Phenotypes of endocrine ophthalmopathy: clinical manifestation and tomographic characteristics

2019 ◽  
Vol 64 (6) ◽  
pp. 383-389
Author(s):  
Irina M. Belovalova ◽  
Natalya Yu. Sviridenko ◽  
Elena G. Bessmertnaya ◽  
Anna A. Chepurina ◽  
Marina S. Sheremeta ◽  
...  
Keyword(s):  
Clinical Symptoms ◽  
Ophthalmological Examination ◽  
Autoimmune Process ◽  
Endocrine Orbitopathy ◽  
Anatomical Structures ◽  
Clinical Criteria ◽  
Orbital Tissue ◽  
Endocrine Ophthalmopathy ◽  
Clinical Variants ◽  
Visual Disturbances

The clinical manifetstations of endocrine orbitopathy (EOP) significantly because autoimmune process may involve various anatomical structures of the eye. Choosing an effective method for EOP treatment requires to determine the selectivity of orbital tissue damage, which is difficult when only clinical criteria are applied. 102 patients with EOP and Graves’ disease were examined. All patients underwent the standard ophthalmological examination and multispiral computed tomography of orbits. The analysis of clinical and tomographic parameters allowed us to distinguish 3 variants of EOP flow: classical, lipogenic, and myogenic. The prevailing symptoms of patients with the lipogenic variant were distinct exophthalmos without a disturbance of the function of extraocular muscles (EOM) and visual disturbances. Oculomotor disorders, diplopia, strabismus, and decreased vision were prevalent in patients with the myogenic variant. Patients with the classical variant suffered from exophthalmos, periorbital edema, and oculomotor disorders. The identification of independent clinical variants of EOP with specific clinical symptoms and different tomographic characteristics testifies different pathogenetic mechanisms of EOP development is to determine personalized approaches to treatment.

Endocrine ophthalmopathy: pharmacogenetic markers of efficiency of glucocorticoid therapy

2020 ◽  
Vol 75 (3) ◽  
pp. 250-255
Author(s):  
Olga S. Toropova ◽  
Alevtina F. Brovkina ◽  
Dmitry A. Sychev
Keyword(s):  
Soft Tissues ◽  
Plasma Cells ◽  
Clinical Symptoms ◽  
Morphological Changes ◽  
Cellular Tissue ◽  
Pathological Process ◽  
Glucocorticoid Therapy ◽  
Orbital Tissue ◽  
Endocrine Ophthalmopathy ◽  
The Many

The pathological process of endocrine ophthalmopathy is based on damage to the soft tissues of the orbit against the background of impaired thyroid function and even its euthyroid state. The pathogenetic mechanisms of the development of clinical symptoms of endocrine ophthalmopathy (EOP) are based on morphological changes in extraocular muscles (EOM) and orbital tissue: cellular tissue infiltration by representatives of the immune system (T- and B-lymphocytes, macrophages, mast and plasma cells), with the production of pro-inflammatory cytokines, fibroblasts and glycosaminoglycans, contributing to an increase in the contents of the orbit in volume with the development of exophthalmos and tissue fibrosis at the end of the inflammatory process. Glucocorticoids are the gold standard for the pathogenetic treatment of patients with clinical forms of endocrine ophthalmopathy: edematous exophthalmos and endocrine myopathy. The properties of drugs of this group are such that they can be used to suppress all stages of inflammation in the orbital tissues, preventing the progression of the disease. Despite the many years of experience in applying various glucocorticoid therapy techniques, to date there are no uniform criteria for the effectiveness of this treatment in patients with endocrine ophthalmopathy. The article presents the features of glucocorticoid therapy of endocrine ophthalmopathy, as well as literature data, on the basis of which attempts have been made to explain the causes of glucocorticoid resistance taking into account the pharmacogenetic profile.

scholarly journals Characteristics of Pruritus in Various Clinical Variants of Psoriasis: Results of the Multinational, Multicenter, Cross-Sectional Study

Life ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. 623
Author(s):  
Kamila Jaworecka ◽  
Dominika Kwiatkowska ◽  
Luiza Marek ◽  
Funda Tamer ◽  
Aleksandra Stefaniak ◽  
...  
Keyword(s):  
Clinical Symptoms ◽  
Cross Sectional Study ◽  
Pustular Psoriasis ◽  
Cross Sectional ◽  
Large Plaque ◽  
Scalp Psoriasis ◽  
Generalized Pustular Psoriasis ◽  
Itch Sensation ◽  
Clinical Variants ◽  
Subtype A

