Πέμπτη 17 Νοεμβρίου 2022

Qué es el bocio amiloide y otras causas inusuales

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¿Qué es el bocio y cuál es su relevancia?

El bocio es el aumento de tamaño de la glándula tiroides, detectable a simple vista, por palpación o por pruebas de imagen. Cuando es visible en forma de bulto en la cara anterior del cuello, una característica del mismo es que el bulto sube y baja al tragar.

La relevancia del bocio es, en primer lugar, llamar la atención hacia el tiroides, su posible disfunción y las causas que lo originan. En segundo lugar, el aumento de tamaño per se puede ser un problema si provoca compresión de las estructuras vecinas (dificultad al tragar si comprime el esófago (disfagia), dificultad al respirar si comprime la tráquea (disnea), alteración de la voz si comprime el nervio recurrente que inerva las cuerdas vocales (disfonía).

Cuando el bocio ocasiona síntomas compresivos, es necesario tratarlos y habitualmente el tratamiento es quirúrgico.

¿Qué puede provocar bocio?

Las causas más frecuentes de bocio son las que se acompañan de disfunción del tiroides (hipo o hipertiroidismo) y aquellas en que el organismo aumenta el tamaño del tiroides para prevenirla (por ejemplo, en caso de falta de yodo o de autoinmunidad tiroidea). A nivel mundial, la deficiencia de yodo es la causa más frecuente.

Otras posibles causas son los nódulos tiroideos (quistes o tumores) y las infecciones e inflamaciones de la glándula. Cuando el bocio incluye nódulos se denomina bocio nodular.

Otro grupo de posibles causas son las infiltrativas/por depósito, muy infrecuentes pero diversas (sustancia amiloide, sarcoidosis, lipomatosis). La sustancia amiloide es un material formado por componentes proteicos que se pliegan anormalmente de una manera determinada. Se puede producir por acúmulo de sustancia amiloide de origen genético (amiloidosis primaria), por consecuencia de una infección o inflamación en el organismo de larga duración (por ejemplo, broquiectasias o artritis reumatoide, amiloidosis secundaria) o en ocasiones acompañando a un tumor. El bocio amiloide puede acompañarse de crecimiento rápido del tiroides y hay que sospechar la posibilidad de este diagnóstico cuando un bocio de crecimiento rápido se presenta en un paciente que tiene una enfermedad que lo puede originar.

La sustancia amiloide se puede apreciar por análisis microscópico del material de punción-aspiración con aguja fina, pero el diagnóstico definitivo de bocio amiloide se realiza tras cirugía y examen anatomopatológico. La cirugía supone también el tratamiento.

  • El bocio amiloide es el aumento de tamaño de la glándula tiroidea por acumulación de sustancia amiloide (fragmentos de proteína plegados de manera característica).
  • Se da por causas genéticas (amiloidosis primaria) o como consecuencia de infecciones o enfermedades inflamatorias de larga duración (amiloidosis secundaria).
  • Puede originar crecimiento rápido del tiroides y la cirugía proporciona confirmación diagnóstica y tratamiento.

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La entrada Qué es el bocio amiloide y otras causas inusuales se publicó primero en Cuida tu tiroides.

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Mediterranean Diet component oleic acid increases protective lipid‐mediators and improves trabecular bone in a Porphyromonas‐gingivalis‐inoculation‐model

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Abstract

Background

Therapeutic modulation of bacterial-induced inflammatory host response is being investigated in gingival inflammation and periodontal disease pathology. Therefore, dietary intake of monounsaturated fatty acid (FA) oleic acid (OA (C18:1)), main-component of Mediterranean-style diets, and Western-style diet component saturated FA palmitic acid (PA (C16:0)) were investigated for their modifying potential in a P.gingivalis-oral-inoculation-model.

Methods

Normal-weight C57BL/6-mice received OA-or PA-enriched diets (PA-ED, OA-ED, PA/OA-ED) or normal-standard-diet for 16 weeks and were inoculated with P.gingivalis/placebo (n=12/group). Gingival inflammation, alveolar bone structure, circulating lipid mediators and in vitro cellular response were determined.

Results

FA-treatment of P.gingivalis-LPS-incubated gingival fibroblasts (GFb) modified inflammatory activation, which only PA exacerbated with concomitant TNF-α-stimulation. Mice exhibited no signs of acute inflammation in gingiva or serum and no inoculation-and nutrition-associated changes of crestal alveolar bone. However, following P.gingivalis-inoculation, OA-ED improved oral trabecular bone-micro-architecture and enhanced circulating pro-resolving mediators Resolvin D4 (RvD4) and 4-hydroxydocosahexaenoic acid (4-HDHA), whereas PA-ED did not. In vitro-experiments demonstrated significantly improved differentiation in RvD4-and 4-HDHA-treated primary osteoblast-cultures and reduced expression of osteoclastogenic factors in GF. Further, P.gingivalis-infection of OA-ED animals led to a serum composition that suppressed osteoclastic differentiation in vitro.

Conclusions

Results underline preventive impact of Mediterranean-style-OA-EDs by indicating their pro-resolving nature beyond anti-inflammatory properties.

