scholarly journals Patellar Shape is Associated With Femoral Trochlear Morphology in Individuals with Mature Skeletal Development

2021 ◽  
Author(s):  
Lanyu Qiu ◽  
Jia Li ◽  
Bo Sheng ◽  
Haitao Yang ◽  
Fajin Lv ◽  
...  
Keyword(s):  
Inclination Angle ◽  
Skeletal Development ◽  
Developmental Outcomes ◽  
Trial Registration ◽  
Type I ◽  
Type Ii ◽  
Sulcus Angle ◽  
Group A ◽  
Trochlear Height ◽  
Lateral Facet

Abstract Background: As several studies have detected correlations between patellar and femoral trochlear development, this raises the question of whether patellar shape is associated with trochlear developmental outcomes.Methods: Patellar shape and femoral trochlear morphology were retrospectively analyzed in 240 subjects, of whom 80 each were classified as having Wiberg type I, II, and III patellae (groups A, B, and C, respectively). The sulcus angle (SA), lateral trochlea inclination angle (LTA), medial trochlear inclination angle (MTA), lateral facet length (LFL), medial facet length (MFL), lateral trochlear height (LTH), medial trochlear height (MTH), trochlea sulcus height (TH), and lateral-medial trochlear facet distance (TD) were analyzed as a means of evaluating trochlear morphology. Trochlear depth, trochlear condyle asymmetry, and trochlear facet asymmetry were additionally calculated, and differences in trochlear morphology and correlations between trochlear morphology and patellar shape were evaluated.Results: The femoral trochlear parameters of patients in group A differed significantly from those of patients in groups B and C. No significant differences between groups B and C were evident. Patellar shape was positively correlated with LTA, MTA, MFL, trochlear index trochlear condyle asymmetry, and trochlear facet asymmetry, and was negatively correlated with SA.Conclusions: These data indicated that patellar shape and trochlear morphology are related to one another. Relative to patients with Wiberg type II and III patellae, those with Wiberg type I patellae exhibited an increased trochlear inclination angle and a greater trochlear facet and condyle asymmetry, as well as a decreased SA.Trial registration: Retrospectively registered

Defining the Molecular Mechanisms Responsible for the ABO High Expresser Phenotype.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 2119-2119
Author(s):  
Diarmaid O Donghaile ◽  
Vince P Jenkins ◽  
Rachel McGrath ◽  
Lisa Preston ◽  
Roger JS Preston ◽  
...  
Keyword(s):  
Blood Group ◽  
Base Pair ◽  
Antigen Expression ◽  
Regulatory Elements ◽  
Transferase Activity ◽  
Type I ◽  
Type Ii ◽  
Blood Group A ◽  
Group A ◽  
Abo Genotype

