BACKGROUND: The antithyroid drugs, methimazole and carbimazole, are conventionally used in divided daily doses. However, these drugs have a longer intrathyroidal than a plasma half-life. We undertook this prospective, controlled study, in an area of mild iodine deficiency, to compare the efficacy of a single daily dose of carbimazole with divided doses in the treatment of hyperthyroidism. METHODS: Nineteen patients with hyperthyroidism received 30 mg of carbimazole daily at bed time (group A) while 14 received 10 mg of carbimazole every 8 hours (group B). These patients were assessed clinically and biochemically by estimation of serum total thyroxine, total triiodothyronine and thyrotropin before and 1, 2, 3, 4 and 6 weeks after treatment. RESULTS: There was no significant difference between mean baseline concentrations of thyroxine and triiodothyronine. After 1, 2, 3, 4 and 6 weeks there was a decline in their concentrations which was similar in both groups (p > 0.05). Euthyroidism was achieved in 4.6 +/- 1.4 weeks (range 2-6 weeks) in group A and in 3.8 +/- 1.2 weeks (range 3-6 weeks) in group B (p > 0.05). CONCLUSIONS: We conclude that carbimazole in a single daily dose is an effective method for treating hyperthyroidism in an area of mild iodine deficiency and its efficacy is comparable to divided dose therapy. This practical and acceptable method of treatment can be specially useful in patients who find it difficult to remember to take divided doses.

Adolescent↗

PubMedDate not supplied

Iopanoic acid as an adjunct to carbimazole in the management of hyperthyroidism.

BACKGROUND: The thiourea drugs take a few weeks to control the symptoms of hyperthyroidism whilst iodine containing radiographic contrast agents (iopanoic acid and sodium ipodate) have a more rapid effect. There is no report on the use of iopanoic acid administered in conjunction with carbimazole, so we evaluated the efficacy of this combination in the early medical management of patients with hyperthyroidism. METHODS: Thirty hyperthyroid patients diagnosed by clinical and biochemical criteria were randomized into two treatment groups. Group A (n = 16) received iopanoic acid (500 mg orally twice a day for the first 3 weeks) and carbimazole (30 mg orally in three divided doses) while group B (n = 14) received carbimazole alone. Clinical examination and estimation of serum total T3, total T4 and TSH were done by radioimmunoassay at the start of therapy, weekly for 4 weeks and then at 6, 8 and 12 weeks. RESULTS: In the initial 3 weeks, iopanoic acid induced a significantly greater fall in mean serum total T3 levels (Z = 2.298, p < 0.02) and a slower fall in mean serum total T4 (Z = 2.396, p < 0.05) in group A patients compared to those in group B. This was accompanied by earlier clinical improvement in group A patients. The mean serum total T3 and T4 values rose to higher levels in group A at 4 weeks, one week after discontinuation of iopanoic acid. At the end of 12 weeks, however, there was no significant difference in the mean serum total T3 and T4 levels between the two groups (p > 0.05). Biochemical euthyroidism (i.e. total T3 < 3 nmol/L and total T4 < 170 nmol/L) was achieved later in group A patients than in group B (10.4 +/- 5.0 weeks v. 3.6 +/- 1.2 weeks, p < 0.0001). CONCLUSIONS: Iopanoic acid given together with carbimazole induces rapid clinical improvement in hyperthyroid patients than carbimazole alone. However, the delayed achievement of euthyroidism may preclude its routine use in the management of patients with hyperthyroidism except in those with thyrotoxic emergencies.

Adult↗

PubMedDate not supplied

Fine needle aspiration cytology of mesoblastic nephroma. A case report.

A case of congenital mesoblastic nephroma of the left kidney was diagnosed in a 4-month-old child by fine needle aspiration cytology. The smears consisted of clustered and dyshesive spindle cells with minimal nuclear atypia and mitosis. No epithelial, tubular or glomeruloid differentiation was noted. Considering the age and cytomorphology, a diagnosis of mesoblastic nephroma was made. Histopathology of the nephrectomy specimen showed a tumor with features of atypical mesoblastic nephroma. Cytologic diagnosis of mesoblastic nephroma is important because the tumor has an excellent prognosis, and unlike Wilms' tumor, requires only surgery.

Biopsy, Needle↗

PubMedDate not supplied

Serum angiotensin converting enzyme in respiratory diseases.

More than 1700 estimations of serum angiotensin converting enzyme (SACE) were undertaken, mostly in respiratory disorders, to assess its value as a specific and/or a sensitive indicator of different diseases. Though highest levels were found in lepromatous leprosy consistently, it was also found almost always elevated in active stages of sarcoidosis. Since it is raised in a variety of respiratory disorders, it is not a specific diagnostic test. It is, however, a fairly sensitive index of disease activity in sarcoidosis whether on treatment or not. Sudden elevation, after a prolonged period of low or normal values may indicate relapse in sarcoidosis.