Psoriasis is a chronic, inflammatory skin disease present in about 3% of the world’s population. The clinical symptoms manifest diversely, therefore one can distinguish several subtypes of psoriasis. The majority of patients with psoriasis experience pruritus, which is an unpleasant sensation that decreases patients’ quality of life. The knowledge on pruritus in different subtypes of psoriasis is limited. We have performed a cross-sectional, prospective, and multicenter study to evaluate the relationship between clinical subtypes of psoriasis (large-plaque, nummular, guttate, palmoplantar, inverse, erythrodermic, palmoplantar pustular, generalized pustular psoriasis, and psoriasis of the scalp) and the prevalence, intensity, and clinical manifestation of itch. We introduced a questionnaire assessing various aspects of pruritus to a total of 254 patients. Out of these, 42 were excluded. Pruritus was present in 92.9% of the remaining patients and its prevalence did not depend on the clinical subtype. A correlation between the severity of psoriasis and the intensity of itch was explicitly noticeable in palmoplantar pustular psoriasis and scalp psoriasis (p < 0.05). The itch sensation was individual and differed among subtypes of psoriasis. In conclusion, pruritus is a frequent phenomenon, and its presentation is different in various subtypes of psoriasis.

scholarly journals Immunotherapy in Allergic Rhinitis: It’s Effect on the Immune System and Clinical Symptoms

2018 ◽  
Vol 6 (7) ◽  
pp. 1248-1252 ◽  
Author(s):  
Samaneh Kouzegaran ◽  
Mohammad Ali Zamani ◽  
Reza Faridhosseini ◽  
Houshang Rafatpanah ◽  
Abdolrahim Rezaee ◽  
...  
Keyword(s):  
Allergic Rhinitis ◽  
Clinical Symptoms ◽  
Nasal Congestion ◽  
Subcutaneous Immunotherapy ◽  
Positive Skin Prick Test ◽  
Tgf Beta ◽  
Positive Skin ◽  
Ifn Gamma ◽  
Clinical Criteria ◽  
Prick Test

BACKGROUND: Allergic rhinitis is one of the most common allergic diseases and characterised by sneezing, rhinorrhea, nasal congestion and nasopharyngeal itching. Subcutaneous immunotherapy (SCIT) for specific allergens is an effective treatment and induces the inhibitory effect of T regulatory lymphocytes and decreases clinical symptoms in allergic rhinitis.AIM: In this study effect of subcutaneous immunotherapy with specific allergens on clinical symptoms and T regulatory and T Helper cells cytokines, in patients with allergic rhinitis are evaluated.METHODS: In this study, 30 patients with moderate to severe allergic rhinitis according to clinical criteria and positive skin prick test for aeroallergens were selected and treated by SCIT. Clinical symptoms and T cells cytokines IL4, IL17, IFN gamma, TGF beta, GITR, FOXP3 and IL-10 (by RT-PCR) were evaluated before and one year after initiation of treatment.RESULTS: Thirty (30) patients with allergic rhinitis at age range 15-45 years old were treated by SCIT, and 23 (14 female, 9 male) patients continued the study, and 7 patients did not continue treatment. After immunotherapy, clinical symptoms decreased significantly. The specific cytokines TGF beta and IL10 levels increased and changes were statistically significant. (Respectively P = 0.013 and P = 0.05) The IL17 level was also increased, but not statistically significant. (P = 0.8) IFN gamma, IL4, GITR, FOXP3, all decreased, but the changes were not statistically significant (P > 0.05).CONCLUSION: Subcutaneous Immunotherapy for specific allergens decreases clinical symptoms in patients with allergic rhinitis and induces tolerance in T lymphocytes, especially by increasing T regulatory cells cytokines, TGF beta and IL10.

scholarly journals Gender, clinical and topographic features of the localized scleroderma lesions in anogenital area

2020 ◽  
Vol 23 (3) ◽  
pp. 165-173
Author(s):  
Elena S. Snarskaya ◽  
Yulia A. Semenchak
Keyword(s):  
Clinical Symptoms ◽  
Skin Lesions ◽  
Localized Scleroderma ◽  
Steady Increase ◽  
Family Doctors ◽  
Topographic Features ◽  
Anogenital Area ◽  
Clinical Variants ◽  
Limited Scleroderma ◽  
And Gender

