Hashimoto encephalopathy: a case study

The impact of thyroid hormones upon the proper function of central nervous system has been known for many years. The neurological symptoms and psychiatric disturbances may occur both in case of hypo- as well as hyperthyreosis. The encephalopathy Hashimoto (EH) described in this paper is a rare illness which occurs in case of patients suffering from the autoimmunological thyroid disease and increased level of antibodies in serum without any connections to the thyroid function. It is characterised by a variety of neurological symptoms and psychotic disturbances, acute state, high re-occurrence and good reaction to glicocorticosteroid treatment. Although we face encephalopathy Hashimoto extremely rarely in the clinical practice one should remember about it during the diagnostic process because when it is a long lasting untreated illness it may lead to the irreversible changes in the central nervous system.     

Effects of the sharav and bora on urinary neurohormone excretion in 500 weather-sensitive females

Changes from normal weather to hot dry heat (Sharav) or cold rainy weather (Bora) evoked specific reactions of neurohormone secretion in 500 female weather-sensitive patients studied in Jerusalem (Israel). Urinary 17-KS increased only during the weather front period, whereas 17-OH increased steadily during the weather front and heat period. Adrenaline and noradrenaline decreased during both the weather front and the following heat period, clinically presenting all symptoms of adrenal medulla exhaustion. Serotonin increased during the weather front period and returned to normal thereafter, whether it was followed by a hot spell or a cold period, whereas 5-HIAA was increased throughout the weather front and hot period. Clinically, serotonin overproduction manifested itself as the serotonin irritation syndrome (migraine, etc.). Patients suffering from occult hyperthyroidism reacted with an increase of urinary thyroxine and histamine as soon as a weather front arrived with the clinical signs of slight hyperthyroidism, especially tachycardia. The serotonin irritation syndrome and the hyperthyroidism were prevented and cured by negative air ionisation treatment in 75% or 45% of the cases respectively.     

Current diagnosis and treatment of cardiac arrhythmias of thyroid origin

Cardiac arrhythmias may often be of the thyroid origin. It is so-called thyroid-cardiac syndrome which may also be manifested by the circulatory failure and angina pectoris. The authors have been observed 54 cases of such arrhythmias; they have frequently been manifested by the paroxysmal tachycardia, extrasystolic beats, and paroxysmal or stable atrial fibrillation. Diagnosis of such arrhythmias may be difficult in case of the masked hyperthyroidism being its only clinical symptom. In order to establish a proper diagnosis the following tests of thyroid gland functioning have been carried out: TRH-TSH, scintigraphy and ultrasound examination of the thyroid gland. TRH-TSH test enables to detect disorders of hypophyseal-thyroidal regulation characteristic for both overt and masked hyperthyroidism. Scintigraphic examination reveals autonomic nodules of the thyroid glands being frequently a cause of cardiac arrhythmias. Ultrasound examination enables confirmation of the diagnosed autonomic thyroid nodules without TSH test. In the majority of cases of cardiac arrhythmias therapy with radioactive iodine isotope was introduced. Some patients with appropriate indications have been treated surgically after proper preparation. Pharmacological treatment in thyroid-cardiac syndrome produces transient and instable result.     

Lack of development, factor of congenital ureterohydronephrosis.

Female Swiss mice (25-30 g) received a single subcutaneous injection of 200 mug nucleotoxic substance (chloraminophen) on day 11 of pregnancy. The fetuses taken from the treated mother on day 18 show a significant lack of development and urinary anomalies, such as ureterohydronephrosis (26%) and renal agenesis (few cases). Ureterohydronephrosis seems to be caused by lacking development of the ureterovesical junction region.     

