Biomedical subjects

Zorica Caparević

Publications and source records attributed to Zorica Caparević.

11 recordsLinked to original sources

PubMedDate not supplied

[Psychological evaluation of patients with a nodular goiter before and after surgical treatment].

INTRODUCTION: Association between endocrine and mental disorders has been recognized a long time ago, as well as their mutual dependence. The aim of this study was to evaluate the psychological structure of patients with thyroid nodule before and after surgical treatment. MATERIAL AND METHODS: In order to establish the type and degree of psychological disorders, we have examined 60 patients with thyroid nodule before and after surgical treatment by using DSM-IV classification of mental disorders and psychological instruments: semistructured psychiatric interview, MMPI, Zung Depression Scale and a list of panic symptoms. Patients with nonautonomous ("cold") nodules presented as euthyroid, and those with autonomous ("hot") nodules (after a period of drug therapy if they were hyperthyroid), required surgery. After a period of drug therapy two groups of patients were compared: group 1--euthyroid with "cold" nodules and group 2--euthyroid with "hot" nodules. Before surgical treatment both groups underwent psychological evaluation. Group 2 presented with: anxiety, depression and panic disorder with or without agoraphobia (72%, 46%, 28%) while group 1 presented with following results: 48%, 23%, 14% respectively. After surgical treatment patients from group 1 presented with psychologic disorders in less than 1%. DISCUSSION AND CONCLUSION: In some physical disorders, psychologic factors contribute directly or indirectly to the etiology, in others, psychologic symptoms are the direct results of a lesion affecting neural or endocrine organs. One of the key etiological factors is often a short-time or long-time stress and its direct consequence is altered functioning of various hormonal systems. Unexpected high percentage of psychological disorders in patients with thyroid disorders suggests that psychological evaluation before and after surgical treatment is unavoidable for good assessment and choice of treatment.

Anxiety Disorders↗

PubMedDate not supplied

[Malignant lymphoma of the thyroid gland].

INTRODUCTION: Malignant lymphoma of the thyroid gland can be defined as a lymphoma arising from the thyroid gland. Lymphomas of the thyroid gland represent less than 5% of primary thyroid neoplasms and are two to three times more common in women than in men, whereas the median age is usually close to 60 years. Majority of thyroid lymphomas are diffuse, large-cell lymphomas. The incidence of thyroid lymphomas in patients with Hashimoto thyroiditis has markedly increased and this phenomenon is probably related to their pathogenesis. CLINICAL PRESENTATION: Unlike most other thyroid neoplasms, lymphomas are usually rapidly enlarging masses and local symptoms are common: pain, hoarseness, dysphagia, and dyspnea or stridor. DIAGNOSIS: To evaluate the extent of disease, a chest x-ray and CT scans of the head and neck, chest, abdomen, and pelvis are necessary. An excisional or large-needle biopsy may also be necessary to make the correct diagnosis. Occasionally, these tumors can be confused with anaplastic thyroid carcinomas, which can lead to serious mistakes in management. A gallium scan or a positron emission tomography (PET) scan can help later to establish whether any residual abnormality, observed on x-ray studies after treatment, contains active lymphoma or scar tissue. After diagnosis, patients are clinically staged (without surgery) using appropriate computed tomography scans or magnetic resonance imaging. THERAPY: Assessment of the extent of thyroid lymphomas is crucial for prognosis and treatment. Total thyroidectomy may improve the prognosis in patients with intrathyroidal disease only. It is very important to identify patients with favorable prognostic factors and to treat them with standard chemotherapy (CHOP) and radiotherapy protocols. Patients with diffuse large-cell primary thyroid lymphomas should not be treated with radiation therapy alone. CONCLUSION: The best treatment results for malignant lymphomas of the thyroid gland are achieved using a combined-modality therapy.

Aged↗

PubMedDate not supplied

[Emphysematous cholecystitis].

INTRODUCTION: Emphysematous cholecystitis is a rare gallbladder pathology characterized by gas accumulation in the gallbladder wall as a result of severe inflammation, mostly caused by bacteria known as Clostridium species. CASE REPORT: This is a case report of a 59 year-old male diabetic, with typical anamnestic, clinical, ultrasonographic and radiological findings, pointing to acute cholecystitis of emphysematous form. Surgical and bacteriological procedures confirmed the preoperative findings. CONCLUSION: Reliable findings considering clinical status, ultrasonographic and radiological differential diagnosis, adequate and quick preoperative preparation, cholecystectomy and drainage with appropriate antibiotic treatment and hyperbaric oxygenation, represent the basic principles in diagnostics and treatment of this disease.

