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C Dejax

Publications and source records attributed to C Dejax.

9 recordsLinked to original sources

[Epidemiologic characteristics of 336 thyroid cancers observed in the Auvergne region].

Patients treated and followed for thyroid cancer by a multidisciplinary group were studied between 1989 and 1993, 336 patients living in the French region Auvergne underwent total or partial thyroidectomy for thyroid carcinoma. The sex ratio was 4.3 and the median age was 52 (14-57) and 49 (17-83) in females and males respectively. Papillary carcinoma was the most common form: 76.5 of all thyroid tumors. The incidence of occult thyroid cancer was 17.4%; tumor size was smaller than for intranodular cancer (p < 0.00001). Tumor size at diagnosis of patients who died was higher than in patient who survived (p < 0.0001) and changed with histological type. It decreased between 1989 and 1993 (p < 0.01). 73% of the patients were asymptomatic before surgery, 23% described a rapid growth of their nodule. Clinically, 43.9% of the patients had a single nodule, 83% of these nodules were suspect because of their hardness. Median follow-up was 2.8 years. 279 patients are living and well, 28 were lost to follow-up and 39 died. There were 30 (8.93%) deaths due to thyroid carcinoma. In our study, significant prognostic factors for death were age at diagnosis (p < 0.0001), histological type (p < 0.0001) and nodular size (p < 0.01).

Adolescent

Hyperthyroidism without elevated levels of thyroxine and triiodothyronine in a patient with pulmonary tuberculosis.

We have reported a case of toxic thyroid adenoma with low T3 and low T4 syndrome in a patient who received antituberculous drugs for active pulmonary tuberculosis. Search for thyroid-hormone-binding antibodies was negative. Thyroid lobectomy was done and histologic examination confirmed toxic thyroid adenoma; two months after operation the patient was clinically and biologically euthyroid. During the course of a severe nonthyroidal illness, normal thyroid hormone levels must be regarded as an indicator of hyperthyroidism. In addition, we believe that rifampin has a significant effect on thyroid function tests and results of thyroid physiology.

Adenoma

[Myxedema coma with hypervasopressinism. 2 cases].

Hyponatremia is usual during myxedema coma. Hereafter we report two cases with increased plasma arginine vasopressin (AVP). Patients were admitted because of hypothyroid coma. In each case, there was an hyponatremia with normal urine sodium and low serum osmolality. Renal function was normal. On hormonal results, primary hypothyroidism was evident. Plasma AVP was increased. The plasma cortisol of one patient was high. Immediate therapy associated: water restriction, hypertonic saline infusion, furosemide, oral thyroid hormones with low doses. On the fourth day, conscience improved obviously. Natremia and plasma AVP went back to normal state before returning to euthyroid state. Patients went on improving along with normalizing thyroid status. Hyponatremia can be a serious sign of hypothyroidism. In case of myxedema coma with hyponatremia, clinical improvement seems to be related to fast correction of water and electrolyte disturbances and we prefer to give low doses of thyroid hormones at first. The hyponatremia and increased plasma AVP mechanisms are complex. However, in each of these cases, plasma AVP come back to normal before returning to euthyroid state. In one case, high plasma cortisol level rules out adrenal insufficiency as causal mechanism of electrolyte disorders.

Aged

[Lipoatrophic diabetes with acanthosis nigricans. Prolonged blood glucose normalization by continuous infusion of insulin].

Insulin resistance is a permanent feature of lipoatrophic diabetes, the resistance being almost regularly stubborn. We report the case of a 23-year old unmarried woman with generalized lipoatrophy and Acanthosis nigricans. Seven years after a diabetes resistant to all treatments was diagnosed, blood glucose levels were permanently around 25 mmol/l. Multiple and severe micro- and macroangiopathies were present. Partial resistance to insulin was demonstrated. This resistance could not be explained by abnormalities in anti-insulin hormones nor by a decrease in the number or affinity of insulin receptors, which suggested an intracellular abnormality below membrane receptors. Sustained control of glycaemia at a normal level was achieved by continuous infusion of insulin in high doses. It would appear that optimum insulin therapy using an insulin pump would offer hopes of therapeutic success in this particular form of insulin resistance.

Acanthosis Nigricans

[Prolonged hyperthyroidism and recurrent atrio-ventricular block].

The authors report the case of a patient with hyperthyroidism who had three episodes of grade 2 and 3 atrio-ventricular block over a 6-year period. After he recovered from hyperthyroidism, the atrio-ventricular conduction returned to normal and remained so throughout a 5-year follow-up. A grade 1 atrio-ventricular block is found in 6 to 8 p. 100 of hyperthyroid patients, but grade 2 and 3 blocks are rare in such patients. Case reports in which thyrotoxicosis alone seemed to be responsible for disorders of conduction are exceptional; frequently, other factors likely to induce such disorders were present. In 90 p. 100 of the cases hyperthyroidism was due to Graves' disease; it lasted for more than one year and thyrotoxicosis was often severe. These facts suggest the possibility of a thyrotoxic myocarditis and/or an autoimmune focal myocarditis. Although rare, atrio-ventricular block in hyperthyroid subjects is a possibility that warrants electrocardiographic monitoring, notably when negative dromotropic drugs are prescribed.

Adult