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Clinical and Biological Characteristics of Patients Aged 65 and Older with Newly Developed Type 1 Diabetes 65岁及以上新发1型糖尿病患者的临床和生物学特征
Pub Date : 2016-10-27 DOI: 10.4172/2161-1017.1000252
Achilov Mt, Njah Mk, E. Yh, Beizig Am, M. Chadli, K. Ach
Objective: Diabetes of elder subjects is characterized by onset after the age of 65, absence of Ketoacidosis, insulin independence for at least 6 months, and presence of circulating islet-cell antibodies. Its marked heterogeneity in clinical features and immunological markers suggests the existence of multiple mechanisms underlying its pathogenesis. Methods: This is a retrospective study related to the observation of 5 patients aged over 65 years old, diagnosed with diabetes. All patients have had a dosage of pancreatic antibodies: anti glutamic acid decarboxylase antibodies (GAD antibodies) and tyrosine phosphatase antibodies IA2 (IA2 antibodies), with positivity to at least one of them. Their clinical and biological data, namely clinical aspects, family and personal history, metabolic and biological profile, autoimmune context, and degenerative complications, have been determined at the moment of the diagnosis. Results: This study was carried out on 4 female patients and one male, with an age between 65 and 71 years with a mean of 68 years. The clinical diagnosis is dominated by an insulinopenia in 3 cases with cardinal syndrome, an average blood glucose at admission=17.88 mmol/L, and an average HbA1C=13.24%. This insulinopenia has occurred in 2 cases immediately, realizing an inaugural ketosis. As far as the other 3 cases are concerned, the insulinopenia has taken place, right after a monitored oral anti-diabetic treatment for an average period of 21 months, fulfilling slow Mellitus Diabetes. An average BMI of 25.8 (Extremities 19 and 39) and a waist circumference>80 cm among all patients (range: minimum: 80, maximum 117 cm) with an average of 92.4 cm are also noted. Retinopathy has been recorded among one female patient. Pancreatic antibodies are all directed against GAD-65 antigen while IA-2 antibodies are found negative. Conclusions: These observations suggest that auto immune Diabetes is possible among the elderly subjects. The absence of any autoimmune context associated with insulin resistance stigma indicates a specific pathophysiology of pancreatic autoimmunity among the elderly subjects. It emphasizes the importance of testing for an appropriate classification of persons with Elder Diabetes. Early diagnosis of LADA would help direct appropriate therapy to optimize glycemic control.
目的:老年糖尿病患者的特点是65岁以后发病,无酮症酸中毒,胰岛素独立至少6个月,存在循环胰岛细胞抗体。其临床特征和免疫标志物的明显异质性表明其发病机制存在多种机制。方法:对5例65岁以上的糖尿病患者进行回顾性观察。所有患者均有一定剂量的胰腺抗体:抗谷氨酸脱羧酶抗体(GAD抗体)和酪氨酸磷酸酶抗体IA2 (IA2抗体),其中至少有一种呈阳性。他们的临床和生物学数据,即临床方面、家庭和个人病史、代谢和生物学特征、自身免疫背景和退行性并发症,在诊断时已经确定。结果:本组患者女性4例,男性1例,年龄65 ~ 71岁,平均68岁。临床诊断以胰岛素减少为主3例,入院时平均血糖=17.88 mmol/L,平均HbA1C=13.24%。2例患者立即出现胰岛素减少,首次出现酮症。其余3例患者在接受平均21个月的口服降糖药监测治疗后,立即出现胰岛素减少,达到了慢性糖尿病的标准。所有患者的平均BMI为25.8(四肢19和39),腰围为bbbb80 cm(范围:最小:80,最大117 cm),平均为92.4 cm。视网膜病变在一名女性患者中有记录。胰腺抗体均针对GAD-65抗原,而IA-2抗体为阴性。结论:这些观察结果表明,自身免疫性糖尿病可能存在于老年受试者中。缺乏任何与胰岛素抵抗相关的自身免疫背景,表明在老年受试者中存在特定的胰腺自身免疫病理生理。它强调了对老年糖尿病患者进行适当分类的检测的重要性。早期诊断LADA有助于指导适当的治疗,优化血糖控制。
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引用次数: 1
Hyponatremia-Finding the Cause 低钠血症——寻找病因
Pub Date : 2016-10-27 DOI: 10.4172/2161-1017.1000253
A. Farhan, T. Tanveer, U. Mumtaz, Raza Ma, M. Shoaib
Hyponatremia is a very common finding in elderly and hospitalized patients. Finding its cause is where one has to scratch his head. This case emphasizes how a common occurrence (hyponatremia) can be a manifestation of an underlying rare diagnosis- hypopituitarism. This case is about a seventy years old female presenting with altered state of mentation. Her systemic examination was completely normal except for generalized hypertonia and a Glasgow coma scale of seven. Laboratory investigations revealed hyponatremia with normal chemistry and normal blood complete picture. CT brain and cerebrospinal fluid analysis was also unremarkable. When she was found resistant to treatment (free water restriction and hypertonic saline), she was further investigated and finally diagnosed as a case of hypopituitarism.