Background: Currently, there is an increase in the number of skin lesions of anogenital localization, which is a silent epidemic, both due to the steady increase in the incidence of this pathology, and the interdisciplinary aspect of this problem. Materials and methods: In the article, the authors first analyzed and presented the data of clinical and morphological analysis of 104 patients with various clinical variants of limited scleroderma, on the basis of which the main phenotypic and gender-specific clinical and topographical features of anogenital zone lesions in this group of patients are presented. Results: Scleroatrophic lichen is one of the clinical variants of limited scleroderma, which is characterized by damage to the mucous membranes of the external genitals in both women and men. Lesions of such localization are late and often mistakenly diagnosed by specialists of related disciplines (obstetricians, gynecologists, urologists, family doctors, allergists, cosmetologists), which leads to high risks of developing genitourenal syndrome. Conclusions: The development of scleroatrophic lesions in the anogenital zone is accompanied by pronounced clinical symptoms, including: itching, pain of varying intensity, dysuria, dyspareunia and significant sexual dysfunction.

A STUDY OF CLINICAL PRESENTATION AND MANAGEMENT OF PITUITARY TUMORS

2021 ◽  
pp. 58-60
Author(s):  
Manthan Patel ◽  
Naimish Patel
Keyword(s):  
Clinical Presentation ◽  
Clinical Symptoms ◽  
Pituitary Tumors ◽  
Csf Leak ◽  
Total Removal ◽  
Diagnostic Investigation ◽  
Subtotal Removal ◽  
Visual Disturbances ◽  
Bitemporal Hemianopia

The study includes 25 cases of pituitary adenomas. Most common age group by pituitary tumors falls between 41-50 years of age. Male: Female incidence of these tumors is 1: 2.12. Most common clinical symptoms in our series are visual disturbances followed by headache. Optic nerve involvement is other common clinical nding presenting in form of decreased vision or loss of vision, eld defect or fundus changes. Commonest eld defect is bitemporal hemianopia. MRI is the diagnostic investigation of choice in pituitary tumors to dene extent, invasion and relationship to major vessels and nerves. Approximately half (44%) of the patients exhibited normal preoperative pituitary function in form of baseline hormone prole. Increased GH level (32%) followed by hyperprolactinemia (20%) are the most common endocrinologic abnormalities. Total/near total removal was done in 21 patients (84%) and subtotal removal done in 4 patients (16%). Adjuvant therapies were given in 5 patients. Two patients were given radiotherapy and 3 were given pharmacotherapy. Post operative complications were CSF leak, diabetes insipidus and meningitis. 20 patients (80%) had improvement in their symptoms including relief from headache, improvement in vision and endocrinal dysfunction. Post operatively visual functions improved in 13 patients (52%) and it remained stationary in 11 (44%) patients. Only one patient (4%) complained of worsening of his visual function and it was improved in follow up period

scholarly journals Topographic Distribution of Amyloid-β, Tau, and Atrophy in Patients With Behavioral/Dysexecutive Alzheimer Disease

Neurology ◽  
2020 ◽  
Vol 96 (1) ◽  
pp. e81-e92
Author(s):  
Joseph Therriault ◽  
Tharick A. Pascoal ◽  
Melissa Savard ◽  
Andrea L. Benedet ◽  
Mira Chamoun ◽  
...  
Keyword(s):  
Alzheimer Disease ◽  
Clinical Symptoms ◽  
Characteristic Curve ◽  
Tertiary Care ◽  
Amyloid Β ◽  
Executive Dysfunction ◽  
Anterior Cingulate ◽  
Amyloid Pet ◽  
Clinical Criteria ◽  
Tau Pet

ObjectiveTo determine the associations between amyloid-PET, tau-PET, and atrophy with the behavioral/dysexecutive presentation of Alzheimer disease (AD), how these differ from amnestic AD, and how they correlate to clinical symptoms.MethodsWe assessed 15 patients with behavioral/dysexecutive AD recruited from a tertiary care memory clinic, all of whom had biologically defined AD. They were compared with 25 patients with disease severity– and age-matched amnestic AD and a group of 131 cognitively unimpaired (CU) elderly individuals. All participants were evaluated with amyloid-PET with [18F]AZD4694, tau-PET with [18F]MK6240, MRI, and neuropsychological testing.ResultsVoxelwise contrasts identified patterns of frontal cortical tau aggregation in behavioral/dysexecutive AD, with peaks in medial prefrontal, anterior cingulate, and frontal insular cortices in contrast to amnestic AD. No differences were observed in the distribution of amyloid-PET or atrophy as determined by voxel-based morphometry. Voxelwise area under the receiver operating characteristic curve analyses revealed that tau-PET uptake in the medial prefrontal, anterior cingulate, and frontal insular cortices were best able to differentiate between behavioral/dysexecutive and amnestic AD (area under the curve 0.87). Voxelwise regressions demonstrated relationships between frontal cortical tau load and degree of executive dysfunction.ConclusionsOur results provide evidence of frontal cortical involvement of tau pathology in behavioral/dysexecutive AD and highlight the need for consensus clinical criteria in this syndrome.