Low serum selenium concentration as a possible factor for persistent goiter in Iranian school children

Selenium deficiency can have adverse effect on thyroid metabolism and response to iodine supplementation. The aim of this study was to determine relationship between prevalence of goiter, thyroid hormone profile, urinary iodine and serum selenium concentrations in Iranian schoolchildren. In a cross- sectional study, 1188 schoolchildren in the age group of 8-13 years were evaluated for goiter prevalence. Urine and serum samples were collected from 500 children and assayed for urinary iodine concentration, thyroid hormone profile and serum selenium concentration. The overall goiter prevalence was 39.6% and the median urinary iodine excretion, indicated to an adequate iodine intake. The mean serum selenium concentration was 119.1 +/- 31 mug/l with significant difference between boys and girls (108.4 +/- 26.2 mug/l vs 127.7 +/- 32.1 mug/l). An increase in free T4 concentration was observed in those with a lower selenium level and there was a significant relationship between the presence or absence of goiter and serum selenium concentration. Selenium supplementation may be an advisable measure to optimize thyroid hormone metabolism and decrease the prevalence of goiter in schoolchildren with low serum selenium concentration.     

What might cause pain in the thyroid gland? Report of a patient with subacute thyroiditis of atypical presentation

Subacute granulomatous thyroiditis (SAT), also known as de Quervain's thyroiditis or painful subacute thyroiditis, is the commonest thyroid condition responsible for neck tenderness. Other causes of pain in the thyroid gland should be taken into consideration during differential diagnosis, especially when a patient presents with misleading or equivocal signs and symptoms. We report the case of a 39 year-old woman diagnosed as having SAT whose clinical, biochemical and radiological presentation varied significantly from the common SAT manifestation. A tentative diagnosis of SAT was made based on the presented symptoms, ultrasonography and fine-needle biopsy results. However, biochemical analysis suggested neither inflammatory process nor the presence of thyrotoxicosis. Moreover, technetium scan of the thyroid revealed normal uptake of the isotope and there was neither clinical nor ultasonographic response for corticosteroids. The patient's symptoms, despite being prescribed typical treatment, gradually deteriorated and the pain became increasingly debilitating. Eventually, the patient underwent total thyroidectomy. As a result, she has become free of symptoms, but the macroscopic picture of thyroid gland, noted during the operation, gave a suspicion of neoplastic process. Nevertheless, histological study of flow samples confirmed the tentative diagnosis of de Quervain's thyroiditis, despite all previous findings that were not suggestive of it. This report confirms the likelihood that SAT can present atypically. Additionally, it indicates that surgical treatment may be considered in patients with severe, debilitating, persistent thyroid gland pain connected with SAT clinical course.     

POST-TRAUMATIC SUPERIOR LARYNGEAL NEURALGIA

Several years after tonsillectomy—or more quickly after foreign-body trauma—the superior laryngeal nerve may be so bound by fibrosis that any regional inflammation or further local trauma, aggravated by normal laryngeal movements, can give rise to localized neuritis at the thyrohyoid membrane and cause a characteristic pain.In every one of 21 patients observed in the past five years, a point of tenderness was readily found by digital palpation over the lateral portion of the thyrohyoid membrane or over the superior cornu of the thyroid cartilage. Frequently the pain extended into the throat and became worse as anything was swallowed past this point.Medical therapy alone or with external injection followed by five minutes of local massage relieved the pain in most cases. It seems possible that, in a more recalcitrant case, relief could be obtained by incising the thyrohyoid membrane so as to relax the superior laryngeal nerve.     

Excessive iodine intake and thyroid dysfunction among lactating Saharawi women

ObjectivesExcessive iodine intake may lead to thyroid dysfunction, which may be particularly harmful during pregnancy and lactation. The main objective was to describe iodine status and the prevalence of thyroid dysfunction among lactating women in areas with high iodine (HI) and very high iodine (VHI) concentrations in drinking water.Design and methodsA cross-sectional survey was performed among 111 lactating women in the Saharawi refugee camps, Algeria. Breast milk iodine concentration (BMIC), urinary iodine concentration (UIC) and the iodine concentration in the most commonly consumed foods/drinks were measured. A 24-h dietary recall was used to estimate iodine intake. Thyroid hormones and antibodies were measured in serum.ResultsMedian UIC, BMIC and iodine intake across both areas was 350 μg/L, 479 μg/L and 407 μg/day, respectively. In multiple regression analyses, we discovered that being from VHI area was associated with higher UIC and BMIC. BMIC was also positively associated with iodine intake. Thyroid dysfunction and/or positive thyroid antibodies were found in 33.3% of the women, of which 18.9% had hypothyroidism and 8.1% had hyperthyroidism and 6.3% had positive antibodies with normal thyroid function. Elevated thyroid antibodies were in total found in 17.1%. We found no difference in distribution of thyroid dysfunction or positive antibodies between HI and VHI areas. BMI, BMIC and elevated thyroglobulin (Tg) predicted abnormal thyroid function tests.ConclusionsThe high prevalence of thyroid dysfunction may be caused by excessive iodine intake over several years.     

