OVARIAN GOITER AS A RARE CAUSE OF HYPERTHYROIDISM.

INTRODUCTION: Thyroid tissue ectopically located in the ovary can be reported accidentally after adnexectomy, but as a primary cause of hyperthyroidism this diagnosis is rare. The clinical search for a functional ectopic thyroid tissue requires intense clinical focus and a multidisciplinary approach. CASE DESCRIPTION: This case report demonstrates a patient with a history of Graves' disease who had undergone thyroidectomy combined with postoperative 131I radioablation. Despite the previous treatment, she developed an outburst of hyperthyroidism ten years later. Only very close follow-up enabled us to disclose the right condition. The ovarian source of thyroid hormone production was removed by laparoscopic adnexectomy and a right sided benign ovarian struma was confirmed. CONCLUSION: Most patients treated by thyroidectomy and radioiodine do not require extended periods of follow-up or postoperative investigations, but when the clinical or laboratory signs change, clinicians should be prepared to perform the necessary re-evaluation in order to provide the best care.

Pilot study of A-FABP levels as a predictive factor of SPECT results in asymptomatic relatives of patients with cardiovascular disease.

BACKGROUND: A-FABP is a promising link between metabolic syndrome and atherosclerosis. It is not well known whether level of A-FABP predicts results of SPECT. PATIENTS & METHODS: In 82 subjects (53 males) with a median age of 54 years, who were first-degree relatives of patients with cardiovascular disease, the following tests and examinations were performed: A-FABP, calcium score (CS) and SPECT. RESULTS: Subjects with positive and negative SPECT results differed significantly in the noncategorized CS (p = 0.001), uric acid (p = 0.025) and the total cholesterol:high-density lipoprotein ratio (p = 0.043), but not in other parameters (including A-FABP). To predict SPECT results, the best model proved to be a logistic regression model with gender and noncategorized CS as predictors, with an area under the receiver operating characteristic curve of 0.89 (the sensitivity and specificity based on a CS cutoff of 11.1 were 77.78 and 75.34%, respectively). CONCLUSION: The serum level of A-FABP is not a predictor of a positive SPECT result.

[Is there dependence between the level of adipocyte fatty acid-binding protein and calcium score in asymptomatic relatives of patients with cardiovascular diseases?]. / Existuje závislost mezi hladinou adipocyte fatty acid binding proteinu a kalciovým skóre u asymptomatických príbuzných pacientu s KVO?

UNLABELLED: The objective of our study was to determine a correlation between the level of adipocyte fatty acid-binding protein (A-FABP) (as a possible link between metabolic syndrome and atherosclerosis), the calcium score (CS) and laboratory parameters, including insulin resistance indices in asymptomatic first degree relatives of patients with cardiovascular diseases. SET AND METHODOLOGY: Examination was conducted in 82 persons (53 male) with the average age of 52.79 ± 9.6. The examinations consisted of anthropometric and physical tests (determination of body weight, height, body mass index - BMI and casual blood pressure measurement), laboratory analysis (uric acid, creatinine, lipid panel, insulin, glucose, C-reactive protein, fibrinogen, glycated hemoglobin, adipocyte fatty acid-binding protein - A-FABP) and determination of insulin resistance indices HOMA and QUICKI. Total calcium score (CS) was determined by the Agatston method without the need to administer a contrast agent. RESULTS: The value of the A-FABP level does not show a statistically significant dependence on the categorised CS or on non-categorised CS values. There is a statistically significant positive dependence of the level of A-FABP on the HOMA index (p = 0.00688) and a statistically significant negative dependence on the QUICKI index (p = 0.0068). The A-FABP level is statistically significantly higher in women (p = 0.048), in elder persons (p = 0.043), and in persons with higher BMI values (p = 0.029). Among continuous variables, statistically significant is the difference in the A-FABP level in relation to age (p = 0.002), creatinine (p = 0.026), insulin (p = 0.005), and BMI (p = 0.031). CONCLUSION: Our study confirmed the correlation of the A-FABP level with insulin resistance indices, BMI, age, gender, and insulin and creatinine levels in a group of asymptomatic first degree relatives of patients with cardiovascular diseases. A-FABP could potentially be a marker when determining the risk of CVD; however, this conclusion requires additional clinical trials.

[Risk stratification by cardiac gated SPECT combined with coronary artery calcium score in patients with diabetes mellitus and/or renal failure]. / Stratifikace rizika pomocí zátezového SPECT zobrazení myokardu v kombinaci se stanovenim koronárního kalciového skóre u rizikových pacientu s diabetem a/nebo ledvinným selháním.

AIM: The aim of this study was to evaluate added value of coronary artery calcium score (CAC) measurement as an adjunct to cardiac gated SPECT for risk stratification in population of patients with diabetes mellitus (DM) and/or chronic renal failure on hemodialysis (CHRF-HD). METHODS: Retrospective analysis of 67 patients, who were referred for stress gated myocardial perfusion SPECT and CAC. Characteristics of study population: 40 men, mean age 59 +/- 12 years, DM (n = 28), CHRF-HD (n = 22), DM and CHRF-HD simultaneously (n = 17). Perfusion summed stress and different scores (SSS, SDS), the left ventricle ejection fraction (LVEF) and enddiastolic/endsystolic volumes (EDV/ESV) were automatically calculated using 4D-MSPECT software. The hard cardiac event was defined as sudden cardiac death or myocardial infarction (MI); angina or other symptoms requiring coronary revascularization were also calculated. RESULTS: During the average period of 18 +/- 10 months, we registered 8 cardiac deaths, 4 nonfatal MI and 7 patients underwent revascularization. In the subgroup of 19 patients with cardiac events, the observed parameters were significantly worse concerning perfusion (SSS 9 +/- 11 vs 2 +/- 3 and SDS 6 +/- 9 vs 1 +/- 2, P < 0.05), the left ventricle function (stress LVEF 53% +/- 13% vs 59% +/- 13%, rest LVEF 55% +/- 14% vs 59% +/- 12%, stress EDV/ESV 144 ml/71 ml vs 128 ml/59 ml, P < 0.05), and CAC score (1 965 +/- 1 772 vs 387 +/- 740, P < 0.05) in comparison with patients without cardiac event. In patients without a reversible perfusion abnormality (SDS < 2), we observed lower annual hard event rate (8% vs 19.6%, P < 0.05) and revascularization procedures (4% vs 19.6%, P < 0.05) in comparison with patients with SDS > or = 2. In patients with or without reversible defects, we registered significantly higher annual hard event rate in the setting of post-stress worsening of the LVEF > 5% and/or severe CAC score > or = 709 (23.8% vs 1.9% in patients with SDS < 2, and 26.7% vs 9.5% in patients with SDS > or = 2, P < 0.05). CONCLUSION: The findings of highly elevated CAC score as well as the post-stress left ventricle stunning enable further risk stratification in patients with or without reversible perfusion abnormalities.