Panniculitides

2013 ◽  
Author(s):  
Cord Sunderkötter ◽  
Luis Requena
Keyword(s):  
Lupus Erythematosus ◽  
Erythema Nodosum ◽  
Clinical Symptoms ◽  
Subcutaneous Tissue ◽  
Excisional Biopsy ◽  
The Body ◽  
Fatty Tissue ◽  
Livedo Racemosa ◽  
Clinical Criteria ◽  
Lobular Panniculitis

Panniculitis is an inflammation that originates primarily in the subcutaneous fatty tissue (panniculus adiposus). It is associated with rheumatological diseases and with adverse events to rheumatological therapies (e.g. poststeroid panniculitis, erythema nodosum, infective panniculitis). The panniculitides are classified histopathologically into mostly septal panniculitis and mostly lobular panniculitis, according to the major or denser localization of the infiltrate, and also into those with or without vasculitis. Additional criteria involve the composition of the inflammatory infiltrate, the cause, and an underlying or associated disease. The clinical hallmarks of panniculitis are subcutaneous nodules or plaques, often located on the lower limb. A deep excisional biopsy is often required for a more precise diagnosis, given the often sparse and monotonous clinical symptoms. Erythema nodosum is the most common form and a typical example of septal panniculitis. It occurs in response to many different provoking factors, the most common trigger in children being a 'strep throat', in adults sarcoidosis. Clinically, it presents with a sudden symmetrical appearance of painful, tender, warm, erythematous nodes or plaques, usually on the shins, which resemble bruises. Classical and cutaneous polyarteriitis nodosa present a mostly septal panniculitis associated with vasculitis. Here subcutaneous, partially ulcerating nodules are surrounded by livedo racemosa. The mostly lobular panniculitides not associated with vasculitis include lupus panniculitis (lupus erythematosus profundus, typically with ensuing lipoatrophy and predilection for the upper part of the body), panniculitis in dermatomyositis (often calcifiying), cold panniculitis, pancreatic panniculitis, panniculitis due toα‎-antitrypsin deficiency, poststeroid panniculitis (in children after rapid withdrawal of corticosteroids), calciphylaxis (with and without renal failure), and factitious panniculitis (after mechanical, physical, or chemical injuries to the subcutaneous tissue, often self-inflicted). Nodular vasculitis (formerly erythema induratum Bazin) is a lobular panniculitis with vasculitis involving mostly the small blood vessels of the fat lobule. It appears to present a (hyper)reactive response to certain infections (tuberculosis, streptococci, candida) or to cold exposure or chronic venous insufficiency in susceptible females. In conclusion, the panniculitides are a heterogenous group of diseases requiring a systematic work-up and knowledge of certain histological or clinical criteria.

Thyrotoxic hepatitis

2017 ◽  
Vol 63 (1) ◽  
pp. 46-50
Author(s):  
Dmitrij V. Pikulev ◽  
Aleksej V. Klemenov
Keyword(s):  
Liver Injury ◽  
Clinical Symptoms ◽  
Correct Diagnosis ◽  
Clinical Signs ◽  
Rare Condition ◽  
Liver Function Tests ◽  
Biliary Cirrhosis ◽  
Liver Pathology ◽  
Drug Induced ◽  
Clinical Variants

In most cases, liver pathology in hyperthyroidism is confined to asymptomatic changes in laboratory indices, while clinical signs are much rarer. Three clinical variants of liver pathology in patients with hyperthyroidism can be differentiated: drug-induced hepatitis that develop in response to administration of thyrostatic agents (mainly propylthiouracil); concomitant autoimmune liver diseases (autoimmune hepatitis, primary biliary cirrhosis), and hepatopathies as a direct manifestation of thyrotoxicosis (thyrotoxic hepatitis). Thyrotoxic hepatitis is a rare condition difficult to diagnose. The variety of etiological factor of liver pathology in hyperthyroidism, universal clinical symptoms, and the lack of specific histological markers make it difficult to make a correct diagnosis. A clinical case of Graves’ disease complicated with severe thyrotoxic hepatitis, the edema-ascites syndrome and hyperbilirubinemia is reported. The patient was diagnosed with thyrotoxic hepatitis after all other reasons for liver pathology have been ruled out. The concomitant thyrogenic myocardiodystrophy, cardiomegaly and atrial fibrillation required ruling out the diagnosis of cardiogenic liver injury and made diagnosing more difficult. Normalization of the thyroid status in patients receiving mercazolyl therapy was accompanied by alleviation of clinical symptoms of hepatitis and the positive dynamics of the indices of liver function tests. A brief review of the data on clinical variants and mechanisms of liver injury in patients with thyrotoxicosis is presented.

