent laryngeal nerve injury. Recurrent laryngeal nerve injury paralysis induced by local anesthetics is a rare complication with very few published casesVarious techniques are available for diagnosing vocal cord paralysis, including, flexible fiberoptic laryngoscopy, videostrobolaryngoscopy and indirect laryngoscopy. However, these techniques are expensive and are often associated with pain and discomfort among patients. Considering these disadvantages, transcutaneous laryngeal ultrasound is an alternative imaging tool for vocal cord examination in patients undergoing thyroid and parathyroid surgery.We describe a case which was sonographically diagnosed a transient bilateral vocal cord paralysis after the local infiltration of 10mL of 2% mepivacaine administered for the revision of the surgical wound due to a subcutaneous hematoma that occurred after a subtotal parathyroidectomy.(AU)
Subject(s)
Humans , Female , Middle Aged , Vocal Cord Paralysis , Anesthetics, Local , Recurrent Laryngeal Nerve Injuries , Vocal Cords/diagnostic imaging , Anesthesiology , Anesthesia/methods , Inpatients , Physical ExaminationABSTRACT
One of the most important complications associated with thyroid and parathyroid surgery is vocal cord paralysis due to a recurrent laryngeal nerve injury. Recurrent laryngeal nerve injury paralysis induced by local anesthetics is a rare complication with very few published cases Various techniques are available for diagnosing vocal cord paralysis, including, flexible fiberoptic laryngoscopy, videostrobolaryngoscopy and indirect laryngoscopy. However, these techniques are expensive and are often associated with pain and discomfort among patients. Considering these disadvantages, transcutaneous laryngeal ultrasound is an alternative imaging tool for vocal cord examination in patients undergoing thyroid and parathyroid surgery. We describe a case which was sonographically diagnosed a transient bilateral vocal cord paralysis after the local infiltration of 10mL of 2% mepivacaine administered for the revision of the surgical wound due to a subcutaneous hematoma that occurred after a subtotal parathyroidectomy.
Subject(s)
Recurrent Laryngeal Nerve Injuries , Vocal Cord Paralysis , Anesthetics, Local/adverse effects , Humans , Ultrasonography , Vocal Cord Paralysis/chemically induced , Vocal Cords/diagnostic imagingABSTRACT
CONTEXT: LPIN1 is the phosphatidic acid phosphatase that produces 1,2-diacylglycerol, and thus it is related to the synthesis of triglycerides in the adipocyte. LPIN1 has a role in lipid synthesis and nuclear receptor coactivation, both of which may be involved in lipid homeostasis and metabolism. Among others, hypoxia and endoplasmic reticulum (ER) stress are being shown to be related to the adipose dysfunction found in human obesity. OBJECTIVE: The aim of this study was to analyze LPIN1 gene expression in human adipose tissue in parallel with several hypoxia, angiogenic, ER stress and peroxisome proliferator-activated receptor (PPAR)-related genes in human obesity. DESIGN AND PATIENTS: Gene expression was quantified in abdominal (subcutaneous and visceral) adipose tissue from 62 subjects. RESULTS: We have shown a marked association between LPIN1 and PPARalpha gene expression both in subcutaneous and visceral adipose tissues. Similarly, a strong interdependence with vascular endothelial growth factor (VEGF) gene expression was also described; in fact, LPIN1 and VEGF expression levels were significantly decreased with obesity to a similar extent. CONCLUSION: These associations might suggest a possible role of LPIN1 in stress conditions that occur in chronic obesity and underlie insulin resistance.
