ASSOCIATION BETWEEN PRIMARY HYPERPARATHYROIDISM AND THYROID DISEASE.ROLE OF PREOPERATIVE PTH

BACKGROUND: The association between patients with surgically treatable thyroid disease and patients affected by PHPT is not just accidental. MATERIALS: We report 591 patients who underwent total thyroidectomy in our center. Data, collected during the preoperative period according to our protocol for candidates to total thyroidectomy, included: type of thyroid disease, sex, age, type of surgical procedure, preoperative PTH and plasmatic calcium level. Calcium plasmatic level has been monitored at 24 hours after surgery on day 6 and monthly for 6 months. RESULTS: On 591 cases, PTH above the normal range were present in 19.1% (113 patients), all asymptomatic for PHPT 30 were males (26.6%) and 83 females (73.4%), with a mean age of 62.97 +/- 12.51 years and 57.38 +/- 15.09 years ( p = 0.19). The mean preoperative PTH and calcium plasmatic level were 104.4 +/- 21.96 pg/ml and 119.7 +/- 37.93 pg/ml (p = 0.39) and 9.21 +/- 0.59 mg/dL e 9.37 +/- 0.87 mg/dl (p = 0.45) respectively. Intraoperative exploration proved a pathological parathyroid gland in 12 on 113 cases. In 9 of the 12 patients with parathyroid adenoma, hypocalcaemia developed. It resolved in 7 days for 4 patients and within 30 days for the others. No hypocalcaemia has been recorded at a 6 months follow up for the 97 considered (4 were lost at follow up). CONCLUSION: Preoperative PTH measurement for all patients undergoing total thyroidectomy may offer a concrete tool to screen and identify the above-described category of patients, with no additional cost for further radiological investigations, because this class of patients will be submitted to bilateral cervical exploration associated with a total thyroidectomy

Wczesna kinetyka stężenia sercowego białka wiążącego kwasy tłuszczowe u chorych poddanych echokardiografii obciążeniowej z dipirydamolem oraz zależności ze stężeniem troponin oznaczonych metodą wysokoczułą

Background: The assessment of cardiospecific troponins is the main stay for diagnosing myocardial injury, although their diagnostic sensitivity remains suboptimal at patient admission to the emergency department (ED), thus paving the way for translational research to identify early and complementary biomarkers which may help improve the diagnostic sensitivity of high-sensitivity troponin immunoassays at patient presentation to the ED.Aim: To investigate whether heart-type fatty acid binding protein (H-FABP) provides distinctive and/or adjunctive information over high-sensitivity troponin I (HS-TnI) in ED patients undergoing dipyridamole stress testing.Methods: Thirty consecutive ED patients with chest pain but no myocardial ischaemia were challenged with dipyridamole-atropine and followed by echocardiography. Blood samples for assessing H-FABP and HS-TnI were collected before the dipyridamole challenge, immediately after, and 6 h afterwards.Results: The concentration of HS-TnI in the whole cohort of patients did not vary significantly throughout the study period, whereas H-FABP significantly increased after the test (4.2 ng/mL, p = 0.003), but not 6 h afterwards (3.8 ng/mL, p = 0.372) compared to baseline (4.0 ng/mL). The kinetics was similar in patients with positive or negative results of stress testing. The frequency of biomarker increase after the test was greater for H-FABP than for HS-TnI immediately after the pharmacological challenge (77% vs. 53%), but was lower 6 h afterwards (30% vs. 63%). The number of patients with values exceeding the diagnostic threshold of both biomarkers remained constant throughout the study period.Conclusions: These results suggest that dipyridamole stress echocardiography does not trigger substantial myocardial injury. We have also shown that release of H-FABP from stressed myocardium occurs without progression towards irreversible necrosis, and is more precious than that of TnI.Wstęp: Podstawową metodą w diagnostyce uszkodzenia mięśnia sercowego jest oznaczenie swoistych troponin sercowych, jednak czułość tego badania nie jest wystarczająca w przypadku pacjentów zgłaszających się na oddział ratunkowy. Dlatego też poszukuje się wczesnych biomarkerów zapewniających dodatkowe informacje, które umożliwiłyby zwiększenie czułości diagnostycznej w stosunku do oznaczenia troponin metodą wysokoczułą u pacjentów zgłaszających się na oddział ratunkowy.Cel: Celem pracy było zbadanie, czy sercowe białko wiążące kwasy tłuszczowe (H-FABP) dostarcza odmiennych i/lub dodatkowych informacji w stosunku do oznaczenia stężenia troponiny I metodą wysokoczułą (HS-TnI) u chorych, u których przeprowadzono próbę dipirydamolową na oddziale ratunkowym.Metody: U 30 kolejnych pacjentów, którzy zgłosili się na oddział ratunkowy z bólem w klatce piersiowej, jednak bez cech niedokrwienia mięśnia sercowego, przeprowadzono echokardiograficzną próbę obciążenia dipirydamolem–atropiną. Próbki krwi w celu oznaczenia H-FABP i HS-TnI pobrano przed przeprowadzeniem próby dipirydamolowej, bezpośrednio po niejoraz po 6 godzinach.Wyniki: Stężenia HS-TnI w całej grupie chorych nie różniły się znamiennie w okresie badania, natomiast H-FABP zwiększyło się istotnie w stosunku do wartości wyjściowych (4,0 ng/ml) bezpośrednio po próbie dipirydamolowej (4,2 ng/ml; p = 0,003), ale nie 6 godzin później (3,8 ng/ml; p = 0,372). Parametry kinetyczne były podobne u pacjentów z dodatnim i ujemnym wynikiem próby wysiłkowej. Bezpośrednio po próbie obciążeniowej częściej obserwowano zwiększenie stężenia H-FABP niż HS-Tn-1 (77% vs. 53%), natomiast po 6 godzinach te proporcje się odwróciły (30% vs. 63%). Liczba chorych, u których wartości obu markerów przekraczały próg diagnostyczny, pozostawała niezmienna przez cały okres badania.Wnioski: Wyniki sugerują, że echokardiograficzna próba obciążeniowa z dipirydamolem nie powoduje istotnego uszkodzenia mięśnia sercowego. Ponadto wykazano, że uwalnianie H-FABP z mięśnia sercowego w warunkach obciążenia nie wiąże się z progresją do nieodwracalnej martwicy i że ma większą wartość diagnostyczną niż oznaczenie TnI

