Myocardial necrosis due to vitamin D3 overdose - scanning electron microscopic observations

Our studies were carried out on the hearts of virgin female Wistar rats treated with 100.000 i.u. of vitamin D3 (calciol) per os for 3 consecutive days. Multifocal cardionecrosis was established macroscopically in 70% of the vitamin D-treated rats on the 7th day of the experiment when the rats were in the acute phase of intoxication. Using a scanning electron microscopy (SEM), we received three-dimensional information about the structural changes to the rat myocardium damaged by high doses of vitamin D3. The images of necrotic hearts revealed significant disruption of the structural integrity of the myocardium linked to fragmentation of the cardiac muscle bundles and a visible disruption of the extracellular matrix (ECM) components. In healthy hearts, the structural integrity of the myocardium and the dense network of the extracellular matrix were well preserved. In parallel, the effect of an increasing concentration of free Ca2+ on the total proteolytic activity of the heart muscle homogenate of the healthy and necrotic rats was investigated at neutral pH. These data showed that following vitamin D3 intoxication, the proteolytic processes in the rat hearts occurred in Ca2+ overload or saturation. On the basis of our morphological and biochemical results we can suggest that calcium-activated neutral proteinases may have contributed to the structural alteration of the extracellular matrix components and were in this way involved in vitamin D-induced cardionecrosis

Diagnostyka różnicowa: opis przypadku wola Riedla z cechami choroby Hashimoto

Riedel’s disease (RD) is a rare form of chronic thyroiditis, predominantly characterised by fibrosis which may involve neighbouring tissues and organs. Hashimoto’s disease (HD), on the other hand, is fairly common. Clinical differentiation between these diseases is often difficult, and the results of diagnostic imaging, laboratory tests and cytology studies are often similar. We report the case of a female patient with Riedel’s thyroiditis displaying clinical, laboratory and radiological traits of both diseases. A 44 year-old Caucasian female was diagnosed with hypothyroidism. A fine-needle aspiration biopsy was performed; the findings were suggestive of an exacerbated chronic inflammatory process. However, a small lymphocyte-derived malignancy could not be ruled out with certainty, and so the patient was referred for elective thyroidectomy. The microscopic features of both specimens did not meet the criteria of Hashimoto’s thyroiditis. The immunohistochemical studies revealed few scattered B lymphocytes (CD20 positive) and numerous scattered T lymphocytes (CD3 positive). Finally, Riedel’s thyroiditis with an intense inflammatory infiltrate composed of lymphocytes was diagnosed. Reaching a diagnosis was particularly difficult in this patient, since Riedel’s thyroiditis, the fibrosing form of Hashimoto’s disease and malignant tumours of the thyroid can show similar traits upon physical and histopathological examination. As the clinical data was indicative of Hashimoto’s thyroiditis and there were partial histological criteria of two forms of thyroiditis, namely Hashimoto’s and Riedel’s, the very rare diagnosis of a combined disease was made. Dense B and T lymphocytes and some plasma cell infiltrates, as well as the destruction of thyroid follicles by fibrosis extending into surrounding tissues, were supportive of the eventual diagnosis. Differentiating between the histopathological and clinical presentation of both diseases in one patient is difficult, primarily due to the partial overlapping of their histopathological traits. In order to avoid a diagnostic error, close cooperation between the endocrinologist and pathologist is mandatory. It is our opinion that in our patient the two diseases existed separately, and their coexistence was most likely coincidental. (Pol J Endocrinol 2011; 62 (4): 351–356)Wole Riedla jest rzadką postacią przewlekłego zapalenia tarczycy, w której dominuje włóknienie mogące obejmować sąsiednie tkanki. Choroba Hashimoto jest stosunkowo częstym schorzeniem. Różnicowanie tych schorzeń bywa trudne, gdyż wyniki badań laboratoryjnych, obrazowych i cytologicznych bywają podobne. Autorzy przedstawiają przypadek pacjentki z wolem Riedla prezentującym kliniczne, laboratoryjne i obrazowe cechy obu tych chorób. U 44-letniej kobiety rozpoznano niedoczynność tarczycy. W preparatach z wykonanej biopsji aspiracyjnej cienkoigłowej rozpoznano zaostrzony przewlekły proces zapalny, ale jednocześnie nie można było wykluczyć chłoniaka. Pacjentkę poddano tyreoidektomii. W badaniu histopatologicznym nie potwierdzono jednoznacznie choroby Hashimoto. Badanie immunohistochemiczne wykazało nieliczne limfocyty B (CD20) i liczne limfocyty T (CD3). Ostatecznie rozpoznano wole Riedla z naciekiem limfocytarnym. Diagnostyka u tej pacjentki była utrudniona, gdyż wole Riedla, włókniejąca forma choroby Hashimoto oraz guz złośliwy mają podobne cechy w badaniu fizykalnym i histopatologicznym. Jeżeli występują kliniczne cechy choroby Hashimoto oraz histologiczne cechy obu form zapalenia, można rozpoznać rzadką kombinację choroby Hashimoto i wola Riedla. Naciek limfocytów B i T oraz komórek plazmatycznych, jak również niszczenie pęcherzyków tarczycy przez włóknienie, które przechodzi na sąsiednie tkanki, może pomóc w postawieniu ostatecznego rozpoznania. Różnicowanie pomiędzy histopatologicznym i klinicznym obrazem obu chorób bywa trudne szczególnie z powodu nakładania się cech histopatologicznych. Konieczna jest ścisła współpraca patologa i klinicysty w celu uniknięcia pomyłki diagnostycznej. Zdaniem autorów u badanej pacjentki występowały obie te choroby, ale związek pomiędzy nimi był jedynie przypadkowy. (Endokrynol Pol 2011; 62 (4): 351–356

