ABSTRACT
INTRODUCTION: Perchlorates are ionic inhibitors antagonizing iodine transport into thyrocytes, hampering thyroid hormone synthesis. Nevertheless, perchlorates are not considered as first-line treatment in hyperthyroidism and thyrotoxicosis as compared to other pharmacological and non-pharmacological interventions. AIM: Reassessing the therapeutic role of perchlorates in hyperthyroidism and thyrotoxicosis throughout a systematic review of the Literature. METHODS: Guidelines were searched and examined to summarize current recommendations on the use of perchlorates in the management of hyperthyroidism. Randomized and non-randomized clinical trials were also searched and reviewed to summarize the efficacy/effectiveness and safety of perchlorates in hyperthyroidisms and thyrotoxicosis. RESULTS: The management of specific forms of hyperthyroidism was considered, including Graves' disease (GD) in non-pregnant adults, hyperthyroidisms in pregnancy, iodine media contrast-induced hyperthyroidism, amiodarone-induced hyperthyroidisms, and thyroid storm. Most of the reported studies had remarkable limitations in terms of study design (non-controlled trials, lack of blinding), low number of participants, and the lack of clinically relevant endpoints, such as cardiovascular events, cardiovascular mortality, and teratogenicity. Overall, perchlorates could be considered a second-line treatment after thionamides, radioiodine, and total thyroidectomy in both GD and hyperthyroidisms in pregnancy. The therapeutic potential of perchlorates alone or in combination with other agents could be considered a second-line treatment of iodine-related hyperthyroidisms and thyroid storm. CONCLUSION: Despite the low level of evidence, perchlorates could be considered in such specific forms of thyroid disorders, including iodine-induced hyperthyroidism and thyroid storm.
Subject(s)
Hyperthyroidism , Perchlorates , Thyrotoxicosis , Humans , Thyrotoxicosis/therapy , Thyrotoxicosis/drug therapy , Hyperthyroidism/therapy , Perchlorates/therapeutic use , Pregnancy , Female , Antithyroid Agents/therapeutic useABSTRACT
Nocardia is a genus of gram-positive, filamentous, aerobic bacteria that belongs to the Actinomycetales order. With over 50 species, it is ubiquitous in dust, soil, decaying organic matter, and stagnant water. Inhalation of the pathogen often leads to pulmonary nocardiosis, while extrapulmonary nocardiosis can affect the central nervous system, skin, and subcutaneous tissues. Primary cutaneous nocardiosis occurs when the pathogen is introduced through a skin lesion or insect bite, for example, this report presents a case of primary cutaneous nocardiosis in a patient with Minimal Change Glomerulonephritis and iatrogenic immunosuppression. Magnetic resonance imaging revealed extensive involvement of the skin, subcutaneous tissue, and lower limb muscles.
ABSTRACT
Objective To explore the diagnostic performance of the most recent 2018 version of liver reporting and data system (LI?RADS) on gadolinium?ethoxybenzyl?diethylenetriamine pentaacetic acid (Gd?EOB?DTPA) enhanced MRI to diagnose hepatocellular carcinoma (HCC) in high?risk patients. Methods From July 2015 to September 2018, 130 consecutive high?risk patients with 134 focal liver lesions were retrospectively enrolled in our center and underwent Gd?EOB?DTPA?enhanced MRI and subsequent hepatectomy within 1 month. Two independent radiologists blindly reviewed the preoperative MR images of all patients, and determined the presence of major features, ancillary features and the LI?RADS categories according to the version 2018 LI?RADS of each liver observation. The sensitivity, specificity, positive predictive value, negative predictive value, Youden index and accuracy of the 2018 version of LI?RADS were evaluated with postoperative histopathological results as references. The inter?observer agreement between the two radiologists was tested by Kappa analysis. Results The Kappa value of the LI?RADS categories between two radiologists was 0.628 (95%CI: 0.565 to 0.691). The sensitivity, specificity, Youden index values and accuracy of LR?5 by the two reviewers were 80.4% (78/97), 87.6% (85/97); 75.7% (28/37), 73.0% (27/37); 0.560 8, 0.605 9; 79.1% (106/134), 83.6% (112/136), respectively. These measures of LR?4+LR?5 were 91.8% (85/97), 96.9% (94/97); 67.6% (25/37), 67.6% (25/37); 0.605 9, 0.644 6; 82.1% (110/134), 88.8% (119/134), respectively. Conclusion Version 2018 LI?RADS demonstrated high sensitivity and accuracy to diagnosis HCC in high?risk patients on Gd?EOB?DTPA enhanced MRI.
ABSTRACT
Objective@#To explore the diagnostic performance of the most recent 2018 version of liver reporting and data system (LI-RADS) on gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) enhanced MRI to diagnose hepatocellular carcinoma (HCC) in high-risk patients.@*Methods@#From July 2015 to September 2018, 130 consecutive high-risk patients with 134 focal liver lesions were retrospectively enrolled in our center and underwent Gd-EOB-DTPA-enhanced MRI and subsequent hepatectomy within 1 month. Two independent radiologists blindly reviewed the preoperative MR images of all patients, and determined the presence of major features, ancillary features and the LI-RADS categories according to the version 2018 LI-RADS of each liver observation. The sensitivity, specificity, positive predictive value, negative predictive value, Youden index and accuracy of the 2018 version of LI-RADS were evaluated with postoperative histopathological results as references. The inter-observer agreement between the two radiologists was tested by Kappa analysis.@*Results@#The Kappa value of the LI-RADS categories between two radiologists was 0.628 (95%CI: 0.565 to 0.691). The sensitivity, specificity, Youden index values and accuracy of LR-5 by the two reviewers were 80.4% (78/97), 87.6% (85/97); 75.7% (28/37), 73.0% (27/37); 0.560 8, 0.605 9; 79.1% (106/134), 83.6% (112/136), respectively. These measures of LR-4+LR-5 were 91.8% (85/97), 96.9% (94/97); 67.6% (25/37), 67.6% (25/37); 0.605 9, 0.644 6; 82.1% (110/134), 88.8% (119/134), respectively.@*Conclusion@#Version 2018 LI-RADS demonstrated high sensitivity and accuracy to diagnosis HCC in high-risk patients on Gd-EOB-DTPA enhanced MRI.
