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Revising the Exclusivity of Pemberton’s Sign: A Case Report
Philip W. Tipton,
Jeremy J. Blanchard,
Will P. Guider,
Jessica J. Keel,
Allison D. Locke,
Franchesca N. Robichaud,
Adam Price,
William L. Joyner,
John K. Smith
Issue:
Volume 2, Issue 3, May 2014
Pages:
41-43
Received:
12 April 2014
Accepted:
24 April 2014
Published:
30 April 2014
Abstract: The Pemberton maneuver is a tool that may be utilized during the physical examination to demonstrate the presence of latent pressure in the thoracic inlet [1]. The maneuver is achieved by having the patient elevate both arms until they touch the sides of the face. A positive sign is marked by the presence of facial congestion and cyanosis, as well as respiratory distress after approximately one minute [2]. The sign is most commonly present in patients with substernal goiters where the goiter “corks off” the thoracic inlet [3]. We describe a 67-year-old Caucasian male with a positive Pemberton’s sign due to compression of the thoracic inlet by enlarged mediastinal nodes. The sign was amplified by the presence of a restrictive cardiomyopathy and constrictive pericarditis due to amyloidosis. We propose that a positive Pemberton’s sign should not be used exclusively to evaluate the probability of a substernal goiter, but rather to assess the potential for vascular compression due to pathological changes in the anatomical environment of the thoracic inlet.
Abstract: The Pemberton maneuver is a tool that may be utilized during the physical examination to demonstrate the presence of latent pressure in the thoracic inlet [1]. The maneuver is achieved by having the patient elevate both arms until they touch the sides of the face. A positive sign is marked by the presence of facial congestion and cyanosis, as well ...
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Frequency of Hashimoto’s Thyroiditis in Women with Vitamin D Deficiency: A Cross Sectional Study
Tayyibe Saler,
Şakir Özgür Keşkek,
Süleyman Ahbab,
Sedat Cakir,
Gülay Ortoğlu,
Mehmet Bankir,
Ömer Arif Pamuk
Issue:
Volume 2, Issue 3, May 2014
Pages:
44-48
Received:
17 April 2014
Accepted:
4 May 2014
Published:
20 May 2014
Abstract: Objective: Vitamin D deficiency has been reported to be associated with different autoimmune diseases such as type 1 diabetes, rheumatoid arthritis and Crohn’s disease. The aim of this study was to evaluate the association between Hashimoto's thyroiditis and vitamin D deficiency. Material and Methods: This case-control study was carried out in tertiary hospitals from 2011 to 2012. A total of 198 female subjects were included, of whom 84 and 114 participants were healthy or had vitamin D deficiency, respectively. Serum vitamin D levels, parathyroid hormone concentrations thyroid hormone levels and thyroid auto-antibodies were measured in all subjects. Results: Demographic characteristics of participants were not significantly different between the control and study groups (p > 0,05). Frequency of Hashimoto’s thyroiditis was similar in both groups (p = 0.958). Thyroid auto-antibodies did not correlate with vitamin D levels (p > 0.05). Conclusion: Although vitamin D deficiency is associated with some of autoimmune diseases, Hashimoto’s thyroiditis was not found to be associated with vitamin D deficiency in female patients in this study.
Abstract: Objective: Vitamin D deficiency has been reported to be associated with different autoimmune diseases such as type 1 diabetes, rheumatoid arthritis and Crohn’s disease. The aim of this study was to evaluate the association between Hashimoto's thyroiditis and vitamin D deficiency. Material and Methods: This case-control study was carried out in tert...