Nastrój osób z chorobą Gravesa-Basedowa i chorobą Hashimoto

Introduction: Mood can be characterized as subjective, relatively long lasting emotional state. The impact of the mood on health can be considered in two aspects: mood as an intermediary factor/cause of disease or as its result. The aim of following paper was to define the mood of individuals with Graves-Basedow’s disease Hashimoto’s disease in comparison to each other and in comparison to healthy individuals. Material and methods: The study group consisted of 70 individuals with Graves-Basedow’s disease (56 women and 14 men) and the same amount of healthy ones. The study group of Hashimoto’s disease consisted of 54 individuals (46 women and 8 men) and the same amount of healthy ones. The patients filled out three psychological methods: Profile of Mood States (POMS), University of Wales Institute of Science and Technology Mood Adjective Check List (UMACL), a personal survey and an analysis of the medical documentation. Results: Results indicate difference between individuals with Graves-Basedow’s disease and healthy ones taking under consideration mood: anger and tension, dejection, embarrassment and vigor. There is no difference between individuals with Hashimoto’s disease and healthy ones considering mood. There are differences between Graves-Basedow’s disease and Hashimoto’s disease regarding tension - anger. No differences have been claimed concerning criterions of health such as: time of duration of disease, complications, coexisting other diseases. Nevertheless the level of hormones is connected with the mood. Conclusions: In case of Graves-Basedow’s disease has been claimed stronger anger, sadness, embarrassment and less vigor. Individuals with Hashimoto’s disease are regarded as similar to the healthy ones, without features of forced depression, irritability or embarrassment. To sum up the mood of individuals among testing group is a result of disease.Wstęp: Nastrój można scharakteryzować jako subiektywny, względnie długotrwały stan emocjonalny. Wpływ nastroju na zdrowie somatyczne można rozpatrywać w dwóch aspektach: nastrój jako czynnik pośredniczący/przyczyna choroby lub jako jej wynik. Celem niniejszej pracy było określenie nastroju osób z chorobą Gravesa-Basedowa i z chorobą Hashimoto w porównaniu ze sobą, jak również w stosunku do osób zdrowych. Materiał i metody: Grupa badawcza składała się z 70 osób z chorobą Gravesa-Basedowa (56 kobiet i 14 mężczyzn) i z takiej samej liczby osób zdrowych oraz 54 osób z chorobą Hashimoto (46 kobiet i 8 mężczyzn) i takiej samej liczby osób zdrowych. W badaniu zastosowano trzy metody: skalę POMS (Profile of Mood States), Przymiotnikową Skalę Nastroju (UMACL, University of Wales Institute of Science and Technology Mood Adjective Check List) oraz ankietę osobową i analizę dokumentacji lekarskiej. Wyniki: Wyniki wskazują na istotne statystycznie różnice między osobami z chorobą Gravesa-Basedowa i zdrowymi w zakresie nastroju: lęku i napięcia, przygnębienia, zakłopotania i aktywności. Nie stwierdzono różnic w zakresie różnych rodzajów nastroju między osobami z chorobą Hashimoto a zdrowymi. Nastrój różnicuje w sposób istotny statystycznie osoby z chorobą Gravesa-Basedowa i z chorobą Hashimoto między sobą w zakresie napięcie-lęk. Nie istnieją różnice istotne statystycznie w nastroju ze względu na stan kliniczny wyrażony w czasie chorowania, występowaniu powikłań i współwystępowaniu innych chorób. Natomiast stężenia hormonów tarczycy ujawniają związek z nastrojem. Wnioski: W przypadku osób z chorobą Gravesa-Basedowa stwierdzono większy niepokój, smutek, zakłopotanie oraz mniejszą aktywność. Osoby z chorobą Hashimoto jawią się jako podobne do osób zdrowych

