Anatomical basis for acquired intracardiac shunt postaortic valve replacement: Doppler echocardiographic diagnosis.

We report a case of postoperative intracardiac shunts across the membranous septum detected by Doppler echocardiography and discuss the anatomical basis for the development of such a complication.

Papillary thyroid cancer in Saudi Arabia. Clinical, pathologic, and management characteristics.

During a 3-year period, 233 patients with papillary thyroid cancer were seen at King Faisal Specialist Hospital (KFSH) (79% were female; 94% were national subjects). Pathology revealed 88% pure papillary carcinoma and 12% mixed papillary and follicular carcinoma, 7% microfocus, 18% well encapsulated, 24% capsular invasion, and 51% soft tissue invasion. Thirty percent of patients who had initial surgery not done at KFSH compared with 93% of patients who had initial surgery done at KFSH had an I-123 24-hour uptake < 5%. One hundred seventeen patients required completion thyroidectomy at KFSH for significant residual thyroid tissue, 56% of those had residual papillary carcinoma. The amenability of papillary thyroid cancer for cure necessitates the optimization of management at the national level. In Saudi Arabia, papillary thyroid cancer presented in an advanced stage, especially in males as manifested by the large primary tumor size, advance pathologic staging, and distant metastases at the time of presentation. Findings at second surgery, showed significant residual disease.

Influence of age and sex in modulating TSH level in primary hypothyroidism.

Previous studies addressing the interaction of age and sex with the function of the hypothalamic-pituitary-thyrotrophs axis yielded conflicting results, due in part to inability to control for the effect of variable free thyroid hormone levels. We studied the effect of age and sex on TSH levels in patients with severe primary hypothyroidism who have essentially undetectable plasma thyroid hormone levels. The TSH levels were measured in 116 thyroid cancer patients four weeks after the withdrawal of thyroxine therapy in preparation for radioidine scan/treatment. All patients has a TSH >/= 30 mU/L (normal = 0.2-5) and a free T4 < pmol/L (normal = 10-25). Thirty males and 86 females with a mean age (+/- SD) of 40 +/- 16 (range 6-89 years) were studied on up to four hypothyroid episodes, with a total of 191 episodes. The TSH level during the first hypothyroid episode correlated significantly with the TSH level during subsequent episodes (first episode versus second episode, r = 0.7, P = 0.0001; first versus third episode, r = 0.6, P = 0.03). There was a significant negative correlation between age and TSH level (r = -0.24, P = 0.0009) that persisted when only the first hypothyroid episode was considered (r = -0.23, P = 0.01), or when only males (r = -0.32, P = 0.02) or only females (r = -0.23, P = 0.005) were considered. Means of TSH levels in males and females were not significantly different (130 verus 114 mU/L, respectively; P = 0.28). We conclude that age but not sex may modulate the sensitivity/responsiveness of the hypothalamic-pituitary thyrotroph axis to primary hypothyroidism.