Acta medica Austriaca最新文献

Mesenchymal hamartoma of the liver is an uncommon benign lesion seen almost exclusively in children younger than two years of age. The first case was reported in 1903, and until now fewer than 200 cases have been reported. A 38-year-old male complaining of dull subcostal pain lasting for almost 10 months was found on abdominal ultrasound to have a focal lesion of the liver. He was referred to our Unit where imaging procedures (ultrasound and computed tomography) revealed a solid lesion, 8 centimeters in diameter, located in the IVb and V segments of the liver. There were no clear margins between the lesion and the gallbladder wall. Alpha-fetoprotein and carcinoembryonic antigen were within normal limits and carbohydrate antigen 19-9 was minimally elevated. There was no evidence of metastatic disease. Ultrasound-guided biopsy of the lesion was done and pathology report of a biopsy specimen suggested that the tumor was probably a benign mesenchymal hamartoma. The patient underwent a formal bi-segmentectomy (IVb and V segments) with cholecystectomy. Definitive pathology report confirmed the diagnosis of a benign mesenchymal hamartoma.

Post-transfusion graft-versus-host disease (PT-GVHD) is seldom, but it has a high mortality rate, exceeding 90 percent. There is no standard treatment for PT-GVHD and irradiation of blood and its components before transfusion is broadly accepted for the prevention of PT-GVHD. In this report we present a case (a 17-year-old female) of PT GVHD, who died in spite of the use of all available therapeutic options.

Subclinical hypothyroidism is defined as elevated TSH in the presence of normal free T4 and T3 levels. This review discusses the following questions concerning subclinical hypothyroidism that have not been solved yet: 1) does elevated TSH always mean failure of the thyroid gland? 2) Do patients with subclinical hypothyroidism always develop overt hypothyroidism? 3) Are they symptomatic? 4) Does treatment with L-Thyroxine cure these symptoms,--if they exist? Summarizing the results of the literature one can give the following answers: 1) Elevated TSH with normal free T4 can but does not necessarily mean thyroid failure. 2) Patients with positive thyroid antibodies and especially with TSH levels above 10 mU/l are at high risk to develop overt hypothyroidism. 3) Typical symptoms (thyroid-specific, cardiovascular, neurological and psychiatric and finally alterations of risk factors for atherosclerosis) seem to occur in a greatly varying percentage of patients--some of the described symptoms are of questionable clinical importance. 4) Some of the symptoms, especially the cardiovascular, seem to be treatable by L-T4, whereas others like most of the changes in lipid metabolism can not be influenced by normalization of the TSH levels. In conclusion, screening for TSH and free T4 seems to be justified in elderly women, where the prevalence of the disease is approximately 20%. However, treatment of "symptoms" of subclinical hypothyroidism like elevated cholesterol levels or depression should be done only in patients with a TSH > 10 mU/l and there only with great caution in order to avoid unnecessary overdosage with the danger of eliciting atrial fibrillation.

Aim: Thyroid hormone status and thyroid antibodies were evaluated in patients suffering from dementia for further study of an association of hyperthyroidism with AD and vascular dementia (VD), respectively.

Patients: In 77 patients with dementia, and 42 controls, thyrotropin (TSH) and thyroid antibodies were correlated with the different types of dementia and the metabolic index (MI) based on imaging with F-18-2-fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET).

Results: Twenty-two of all patients with dementia (29%) had borderline (TSH 0.3-0.5 mU/l) or decreased TSH levels (TSH < 0.3 mU/L). TSH values were significantly lower in patients suffering from AD (median: 1.1 mU/l) and VD (0.5 mU/l) than in the control group (1.5 mU/l) (p < 0.01). Decreased or borderline TSH levels were present in 52% of the patients with VD, but in only 10% of the controls, and in 23% of the patients with AD. Antibodies to thyroid peroxidase were positive in 16% of all patients with dementia. The MI in patients suffering from AD with borderline TSH levels was 0.81 (0.70, 0.94). In contrast, patients suffering from AD with normal TSH values showed a slightly higher MI of 0.84 (0.76, 0.89) (p = n.s.).

Conclusion: Decreased or borderline TSH values are associated with an increased probability of having dementia, especially VD.