Abstract Abstract 2119 Poster Board II-96 ABO(H) blood group antigen expression on platelets varies widely among normal blood donors. An ABO ‚High Expresser' phenotype (HXP) that exhibits significantly increased A and/or B antigen expression on platelets has been identified in ∼7% of normal donors. HXP has been implicated in both platelet-refractoriness and neonatal alloimmune thrombocytopenic purpura, however, the underlying molecular and genetic elements that mediate this phenomenon are not well-defined. To investigate the mechanisms underlying HXP, blood samples were collected from 231 group A (180 A1and 51 A2) and 310 group O individual apheresis platelet donors. Quantitative expression of platelet A and H antigen were then assessed by flow cytometry of platelet-rich plasma. In total, 10 A1 donors (5.6%) exhibited HXP. Analysis of the platelet A antigen expression in these individuals identified 8 HXP donors who exhibited ‚type I' HXP (normal bimodal population of platelets, but with predominant A antigen expression) whereas 2 individuals exhibited ‚type II' HXP (a single uniform population of platelets, strongly positive for blood group A expression). Both types of HXP were found to be a stable donor characteristic. ABO(H) determinants have also been identified on the N-linked glycans of the plasma von Willebrand factor (VWF), and influence plasma VWF levels and susceptibility to proteolysis by ADAMTS13. To determine whether HXP was platelet-specific, blood group A antigen expression on plasma VWF from group A donors was determined. Interestingly, blood group A antigen expression on plasma VWF was concordantly increased in donors with type I and type II HXP, indicative of increased glycosyltransferase expression in HXP individuals. To ascertain whether increased glycosyltransferase expression contributes to HXP, ABO genotype was determined for all 231 group A donors by PCR-RFLP analysis. Genotype at the ABO locus on 9q34 exerts a dosage effect on glycosyltransferase expression. 80% HXP (all type I) donors were genotyped A1A1. suggesting increased A transferase activity contributes to type I HXP. Despite this, the majority of A1A1individuals (67%) did not exhibit HXP, and 2 HXP donors were found to possess the A2 allele, which expresses limited A transferase enzymatic activity. Collectively, this data clearly demonstrates the contribution of additional factors to ABO genotype that contribute to HXP. To identify additional HXP modifiers, potential enhancer repeat elements upstream of the ABO gene were examined in group A donors, including those with HXP. Typically, A1alleles contain a single 43-base pair repeat within a minisatellite positive regulatory region upstream of the ABO gene. In contrast, A2and O1alleles contain four 43bp repeats, which are associated with a 100-fold enhancement of transcriptional activity. Analysis of this enhancer region demonstrated two HXP donors with A1alleles containing four copies of the 43-base pair repeat. Consequently, this allele would be predicted to modulate A transferase expression via enhanced ABO gene transcription. In conclusion, we have demonstrated the multi-factorial nature of the regulatory elements mediating platelet type I and type II HXP. A1alleles containing novel upstream enhancer repeats identified in donor individuals may represent a novel genetic mediator of HXP, and contribute to the pathophysiology associated with this phenomenon independently of ABO genotype. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Sagittal Maxillary Fracture: Diagnosis and Management

2021 ◽  
Author(s):  
Umesh Kumar ◽  
Pradeep Jain
Keyword(s):  
Type I ◽  
Type Ii ◽  
Oroantral Fistula ◽  
Young Males ◽  
Maxillomandibular Fixation ◽  
Single Plate ◽  
Group A ◽  
Group B ◽  
Palatal Vault ◽  
Maxillary Fracture

Abstract Background The sagittal maxillary fracture often coexists with maxillary fractures and warrants a definitive management strategy together with other maxillary fractures. Method This study was conducted on 60 patients suffering from sagittal maxillary fracture. Palatal fractures were classified into six subgroups. During management, patients were divided into three groups. In group A, patients with type I, IV, V, and VI were managed with maxillomandibular fixation and anterior maxillary buttress stabilization. Group B patients included type II, III, and IV palatal fractures. These fractures were undisplaced and were managed with maxillomandibular fixation, anterior alveolar plating, and anterior maxillary buttress stabilization. Group C included type II and III fractures with visible gap in the palate and were managed with maxillomandibular fixation, palatal vault plating, anterior alveolar plating, and anterior maxillary buttress stabilization. Result Sagittal maxillary fracture was more common in young males. Le Fort I and II fractures were more frequently associated with it in isolation or in combination. Parasagittal and sagittal fractures were the most common types. Sixteen patients of group A, twenty patients of group B, and twenty-four patients of group C were managed. Malocclusion (2), plate extrusion (2), and oroantral fistula (2) were the most common complications. Conclusion Sagittal maxillary fracture can be diagnosed with clinical and radiological examination. Palatal vault plating is required in displaced palatal fractures of type II and III. Single plate fixed in posterior half of middle one-third of palate gives sufficient stability to the palatal vault.

scholarly journals A TYPE-SPECIFIC PROTEIN FROM PNEUMOCOCCUS

1949 ◽  
Vol 89 (4) ◽  
pp. 439-450 ◽  
Author(s):  
Robert Austrian ◽  
Colin M. MacLeod
Keyword(s):  
Specific Protein ◽  
Type I ◽  
Capsular Polysaccharides ◽  
Type Ii ◽  
Group A Streptococci ◽  
Capsular Type ◽  
Isolation And Characterization ◽  
M Proteins ◽  
Group A

