Graves' disease occurring after subacute thyroiditis: report of a case and review of the literature.

A 57-year-old woman with no previous personal or family history of thyroid disease developed typical subacute thyroiditis, with pain and tenderness in the anterior cervical region, fever, mild thyrotoxicosis; thyroid autoantibodies were negative, serum thyroglobulin (TG) levels were increased, radioactive iodine uptake (RAIU) values were decreased, urinary iodine excretion was normal, and erythrocyte sedimentation rate (ESR) elevated. Symptoms subsided with glucocorticoid treatment, with normalization of serum thyroid hormone and TG levels. Four months later, while still on a low dose of glucocorticoid, she had recurrence of hyperthyroidism, with no thyroid pain or tenderness, high RAIU values, positive thyroid-directed autoantibodies including TSH-receptor antibody. HLA typing showed positivity for B35 and DR3, suggesting a genetic susceptibility for both subacute thyroiditis and Graves' disease. The development of Graves' disease after subacute thyroiditis is extremely rare, suggesting that a genetic susceptibility to the disease must exist in such an instance.

Gestosis and fetal rejection: immunopathogenetic role of HLA-DR.

In this study we faced the problem of etiopathogenesis of EPH Gestosis, focusing our attention on the role of immunitary aspects in determining its onset. We typed HLA-DR in 20 couples with gestosic patient and in 20 control couples. Blood samples were taken into heparin-treated test tubes, from all the couples and HLA typed through standard lymphotoxicity technique in accordance with Terasaky (1). Our results in couples with a gestosic patient, showed homozygosis in 65% of patients and in 70% of partners; in 35% of cases homozygosis was present in both partners, and these were the most severe cases. It is also worth mentioning that in all the couples with gestosic patient, at least one of the partners resulted homozygotic. Homozygosis would therefore represent a predisposing factor in the etiopathogenesis of gestosis, and pre-conception HLA-DR typing of the couple could prove to be a valid alarm signal for gestosis risk.

[Etiopathogenesis of dilated cardiomyopathies]. / Eziopatogenesi delle cardiomiopatie dilatative.

This study was carried out on 43 patients affected by dilated cardiomyopathy to investigate some of the etiopathological hypotheses on this illness. The Authors investigated: the persistence of virus genoma (coxsackie, HBV) on endomyocardial biopsies; the pattern of the II class major histocompatibility complex (MHC) were in the blood lymphocytes; the microvascular aspect of coronary circulation in the endomyocardial biopsies. Finally, in a separated group of 19 patients, the microvascular circulation was studied on skin biopsies and correlated with diabetic, valvular and normal subject. The results showed a 14% positivity for the presence of the virus genoma and a significant predominate of DR5 in the II class MHC of patients with a worse ventricular function. Capillary vessels of the coronary microcirculation were dilated in the 48% of the patients, especially in more compromised subjects. Viral myocarditis seem to play a role in the etiopathogenesis of dilated cardiomyopathies (DCM) and the pattern of MHC could influence the progression of the illness. The microcirculation is probably a pathophysiological aspect. No etiological hypothesis seems to predominate.

Ankylosing spondylitis with predominant involvement of the cervical spine in a woman with Behçet's syndrome.

The case of a 45 year old woman affected by both Behçet's syndrome (BS) and ankylosing spondylitis (AS) is reported. Cervical spine involvement was observed long before the appearance of the sacroiliac and lumbar changes.

Plasma exchange with prostaglandin I2 and ACD solution: comparative effects.

Discontinuous plasma exchange with prostaglandin I2 (5 ng/kg/min) and low dosage heparin (5-6 IU/kg/min) (treatment I), and ACD solution alone (treatment II) was studied. During both treatments the activated partial thromboplastin time remained within the normal range. After treatment I platelet count was not decreased but in vitro platelet aggregation was reduced (p less than 0.001). After treatment II platelet count was reduced and in vitro platelet aggregation unchanged. Prostaglandin I2 at this dosage caused no cardiovascular complications. The physiopathological implications of these differences are discussed.

Acute effect of plasma exchange on arterial blood pressure and plasma renin activity.

Blood pressure (BP) decreases significantly in patients with immune complex nephritis and hypertension in the course of therapeutic plasma exchange (TPE). To investigate possible underlying mechanisms of this effect, the variations of supine and upright BP and plasma renin activity (PRA) acutely induced by PE (performed by isovolumetric replacement of plasma with 4% albumin in saline solution) were analyzed in six patients. On the average, both supine and upright BP decreased after TPE; however, statistical significance was obtained only for upright systolic BP. Supine and upright PRA did not change significantly, although a clearly blunted response to posture was observed in three patients. The changes of BP induced by TPE were apparently not due to a functional depression of the renin-angiotensin system, since the more marked decrements in BP were observed in the patients with lower basal PRA.