- Email: [email protected]
Birds of the same feather flock together
Abstracts
P = 0.040). Conclusions: These findings suggest that yoga may be an effective treatment for sexual dysfunction in women with MS as well as for metabolic risk factors. doi:10.1016/j.ejim.2013.08.261
ID: 43 Obesity and insulin resistance in patients with non-alcoholic fatty liver disease diagnosed by non invasive diagnostic methods T. Novakovica, LJ. Jovicevicb, Z. Mirkovica, B.I. Kosticc, S. Milinica a
OF
Department of Internal Medicine, Medical Faculty Pristina/Kosovska Mitrovica, University of Pristina, Kosovska Mitrovica, Serbia b Department of Epidemiology, Health Centre, Bar, Montenegro c Department of Internal Medicine, Health Centre, Gracanica, Serbia
Objectives: The insulin resistance is the common factor connecting obesity, diabetes, hypertension and dyslipidemia with fatty liver. The aim of this study was to analyze incidence obesity and insulin resistance in patients with fatty liver. Material and methods: The study included 130 examinees, 72 of them had fatty liver diagnosed by non-invasive diagnostic methods and they made a study group. A control group was made of 58 persons with normal weight and without finding that refers to fatty liver. Alcohol intake was assessed by a questionnaire. Regular biochemical analyses were done by usual laboratory procedure. Measuring the level of insulin was done to all examinees while their stomachs were empty. Furthermore, insulin resistance was assessed by using the HOMA-index, as well as biochemical tests and abdominal ultrasonography. Results: In the study group, fatty liver was demonstrated by ultrasound in 72 (55.38%) subjects and in the control group there were 58 respondents (44.62%) without pathological findings of ultrasound and with the level of p b 0.001. The values of BMI (34.56 ± 6.05 kg/m2 vs 24.47 ± 3.51 kg/m2; p b 0.001), waist circumference (110.13 ± 11.22 vs 88.63 ± 10.32 cm; p b 0.001), level of glucose (6.23 ± 0.95 vs 4.82 ± 0.38 mmol/l; p b 0.00), level of insulin (16.56 ± 3.89 vs 7.37 ± 2.30 mU/I; p b 0.001) and HOMA-IR (4.16 ± 1.20 vs 1.6 ± 0.65; p b 0.001) were significantly higher. Conclusions: These results confirm that obesity and insulin resistance are associated with fatty liver infiltration.
EC
TE
DP
before), was attended in our hospital because of 3-week clinical profile of asthenia, acute confusional syndrome, myalgia and muscles cramps and fasciculations. This clinical picture started shortly after increasing dose of atorvastatine 40 to 80 mg/day later on the refered ictus, and after associating sitagliptin with metformin because of poor glycemic control. The physical examination evidenced muscles fasciculations. The laboratory investigations showed: urea of 49.3 mg/dL; creatinine 1.45 mg/dL; sodium 145.2 mg/dL; potassium 3.3 mg/dL; calcium 4.9 mg/dL; P 5.1 mg/dL; magnesium 0.9 mg/dL; creatin phosphokinase (CK) 1253 IU/L; lactic dehydrogenase (LDH) 352 mg/dL; total proteins 6.6 mg/dL; albumin 2.6 mg/dL; uric acid 9.2 mg/dL; and D-vitamin 43.0 ng/mL. 24-hour test: normal. Anti-nuclear antibodies were negative; HIV serology was negative as well; TSH and PTH values were normal. The patient was treated at first with calcium 10% gluconate (iv) and oral lactate magnesium (60 mg/day). When we got calcemia levels aroud 8–9 mg/dL, treatment with oral calcium carbonate (3 g/day) was continued. Clinical and analytical improvements were observed seven days after the treatment with sitagliptin and atorvastatin was interrupted, and calcium, magnesium, uric acid, CK and LDH levels got back to the normality. By contrast, kidney function has not completely recovered and serum creatinine values around 1.3 mg/dL persist. To date, the patient is treated with atorvastatin (40 mg/day) and metformin and glargine insulin. Conclusions: Rhabdomyolysis is a well documented complication in treatments with statins, mainly when high doses are used. Nevertheless, the association between sitagliptin and myopathy is excepcional, and we have only found one previous case in the international literature review (MEDLINE database and EMBASE). It is supposed that sitagliptin is nephrotoxic and that statin renal excretion is reduced because it. We cannot allow that the clinical profile is entirely caused by sitagliptin, because of the fact that the patient was treated with full-dose atorvastatin from some weeks before, as well as sitagliptin. In any case, we should remember that rhabdomyolysis and acute kidney failure can happen when statin doses are increased, mainly if the patient is treated with sitagliptin at the same time. In all this cases clinical and analytical monitoring to rule out myopathy should be done.