The isolation and characterization of a type-specific M protein from pneumococcus are described. This protein is similar chemically in all respects studied to the M proteins of group A streptococci. No immunological crossreactions have been observed, however, between M proteins of the two species. Strains of capsular type I pneumococcus have been encountered which contain different M proteins. The same is true for capsular type II pneumococcus. It is apparent, therefore, that the capsular polysaccharides and M proteins can vary independently of each other.

scholarly journals Blood group A and B antigens are strongly expressed on platelets of some individuals

Blood ◽  
2000 ◽  
Vol 96 (4) ◽  
pp. 1574-1581 ◽  
Author(s):  
Brian R. Curtis ◽  
Jennifer T. Edwards ◽  
Martin J. Hessner ◽  
John P. Klein ◽  
Richard H. Aster
Keyword(s):  
Antigen Expression ◽  
Type I ◽  
Type Ii ◽  
Autosomal Dominant Trait ◽  
Cell Lineages ◽  
Flow Cytometric ◽  
Normal Expression ◽  
Group A ◽  
The Mean ◽  
Group B

It is widely thought that expression of ABH antigens on platelets is insufficient to materially affect the survival of ABH-incompatible platelets in transfusion recipients, but anecdotal reports of poor survival of A and B mismatched platelets suggest that this is not always the case. The A and B antigen expression on platelets of 100 group A1 and group B blood donors was measured, and 7% and 4%, respectively, had platelets whose A and B antigen levels consistently exceeded the mean plus 2 SD. On the basis of flow cytometric and statistical analysis, donors whose platelets contained higher than normal levels of A antigen were subdivided into 2 groups, designated Type I and Type II (“high expressers”). Serum A1- and B-glycosyltransferase levels of A and B high expressers were significantly higher than those of group A1 and B individuals with normal expression. H antigen levels were low on the red cells of high expressers, indicating that the anomaly affects other cell lineages. Immunochemical studies demonstrated high levels of A antigen on various glycoproteins (GPs) from high-expresser platelets, especially GPIIb and PECAM (CD31). The A1 Type II high-expresser phenotype was inherited as an autosomal dominant trait in one family. The sequences of exons 5, 6, and 7 of the A1-transferase gene of one Type II A1 high expresser and exon 7 from 3 other genes were identical to the reported normal sequences. Further studies are needed to define the molecular basis for the high-expresser trait and to characterize its clinical implications.

scholarly journals Discovery and characterization of 2 novel subpopulations of aPS/PT antibodies in patients at high risk of thrombosis

2019 ◽  
Vol 3 (11) ◽  
pp. 1738-1749 ◽  
Author(s):  
Mathivanan Chinnaraj ◽  
William Planer ◽  
Vittorio Pengo ◽  
Nicola Pozzi
Keyword(s):  
High Risk ◽  
Antigenic Determinants ◽  
Type I ◽  
Type Ii ◽  
Autoantibody Profile ◽  
Group A ◽  
Gla Domain ◽  
Group B ◽  
Unexpected Findings

Abstract Anti-phosphatidylserine/prothrombin (aPS/PT) antibodies are often detected in patients with antiphospholipid syndrome (APS), but how aPS/PT engage prothrombin at the molecular level remains unknown. Here, the antigenic determinants of immunoglobulin G aPS/PT were investigated in 24 triple-positive APS patients at high risk of thrombosis by using prothrombin mutants biochemically trapped in closed and open conformations, and relevant fragments spanning the entire length of prothrombin. Two novel unexpected findings emerged from these studies. First, we discovered that some aPS/PT are unique among other anti-prothrombin antibodies insofar as they efficiently recognize prothrombin in solution after a conformational change requiring exposure of fragment-1 to the solvent. Second, we identified and characterized 2 previously unknown subpopulations of aPS/PT, namely type I and type II, which engage fragment-1 of prothrombin at different epitopes and with different mechanisms. Type I target a discontinuous density-dependent epitope, whereas type II engage the C-terminal portion of the Gla-domain, which remains available for binding even when prothrombin is bound to the phospholipids. Based on these findings, APS patients positive for aPS/PT were classified into 2 groups, group A and group B, according to their autoantibody profile. Group A contains mostly type I antibodies whereas group B contains both type I and type II antibodies. In conclusion, this study offers a first encouraging step toward unveiling the heterogeneity of anti-prothrombin antibodies in correlation with thrombosis, shedding new light on the mechanisms of antigen–autoantibody recognition in APS.