The authors have conducted a prospective investigation on 15 patients with hemodynamically unstable pericardial effusion (main criteria: echocardiographic signs of various degrees of right ventricular diastolic collapse and clinical instability) hospitalized in the Intensive Cardiac Unit (1.97% of all patients) for one year and have compared the results with literature data. The causes of pericardial effusion were neoplasms, infections, rupture of heart of aorta and hypothyroidism. Investigation revealed the most frequent findings: symptoms (dyspnea, retrosternal pain, loading intolerance, nonproductive cough), clinical signs (soft heart sounds, changes in pulmonal findings, fever, jugular venous distention, tachycardia, arterial hypotension and hepatomegaly), laboratory changes (elevated erythrocyte sedimentation rate, leukocytosis), ECG changes (ST-T abnormality, microvoltage, tachycardia) and chest X-rays changes (enlarged cardiac silhouette, pleural effusion). Echocardiography found an average width of pericardial effusion of 2.5 cm (+/- 1.2), frequently thickened pericardium and changes in heart motions. The most used drugs in therapy were indomethacin, antibiotics, analgesics and corticosteroids. In three patients pericardiocentesis, and in two pericardiectomy were performed. Two patients died, 13 patients were discharged from the ICU with an improved health condition. Literature data on this condition are either lacking, or differ from the above findings.

Atrial fibrillation (AF), the most widespread arrhythmia, is a source of disability and death in the elderly, in particular because of the functional heart failure entailed and the considerable frequency of thromboembolic complications. Today, overt hyperthyroidism (oHT) is generally believed to be the most important extracardiogenic predisposition factor for AF. There exists no widespread acceptance so far that subclinical hyperthroidism (sHT) influences the occurrence of AF. Furthermore, there are no clear recommendations for treatment of sHT to prevent AF. Recent data confirm AF prevalence to be 5-6 times higher not only in cases of oHT but also in sHT patients compared with a reference group with normal thyroid function. Subclinical hyperthyroidism increases the prevalence of AF approximately to the same extent as oHT and has to be included in diagnostical considerations in patients with AF.

The demographic development will lead to an increase in endoscopic examinations in elderly patients. Indications feasibility, complication rate and therapeutic consequences following detection of pathologic findings are important for assessing the relevance of endoscopy in geriatric patients. Indications and results of colonoscopy as well as special features of clinical presentation and endoscopic intervention in cases of acute gastrointestinal bleeding are discussed. The placement of a percutaneous endoscopic gastrostomy and the endoscopic retrograde cholangiopancreaticography represent inconvenient endoscopic techniques in elderly patients. However, according to recent data, these procedures are assessed as being safe and effective.

Etiology and clinical manifestation of subclinical hypothyroidism is different in neonates and in young. In the neonatal period babies present with jaundice and/or constipation due to thyroid hypoplasia, thyroid ectopia or transient hypothyroidism. The main reason for subclinical hypothyroidism in the youth is Hashimoto thyroiditis. Indication for thyroxin therapy in subclinical hypothyroidism is discussed controversial in the literature. For best growing and maturation in childhood thyroxin therapy should be given. Subclinical hyperthyroidism is rare in childhood. The main reasons are Graves' disease or Hashimoto thyroiditis (initial period). The therapy of subclinical hyperthyroidism is the same as in overt hyperthyroidism.

We present three cases of patients with symptomatic, chronic, diagnosis-resistant hypokalaemia. Differential diagnosis of renal potassium loss between Gitelman's syndrome, Bartter's syndrome and loop diuretic abuse was made. Key elements in differential diagnosis of chronic hypokalaemia are blood pressure assessment, acid base equilibrium, serum calcium concentration, 24-hour urine potassium and calcium excretion.

The cardiovascular system is sensitive to the action of thyroid hormones, and thyroid dysfunction causes a wide spectrum of cardiovascular changes. The effect of overt hypothyroidism on the cardiovascular system has long been recognised. Nowadays, the clinical presentation of cardiovascular symptoms related to hypothyroidism is only rarely observed due to early diagnosis of hypothyroidism by easily available thyroid-stimulating hormone assays. Overt hypothyroidism causes changes in such parameters of cardiovascular function as heart rate, left ventricular systolic and diastolic function, blood, arterial pressure and systemic vascular resistance. During the last years, there has been increasing evidence that subclinical hypothyroidism may also impair the cardiovascular system. This review discusses the effect of hypothyroidism on the cardiovascular system.