Corticosteroid-sparing effect of chromoglycate sodium and nedocromil

The most appropiate management for bronchial asthma is the control of airway inflammation. Corticosteroids are the most effective anti-inflammatory drugs available, but they have a number of side effects; most of these are dose-dependent. In children, asthma control should be accomplished with low steroid doses possibly given by inhalation. In a double-bind placebo-controlled crossover study a group of children with mild to moderate asthma received NED 16 mg/day or BDP 400 mug/day. Values for FEV(1), PEF, symptoms use ofbronchodilators overlapped, whereas bronchial hyper-responsiveness assessed by histamine bronchoprovocation challenge was better with BDP than NED. In another case, one boy with high bronchial hyper-reactivity assessed by provocation test with hypertonic solution, experienced a significant improvement only after 2 weeks of therapy with Deflazacort (2 mg/Kg/day) followed by 4 months on combined treatment with NED (16 mg/day) and BDP (300 mu/day). Authors conclude that NED could have a steroidsparing effect over long-term use.     

Effect of ethanol feeding on the urinary histamine level of the pregnant rat

The influence of ethanol feeding during pregnancy on histamine excretion was studied. Pregnant Sprague-Dawley rats (N = 5) were fed a liquid diet containing 30% ethanol-derived calories from gestation-day 7 to 21; control rats (N = 5) were pair-fed with isocaloric sucrose substituted for ethanol. Twenty-four hour urines were collected for histamine analysis. Rats were killed on day 21 of gestation. Food and ethanol intakes averaged 260 kcal and 11 g/kg/day, respectively. No differences were found between ethanol and control rats in maternal weight gain, litter size or in fetal and placental weights. Although urinary histamine increased in all rats with the advance of pregnancy, on day 16, ethanol rats excreted significantly more (47%) than the controls (199.1 +/- 33.9 vs 135.5 +/- 51.4 ug/24 hr); on day 20, it was 123% more (534.6 +/- 114.4 vs 239.5 +/- 99.3 ug/24 hr). Ethanol enhanced urinary histamine did not reflect the histamine content or histidine decarboxylase activity of fetal liver, presumed site of histamine formation; its physiological significance is discussed.     

损毁大鼠双侧蓝斑引起多脏器出血

目的和方法：用直流电极毁大鼠双侧蓝斑,观察膀胱及各内脏组织的出血性变化。结果：完全损毁双侧蓝斑枷恒定地引起严重的膀胱出血,并伴有其它脏器不规律性发生的充血或轻微出血。部分损毁双侧蓝斑亦可引起多脏器轻微的充血和出血,但膀胱出血不再恒定发生。切除肾上腺减轻应激反应,或应用组织按H2受体拮抗剂,对完全损毁双侧蓝斑引起的膀胱出血或其它脏器的组织学出血性变化无明显影响。结论：损毁大鼠双侧蓝斑引起的多脏器出血并非由于手术应激引起;也与组织胺H2受 体无关,其机制有待进一步研究。     

Interstitial cystitis and lower urinary tract symptoms in males and females-the combined role of potassium and epithelial dysfunction

Evidence of a lower urinary tract dysfunctional epithelium has been detected in women and men with interstitial cystitis and other complexes of lower urinary tract symptoms. Lower urinary tract dysfunctional epithelium can affect the bladder, the urethra, the labia or vaginal introitus in women, and the prostatic ducts and urethra in men. Because an individual with lower urinary tract dysfunctional epithelium may experience pain in one or more locations throughout the pelvis in any combination, the clinician cannot reliably establish a diagnosis based on "where it hurts." A useful diagnostic tool is the intravesical potassium sensitivity test, which detects the abnormal epithelial permeability of lower urinary tract dysfunctional epithelium. In most cases, lower urinary tract dysfunctional epithelium can be treated successfully.     