scholarly journals Blood group A and B antigens are strongly expressed on platelets of some individuals

Blood ◽  
2000 ◽  
Vol 96 (4) ◽  
pp. 1574-1581 ◽  
Author(s):  
Brian R. Curtis ◽  
Jennifer T. Edwards ◽  
Martin J. Hessner ◽  
John P. Klein ◽  
Richard H. Aster
Keyword(s):  
Antigen Expression ◽  
Type I ◽  
Type Ii ◽  
Autosomal Dominant Trait ◽  
Cell Lineages ◽  
Flow Cytometric ◽  
Normal Expression ◽  
Group A ◽  
The Mean ◽  
Group B

Abstract It is widely thought that expression of ABH antigens on platelets is insufficient to materially affect the survival of ABH-incompatible platelets in transfusion recipients, but anecdotal reports of poor survival of A and B mismatched platelets suggest that this is not always the case. The A and B antigen expression on platelets of 100 group A1 and group B blood donors was measured, and 7% and 4%, respectively, had platelets whose A and B antigen levels consistently exceeded the mean plus 2 SD. On the basis of flow cytometric and statistical analysis, donors whose platelets contained higher than normal levels of A antigen were subdivided into 2 groups, designated Type I and Type II (“high expressers”). Serum A1- and B-glycosyltransferase levels of A and B high expressers were significantly higher than those of group A1 and B individuals with normal expression. H antigen levels were low on the red cells of high expressers, indicating that the anomaly affects other cell lineages. Immunochemical studies demonstrated high levels of A antigen on various glycoproteins (GPs) from high-expresser platelets, especially GPIIb and PECAM (CD31). The A1 Type II high-expresser phenotype was inherited as an autosomal dominant trait in one family. The sequences of exons 5, 6, and 7 of the A1-transferase gene of one Type II A1 high expresser and exon 7 from 3 other genes were identical to the reported normal sequences. Further studies are needed to define the molecular basis for the high-expresser trait and to characterize its clinical implications.

CT-guided microcoil localization of pulmonary nodules: the effect of the position of microcoil proximal end on the incidence of microcoil dislocation

2021 ◽  
Author(s):  
Zhen-Guo Huang ◽  
Cun-li Wang ◽  
Hong-liang Sun ◽  
Shu-Zhu Qin ◽  
Chuan-Dong Li ◽  
...  
Keyword(s):  
Chest Wall ◽  
Pleural Cavity ◽  
Pulmonary Nodules ◽  
Type I ◽  
Type Ii ◽  
Ct Guided ◽  
Group A ◽  
The Difference ◽  
Group B ◽  
Wall Group