Subject(s)
Endoplasmic Reticulum/metabolism , Insulin Resistance/physiology , Lipid Metabolism/physiology , Nuclear Proteins/genetics , Obesity/metabolism , PPAR alpha/genetics , Adipocytes/metabolism , Blotting, Western , Body Mass Index , Cell Hypoxia/genetics , Endoplasmic Reticulum/genetics , Female , Gene Expression , Humans , Insulin Resistance/genetics , Intra-Abdominal Fat/metabolism , Lipid Metabolism/genetics , Male , Middle Aged , Nuclear Proteins/metabolism , Obesity/genetics , PPAR alpha/metabolism , Phosphatidate Phosphatase , Subcutaneous Fat/metabolismABSTRACT
CONTEXT: Zinc-alpha2-glycoprotein (ZAG) is a soluble protein similar to the class I major histocompatibility complex heavy chain, which has been implicated in lipid catabolism. We hypothesized that ZAG mRNA expression in adipose tissue may be linked with lipolytic and adipokine gene expression and have a close relationship with clinical phenotype. OBJECTIVES: The objective of the study was to analyze ZAG gene expression in human adipose tissue from lean and obese subjects. ZAG circulating plasma levels and its relationship with cardiometabolic risk factors were also studied. DESIGN: Seventy-three Caucasian (43 male and 30 female) subjects were included. Plasma and adipose tissue [sc (SAT) and visceral (VAT)] from the same patient were studied. mRNA of PPARgamma, hormone-sensitive lipase (HSL), adipose triglyceride lipase, adiponectin, omentin, visfatin, and ZAG were quantified. Plasma concentrations of ZAG were determined with ELISA. RESULTS: ZAG plasma levels showed a negative correlation with insulin (r = -0.39; P = 0.008) and the homeostasis model assessment for insulin resistance index (r = -0.36; P = 0.016). No differences in ZAG circulating levels according to body mass index classification were observed. ZAG expression in SAT was significantly reduced in overweight and obese individuals compared with lean subjects (P < 0.001 and P = 0.007, respectively). ZAG mRNA expression in both SAT and VAT depots were negatively correlated with many clinical and metabolic cardiovascular risk factors. After multiple linear regression analysis, SAT ZAG was mainly predicted by adiponectin mRNA expression (B = 0.993; P < 0.0001) and plasma triglyceride levels (B = -0.565; P = 0.006). VAT ZAG expression was predicted by adiponectin expression (B = 0.449; P < 0.0001), and HSL VAT expression (B = 0.180; P = 0.023). CONCLUSIONS: The present study provides evidence of a role of ZAG gene in adipose tissue metabolism, with a close association with adiponectin gene expression in sc and visceral fat.
Subject(s)
Adipokines/genetics , Adipose Tissue/enzymology , Carrier Proteins/genetics , Carrier Proteins/metabolism , Glycoproteins/genetics , Glycoproteins/metabolism , Lipolysis/genetics , Obesity/genetics , Obesity/metabolism , Adult , Aged , Anthropometry , Cohort Studies , Female , Gene Expression , Gene Expression Regulation, Enzymologic/genetics , Gene Expression Regulation, Enzymologic/physiology , Genetic Markers , Humans , Male , Metabolic Syndrome/genetics , Metabolic Syndrome/metabolism , Middle Aged , RNA, Messenger/biosynthesis , RNA, Messenger/genetics , Regression AnalysisABSTRACT
CONTEXT: Aquaporin-7 is required for efflux of glycerol from adipocytes and influences whole-body glucose homeostasis in animal studies. OBJECTIVE: Our objective was to test the hypothesis that AQP7 gene expression levels may be affected by presence of obesity and type 2 diabetes in humans. DESIGN: The obesity study cohort consisted of 12 lean, 22 nonseverely obese, and 13 severely obese subjects. The type 2 diabetes study cohort consisted of 17 lean and 39 obese type 2 diabetic patients. Circulating levels of plasma soluble proteins monocyte chemoattractant protein-1, TNF receptors 1 and 2, and IL-6 and glycerol were measured. The sc adipose tissue gene expression of AQP7, MCP-1, IL-6, TNFalpha, PPARgamma, and SREBP1c genes was measured by real-time PCR. AQP7 gene mutation analysis was performed. RESULTS: Severely obese women showed lower AQP7 expression levels compared with lean and nonseverely obese (P < 0.001). Moreover, circulating glycerol concentration was lower in severely obese subjects, but no correlation with AQP7 adipose tissue expression was observed. AQP7 expression was negatively related with proinflammatory genes (for monocyte chemoattractant protein-1, r = -0.203 and P = 0.044; for TNFalpha, r = -0.209 and P = 0.036). Concerning adipogenic factors, AQP7 expression levels were found to be positively determined by PPARgamma mRNA expression levels (r = 0.265; P = 0.012). AQP7 expression did not show differences regarding the presence of type 2 diabetes. CONCLUSION: Expression of AQP7 is down-regulated in women with severe obesity. The expression of this glycerol channel is not affected by type 2 diabetes.