帕金森病的尿动力学表现及临床意义

为了评估有持久膀胱排尿障碍的帕金森氏病患者的尿动力学表现及其临床意义,对25例帕金森氏病患者行尿动力检查,并要求记录并回收24小时排尿日记.结果显示,1)有18例患者出现膀胱过度活动,逼尿肌收缩力低下或无反射4例,膀胱出口梗阻6例,另3例检查结果正常,无一例出现逼尿肌-括约肌协同失调; 2)患者所返回的排尿日记显示帕金森氏病患者普遍出现日排尿次数增加及每次排尿量的减少.由此可以得出结论:逼尿肌反射亢进是帕金森氏病患者尿动力学检查的最常见类型;尿动力学检查对正确处理帕金森氏病患者的排尿障碍有指导意义.     

Psychosocial stress and abdominal pain in adolescents

Children and adolescents may express psychiatric symptoms via somatic complaints. Likewise, children with chronic somatic illnesses are likely to experience psychiatric sequelae. We report three cases of adolescents who were admitted to general paediatrics services for abdominal pain and/or nausea and vomiting with a negative medical workup. In each case, a clear psychosocial stressor was evident. It is possible that somatic symptoms without clear medical causes may reflect psychosocial stress, but it is difficult to discern whether the psychosocial issues preceded the somatic complaints or were a result of them. Making an accurate diagnosis is difficult, and broaching such a subject with patients and their families is a delicate matter. More research is needed to determine appropriate screening tools for identifying cases where psychosocial stress may play a relevant role in symptom presentation, as well as potential treatment modalities for such cases.     

A proteomic analysis of the aphid Macrosiphum euphorbiae under heat and radiation stress

Temperature and solar radiation can be important sources of abiotic stress for small herbivorous insects living in close association with plants. We examined the effects of daily fluctuations of heat and UV radiation on the proteome and performance of winged and wingless morphs of the aphid Macrosiphum euphorbiae. A daily regime of 4 h of heat stress at 35 °C had more negative effects on the aphid's fitness than a similar period of UV-B stress (11.6 kJ m^?2 per day), and these effects were most pronounced on wingless aphids. Aphid proteomes as detected on 2-D gels revealed ～470 protein spots, with the fluctuating heat stress leading to many more changes than exposure to UV-B. The reduced performance of aphids under heat stress correlated with lower abundance of several enzymes in central pathways of energy metabolism, including the TCA cycle and the respiratory chain. Several exoskeletal proteins were induced or their abundance was increased under high temperature stress, suggesting that cuticle barrier enhancement at molting in response to heat stress is an aphid adaptation to stressful thermal conditions. The proteome of winged aphids was more broadly modulated under stress than that of wingless aphids. Greater homeostatic capabilities as revealed at the proteomic level could explain the higher tolerance of the alate aphid morph to environmental stress and its more stable performance and fitness.     

Ethylene and plant responses to stress

When plants are subject to a variety of stresses they often exhibit symptoms of exposure to ethylene. Although this relationship usually results from induction of ACC synthase thus raising the concentration of the precursor of ethylene, it is now apparent that there are numerous other ways that stresses produce ethylene-like symptoms. This complex relationship between stress and ethylene-like symptoms is here termed the stress ethylene syndrome. ACC synthase exists as a multi-gene family whose individual members are differentially regulated, many by various stresses. In addition, ACC oxidase. AdoMet synthetase, enzymes in the Yang methionine cycle, and enzymes that conjugate ACC are regulated by stress. In more unusual cases, ethylene production is not increased by stress or may be reduced. There is evidence for stress effects on perception of ethylene and the potential exists that some steps of the ethylene signal transduction pathway may be influenced by stress. Because of the variability possible in the stress ethylene syndrome, it continues to be studied for a number of stresses and species. In particular, attention is being given to wounding, mechanical stress, drought, heat and water deficit stress, chilling, air pollution, chemical and salt stress, and low O₂stress. It is becoming more apparent that a number of stress responses involve interactions with other hormones.     

