Notalgia paresthetica

Notalgia paresthetica is a common, although under-recognized condition characterized by localized chronic pruritus in the upper back, most often affecting middle-aged women. Apart from pruritus, patients may present with a burning or cold sensation, tingling, surface numbness, tenderness and foreign body sensation. Additionally, patients often present with hyperpigmented skin at the site of symptoms. The etiology of this condition is still poorly understood, although a number of hypotheses have been described. It is widely accepted that notalgia paresthetica is a sensory neuropathy caused by alteration and damage to posterior rami of thoracic spinal nerves T2 through T6. To date, no well-defined treatment has been found, although many treatment modalities have been reported with varying success, usually providing only temporary relief.Notalgia paresthetica je učestalo, iako slabo prepoznato stanje koje obilježava lokalizirani kronični pruritus gornjeg dijela leđa, a najčešće se javlja u žena srednje životne dobi. Uz svrbež u bolesnika se također može javiti osjećaj žarenja ili hladnoće, trnci, utrnulost, osjetljivost i osjećaj stranog tijela. Uz to, na mjestu simptoma često se javlja područje hiperpigmentirane kože. Iako postoji više hipoteza, etiologija ove bolesti slabo je poznata. Opće je prihvaćeno da je notalgia paresthetica senzorna neuropatija uzrokovana oštećenjem stražnjih ogranaka torakalnih kralježničnih živaca od T2 do T6. Unatoč mnogim različitim terapijskim metodama koje su bile promjenjivoga uspjeha i najčešće pružale privremeno olakšanje, do danas nema uspješnoga liječenja ove bolesti

Neobično mjesto presadnice papilarnog karcinoma štitnjače u nadbubrežnu žlijezdu: prikaz slučaja

Papillary thyroid carcinoma (PTC) is considered one of the most favorable tumors, indolent, with rare distant dissemination. Lungs and bones are the most common metastatic sites. Unusual sites of PTC distant metastases are extremely rare. Brain, liver, skin, kidney, pancreas, and adrenal gland PTC metastases have been sporadically reported in the literature. An 86-year-old female patient underwent total thyroidectomy and neck dissection due to PTC. Postoperative whole body iodine-131 scintigraphy with I-131 SPECT/CT of the abdomen revealed radioiodne avid left adrenal gland metastasis together with high postoperative serum thyroglobulin (Tg) value of more than 5000 µg/L and high serum Tg antibodies. Considering the above-mentioned findings, patient‘s age and multiple comorbidities, radioiodine therapy was applied. PTC metastases to the adrenal gland are extremely rare, and to our knowledge, only nine cases have been reported in the literature. This case report complements rare examples of unusual PTC metastases.Papilarni karcinom štitnjače svrstava se u maligne tumore s najpovoljnijom prognozom, polaganog je rasta, a presadnice na udaljenim mjestima su rijetke. Najčešća mjesta udaljene diseminacije papilarnog karcinoma štitnjače su pluća i kosti. Rijetka mjesta udaljene diseminacije opisana u literaturi su mozak, jetra, koža, gušterača i nadbubrežna žlijezda. Bolesnica u dobi od 86 godina operirana je zbog papilarnog karcinoma štitnjače. Nakon operativnog odstranjenja štitnjače s tumorom i disekcije vrata učinjena je poslijeoperacijska onkološka obrada uključujući scintigrafiju cijelog tijela jodom-131 uz SPECT/CT abdomena. U području lijeve nadbubrežne žlijezde zabilježena je intenzivna nakupina joda-131 koja je odgova-rala presadnici papilarnog karcinoma štitnjače. Serumska vrijednost tumorskog biljega tireoglobulina bila je izrazito poviše-na i iznosila je više od 5000 µg/L uz pozitivna antitireoglobulinska protutijela. Uzevši u obzir nalaze poslijeoperacijske onkološke obrade, dob i opće loše stanje bolesnice provedeno je liječenje jodom-131. Presadnice papilarnog karcinoma štitnjače u nadbubrežnu žlijezdu su iznimno rijetke i dosad je u literaturi opisano samo 9 slučajeva. Ovaj prikaz bolesnice upotpunjuje dosadašnje rijetke slučajeve neobičnih mjesta udaljene diseminacije papilarnog karcinoma štitnjače

Povezanost koštane mineralne gustoće i sastavnica metaboličkog sindroma u postmenopauzalnih žena sa šećernom bolešću tipa 2