Objectives: To evaluate the effect of the position of microcoil proximal end on the incidence of microcoil dislocation during CT-guided microcoil localization of pulmonary nodules (PNs). Methods: This retrospective study included all patients with PNs who received CT-guided microcoil localization before video-assisted thoracoscopic urgery (VATS) resection from June 2016 to December 2019 in our institution. The microcoil distal end was less than 1 cm away from the nodule, and the microcoil proximal end was in the pleural cavity (the pleural cavity group) or chest wall (the chest wall group). The length of microcoil outside the pleura was measured and divided into less than 0.5 cm (group A), 0.5 to 2 cm (group B) and more than 2 cm (group C). Microcoil dislocation was defined as complete retraction into the lung (type I) or complete withdrawal from the lung (type II). The rate of microcoil dislocation between different groups was compared. Results: A total of 519 consecutive patients with 571 PNs were included in this study. According to the position of microcoils proximal end on post-marking CT, there were 95 microcoils in the pleural cavity group and 476 in the chest wall group. The number of microcoils in group A, B, and C were 67, 448 and 56, respectively. VATS showed dislocation of 42 microcoils, of which 30 were type II and 12 were type I. There was no statistical difference in the rate of microcoil dislocation between the pleural cavity group and the chest wall group (6.3% vs 7.6%, x2 = 0.18, p = 0.433). The difference in the rate of microcoil dislocation among group A, B, and C was statistically significant (11.9%, 5.8%, and 14.3% for group A, B, and C, respectively, x2 = 7.60, p = 0.008). In group A, 75% (6/8) of dislocations were type I, while all eight dislocations were type II in group C. Conclusions: During CT-guided microcoil localization of PNs, placing the microcoil proximal end in the pleura cavity or chest wall had no significant effect on the incidence of microcoil dislocation. The length of microcoil outside the pleura should be 0.5 to 2 cm to reduce the rate of microcoil dislocation. Advances in knowledge: : CT-guided microcoil localization can effectively guide VATS to resect invisible and impalpable PNs. Microcoil dislocation is the main cause of localization failure. The length of microcoil outside the pleura is significantly correlated with the rate and type of microcoil dislocation. Placing the microcoil proximal end in the pleura cavity or chest wall has no significant effect on the rate of microcoil dislocation.

scholarly journals PHYSICAL AND MENTAL FUNCTIONING OF PEOPLE WITH DIABETIC POLYNEUROPATHY ON THE BACKGROUND OF MULTIMORBIDITY

2020 ◽  
Vol 6 (3-4) ◽  
pp. 8-18
Author(s):  
N.K. Svyrydova ◽  
G.M. Chupryna ◽  
V.M. Dubуnetska ◽  
Z.L. Tyzhuk
Keyword(s):  
Mental Health ◽  
Physical Functioning ◽  
Diabetic Foot ◽  
Diabetic Polyneuropathy ◽  
Type I ◽  
Type Ii ◽  
Group A ◽  
Group B ◽  
Group D