低钠血症在老年和住院患者中很常见。寻找其原因是一个人不得不挠头的地方。本病例强调了低钠血症是一种罕见的潜在诊断——垂体功能减退症的表现。这个病例是一个70岁的女性,表现为精神状态的改变。她的全身检查完全正常,除了全身性高渗和格拉斯哥昏迷评分为7。实验室检查显示低钠血症,化学和血液全貌正常。CT脑及脑脊液分析也无明显差异。当发现她对治疗(自由限水和高渗生理盐水)有抵抗时,进一步检查并最终诊断为垂体功能减退症。
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引用次数: 1
Advanced Granulosa Cell Tumor and Pregnancy: A Case Report, How to Treat and How to Preserve Fertility? 晚期颗粒细胞瘤与妊娠:1例报告,如何治疗及如何保持生育能力?
Pub Date : 2016-10-25 DOI: 10.4172/2161-1017.1000250
Aymen Fm, G. Majed, C. Hanène, L. Joumana, B. Amin
Granulosa cell tumors of the ovary are rare ovarian malignancy developed on stromal ovarian cells and characterized by estrogen secretion. Histologically, there are divided on two types: adult granulosa tumors, which are more frequent and occurring in perimenopausal and post-menopausal women and juvenile granulosa tumors, which are rarer and occurring in teenager and adolescent girls. The association between GCT and pregnancy is a rare condition with therapeutic challenge consisting on the pregnancy and the fertility outcome in a hand and the oncological results in the other. We present a case report of an adult granulosa cell tumor discovered fortuitously during caesarian section. We report the management of this tumor and the way to preserve the fertility.
卵巢颗粒细胞瘤是一种罕见的卵巢恶性肿瘤,发生在卵巢间质细胞上,以雌激素分泌为特征。组织学上分为两种类型:成人颗粒瘤和青少年颗粒瘤,前者多见于围绝经期和绝经后妇女,后者较少见于青少年和少女。GCT与妊娠之间的关联是一种罕见的疾病,其治疗挑战一方面是妊娠和生育结果,另一方面是肿瘤结果。我们报告一例成人颗粒细胞瘤在剖宫产时意外发现。我们报告了这种肿瘤的处理和保持生育能力的方法。
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引用次数: 2
Resistance to Kinase Inhibitors in Poorly Differentiated and Anaplastic Thyroid Cancer: Preclinical In vitro Evidences 低分化和间变性甲状腺癌对激酶抑制剂的耐药性:临床前体外证据
Pub Date : 2016-10-25 DOI: 10.4172/2161-1017.1000251
F. Gianì, D. Tumino, F. Frasca
Poorly differentiated thyroid cancer (PDTC) and anaplastic thyroid cancer (ATC) are rare but highly aggressive malignancies with an extremely short survival. Poor prognosis is due to their unlimited growth, invasion, migration and resistance to common anticancer therapies. Advances in understanding the molecular alterations in thyroid carcinomas led to development of new therapeutic strategies such as kinase inhibitors. Although several of these compounds have been approved by FDA and EMA for the treatment of radioactive-iodine refractory differentiated thyroid cancer (DTC) and medullary thyroid cancer (MTC), no significant clinical efficacy with targeted therapies have been observed in those patients. Herein, we review and summarize the preclinical In vitro evidences of mechanisms of resistance to kinase inhibitors currently used in PDTC and ATC patients.