Adult↗

PubMedDate not supplied

Immunogenicity of deglycosylated zona pellucida antigens and their inhibitory effects on fertility in rabbits.

Influence of carbohydrates on the immunogenicity and immunocontraceptive potential of zona pellucida glycoproteins has been investigated in rabbits. Porcine zonae pellucidae, following deglycosylation with trifluoromethane-sulfonic acid, retained significant immunogenic potential, as shown by the ability to generate antibodies which cross-reacted with the heterologous antigen. Antibody response, however, was much stronger against the native zona glycoproteins, thereby suggesting that both carbohydrate and protein moieties contribute to the overall immunogenicity of the zona pellucida antigens. Contraceptive efficacy of active immunization with the deglycosylated zona antigens, when evaluated by mating experiments, demonstrated inhibition of fertility in all immunized rabbits. Normal ovarian functions were disrupted in these animals, as revealed by the reduction in ovarian weights and gross impairment of folliculogenesis. Flushing of the oviducts of the immunized animals yielded a markedly reduced number of ova ovulated in response to hCG administration, none of which were fertilizable. Results collectively suggest that active heteroimmunization with deglycosylated zona pellucida antigens is effective in reducing fertility in rabbits.

Analysis of Variance↗

PubMedDate not supplied

Simultaneous modeling of the pharmacokinetic and pharmacodynamic properties of enalkiren (Abbott-64662, a new renin inhibitor). I: Single dose study.

This study describes the relationship between the measured effects (angiotensin I and renal plasma flow) and plasma drug levels using a combined pharmacokinetic-pharmacodynamic model after 90 min iv infusion of enalkiren in 15 healthy, salt-depleted subjects. Doses from 0.002 to 0.512 mg/kg were evaluated. One hour prior to enalkiren dosing, para-aminohippuric acid infusion was started for each subject and continued until 3 hr after the start of enalkiren infusion. Timed blood samples were obtained to measure enalkiren, para-aminohippuric acid, and angiotensin I levels in plasma. Enalkiren-induced effect changes lagged in time behind the plasma enalkiren level changes, showing a counterclockwise hysteresis loop. To relate the temporal relationship of effect changes accurately to plasma drug levels, a pharmacokinetic model was combined with a pharmacokinetic model that incorporated a hypothetical effect compartment. The magnitude of the time lag was quantified by the half-time of equilibration between concentrations in the hypothetical effect compartment and the plasma enalkiren levels (t1/2keo). The t1/2keo for angiotensin I (0.002 hr) is significantly shorter than that of renal plasma flow (0.267 hr), indicating that enalkiren equilibrates more rapidly with the angiotensin I-related effect compartment than the renal plasma flow-related effect compartment. Moreover, the model allows for estimation of the effect site concentration that causes one-half of the maximal predicted effect (EC50), which is a measure of an individual's sensitivity to enalkiren. The EC50 of angiotensin I (81.1 ng/ml) is substantially lower than that of renal plasma flow (4414 ng/ml), indicating that angiotensin I may be a more sensitive measure of enalkiren effects than renal plasma flow.

Adult↗

PubMedDate not supplied

A study on the prevalence of chronic bronchitis in workers exposed to smoke and irritant fumes in a railway workshop.

In the present study 108 full time workers employed in various sections of a railway workshop and exposed to smoke and irritant fumes, and 45 matched control subjects from local administrative staff were investigated to find prevalence of chronic bronchitis. In all 18 (16.7%) workers and 4 (8.9%) control subjects had clinical evidence of chronic bronchitis. Peak expiratory flow rate less than 300 L/min was observed in 54.6% workers and 2.2% control subjects. A significantly higher prevalence of chronic bronchitis was seen in workers. The advancing age, smoking and duration of exposure had significant influence on prevalence of chronic bronchitis.

Adult↗

PubMedDate not supplied

Atypical cytologic features of medullary carcinoma of the thyroid. A review of 12 cases.

A total of 12 cases of medullary carcinoma of the thyroid were reviewed with regard to atypical cytologic features. They included clusters of cells with a follicular arrangement, papillary fronds, spindle-shaped cells, pleomorphic nuclei, nucleoli and intranuclear inclusions. Congo red staining on selected destained smears was positive for amyloid in three cases. Histology was also available in 12 cases. Two cases were incorrectly diagnosed as papillary carcinoma and one as follicular carcinoma on cytology. There were no false-positive diagnoses.

Adenocarcinoma↗

PubMedDate not supplied

Silent gallstones: a therapeutic dilemma.