Altered Heavy Metals and Transketolase Found in Autistic Spectrum Disorder

Autism and autism spectrum disorder (ASD) are developmental brain disorders with complex, obscure, and multifactorial etiology. Our recent clinical survey of patient records from ASD children under the age of 6?years and their age-matched controls revealed evidence of abnormal markers of thiol metabolism, as well as a significant alteration in deposition of several heavy metal species, particularly arsenic, mercury, copper, and iron in hair samples between the groups. Altered thiol metabolism from heavy metal toxicity may be responsible for the biochemical alterations in transketolase, and are mechanisms for oxidative stress production, dysautonomia, and abnormal thiamine homeostasis. It is unknown why the particular metals accumulate, but we suspect that children with ASD may have particular trouble excreting thiol-toxic heavy metal species, many of which exist as divalent cations. Accumulation or altered mercury clearance, as well as concomitant oxidative stress, arising from redox-active metal and arsenic toxicity, offers an intriguing component or possible mechanism for oxidative stress-mediated neurodegeneration in ASD patients. Taken together, these factors may be more important to the etiology of this symptomatically diverse disease spectrum and may offer insights into new treatment approaches and avenues of exploration for this devastating and growing disease.     

Alpha-blockers for the treatment of prostatitis-like syndromes

Prostatitis is a common medical diagnosis. The etiology of this symptomatic syndrome can be an acute or chronic bacterial infection, a noninfectious initiator (the most common cause), or iatrogenic heat or radiation; the syndrome may coexist with benign prostatic hyperplasia. Alpha-blockers have a role in the treatment of the prostatitis syndromes. In Category I, acute bacterial prostatitis, alpha-blockers have been shown to possibly ameliorate obstructive and irritative voiding symptoms. In Category II, chronic bacterial prostatitis, alpha-blockers seem to reduce the risk of clinical and bacteriological recurrence. In Category III, chronic pelvic pain syndrome, alpha-blockers improve symptoms and quality of life. Alpha-blockers also seem to ameliorate the symptoms and reduce the risk of acute urinary retention in patients who suffer from either heat- or radiation-induced prostatic inflammation. Alpha-blockers improve lower urinary tract symptoms, including pain, in patients who are diagnosed with both prostatitis and benign prostatic hyperplasia. Evidence has proven there is definitely a role for alpha-blockers in the management of the prostatitis syndromes.     

Towards positive diagnosis of the irritable bowel.

A questionnaire to establish the presence of 15 symptoms thought to be typical of the irritable bowel syndrome (IBS) was given to 109 unselected patients referred to gastroenterology or surgery clinics with abdominal pain or a change in bowel habit or both. Review of case records 17--26 months later established a definite diagnosis of IBS in 32 patients and of organic disease in 33. Four symptoms were significantly more common among patients with IBS--namely, distension, relief of pain with bowel movement, and looser and more frequent bowel movements with the onset of pain. Mucus and a sensation of incomplete evacuation were also common in these patients. The more of these symptoms that were present the more likely was it that the patient''s pain or altered bowel habit, or both, was due to IBS. We conclude that a careful history can increase diagnostic confidence and reduce the amount of investigation in many patients with chronic abdominal pain.     

Cobalt Tumor of the Thyroid Gland

Diminutive kidney, hypoplasia or atrophic pyelonephritis, may be the cause of hypertension, lumbar or abdominal pain, obscure gastrointestinal symptoms or chronic urinary infection accompanied by chills and fever. A hypoplastic kidney is prone to infection and stone formation.Diagnosis includes meticulous x-ray examination and renal function studies employing the more accurate quantitative phenolsulfonphthalein test of each kidney.Nephrectomy is the treatment for unilateral disease causing symptoms; localized atrophic pyelonephritis is amenable to partial resection.Since urinary stasis invites infection, obstructing ureteral strictures should be dilated. Pyelectasis, secondary to ptosis, and ureteropelvic obstruction should be corrected by nephropexy or plastic repair. These conservative measures may prevent renal destruction.Sixteen patients were subjected to nephrectomy: Six because of persistent pain and chronic infection and ten because of hypertension. The six with pain and chronic urinary infection were relieved. In six of the ten with hypertension, the disease recurred within six months to seven years.