The article analyzes the physical and psychological components of the quality of life (QOL) in patients with diabetic polyneuropathy (DP) on the background of type I and II diabetes mellitus (DM) with comorbidity. Has been demonstrated the prevalence of more frequent multimorbidity in this nosology and its effect on patients’ QOL. QOL is recognized as an integral part of a comprehensive analysis of new methods of diagnosis, treatment, prevention, quality of treatment and medical assistance [2]. With the highest frequency in DM detect sensory or sensorimotor forms of distal symmetrical DP. However, there are motor symptoms in DM, including cranial neuropathy and Bruns-Garland syndrome (diabetic amyotrophy) [3], which interfere with the satisfactory functioning of patients. The purpose of our work was to assess the extent of physical and mental functioning of people with DP on the background of multimorbidity. Materials and methods. We examined 92 patients with DP on the background of type I and II DM, aged from 19 to 69 years, which were divided into 2 groups: from DP on the background of type 1 DM (group I) and type II (group II). We distinguished such subgroups: DP on the background of type I DM and concomitant cardiovascular pathology (CVP) (group A), DP on the background of type II DM and concomitant CVP (group B), DP on the background of type I DM and gastroenterological pathology (GEP) (group C), DP on the background of type II DM and GEP (group D), DP on the background of type I DM and pathology of the thyroid gland (thyroid) (group E), DP on the background of type II DM and thyroid pathology (group F). Patients underwent clinical and neurological examination, laboratory tests and ultrasound examination of the abdominal cavity and thyroid gland, electromyography (EMG). Static calculation was done in MS Excel 2003. Results and discussion. In groups A and B with the highest frequency among CVP was arterial hypertension - 91% vs 97% and coronary heart disease - 27% vs 41%. In group C - chronic hepatitis (40%), chronic cholecystitis (40%), chronic pancreatitis (40%), chronic gastroduodenitis (40%). In people of group D, gallstone disease was diagnosed more often than in other pathologies (43%). The leading place in group E was occupied by autoimmune thyroiditis (29%), idiopathic hypothyroidism (29%), thyrotoxicosis (29%), in group F - nodular goiter (57%). The longest duration of DM was observed in group A - 24.54 ± 2.46 years, the smallest in group D - 7.14 ± 1.01 years. Diabetic foot syndrome was diagnosed in patients of groups A and B in 14%, group C - in 2%. In patients of group I, the indicators of QOL were higher than in group II. The highest indicators were of groups I and II in the domains social (SF) and physical functioning (PF) - 66.75 ± 2.41; 65.5 ± 3.23 and 63.39 ± 3.54; 61.42 ± 3.88. In group A, the level of QOL was slightly higher than in group B, in particular in the domains of mental health (MH) - 53.09 ± 3.12, bodily pain (BP) - 50.90 ± 4.05. In addition, the manifestations of DP in such group of individuals (group A) were manifested by the absence or mild pain, which causes in people of this group higher rate of QOL. QOL in patients of group C was higher than in group D, in particular, the indicators of physical functioning (PF) - 68.75 ± 5.88, social functioning (SF) - 65.62 ± 5.35, role emotional (RE) - 58.33 ± 18.75, mental health (MH) - 54 ± 5.36. In group D, the data were high in the domains of social functioning (SF) 60.71 ± 16.0 and physical functioning (PF) 57.14 ± 8.37. In the examined patients of group F the level of QOL was higher than in group E, it was, in the domains of physical functioning (PF) - 76.42 ± 7.99, bodily pain (BP) - 61.28 ± 11.18, general health (GH) - 60.85 ± 7.33. Physical health (PH) was low in all groups, but slightly higher in group F (47.90 ± 3.45). The mental health (MH) was low in all groups of patients, slightly higher in group C (47.89 ± 3.59). Conclusions. The level of QOL in persons with DP on the background of type I and II DM with multimorbidity was generally not high. Patients in group D showed the lowest levels of QOL, they also had a level of glycated hemoglobin much higher than in other groups. In group F, the data of QOL were higher, because people with DP on the background of type I DM (group E) had a higher frequency of concomitant thyroid damage, the manifestations of which significantly complicate the course of the underlying disease and reduce levels of functioning. Often manifestations of diabetic foot occur in the onset of DP, when the fibers responsible for sensitivity were damaged, which causes the appearance of the neuropathic component of pain, so in persons of group B the lowest among all groups was the level of QOL in the domain of pain intensity. In addition, it was convenient to monitor the results of treatment by conducting a QOL survey several times a year. Careful analysis of QOL in all areas of functioning in patients with DP allowed detecting early mental disorders and timely start treatment, including psychotherapy sessions. Keywords: quality of life, diabetic polyneuropathy, comorbidity, diabetic foot.

CTMS in the study of post-EVAR endoleak in the treatment of aneurysmal dilations

2020 ◽  
Author(s):  
Coda Marco ◽  
Novak Anna ◽  
Aliberti Daniele ◽  
Ciccone Vincenzo ◽  
Carbone Mattia
Keyword(s):  
Physiological Solution ◽  
Type I ◽  
Type Ii ◽  
Ct Scanner ◽  
Aortic Diseases ◽  
Type Iii ◽  
Type Iv ◽  
Group A ◽  
Group B ◽  
Endoleak Type Ii