The evaluation of simultaneous combined surgery of the heart and thyroid - own experience

Background: Patients referred for cardiac surgery usually also have other comorbidities. These include thyroid disease, which is relatively common in patients with heart problems. Objective: The aim of the study was to evaluate the feasibility of combined cardiac surgery and thyroidectomy. Material and methods: Six patients (age range: 54-74 years) qualified for elective, simultaneous surgeries on the heart and the thyroid were included in the study. In preparation for thyroidectomy, three patients were diagnosed with diseases requiring cardiac surgery. Two patients, initially referred for coronary artery bypass surgery in one case, and surgery for recurrent fluid in the pericardial sac with concomitant mitral and tricuspid valve regurgitation and atrial fibrillation in the other, were diagnosed in large hyperactive goitre. The last patient with a history of oncology (lung tumour), admitted to the Department of Cardiology due to a heart attack, had a CT scan of the chest, which revealed retrosternal goitre narrowing the lumen of the trachea to 9 mm. All patients underwent combined heart and thyroid operation and were discharged home 8-27 days after surgery. Conclusions: Although preoperative qualification requires a very cautious and individual approach, simultaneous surgeries in patients requiring thyroid and heart interventions are expedient and should be promoted

Assessment of real-world usage of lanreotide AUTOGEL 120 in Polish acromegalic patients - results from

Aim of the study: To assess resource utilization and costs of treatment with lanreotide AUTOGEL 120 mg (ATG120) administered as part of routine acromegaly care in Poland. Material and methods: A multicentre, non-interventional, observational study on resource utilization in Polish acromegalic patients treated with ATG120 at 4 weeks or extended (> 4 weeks) dosing interval. The study recruited adult acromegalic patients treated medically for ≥ 1 year including at least 3 injections of ATG120. Data on dosing interval, aspects of administration, and resource utilization were collected prospectively during 12 months. Costs were calculated in PLN from the public health-care payer perspective for the year 2013. Results: 139 patients were included in the analysis. Changes in dosing regimen were reported in 14 (9.4%) patients. Combined treatment was used in 11 (8%) patients. Seventy patients (50%) received ATG120 at an extended dosing interval; the mean number of days between injections was 35.56 (SD 8.4). ATG120 was predominantly administered in an out-patient setting (77%), by health-care professionals (94%). Mean time needed for preparation and administration was 4.33 and 1.58 min, respectively, mean product wastage - 0.13 mg. Patients were predominantly treated in an out-patient setting with 7.06 physician visits/patient/ year. The most common control examinations were magnetic resonance imaging of brain and brain stem (1.36/ patient/year), ultrasound of the neck (1.35/patient/year), GH (1.69/pa tient/ year), glycaemia (1.12/patient/year), IGF-1 (0.84/patient/year), pituitary-thyroid axis hormone levels assessment (TSH-0.58/patient/year, T4-0.78/patient/ year). There were 0.43 hospitalizations/ patient/year. For direct medical costs estimated at PLN 50 692/pa tient/ year the main item was the costs of ATG120 (PLN 4103.87/patient/month; 97%). The mean medical cost, excluding pharmacotherapy, was PLN 1445/patient/year (out-patient care - 49%, hospitalization - 23%, diagnostics/laboratory tests - 28%). Conclusions: These results represent the current use of ATG120 in the population of Polish acromegalic patients in a realistic clinical setting. Findings that 50% of patients could be treated with dose intervals of longer than 28 days support the potential of ATG120 to reduce the treatment burden