Diabetes mellitus type 2 is associated with greater bone mineral density (BMD) due to obesity, although rapid bone loss observed over time could be explained by elevated chronic inflammation. The objective of this study was to investigate the relationship between central adiposity and hyperinsulinemia, as well as inflammation markers with vertebral and femoral BMD and bone turnover markers in postmenopausal women with type 2 diabetes. Femoral and vertebral BMD, osteocalcin, pyrilinks D, beta-CrossLaps (B-CTx), insulin, C-reactive protein (CRP), fibrinogen and plasminogen activator inhibitor-1 (PAI-1) were measured in 114 postmenopausal female patients with diabetes type 2. The patients of similar age, HbA1c levels and diabetes duration were divided into 2 groups based on their body mass index (BMI) values: lower or equal to 27 kg/m2(31 patients) and higher than 27 kg/m2(83 patients). Lower levels of osteocalcin (p=0.001), B-CTx (p=0.000007) and pyrilinks D (p=0.0365), and higher femoral BMD (p=0.00006), insulin level (p=0.0002), PAI-1 (p=0.00000) and CRP (p=0.002) were found in the overweight group. There were no significant differences in vertebral BMD and fibrinogen. Osteocalcin and B-CTx showed inverse correlation, and femoral BMD positive correlation with waist circumference, insulin level and PAI-1. This suggests that abdominal obesity and hyperinsulinemia as components of the metabolic syndrome could increase femoral BMD by lowering bone rate. In addition, the only inflammation marker linked with femoral BMD was PAI-1, which is associated with increased mineralization of cortical bone in mouse models.Šećerna bolest tipa 2 povezana je s većom koštanom mineralnom gustoćom (bone mineral density, BMD) zbog debljine, iako se zamijećeni ubrzani gubitak koštane mase tijekom vremena može objasniti prisustvom kronične upale. Cilj ovoga istraživanja bio je utvrditi povezanost biljega koštane pregradnje i koštane gustoće s centralnom debljinom, hiperinzulinemijom kao i upalnim biljezima u postmenopauzalnih žena sa šećernom bolešću tipa 2. U 114 ispitanica izmjerena je koštana gustoća kralježnice i kuka, određeni su osteokalcin, pirilinks D, beta-CrossLaps (B-CTx), inzulin, C-reaktivni protein (CRP), fibrinogen i inhibitor aktivatora plazminogena-1 (PAI-1). Ispitanice slične dobi, podjednakog trajanja dijabetesa te HbA1c bile su podijeljene u dvije skupine prema indeksu tjelesne mase (ITM): niži ili jednaki 27 kg/m2(31 ispitanica) te veći od 27 kg/m2 (83 ispitanice). Niže vrijednosti osteokalcina (p=0,001), B-CTx (p=0,000007) i pirilinksa D (p=0,0365) te više vrijednosti košane gustoće kuka (p=0,00006), inzulina (p=0,0002), PAI-1 (p=0,0000) i CRP (p=0,002) utvrđene su u skupini s prekomjernom tjelesnom težinom. Nije bilo statistički značajne razlike u koštanoj gustoći kralježnice i vrijednosti fibrinogena. Osteokalcin i B-CTx su negativno korelirali, dok je BMD kuka bio u pozitivnoj korealciji s opsegom struka, inzulinom i PAI-1. Ovi rezultati upućuju na to da sastavnice metaboličkog sindroma, centralna debljina i hiperinzulinemija utječu na povećanje koštane gustoće kuka inhibirajući koštanu pregradnju. Jedini upalni biljeg povezan s BMD kuka bio je PAI-1 koji povećava mineralizaciju kortikalne kosti na mišjem modelu

Analytical evaluation of the new Seal Autoanalyzer 3 High Resolution for urinary iodine determination

Introduction: The aim of the study was to evaluate the analytical performance of the new colorimetric, automatic analyser, Seal AutoAnalyzer 3 High Resolution (Seal AA3 HR) (Seal Analytical, Wisconsin, USA) for urinary iodine measurement. Materials and methods: This study included testing of several analytical features of the method involving: imprecision (within-run %CVr, between- run %CVb and total laboratory precision %CVl), measurement uncertainty, carryover, linearity and method comparison, with 70 urine samples including the measuring range (20 - 700 μg/L). Results: Within-run, %CVb and %CVl of two control levels were 2.03% and 3.04%, 0.51% and 2.61%, and 2.09% and 4.01%, respectively. Carryover effect was less than 1%. The linearity was good in the range of urinary iodine values between 60 and 500 μg/L (R2 = 0.99). Good agreement of urinary iodine values was found between manual technique and Seal AA3 HR, using Passing-Bablok regression (y = 7.84 (- 3.00 to 15.29) + 0.95 (0.90 to 1.00) x) and Blant-Altman test. Cusum test for linearity indicates that there is no significant deviation from linearity (P > 0.1). Conclusions: The obtained results proved excellent precision, reproducibility and linearity, comparable to the already used, manual method. The New Seal AA3 HR automatic analyser is acceptable for urinary iodine measurement with very good analytical characteristics and can be used for urinary iodine epidemiological studies of the Croatian population