Asymptomatic gall stones are defined as stones that have not caused biliary colic or other biliary symptoms. Nearly two-third of patients with gall stones are asymptomatic. Studies of the natural history of asymptomatic gall stones suggest that the cumulative probability of developing biliary colic after 10 years ranges from 15% to 25%. The incidence of other complications is much less. The operative mortality of elective cholecystectomy is <0.5% but increased mortality is seen in elderly persons (>60 year of age), particularly in those with complications such as acute cholecystitis. Most decision analysis studies do not favour prophylactic cholecystectomy for asymptomatic cholelithiasis. Nonetheless, many studies have listed certain criteria for carrying out elective cholecystectomy in asymptomatic patients. The authors, from their own experience and after reviewing the literature, propose the following criteria for cholecystectomy: life expectancy >20 years, calculi >3 cm in diameter, particularly in individuals in geographical regions with a high prevalence of gall bladder cancer or calculi <3 mm, chronically obliterated cystic duct, non-functioning gallbladder and calcified (porcelain) gallbladder. The widespread use of diagnostic abdominal ultrasonography has led to the increasing detection of clinically unsuspected gall stones. This, in turn, has given rise to a great deal of controversy regarding the optimal management of asymptomatic or 'silent' gall stones. While cholecystectomy is the undisputed gold standard treatment for symptomatic gall stones, the natural history of silent gall stones is not known well enough to recommend a definitive therapeutic strategy for such patients. The treatment options for asymptomatic or silent gall stones range from no treatment to selective cholecystectomy in at-risk group to elective cholecystectomy in all patients. There are a large number of proponents for each of these options so that each merits careful consideration. In this article, the authors examine the evidence for and against treating silent gall stones with the aim of providing more specific guidelines for the management of patients found to have asymptomatic gall stones.

Cholecystectomy↗

PubMedDate not supplied

Fine needle aspiration cytology in malignant Sertoli cell tumor of the testis. A case report.

A rare case of malignant Sertoli cell tumor of the testis occurred in which the diagnosis was initially suggested on fine needle aspiration cytology. Smears of the testicular, inguinal and cervical lymph node aspirates showed cells resembling normal Sertoli cells arranged in nests and tubules. Histopathology of the orchidectomy specimen confirmed the diagnosis. The literature is briefly reviewed.

Adult↗

PubMedDate not supplied

Management of polypoidal lesions of gallbladder in laparoscopic era.

UNLABELLED: The detection of polypoidal lesion of gallbladder (PLG) has increased particularly with widespread use of ultrasonography (US) as a diagnostic modality. Most of the PLG are diagnosed incidentally during scanning. Differentiation of benign from malignant PLG is a major concern and further management is based on this differentiation. DATA SOURCE: A Pubmed database search was performed. Abstract and articles were reviewed in detail. Other references were extracted by cross-reference. CONCLUSION: The risk factors for malignancy in PLG are identified. The newer investigative procedures may differentiate benign from malignant PLG. Follow up of the asymptomatic patient and indication for surgery is established in PLG.

Algorithms↗

PubMedDate not supplied

Physiological pharmacokinetic and pharmacodynamic model of physostigmine in the rat.

A physiological model for physostigmine disposition was developed in the rat which incorporated anatomical, physiological, and biochemical parameters, i.e. tissue volume, plasma flow rates, drug metabolism, and tissue-to-plasma partition coefficients. Predicted concentrations of physostigmine in different tissue compartments were consistent with the experimental observations in the rat following an iv dose. Part of this study also compared the time course changes in measured effect, as percentage change in cholinesterase activity in brain, and related these changes to the plasma or brain drug level in either a combined pharmacokinetic-pharmacodynamic (plasma physostigmine-effect relationship) or a dynamic model (brain physostigmine-effect relationship). Fitting the time course of the effect in a pharmacokinetic-pharmacodynamic model required an effect compartment with the equilibration rate constant between it and the plasma compartment. Both models help to understand whether the cholinesterase activity is homogeneous or heterogenous in the brain.

Animals↗

PubMedDate not supplied

Successful management of melanocytoma-associated choroidal neovascularization with photodynamic therapy.

PURPOSE: To report the efficacy of photodynamic therapy in treatment of choroidal neovascular membrane (CNV) associated with melanocytoma of the optic disc. METHODS: A middle-aged man with visual acuity of 20/200 in right eye was treated with photodynamic therapy for juxtafoveal classic CNV overlying the papillomacular bundle. CNV was secondary to ocular melanocytoma, a rare event. RESULTS: At the 6-month follow-up, a scarred CNV with final visual acuity of 20/30 was noted clinically and angiographically. Tomography revealed high reflective scar tissue with flat macula and microperimetry showed restoration of retinal sensitivity over the papillomacular bundle. CONCLUSIONS: Photodynamic therapy effectively resolved CNV that involved papillomacular bundle (secondary to melanocytoma) and restored retinal function in papillomacular bundle.

Choroidal Neovascularization↗