Uncommon neurodegenerative causes of dementia

2005 ◽  
Vol 17 (s1) ◽  
pp. S35-S49 ◽  
Author(s):  
Alexander F. Kurz
Keyword(s):  
Clinical Symptoms ◽  
Corticobasal Degeneration ◽  
Cortical Atrophy ◽  
Behavioral Alterations ◽  
Autosomal Dominant Disorder ◽  
Personality Changes ◽  
Subcortical Nuclei ◽  
Vertical Gaze ◽  
The Brain ◽  
Visual Disturbances

A group of neurodegenerative diseases is outlined that affect cortical and subcortical areas of the brain. These diseases give rise to atypical forms of dementia and, unlike Alzheimer's disease (AD), are often associated with neurological symptoms. Clinical symptoms reflect the localization of the degenerative process rather than the nature of the underlying histopathology. Degeneration of the frontal and anterior temporal lobe presents initially with behavioral alterations, but later in the course, impairment of cognition and activities of daily living develops. Posterior cortical atrophy affects the parietal and occipital association cortices and causes complex visual disturbances. In corticobasal degeneration (CBD) the focus of pathology includes the frontoparietal cortex and several subcortical nuclei, causing symmetrical rigidity, bradykinesia, myoclonus and dystonia. Progressive supranuclear palsy (PSP) involves the frontal, temporal and parietal cortex as well as parts of the brain stem. Clinical features include a hypokinetic rigid syndrome with nuchal dystonia and vertical gaze palsy. Huntington's disease is a prototypical autosomal dominant disorder that affects the extrapyramidal system and causes choreatic movements in combination with personality changes and cognitive deterioration. Amyotrophic lateral sclerosis (ALS) with dementia is a neurodegeneration of the frontotemporal cortex and of the anterior horn of the spinal cord. Behavioral change similar to frontotemporal dementia (FTD) is paralleled or followed by the classic features of motor neuron disease.

scholarly journals The method of the exophthalmos value predicted calculation when planning the orbital decompression procedure in patients with endocrine ophthalmopathy

2021 ◽  
Vol 14 (3) ◽  
pp. 41-48
Author(s):  
Konstantin A. Konovalov ◽  
Dmitrii V. Davydov ◽  
Dmitrii Anatolevich Lezhnev
Keyword(s):  
Statistical Significance ◽  
Original Method ◽  
Ophthalmological Examination ◽  
Orbital Decompression ◽  
Orbital Fat ◽  
Additional Equipment ◽  
Endocrine Ophthalmopathy ◽  
Group A ◽  
Decompression Procedure ◽  
The Individual

BACKGROUND: The most effective method of surgical treatment of lipogenic and mixed forms of edematous exophthalmos is currently the internal orbital decompression. During this surgical procedure, the excessive pathologically altered adipose tissue is removed from the external and the internal surgical spaces of the orbit. Many scientists are developing methods for calculating the volume of orbital fat, but the question on developing a method for predicted exophthalmos after internal orbital decompression, which could be used without attracting additional equipment and software, is easy to learn and does not require a long calculation time, remains actual. This method has to take into account the individual features of the patients orbital structure and be used for calculations in the bilateral proptosis correction. AIM: To develop and evaluate the effectiveness of a new method for calculating the eyeball position after orbital decompression. MATERIALS AND METHODS: 64 patients (126 orbits) with lipogenic and mixed forms of endocrine ophthalmopathy were examined. All patients underwent internal orbital decompression, during which the orbital fat was removed, the volume of which was calculated according to the developed original method. Patients underwent ophthalmological examination and MSCT before surgery and 6 months after it. . RESULTS: As a result of orbital decompression in the examined group, a decrease in proptosis was observed in all patients, and the exophthalmos calculated by the method corresponded to the eyeball position in patients in 6 months after surgery. The level of statistical significance of the planned postoperative eyeball position in relation to the actual postoperative exophthalmos calculated according to the Students t-test was 0.98 (p 0.05), that is, it can be argued that the groups do not differ, and no statistically significant differences were found. CONCLUSIONS: The developed method for calculating the estimated postoperative exophthalmos is effective without using additional software. This technique allows you to achieve a symmetrical eyeball position in the postoperative period and to reduce the risk of complications.

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