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The Arterial Pattern of the Upper Nasal Septum (S‐Point) and Potential Role in Severe Epistaxis

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The Arterial Pattern of the Upper Nasal Septum (S-Point) and Potential Role in Severe Epistaxis

The previously described S-point, corresponds to the medial projection of the middle turbinate axilla in the superior nasal septum and has been identified as a common source of severe epistaxis. The rich anatomical patterns of vascularization of the S-point area could explain why this area is a common site of severe epistaxis and guide its surgical cauterization when an obvious vascular ectasia is not visualized.


Objectives

The previously described S-point, corresponds to the medial projection of the middle turbinate axilla in the superior nasal septum and has been identified as a common source of severe epistaxis. The objective is to define the anatomical patterns of vascularization of the S-point area that could explain its clinical relevance.

Methods

Thirty-three nasal septums of latex-injected formalin-embalmed and fresh human cadaveric heads were dissected to analyze the arterial arrangement of the S-point area. Measurements and patterns of vascularization were described.

Results

The S-point area, was consistently surrounded by a single or multiple arterial anastomotic arches consistently formed superiorly by the anterior ethmoidal and posterior ethmoidal artery branches, and inferiorly by the posterior septal artery. The caliber of the arterial arches was typically larger than the caliber of the arterial branches supplying them. A single arch was present in 36.3% of septums, and multiple arches in 63.6%. The mean distance from the S-point to the anterior limit of the arch was 9 mm, to the posterior arch when the present was 3 mm, to the superior limit 6 mm, to the inferior limit 6 mm, and to the nasal roof was 10 mm.

Conclusion

This study demonstrates the dense arterial configuration of the S point area, which is characterized by a single or multiple vascular arches of greater caliber than the branches of origin. This finding could explain why the S-point area is a frequent source of epistaxis, and guide its surgical cauterization when an obvious vascular ectasia is not visualized.

Level of Evidence

N/A Laryngoscope, 2022

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Oncologic Outcomes After Clinically Node-Negative Salvage Laryngectomy

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This cohort study investigates the association of elective nec k dissection vs observation with oncologic outcomes among patients who received clinically node-negative salvage total laryngectomy.
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Multimodale Therapie bei lokal fortgeschrittenem kutanem Plattenepithelkarzinom

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Laryngorhinootologie
DOI: 10.1055/a-1949-2936

Die Therapieoptionen für lokal fortgeschrittene oder metastasierte Plattenepithelkarzinome waren bisher stark begrenzt und nicht standardisiert. Durch die Zulassung des monoklonalen Antikörpers Cemiplimab, der gegen den programmed death-1-Rezeptor (PD-1) gerichtet ist, hat sich die Prognose der betroffenen Patienten deutlich gebessert, wobei z.T. anhaltende Komplettremissionen erzielt werden können.In der vorgestellten Kasuistik wurde ein multimorbider, 81-jähriger Patient aufgrund eines ausgedehnten Plattenepithelkarzinoms frontoparietal mit Schädelkalotteninfiltration und Einbruch nach intrakraniell zunächst mit Cemiplimab behandelt. Immunvermittelte Nebenwirkungen sind nicht aufgetreten. Bei klinischer und radiologischer Remission wurde der Restbefund interdisziplinär operativ versorgt, wobei die defekte Schädelkalotte rekonstruiert wurde. Histologisch wurde eine pathologische Komplettremissio n des Plattenepithelkarzinoms nachgewiesen. 6 Monate postoperativ ergab sich kein Anhalt für ein Lokalrezidiv oder Metastasen.Dieser Fall zeigt exemplarisch einen Patienten, der trotz seines hohen Alters und Ko-Morbidität von der Therapie mit Cemiplimab profitiert hat. Darüber hinaus demonstriert dieser Fall die Relevanz eines interdisziplinären/multimodalen Therapieregimes im Management dieser in der Inzidenz deutlich ansteigenden Tumorentität.
[...]

Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany

Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text

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Staphylococcus aureus Carrier Types are not Evidence of Population Heterogeneity

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Abstract
Asymptomatic colonization by Staphylococcus aureus is a precursor for infection, so identifying the mode and source of transmission which leads to colonization could help target interventions. Longitudinal studies have shown that some people are persistently colonized for years, while others seem to carry S. aureus for weeks or less, and conventional wisdom attributes this disparity to an underlying risk factor in the persistently colonized. We analyze published data with mathematical models of acquisition and carriage to compare this hypothesis with alternatives. The null model assumes a homogeneous population and still produces highly variable colonization durations (mean of 1.94 years, 5th percentile 0.1 years, 95th percentile 5.8 years). Simulations show that this inherent variability, combined with censoring in longitudinal cohort studies, i s sufficient to produce the appearance of "persistent carriers," "intermittent carriers," and "noncarriers" in data. Our estimates for colonization duration exhibit sensitivity to the assumption that false positives can occur despite being rare, but our model-based approach simultaneously estimates specificity and sensitivity along with epidemiological parameters. Our results show it is plausible that S. aureus colonizes people indiscriminately, and improved understanding of the types of exposures which result in colonization is essential.
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