Acute Disease↗

PubMedDate not supplied

[Case report: celiac disease].

INTRODUCTION: Celiac disease (nontropical sprue, gluten-sensitive enteropathy, chronic intestinal malabsorption disorder) is caused by gluten intolerance. This hereditary disorder is caused by sensitivity to gliadin. Because the body's own immune system causes the damage, celiac disease is considered to be an autoimmune disorder. However, it is also classified as a disease of malabsorption because nutrients are not absorbed. When people with celiac disease eat foods containing gluten, their immune system responds by damaging the small intestine. Specifically, tiny finger-like protrusions, called villi, on the lining of the small intestine are lost. The diagnosis is suspected on the basis of symptoms and signs, enhanced by laboratory and x-ray studies, and confirmed by biopsy revealing flat mucosa and subsequent clinical and histologic improvement on a gluten-free diet. Gluten must be excluded from diet. Supplementary vitamins, minerals and hematinics may be given depending on deficiency. CASE REPORT: This is a case report of a 23-year old female patient with a mineralization defect (osteomalacia) and secondary osteoporosis caused by long-time unrecognized celiac disease. The patient had many symptoms: short stature, steatorrhea, anemia, weight loss and chronic bone pain. Laboratory and x-ray studies and jejunal biopsy revealed a chronic intestinal malabsorption disorder caused by gluten intolerance. Gluten-free diet and supplementary vitamins, minerals and hematinics were included with apparent clinical remission. DISCUSSION AND CONCLUSION: Some people with celiac disease may not have symptoms. The undamaged part of their small intestine is able to absorb enough nutrients to prevent symptoms. However, people without symptoms are still at risk for complications of celiac disease. Biopsy of the small intestine is the best way to diagnose celiac disease. Decreased bone density (osteoporosis and osteomalacia) is a serious problem for celiacs. If calcium is not absorbed, due to small intestinal damage caused by untreated celiac disease, bones are not as dense. The only treatment for celiac disease is gluten-free diet, that is, avoiding all foods that contain gluten. For most people, this diet stops symptoms, heals the existing intestinal damage, and prevents further damage.

Adult↗

PubMedDate not supplied

[Strategies for endoscopic and surgical treatment of biliary tract calculi].

INTRODUCTION: Common bile duct calculi represent a pathologic entity involving obstructive icterus, cholangitis, hepatic cirrhosis or pancreatitits. Common bile duct calculi mostly have a secondary origin (from gallbladder) in 95% of cases, while primary choledocholithiasis is rare. CLASSIFICATION: From surgical aspect, common bile duct calculi can be: 1. Asymptomatic, without manifested symptoms or signs, 2. Mobile, with intermittent biliar obstruction and disobstruction, 3. Fixed, with obstruction and signs of hepato-biliary and/or bilio-pancreatic duct, 4. Transitory, microcalculi which pass through Vater's Papilla by propulsion into duodenum with symptoms. DISCUSSION: Modern biliary surgery includes diagnosis of common bile duct calculi, and if possible preoperative endoscopic (endoluminal) surgery, which is less invasive for patients. If such approach is not possible, it is necessary to perform stone extraction and cholecystectomy. CONCLUSION: Common bile duct calculi represent a common disease of the digestive system. Endoscopic diagnostic procedure is very important in management of choledocholithiasis. Endoscopic treatment of common bile duct calculi prior to cholecystectomy is a method of choice and a strategy for associated cholecysto-choledocholithiasis.

Cholelithiasis↗

PubMedDate not supplied

[Role of intravenous cholangio-cholecystography in the diagnosis of asymptomatic choledocholithiasis].

INTRODUCTION: Standard diagnostic procedures (anamnesis, physical examination, laboratory analyses, ultrasound diagnosis), commonly used in diagnosis and preparation for surgical intervention of patients with cholelithiasis, are in most cases a reliable indicator for evaluation of the disease and conditions planned for surgery. DISCUSSION: In some cases by application of these narrow diagnostic models, some conditions, anatomic variations and biliary tract malformations remain unrecognized. Asymptomatic ("silent") choledocholithiasis (2.02%) represents a special diagnostic and therapeutic problem. CONCLUSION: Our extended diagnostic protocol includes routine intravenous cholangio-cholecystography as a standard diagnostic procedure for evaluation of cholecysto-choledocholithiasis prior planning cholecystectomy.

Cholangiography↗

PubMedDate not supplied

[Dyslipidemia and subclinical hypothyroidism].

