From Clinical Thyroidology® for the Public: Adding mycophenolate to infusions of methylprednisolone improves treatment of Graves' eye disease. Read More…
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From Clinical Thyroidology® for the Public: Adding mycophenolate to infusions of methylprednisolone improves treatment of Graves' eye disease. Read More…
We welcome your feedback and suggestions. Let us know what you want to see in this publication.
Feedback & SuggestionsThe post Clinical Thyroidology<sup>®</sup> for the Public – Highlighted Article appeared first on American Thyroid Association.
Euglycemic ketoacidosis is defined by the triad of high anion gap acidosis, increased plasma ketones, and the absence of hyperglycemia. Apart from diabetes mellitus, the disorder may occur in prolonged fasting, excessive alcohol consumption, pregnancy, and inborn errors of metabolism. Here, we highlight the diagnosis of euglycemic ketoacidosis in a pediatric nondiabetic patient with spinal muscular atrophy (SMA) type 1 (Werdnig–Hoffmann disease), who, subsequently to her postoperative admission to the intensive care unit following a spinal surgery, developed high anion gap metabolic acidosis. We discuss the pathophysiology of acid-base disorders in SMA, along with the glucose and fatty acids metabolism, the necessary knowledge for medical practitioners.
http://bit.ly/2RSzkVT
Publication date: Available online 26 January 2019
Source: Magnetic Resonance Imaging
Author(s): Kangjoo Lee, Hui Ming Khoo, Constance Fourcade, Jean Gotman, Christophe Grova
Resting state functional magnetic resonance imaging is used to study how brain regions are functionally connected by measuring temporal correlation of the fMRI signals, when a subject is at rest. Sparse dictionary learning is used to estimate a dictionary of resting state networks by decomposing the whole brain signals into several temporal features (atoms), each being shared by a set of voxels associated to a network. Recently, we proposed and validated a new method entitled Sparsity-based Analysis of Reliable K-hubness (SPARK), suggesting that connector hubs of brain networks participating in inter-network communication can be identified by counting the number of atoms involved in each voxel (sparse number k). However, such hub analysis can be corrupted by the presence of noise-related atoms, where physiological fluctuations in cardiorespiratory processes may remain even after band-pass filtering and regression of confound signals from the white matter and cerebrospinal fluid. Handling this issue might require manual classification of noisy atoms, which is a time-consuming and subjective task. Motivated by the fact that the physiological fluctuations are often localized in tissues close to large vasculatures, i.e. sagittal sinus, we propose an automatic classification of physiological noise-related atoms for SPARK using spatial priors and a stepwise regression procedure. We measured the degree to which the noise-characteristic time-courses within the mask are explained by each atom, and classified noise-related atoms using a subject-specific threshold estimated using a bootstrap resampling based strategy. Using real data from healthy subjects (N = 25), manual classification of the atoms by two independent reviewers showed the presence of sagittal sinus related noise in 65% of the runs. Applying the same manual classification after the proposed automatic removal method reduced this rate to 19%. A 10-fold cross-validation on real data showed good specificity and accuracy of the proposed automated method in classifying the target noise (area under the ROC curve= 0.89), when compared to the manual classification considered as the reference. We demonstrated decrease in k-hubness values in the voxels involved in the sagittal sinus at both individual and group levels, suggesting a significant improvement of SPARK, which is particularly important when considering clinical applications.
Fever of unknown origin is often a diagnostic dilemma for clinicians due to its extremely broad differential. One of the rarer categories of disease causing fever of unknown origin is malignancies; of these, s...
http://bit.ly/2MAXWfY
This report describes two maneuvers in different steps of phaco surgery in a case with hard cataract, which provide debulking of the central dense nucleus and prevents posterior capsule rupture (PCR). In the current case, clear corneal incisions were created, and anterior chamber was filled with ophthalmic viscosurgical device (OVD). Anterior capsule was punctured, and capsulorhexis was completed. Nucleus was cracked into two halves following vertical groove formation. Core nucleus was hollowed sideward bilaterally in the capsular bag. Nuclear halves were removed from capsular bag, and each one was pushed to one side on the iris plane. Capsular bag was inflated with OVD, and intraocular lens (IOL) was implanted. Nuclear halves were removed in confidence. The presented maneuvers initially reduce dense nucleus load in the safe zone and allow surgeon to use IOL as a barrier to protect floppy posterior capsule from early steps of the surgery.
http://bit.ly/2sMQJQH
Metastatic disease is common in medullary thyroid carcinoma (MTC) and it is usually detected by raising calcitonin and carcinoembryonic antigen (CEA) levels. Nuclear medicine imaging has an important role in lesion identification/characterisation. We aim to compare 68Ga-DOTANOC PET/CT and 18F-FDG PET/CT performance and to explore the correlations between tumoral markers and functional imaging.
This a retrospective cross-sectional study including 13 patients with MTC and high calcitonin/CEA levels that underwent both 68Ga-DOTANOC PET/CT and 18F-FDG PET/CT.
68Ga-DOTANOC PET/CT identified MTC metastases in 2twopatients that were 18F-FDG-negative (sensitivity of 69.2% vs. 53.9%, respectively). 68Ga-DOTANOC PET/CT also detected a higher number of lesions than 18F-FDG PET/CT in seven patients, with only one patient showing the opposite pattern. Both differences lacked statistical significance (p = 0.50 and p = 0.86, respectively) but 68Ga-DOTANOC PET/CT better performance allowed changes in patients' management. 68Ga-positive/18F-FDG-negative patients were the ones with the lowest calcitonin doubling time and presented a CEA doubling time >24 months, while the patient with more 18F-FDG-positive lesions was the one with the highest CEA/calcitonin ratio. The number of lesions found in 68Ga-DOTANOC PET/CT were correlated with calcitonin levels (r = 0.73; p < 0.01) but not with CEA ones (r = 0.42; p = 0.15). The number of 18F-FDG hypermetabolic focus were correlated with CEA levels (r = 0.60; p < 0.05) but not with calcitonin (r = 0.48; p = 0.09).
This is the first study to describe a positive correlation between 68Ga-positive lesions and calcitonin levels and between 18F-FDG-positivity and CEA levels. Tumoral markers pattern in metastatic MTC could help clinicians to decide which exam to perform first.