Subject(s)
Aquaporins/genetics , Diabetes Mellitus, Type 2/genetics , Obesity, Morbid/genetics , Subcutaneous Fat/metabolism , Adult , Aged , Aquaporins/metabolism , Cohort Studies , Diabetes Mellitus, Type 2/metabolism , Female , Gene Expression Regulation , Humans , Male , Middle Aged , Obesity, Morbid/metabolism , Polymorphism, Single Nucleotide , RNA, Messenger/metabolism , Sex CharacteristicsABSTRACT
TWEAK, a cytokine of the TNF family, has been found to be expressed under different inflammatory conditions but no data is available concerning the expression of this cytokine and its receptor (Fn14) in human obesity. In the present work we have evaluated the expression of many pro-inflammatory TNF system cytokines (TNF-alpha, TWEAK and their respective receptors, TNFR1, TNFR2 and Fn14) in human adipose tissue of 84 subjects some with different degree of obesity and type 2 diabetes, and its relation with inflammation by also measuring the expression of macrophage marker CD68. We detected expression of TWEAK and Fn14 in isolated mature adipocytes and in the stromovascular fraction. Additionally, we found that LPS upregulates the expression of both genes on THP-1 human monocytic cell line. TWEAK was expressed in adipose tissue of all studied subjects with no differences between obesity group, and was associated with Fn14 expression in morbid obese, mainly in women with type 2 diabetes. The data obtained here also showed that TNF-alpha and TNFR2 mRNAs were significantly more expressed in subcutaneous adipose tissue of subjects with morbid obesity compared to obese and non-obese subjects. In contrast, TNFR1 gene expression was negatively associated with BMI. Our results suggest that the expression of TNF-derived pro-inflammatory cytokines are increased in severe obesity, where macrophage infiltrate could modulate the inflammatory environment through activation of its receptors.
Subject(s)
Adipose Tissue/immunology , Obesity/immunology , Receptors, Tumor Necrosis Factor/metabolism , Tumor Necrosis Factors/metabolism , Antigens, CD/analysis , Antigens, CD/genetics , Antigens, Differentiation, Myelomonocytic/analysis , Antigens, Differentiation, Myelomonocytic/genetics , Cell Line , Cytokine TWEAK , Diabetes Mellitus, Type 2/immunology , Female , Gene Expression , Humans , Inflammation Mediators/metabolism , Male , Middle Aged , Obesity/diagnosis , Obesity/genetics , RNA, Messenger/analysis , RNA, Messenger/metabolism , Receptors, Tumor Necrosis Factor/genetics , TWEAK Receptor , Tumor Necrosis Factor-alpha/genetics , Tumor Necrosis Factor-alpha/metabolism , Tumor Necrosis Factors/geneticsABSTRACT
Fundamentos: Los métodos de valoración individual de la ingesta dietética incluyen distintos procedimientos con diferentes modos de estimar la ingesta tanto de alimentos como de energía y nutrientes. El objetivo de este estudio ha sido comparar dos métodos de valoración de la ingesta dietética extensamente utilizados en epidemiología nutricional; el recordatorio de 24 horas y el cuestionario de frecuencia de consumo de alimentos semicuantitativo. Métodos: Se entrevistó a una muestar aleatoria de 155 personas del Valle de Arán (Lérida), en la que se obtuvo la información sobre ingesta nutricional mediante ambos cuestionarios. Resultados: Antes del ajuste por la ingesta de energía, el cuestionario de frecuencia sobreestimaba la ingesta de todos los nutrientes excepto del colesterol. Después de dicho ajuste, las estimaciones de los dos métodos fueron muy parecidos. Cuando se comparó el porcentaje de energía procedente de las proteínas, lípidos, hidratos de carbono y la relación