INTRODUCTION: Subclinical hypothyroidism is defined as an increased serum TSH and normal serum FT4 concentration. In subclinical hypothyroidism, thyroid peroxidase and thyroglobulin antibodies are frequently present. Subclinical hypothyroidism may have endogenous or exogenous causes. The prevalence of subclinical hypothyroidism is rather high. The number of patients progressing to overt hypothyroidism may be higher. These patients may be asymptomatic, or have only mild symptoms or a single symptom. MATERIAL AND METHODS: We investigated 35 patients with subclinical hypothyroidism in order to establish the type and degree of dyslipidemia and effects of therapy with L-thyroxine (50 micrograms/d) during three months. RESULTS: Serum cholesterol, LDL-cholesterol and apo B were increased. A significant reduction of serum cholesterol, LDL-cholesterol and apo B concentrations was established during thyroid hormone replacement. DISCUSSION AND CONCLUSION: Only a few studies reported higher LDL and lower HDL-cholesterol values in subclinical hypothyroidism. Much interest was thus aroused to evaluate whether or not subclinical hypothyroidism is associated with hypercholesterolemia. Only patients with serum thyrotropin (TSH) concentration above 10 mU/L had a significant reduction of serum cholesterol concentration during thyroid hormone replacement. Most patients with subclinical hypothyroidism should be treated with thyroxine to prevent progression to overt hypothyroidism. Thyroid hormone replacement therapy may slow the progression of coronary heart disease, because of its beneficial effects on lipids. These findings and especially high rate of progression towards overt hypothyroidism suggest early thyroxine treatment.

Female↗

PubMedDate not supplied

[Case report: parathyroid gland adenoma].

INTRODUCTION: Primary hyperparathyroidism is a generalized disorder resulting from excessive secretion of parathyroid hormone involving one or more parathyroid glands. Both familial and sporadic forms exist. Histologic examination reveals parathyroid adenoma in about 90% of patients, although it is sometimes difficult to distinguish an adenoma from a normal gland. Primary hyperparathyroidism is commonly characterized by hypercalcemia, hypophosphatemia and excessive bone resorption. CASE REPORT: This is a case report of a 52-year old female patient with toxic thyroid adenoma and a parathyroid gland adenoma. The patient underwent partial thyroidectomy as a method of choice in treatment of toxic thyroid adenoma. Two years later, clinical hyperparathyroidism caused by an adenoma of parathyroid gland has manifested and was surgically removed. DISCUSSION AND CONCLUSION: In mild hypercalcemia, many patients are asymptomatic and this condition is frequently discovered accidentally during routine laboratory screening. In order to provide operative treatment efficiency in thyroid nodule cases, besides thyroid gland morphological diagnostics, it is necessary to perform a preoperative verification of parathyroid glands as well. This diagnostic approach is essential in identifying possible simultaneous occurrence of multiple diseases, such as: thyroid and adenoma of parathyroid gland, in order to diminish incorrect diagnostic estimates.

Adenoma↗

PubMedDate not supplied

[Total thyroidectomy in C-cell hyperplasia of the thyroid gland].

INTRODUCTION: Medullary thyroid carcinoma (MTC) is a neuroendocrine tumor of the thyroid parafollicular or C-cells. MTC accounts for approximately 3 to 5% of thyroid carcinomas. A characteristic feature of this tumor is production of calcitonin. Sporadic MTC accounts for 60-80% of all cases of the disease. The most common presentation of sporadic MTC is a solitary thyroid nodule, which occurs in 75 to 95% of patients. It typically occurs in the fifth or sixth decades, with slight female predominance. CASE REPORT: A case of a 58-year old woman with elevated basal calcitonin levels (221 pg/ml) has been presented. Preoperative ultrasound of the thyroid gland and body (99m)Tc DMSA scintigraphy showed a diffuse goiter. Hyperparathyroidism and pheochromocytoma were not present. Total thyroidectomy was performed. Only C-cell hyperplasia was found. DISCUSSION AND CONCLUSION: Many patients with elevated basal serum calcitonin level ranging between 150 and 1000 pg/ml, have only C-cell hyperplasia, but a few have small MTCs. For persons in known kindreds with familial MTC, prospective screening, using serum calcitonin measurement, can identify those at risk for the disease before MTC is clinically evident. Due to the possibility that any patient with MTC may have multiple endocrine neoplasia type 2 (MEN-2), preoperative testing must also include measurement of serum calcium (to rule out hyperparathyroidism) and a test for pheochromocytoma. Total thyroidectomy is indicated in patients with high levels of calcitonin.