低分化甲状腺癌(PDTC)和间变性甲状腺癌(ATC)是罕见但高度侵袭性的恶性肿瘤,生存期极短。预后不良是由于它们的无限制生长、侵袭、迁移和对常用抗癌治疗的耐药性。了解甲状腺癌分子变化的进展导致了新的治疗策略的发展,如激酶抑制剂。虽然这些化合物中的一些已被FDA和EMA批准用于治疗放射性碘难治性分化甲状腺癌(DTC)和甲状腺髓样癌(MTC),但在这些患者中尚未观察到靶向治疗的显着临床疗效。在此,我们回顾和总结了目前用于PDTC和ATC患者的激酶抑制剂耐药机制的临床前体外证据。
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引用次数: 1
Pheochromocytoma Presents as Takotsubo Cardiomyopathy 嗜铬细胞瘤表现为Takotsubo心肌病
Pub Date : 2016-10-10 DOI: 10.4172/2161-1017.1000249
al-Shawa Yr, K. Ho
A hypertensive crisis, with an acute heart failure and pulmonary oedema had complicated anesthesia induction, during an elective surgery was done to an elderly aged patient. This patient had hypertension, with a very controlled BP on Irbesartan (angiotensin receptor blocker), and a normal cardiac function before admission. The operation was aborted, and the patient was resuscitated in the theatre and the ICU. Investigations showed cardiomegaly on CXR, with abnormal size and function of the Lt Ventricle on echocardiograph, as well as high levels of serum troponin, and very high values of serum catecholamine's metabolites (metanephrines and normetanephrines). A high suspicion of pheochromacytoma was raised, and this was confirmed later by the presence of a large RT adrenal mass on abdominal CT scan and MIBG scan. After 3 weeks of supportive treatment in the ICU, with continuous monitoring of the very labile BP, the patient underwent a laparoscopic adrenalectomy. Postoperatively, the patient's BP and cardiac function were restored
在选择性手术期间,对一位老年患者进行高血压危象,急性心力衰竭和肺水肿合并麻醉诱导。该患者患有高血压,入院前使用厄贝沙坦(血管紧张素受体阻滞剂)血压控制良好,心功能正常。手术流产,病人在手术室和重症监护室接受了抢救。超声心动图显示左心室大小和功能异常,血清肌钙蛋白水平高,血清儿茶酚胺代谢物(肾上腺素和去甲肾上腺素)水平非常高。高度怀疑为嗜铬细胞瘤,后来腹部CT扫描和MIBG扫描显示大的RT肾上腺肿块证实了这一点。在ICU进行了3周的支持治疗,并持续监测非常不稳定的血压,患者接受了腹腔镜肾上腺切除术。术后患者血压及心功能恢复正常
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引用次数: 0
The Effect of Hypothyroidism on Insulin Sensitivity and Their Influence on the Serum Lipid Profile and Renal Function 甲状腺功能减退对胰岛素敏感性的影响及其对血脂和肾功能的影响
Pub Date : 2016-10-10 DOI: 10.4172/2161-1017.1000248
Abdel-Gayoum Aa
The overt and subclinical hypothyroidism is more prevalent in patients with diabetes mellitus than in general population. Recently, more studies have been warranted to elucidate the relationship between thyroid hormones disorders and the insulin activity. The present study aims to investigate the correlations between the thyroid hormone levels in subclinical and overt hypothyroid patients with the insulin resistance and their impact on serum lipid profiles and kidney function. Methods: A total of fifty newly diagnosed hypothyroid patients were recruited for the study and classified into: 1) Subclinical hypothyroid (SH) group: n-26; 2) Overt hypothyroid (OH) group: n=24, and control (C) group: n=18. Fasting blood was collected and serum was used for biochemical analysis. Results: The fasting serum insulin, glucose levels and the estimated insulin resistance index (HOMA) of the SH and OH groups were significantly (P<0.001) elevated compared to control. The regression analysis reviled a significant negative correlation between FT4 and insulin (r=-0.32, P=0.04) and significant positive correlations between TSH and insulin (r=0.57, P=0.002), between TSH and HOMA (r=0.51, P=0.001), between HOMA and uric acid (r=0.37, P=0.02), and between TSH and TG (r=0.47, P=0.002). The serum creatinine, urea and uric acid concentrations were significantly (P<0.001) elevated in the OH group but not the SH. The serum total cholesterol, TG and LDL-cholesterol were significantly elevated in both SH and OH. Conclusion: Hypothyroidism is associated with insulin resistance, renal impairment, hyperurecemia and dyslipidemia, which are atherosclerotic risk indicators. The TSH had maximum impact on the changes. Subclinical and overt hypothyroid patients with elevated TSH are at high risk of developing atherosclerosis, thus may need close monitor to contain the rise in plasma TSH.