de ácidos grasos poliinsaturados/monoinsaturados los resultados también fueron casi iguales. Los coeficientes de correlación entre ambos cuestionarios oscilaban entre 0,81 y 0,23. Los nutrientes que presentaron mayor correlación cruda entre ambos cuestionarios fueron el alcohol, la energía, los hidratos de carbono, el sodio y el yodo (R ò 0,7) mientras que las vitaminas C, B1, B6, B12 y A, niacina, ácido fólico, hierro, fósforo y potasio presentaban la menor correlación (R ó 0,5). Las correlaciones de los nutrientes ajustados por la ingesta energética fueron muy diferentes a las no ajustadas, en especial para los lípidos, ácidos grasos monoinsaturados, hidratos de carbono, fibra, colesterol, cinc y sodio, para los que se obtuvo un menor coeficiente de correlación después del ajuste; y las vitaminas B2, B6, C, D y el potasio, para los que se encontró un coeficiente superior después de ajustar por la ingesta energética. Conclusiones: Si bien los dos métodos de valoración de la ingesta de alimentos y nutrientes tienden a estimar consumos parecidos cuando se expresan ajustados por la ingesta calórica, el cuestionario de frecuencia tiende a subreestimar la ingesta total (AU)
Subject(s)
Comparative Study , Humans , Adolescent , Adult , Middle Aged , Aged , Nutritional Status , Food and Nutritional Surveillance/methods , Nutritional Requirements , Nutrition Surveys , Diet Surveys , Diet , Eating/standards , Diet RecordsABSTRACT
Fundamentos: Los métodos de valoración individual de la ingesta dietética incluyen distintos procedimientos con diferentes modos de estimar la ingesta tanto de alimentos como de energía y nutrientes. El objetivo de este estudio ha sido comparar dos métodos de valoración de la ingesta dietética extensamente utilizados en epidemiología nutricional; el recordatorio de 24 horas y el cuestionario de frecuencia de consumo de alimentos semicuantitativo. Métodos: Se entrevistó a una muestar aleatoria de 155 personas del Valle de Arán (Lérida), en la que se obtuvo la información sobre ingesta nutricional mediante ambos cuestionarios. Resultados: Antes del ajuste por la ingesta de energía, el cuestionario de frecuencia sobreestimaba la ingesta de todos los nutrientes excepto del colesterol. Después de dicho ajuste, las estimaciones de los dos métodos fueron muy parecidos. Cuando se comparó el porcentaje de energía procedente de las proteínas, lípidos, hidratos de carbono y la relación de ácidos grasos poliinsaturados/monoinsaturados los resultados también fueron casi iguales. Los coeficientes de correlación entre ambos cuestionarios oscilaban entre 0,81 y 0,23. Los nutrientes que presentaron mayor correlación cruda entre ambos cuestionarios fueron el alcohol, la energía, los hidratos de carbono, el sodio y el yodo (R ò 0,7) mientras que las vitaminas C, B1, B6, B12 y A, niacina, ácido fólico, hierro, fósforo y potasio presentaban la menor correlación (R ó 0,5). Las correlaciones de los nutrientes ajustados por la ingesta energética fueron muy diferentes a las no ajustadas, en especial para los lípidos, ácidos grasos monoinsaturados, hidratos de carbono, fibra, colesterol, cinc y sodio, para los que se obtuvo un menor coeficiente de correlación después del ajuste; y las vitaminas B2, B6, C, D y el potasio, para los que se encontró un coeficiente superior después de ajustar por la ingesta energética. Conclusiones: Si bien los dos métodos de valoración de la ingesta de alimentos y nutrientes tienden a estimar consumos parecidos cuando se expresan ajustados por la ingesta calórica, el cuestionario de frecuencia tiende a subreestimar la ingesta total
Subject(s)