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Systemic Lupus Erythematosus Associated Hemophagocytic Lymphohistiocytosis: A Case Report and Literature Review
Po-Chung Cheng,
Yun-Chung Cheng
Issue:
Volume 2, Issue 3, May 2014
Pages:
49-53
Received:
17 May 2014
Accepted:
28 May 2014
Published:
10 June 2014
Abstract: Hemophagocytic lymphohistiocytosis (HLH) is a syndrome of immune overstimulation. HLH commonly manifests as multiple organ failure without apparent physiological stress. Primary HLH relates to genetic defects, whereas secondary HLH is triggered by infection, malignancy, or autoimmune disease. An aberrant natural killer cell or absence of T lymphocyte apoptosis causes uncontrolled inflammation. Secondary HLH in patients with systemic lupus erythematosus (SLE) is uncommon with an estimated prevalence of 0.9%. This report describes a male with SLE associated secondary HLH. Patients affected by HLH require prompt management, but delayed diagnosis is common due to its variable presentation. An eight week induction therapy with dexamethasone, etoposide, and intrathecal methotrexate increases survival in primary HLH and virus-associated secondary HLH. However, no standardized regimen exists for autoimmune associated HLH. Some patients respond to steroid monotherapy, while refractory patients may require cyclosporin, cyclophosphamide, or tacrolimus.
Abstract: Hemophagocytic lymphohistiocytosis (HLH) is a syndrome of immune overstimulation. HLH commonly manifests as multiple organ failure without apparent physiological stress. Primary HLH relates to genetic defects, whereas secondary HLH is triggered by infection, malignancy, or autoimmune disease. An aberrant natural killer cell or absence of T lymphocy...
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Carpal Tunnel Syndrome in Hypothyroid Patients: The Effect of Hormone Replacement Therapy
Arafat A. Kasem,
Sabry M. Fathy,
Doaa A. Shahin,
Amir A. Fikry
Issue:
Volume 2, Issue 3, May 2014
Pages:
54-58
Received:
9 May 2014
Accepted:
26 May 2014
Published:
20 June 2014
Abstract: Objectives: To assess the electrodiagnostic evidence of median nerve dysfunction in newly diagnosed hypothyroid patients before and after hormone replacement therapy. Patients and methods: Fifty seven patients (fifty females and seven males) their age ranging from 23 to 61 years diagnosed with hypothyroidism,proved by thyroid hormone profile,were included in this study. Electrodiagnostic workup performed at the initial time of diagnosis and after 3 months including motor and sensory median nerve conduction studies in both right and left median nerves. Results: In our studied group, TSH levels were 30.77±23.51 IU/ mL before hormone replacement therapy and 5.25±1.72 IU/mL after the treatment. FT4 values were 9.2±1.54 pmol/l before treatment and 15.42±2.62pmol/l after treatment. FT3 levels were measured as 1.69±0.63Pmol/l at the diagnosis and 4.23±1.04 Pmol/l after treatment. The pre and post therapy levels difference of all previous parameters were statistically significant(P =0.001). Forty eight patients were normalized after treatment, while nine (13.8%) still had carpal tunnel syndrome symptoms. The differences between before treatment values of median nerve sensory and motor functions in both right and left median nerves respectively (sensory distal latency, sensory nerve conduction velocity, the sensory amplitude, the motor distal latency, the motor conduction velocity and the motor amplitude)(4.156±0.49 and 14.789±8.36 , 51.730±2.32 and 52.088±2.42, 28.123±8.52 and 25.193±5.74 , 4.404±0.66 and 4.393±0.61, 53.074±3.38 and 52.867±3.82 , 4.830±1.09 and 4.984±1.29 ) and after treatment values (3.365±0.44 and 3.561±0.46 , 63.649±2.16 and 63.035±3.56 , 33.123±7.16 and 29.280±5.39 , 3.674±0.52 and 3.767±0.46 , 64.193±2.79 and 63.789±4.00 , 5.368±1.18 and 5.488±1.19 ) were all significant (P =0.001). Conclusion: With hormonal replacement therapy, carpal tunnel syndrome can be reserved in patients with hypothyroidism within three months.
Abstract: Objectives: To assess the electrodiagnostic evidence of median nerve dysfunction in newly diagnosed hypothyroid patients before and after hormone replacement therapy. Patients and methods: Fifty seven patients (fifty females and seven males) their age ranging from 23 to 61 years diagnosed with hypothyroidism,proved by thyroid hormone profile,were i...
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