Calcitonin↗

PubMedDate not supplied

[Lipid abnormalities in elderly patients with subclinical hyperthyroidism].

INTRODUCTION: Sensitive thyroid-stimulating hormone (TSH) assays provide identification of many patients with subclinical hyperthyroidism resulting from excessive production or excessive replacement of thyroid hormone. Subclinical hyperthyroidism is defined by a TSH below normal (suppressed) with normal serum T3 and T4 levels. Subclinical hyperthyroidism is the goal of thyroid hormone therapy in patients with thyroid cancer, solitary thyroid nodules, multinodular or diffuse goiters, or a history of head and neck irradiation. Benefits of TSH suppression in these patients, were thought to exceed the risks of subclinical hyperthyroidism. Subclinical hyperthyroidism also occurs in patients with thyroiditis and those with autoimmune thyroid disease. Other causes of TSH suppression, such as use of glucocorticoids, severe illness and pituitary dysfunction should be excluded. MATERIAL AND METHODS: This investigation included 55 elderly patients with subclinical hyperthyroidism in order to establish the type and degree of lipid abnormalities and effects of therapy with antithyroid drugs (methimazole 10 mg/day) during three months. These patients presented with no or minimal symptoms of thyroid hormone excess, but 56% of patients experienced atrial fibrillation and cardiac hypertrophy. RESULTS: Levels of serum cholesterol, LDL-cholesterol and HDL-cholesterol were decreased. We found a significant increase of serum cholesterol, LDL-cholesterol and HDL-cholesterol levels after treatment. DISCUSSION AND CONCLUSION: Subclinical hyperthyroidism in elderly individuals is difficult to diagnose because it may present only with cardiac manifestations including atrial fibrillation and cardiac hypertrophy. There is general agreement that measurement of serum TSH is the most sensitive indicator of thyroid hormone activity in its target tissues. Patients with subclinical hyperthyroidism tend to have low serum total cholesterol, LDL-cholesterol anf HDL-cholesterol levels. These values increase after treatment. Most patients with subclinical hyperthyroidism should be treated with antithyroid drugs to prevent cardiovascular complications and bone loss, particularly among postmenopausal women.

Aged↗

PubMedDate not supplied

[Oxidized LDL and C-reactive protein as markers for detection of accelerated atherosclerosis in type 2 diabetes].

INTRODUCTION High levels of inflammatory markers are associated with an increased risk for development of coronary heart disease (CHD). The aim of this study was to estimate relations between oxidized LDL (oxLDL), C-reactive protein (CRP) and conventional lipid risk factors for CHD in type 2 diabetics without coronary heart disease. MATERIAL AND METHODS Three groups of subjects were included in the study. 44 well-controlled type 2 diabetics (25 female/19 male; 54.50 +/- 6.54 years); FBG: 5.67 +/- 0.69: HbA1c: 6.5 +/- 1.6%) without clinical signs of CHD; the second group included 24 hypercholesterolemic healthy subjects (14 female/28 male; 51.30 +/- 5.76 years). The control group included 24 normocholesterolemic healthy subjects (17 female/12 male; 48.1 +/- 8.37 years). Lipid profiles were measured by enzymatic methods. OxLDL was measured by a commercially available sandwich ELISA (Mercodia AB, Uppsala, Sweden). Hs-CRP was measured by chemiluminiscence (Immulite-DPC) using Behring Latex hs-CRP assay. RESULTS Serum oxLDL levels were significantly higher in diabetic patients (p<0.05) and subjects with hypercholesterolemia (p<0.01) compared with control subjects. Levels of CRP were significantly increased in hypercholesterolemic subjects, compared with controls (p<0.01). Levels of CRP in diabetic patients also were significantly increased compared to those of controls (p<0.05). In type 2 diabetes oxLDL significantly correlated with CRP (r=0.657; p=0.0001), TG:HDL-C ratio (r=0.690; p=0.0001). In hypercholesterolemic subjects oxLDL significantly correlated with oxLDL:LDL ratio (r=0.788, p=0.0001) but not with CRP. In controls, oxLDL significantly correlated with oxLDL:LDL ratio (r=0.679; p=0.0001, and CRP (r=0.802; p=0.0001). CONCLUSION It is of great importance to identify type 2 diabetics and hypercholesterolemic healthy subjects with high levels of oxLDL and CRP, because they are at increased risk for development of accelerated atherosclerosis.

Atherosclerosis↗