显性和亚临床甲状腺功能减退在糖尿病患者中比在一般人群中更为普遍。近年来,关于甲状腺激素紊乱与胰岛素活性之间关系的研究越来越多。本研究旨在探讨亚临床和显性甲状腺功能减退患者甲状腺激素水平与胰岛素抵抗的相关性及其对血脂和肾功能的影响。方法:将50例新诊断的甲状腺功能减退患者分为:1)亚临床甲状腺功能减退(SH)组:n-26例;2)显性甲状腺功能减退(OH)组24例,对照组(C)组18例。采集空腹血,血清进行生化分析。结果:与对照组相比,SH组和OH组空腹血清胰岛素、葡萄糖水平及胰岛素抵抗指数(HOMA)均显著升高(P<0.001)。回归分析发现,FT4与胰岛素呈显著负相关(r=-0.32, P=0.04), TSH与胰岛素呈显著正相关(r=0.57, P=0.002), TSH与HOMA呈显著正相关(r=0.51, P=0.001), HOMA与尿酸呈显著正相关(r=0.37, P=0.02), TSH与TG呈显著正相关(r=0.47, P=0.002)。OH组血清肌酐、尿素和尿酸浓度显著升高(P<0.001), SH和OH组血清总胆固醇、TG和ldl -胆固醇均显著升高(P<0.001)。结论:甲状腺功能减退与胰岛素抵抗、肾功能损害、高尿毒症、血脂异常相关,是动脉粥样硬化的危险指标。TSH对这些变化的影响最大。伴有TSH升高的亚临床和明显甲状腺功能减退患者发生动脉粥样硬化的风险很高,因此可能需要密切监测以控制血浆TSH的升高。
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引用次数: 6
Adrenal-Renal Fusion Giving Rise to an Intrarenal Adreno-Cortical Adenoma: A Novel Case Report with Review of Current Literature 肾上腺-肾融合导致肾内肾上腺-皮质腺瘤:一例新病例报告并复习当前文献
Pub Date : 2016-08-29 DOI: 10.4172/2161-1017.1000247
Patel, Bejarano Pa, A. Parlade, N. Muruve
Adrenal-renal fusion is a rare developmental anomaly in which adrenal tissue extends into the renal parenchyma without separate encapsulation of the two organs. Of the few cases described in the literature, clinically significant adrenal-renal fusion has been associated with adrenal cortical adenomas, which appear to be solid masses with enhancing and infiltrative features on radiographic studies. Only three cases of adrenocortical adenoma associated to adrenal-fusion have been published. We describe an additional and unique case in a 70 year old woman who had an incidentally discovered ectopic adrenal tissue that gave rise to an adrenal cortical adenoma in the setting of adrenal-renal fusion.