Dipyridamole Stress Echocardiography Does Not Trigger Release of Highly-Sensitive Troponin I and T

Summary Background: The patients with episodes of chest pain and no electrocardiographic or biomarker abnormalities are currently monitored and subjected to non-invasive testing. Stress echocardiography is one of the most often used provocative tests, being the most cost- and risk-effective imaging technique. Some concerns about this technique have been raised regarding potential drug-induced myocardial injury. Our study hence aimed to establish whether or not dipyridamole stress echocardiography elicits release of troponin I (TnI) and T (TnT), as reliable bio-markers of myocardiocyte injury. Methods: Thirty-two patients, after exclusion of ongoing acute coronary syndrome (ACS) during evaluation in the emergency department (ED), were studied with echocar-diography both at the baseline and after pharmacological stress with dipyridamole. Results: All subjects had biomarkers assessment immediately before the stress-test (T1), 1 h from conclusion of the test (T2), and 6 h afterwards (T3). Cardio specific troponins were assessed with one contemporary-sensitive (TnI) and two highly-sensitive (HS) methods (HS-TnI and HS-TnT). The concentration of TnI, HS-TnI and HS-TnT did not differ throughout the three time points. At no time point the concentration of either HS-TnI or HS-TnT was significantly different among patients with negative or positive stress test. Conclusions: The data shows that dipyridamole stress testing does not trigger release of troponin in patients with and without inducible reversible ischemia

In the kingdom of "tortelli" (ravioli-like pasta) plant poisoning is still a threat. A case report of near-fatal poisoning from Digitalis Purpurea accidentally confused with Borago Officinalis

A 58 years healthy old woman was admitted to the Emergency Department (ED) with cardiac arrest due to ventricular fibrillation (VF). Appropriate cardiopulmonary resuscitation (CPR), multiple DC shocks and oro-tracheal intubation (OTI) were effective to induce recovery of spontaneous circulation (ROSC). After ROSC was achieved, the electrocardiogram (ECG) showed an idio-ventricular rhythm with atrioventricular dissociation. A transcutaneous pacing was hence applied and the patient was administered with isoproterenol. Simultaneously, her husband was evaluated in the ED for gastrointestinal symptoms occurred after assumption of home-made "tortelli" (ravioli-like pasta) stuffed with cheese and leaves of a plant which they supposed to be borage two days before admission. Borage, during the non-flowering seasons, can be easily confused with foxglove (Digitalis spp.), and this was the main clue to suspect poisoning. Both patients were given DigiFab®, a sheep antibody fragment with high affinity for digoxin. The woman was then admitted in intensive care unit (ICU), where a rapid clinical  improvement occurred, thus allowing discharge in a few days. The husband was instead discharged from the ED after clinical observation and ECG monitoring. In both cases, a significant plasma concentration of digoxin could be measured

Comparison of high sensitivity and contemporary troponin I immunoassays for the early detection of acute myocardial infarction in the emergency department.

Our study suggests that the diagnostic performance of the novel prototype HS-AccuTnI and HS-TnT is broadly comparable with that of AccuTnI in patients presenting at the emergency department with suspected AMI

Dopaminergic regulation of fetal growth hormone (GH) secretion: study with maternal administration of bromocriptine

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