Humans , Adolescent , Adult , Middle Aged , Nutritional Requirements , Nutritional Status , Food and Nutritional Surveillance , Diet Records , Diet Surveys , Diet , Eating/standards , Nutrition SurveysABSTRACT
BACKGROUND: Methods of dietary collection at an individual level include various procedures with different estimates of food, energy and nutrients intakes. The aim of this study was to compare two dietary methods widely used in nutritional epidemiology: a 24-hour recall and a semiquantitative food frequency questionnaire. METHODS: One hundred and fifty-five people selected at random from the population of the Valle de Arán (Lérida, Spain) were surveyed. Nutritional intake information was obtained from both methods. RESULTS: The frequency method overestimated all the nutrient intakes only before adjustment by energy intake, except for cholesterol. After adjustment by energy intake estimations from both questionnaires were very similar; the percentages of energy supplied by proteins, fatty acids and carbohydrates were very similar, too; the polyunsaturated/monounsaturated fatty acid ratios, were almost the same. Results show a level of correlation between the questionnaires that ranges from 0.81 to 0.23. Nutrients that showed the highest crude correlation between both questionnaires were alcohol, energy, carbohydrates, sodium and iodine (R > or = 0.7) while vitamins C, B1, B6, B12, and A, niacine, folic acid, iron, phosphorus and potassium showed the lowest (R < or = 0.5). Energy adjusted correlations were quite different to unadjusted ones particularly for lipids, monounsaturated fatty acids, carbohydrates, fiber, cholesterol, zinc and sodium, for which a lower coefficient was calculated after adjustment, and vitamins B2, B6, C, D and potassium, for which a higher coefficient was estimated after energy adjustment. CONCLUSIONS: Both methods make similar assessments when adjusting for caloric intake, but food frequency questionnaire tends to overestimate food consumption.
Subject(s)
Nutrition Surveys , Adolescent , Adult , Aged , Diet , Diet Surveys , Eating , Energy Intake , Humans , Middle Aged , Spain , Surveys and QuestionnairesABSTRACT
This study of 285 myopic eyes treated with photorefractive keratectomy (PRK), with a maximum follow up of 18 months, was designed to analyze the clinical subepithelial significance of corneal haze after excimer laser PRK. The treatment parameters included an ablation zone diameter from 3.6 to 5 mm, ablation rate from 0.22 to 0.25 micron pulse, fluence of 180 mJ/cm2, and frequency of 10 Hz. All patients used a standard topical corticosteroid regimen. A statistical analysis of the subjective haze grading showed a maximum at 3 months (mean grading, 1.03) and a decrease to 0.38 at 18 months. Haze is statistically greater with higher amounts of treatment (p = .003 between 2.00 D and 3.00 D groups, p = .0002 between 2.00 D and 6.00 D groups). In males (p = .0004), and in ablations less than 4.5 mm diameter (p = .0002) but no difference was found related to age. The overall frequency of clinically significant haze was 11.5% with a mean age of 35.1 years and a mean attempted correction of -5.71 D. This frequency increased to 24% in the 6.20 D to 9.90 D group and 38.6% in the 4.4 mm and less group, and it decreased to 8.6% in the 1.00 D to 6.00 D group and 6.6% in the 4.5 and 5 mm group. All patients with significant haze gave a history of discontinued use of corticosteroids. We suggest there exists a significant haze risk group in which the absence of steroid or discontinuation of corticosteroids will lead to significant haze.