肾上腺-肾融合是一种罕见的发育异常,肾上腺组织延伸到肾实质而没有将两个器官分开包裹。在文献中所述的少数病例中,临床上显著的肾上腺-肾融合与肾上腺皮质腺瘤有关,其放射学研究显示为实性肿块,具有增强和浸润特征。仅有3例肾上腺皮质腺瘤合并肾上腺融合被报道。我们描述了一个额外的和独特的情况下,在一个70岁的妇女谁偶然发现异位肾上腺组织,导致肾上腺皮质腺瘤在设置肾上腺肾融合。
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引用次数: 1
Thyroid Hormones and the Heart; a Paradigm of Exquisite Fine Tuning,Combining Ancient Hellenic and Oriental Wisdom 甲状腺激素与心脏;一种结合古希腊和东方智慧的精致的微调范例
Pub Date : 2016-08-04 DOI: 10.4172/2161-1017.1000246
Cokkinos Dv, S. Chryssanthopoulos
It must be realized that REM, very plainly defined as LV cavity enlargement above a certain value remains an important cardiological problem. After an anterior AMI despite early primary percutaneous intervention (PPCI) and administration of the drugs considered most efficient today, i.e. Converting enzyme inhibitors (CEIs) or angiotensin receptor blockers (ARBs), βblockers and aldosterone inhibitors, 30% of patients (pts) develop REM which seriously undermines their survival [4].
必须认识到,快速眼动(REM)仍然是一个重要的心脏学问题,它的定义非常明确,即左室腔扩大超过一定值。在急性心肌梗塞后,尽管早期经皮介入治疗(PPCI)和使用目前认为最有效的药物,如转换酶抑制剂(CEIs)或血管紧张素受体阻滞剂(ARBs)、β阻滞剂和醛固酮抑制剂,30%的患者仍会出现快速眼动,严重损害其生存期。
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引用次数: 0
Severe Hyperparathyroidism with Secondary Osteitis Fibrosa Cystica and Brown Tumors Mimicking Bone Metastasis 严重甲状旁腺功能亢进伴继发性囊性纤维性骨炎和棕色肿瘤模拟骨转移
Pub Date : 2016-07-25 DOI: 10.4172/2161-1017.1000245
C. Issa, Daher La
Introduction: The classical presentation of primary hyperparathyroidism, osteitis fibrosa cystica, has become very rare nowadays. This rarity makes it sometimes misdiagnosed leading to disastrous outcomes. Methods: We present a case of an undiagnosed primary hyperparathyroidism with severe osteitis fibrosa cystica and brown tumors that was first misdiagnosed as having bone metastasis. Conclusion: Osteitis fibrosa cystica although rare should be considered in the differential diagnosis of patients presenting with multiple brown tumors, especially since the diagnosis can be easily made by a simple calcium level, thereby avoiding severe adverse outcomes.
摘要原发性甲状旁腺功能亢进的典型表现为囊性纤维性骨炎,目前已变得非常罕见。这种罕见性使得它有时会被误诊,导致灾难性的后果。方法:我们报告一例未确诊的原发性甲状旁腺功能亢进合并严重的囊性纤维性骨炎和棕色肿瘤,最初被误诊为骨转移。结论:囊性纤维性骨炎虽然罕见,但在多发性棕色肿瘤患者的鉴别诊断中应予以考虑,特别是单纯的钙水平诊断可避免严重的不良后果。
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引用次数: 1
Estrogen Receptor Related Receptor Alpha (ERRñ) in Skeletal Tissues 骨组织中雌激素受体相关受体α (ERRñ)
Pub Date : 2016-07-14 DOI: 10.4172/2161-1017.1000244
E. Bonnelye
Estrogen receptor related receptor alpha (ERRα) was the oldest orphan nuclear receptor with sequence identity to the estrogen receptors, ERα/β. The sequence alignment of the ERRα and the ERs reveals a high similarity (68%) in the DNA-binding domain and a moderate similarity (36%) in other parts of the proteins such as the ligand-binding E domain.
雌激素受体相关受体α (Estrogen receptor related receptor α, ERRα)是最古老的孤儿核受体,其序列与雌激素受体ERα/β相同。对ERRα和er的序列比对显示,它们在dna结合结构域具有较高的相似性(68%),而在配体结合E结构域等蛋白质其他部分具有中等的相似性(36%)。
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引用次数: 2
期刊
Endocrinology and Metabolic Syndrome
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