Computed tomography angiography (CTA) has been widely used in diagnostic evaluation of many aortic diseases, but there are not standardized techniques for aortic CTA. The purpose of this study is to compare two methods: biphasic technique and split bolus. A 64-slice CT scanner has been used. There were a total of 28 patients involved in the study. The patients have been divided in two groups: - Group A: 18 patients - Group B: 10 patients The biphasic technique has been used on 18 patients in group A. In this protocol was used a low dose acquisition without contrast medium (CM) and two contrastographic phases with CM. The split bolus technique was performed on 10 patients of group B. 120-140 ml of CM are divided in two boluses. The first bolus of 55-90 ml of CM was injected at a flow of 1,5-2 ml/s, followed by 20ml of physiological solution at a flow of 1,5-2ml/s. After physiological solution the second bolus of 35-60 ml was injected at a flow of 3,5ml/s followed by 20ml of Nacl at a flow of 3,5ml/s. In group A 6 patients had endoleak type I, n=2 endoleak type II, n=8 endoleak type III, n=2 endoleak type IV. (dose of 43.2 mSv). In group B 2 patients had endoleak type I, n= 4 endoleak type II, n=3 endoleak type III and n=1 endoleak type IV. (dose of 16,39 mSv). The biphasic technique has high spatial resolution and contrast resolution, reduction of acquisition times and reduction of artifacts, but an unacceptable a great amount of radiation is involved. The split bolus technique provides results comparable to the biphasic technique but with a lower dose of radiation.

scholarly journals Treatment of Type II Amiodarone-Induced Thyrotoxicosis by Either Iopanoic Acid or Glucocorticoids: A Prospective, Randomized Study

2003 ◽  
Vol 88 (5) ◽  
pp. 1999-2002 ◽  
Author(s):  
Fausto Bogazzi ◽  
Luigi Bartalena ◽  
Chiara Cosci ◽  
Sandra Brogioni ◽  
Enrica Dell’Unto ◽  
...  
Keyword(s):  
Randomized Study ◽  
Prospective Randomized Study ◽  
Type I ◽  
Type Ii ◽  
Free T4 ◽  
Serum Free ◽  
Free T3 ◽  
Iopanoic Acid ◽  
Group A ◽  
Group B

Amiodarone-induced thyrotoxicosis (AIT) may occur either in the presence of underlying thyroid disease (type I AIT) or in apparently normal thyroid glands (type II AIT). Type II AIT, a destructive thyroiditis, often favorably responds to glucocorticoids. Iopanoic acid (IopAc) is an iodinated cholecystographic agent that inhibits deiodinase activity and reduces the conversion of T4 toT3. It has recently been reported that cholecystographic agents restore euthyroidism in patients with type II AIT. We describe the results of a prospective randomized study conducted in 12 patients with type II AIT treated with either iopanoic acid (group A, n = 6) or glucocorticoids (group B, n = 6). Serum free T3 levels normalized rapidly in both groups after 7 d, from 0.75 ± 0.20 ng/dl (11.5 ± 3.1 pmol/liter) to 0.46 ± 0.10 ng/d (7.1 ± 1.7 pmol/liter), P < 0.01, and from 0.58 ± 0.10 ng/dl (9.0 ± 1.2 pmol/liter) to 0.34 ± 0.03 ng/dl (5.2 ± 0.5 pmol/liter), P < 0.003, in groups A and B, respectively (P = NS). Serum free T4 levels reduced at 6 months in group B [from 2.70 ± 0.32 ng/dl (35.1 ± 4.1 pmol/liter) to 1.0 ± 0.04 ng/dl (13.4 ± 0.6 pmol/liter), P < 0.0001] but not in group A (from 2.90 ± 0.6 ng/dl (38.0 ± 7.5 pmol/liter) to 2.30 ± 0.4 ng/dl (35.6 ± 6.1 pmol/liter, P = 0.39; P = 0.005 group B vs. group A). All patients in both groups became euthyroid and had their amiodarone-induced destructive thyroiditis cured as defined by normalization of both serum free T4 and free T3 levels, during both drugs therapy. However, patients in group B were cured more rapidly than patients in group A (43 ± 34 d vs. 221 ± 111 d, respectively, P < 0.002). This study shows that, albeit both drugs are effective, glucocorticoids are probably the drug of choice for more rapidly curing type II AIT.

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