RO
e104
doi:10.1016/j.ejim.2013.08.260
RR
ID: 25 Effects of yoga on sexual function in women with metabolic syndrome H-N Kim, K-S Kim, S-W Kim
CO
Department of Family Medicine, St. Vincent Hospital, College of Medicine, The Catholic University of Korea, Suwon, South Korea
UN
Objective: Female sexual dysfunction is an important public health issue; it has a high global prevalence, but no effective and safe treatment options. The prevalence of sexual dysfunction is higher in women with metabolic syndrome (MS) than in the general population. We investigated the efficacy of yoga as a treatment for sexual dysfunction in women with MS. Methods: In this randomized, controlled study, 41 women with MS were assigned to a 12-week yoga exercise group (n = 20) or a wait-listed control group (n = 21). Outcome measures were changes in total and individual domain scores on the Female Sexual Function Index. Results: The 12-week yoga intervention resulted in significant improvement in arousal (0.74 ± 1.18 vs. 0.16 ± 0.82, respectively; P = 0.042) and lubrication (0.72 ± 1.12 vs. 0.06 ± 0.87, respectively; P = 0.008) compared with the control group. Systolic blood pressure showed significantly greater improvement in the yoga exercise group than in the control group at the 12-week follow up (−3.5 ± 13.7 vs. 2.0 ± 14.7, respectively;
doi:10.1016/j.ejim.2013.08.262
ID: 69 Birds of the same feather flock together H. Vieira Dias, B. Pedro, F. Roque Medicine 3, Hospital de Santarem EPE, Santarem, Portugal
Objective: Autoimmune polyendocrine syndromes (APS) are rare polyendocrinopathies, characterized by the coexistence of immunologically mediated disease in endocrine glands, which may be associated with other endocrine autoimmune diseases. There are four types: I, II, III and IV. The type III APS is characterized by the absence of adrenal involvement. The authors present two clinical cases of type III APS with different organ envolvement. Material and methods: Case 1: A 76 year old woman with diabetes diagnosed 15 years ago developed progressively thyroiditis, myasthenia gravis and pernicious anemia. The immunology study showed positive antithyroid peroxidase antibodies (anti-TPO antibodies), thyrotropin receptor antibodies (TRAbs) and thyroglobulin antibodies; parietal
Abstracts
cell antibody and intrinsic factor antibody were positive as well as antiacetylcholine receptor (AChR); Islet cell antibodies (ICA) and anti Glutamic acid decarboxylase (GAD2); the diagnose of latent autoimmune diabetes in adult (LADA) was then made. Case 2: A 65 old woman with thyroiditis diagnosed 10 years ago, who developed iron deficiency anemia with no other symptom. In the investigation positive antibodies anti-gliadin IgG and IgA and anti transglutaminase IgA were found and celiac disease was diagnosed. Conclusion: In recent years the study of APS has received a great impulse thanks to improved knowledge of autoimmune diseases and their natural history. This has allowed identifying patients with APS in the potential or subclinical phase and starting an early adequate treatment. The authors review the literature apropos of these cases.
Objective: Brown tumors are unusual but serious complications of renal osteodystrophy. Methods: Our study is retrospective and included 12 cases of secondary hyperparathyroidism (HPT) associated with brown tumors. Results: The patients were 4 males and 8 females with a mean age of 39.92 years (range from 19 to 61 years). The renal diagnosis was nephroangiosclerosis in 4 cases, interstitial renal involvement in 5 cases, glomerular renal involvement in one case and undetermined in two cases. All patients but one were undergoing chronic haemodialysis. All patients suffered of bone pain and bone deformation was observed in seven cases. The biological serum mean data were the following: calcium = 2.33 mmol/l (range 2–2.77), phosphate = 2.12 mmol/l (range 1.16–3.26), bone alkaline phosphates = 1527 IU/l (range 568– 2880), and intact PTH = 1771 pg/ml (range 682–3687). All patients have brown tumors with mandibular bone involvement in two cases, maxillary bone involvement in 3 cases, long bones involvement in 3 cases and multiple bone involvement in 3 cases. Histopathologic examination performed in two cases demonstrated a giant cell tumor. We performed partial parathyroidectomy successfully in all patients but one who needed a repeated surgical resection. A progressive decrease in the size of the brown tumor was observed in almost all cases. A surgical resection of a mandibular and maxillary brown tumor was performed in 2 cases. Conclusion: Our serie is one of the greatest study reported in the literature, that lies on the rarity of the disease. The most useful treatment for these patients is surgical therapy for secondary HPT and sometimes a surgical excision of bone lesions is necessary.
ID: 90 Idiopathic hypoparathyroidism: A rare cause of hypocalcemia J Marti, B Lasa, L Sarasola Internal Medicine, Hospital Zumarraga, Guipuzkoa, Spain
DP
Introduction: Idiopathic hypoparathyroidism (IHP) is a rare condition (incidence of approximately 0.02%) which can occur as an isolated disorder or as an autoimmune condition. The onset of IHP may be at any age and it is present lifelong. We report a case of idiopathic hypoparathyroidism. Case: A 47 year-old woman, without past medical history, was admitted because of paresthesias in hands, fatigue, weakness, muscle aches and cramps affecting arms and shoulders. Physical examination discards abnormalities. Laboratory tests: normal blood cell count, calcium 5.9 mg/dl, phosphorus 5.58 mg/dl, and magnesium 1.8 mg/dl. Albumin 4.2 g/dl, alkaline phosphate 72 U/L, ALAT 45 U/L, ASAT 22 U/L, BUN 27 mg/dl, pH 7.45, bicarbonate 22 mEq/L, PTH 3.7 pg/ml, D3-vitamine 17 ng/ml, and calcitonin b4. Thyroid and adrenal functions were normal. IgA antibodies to gliadin and transglutaminase, TPO-Ab, autoantibodies to cytoplasmic parathyroid cells, parietal cells and 21-hidroxilasa were negative. Full body CT was normal. Treatment with calcium carbonate 2 g tid and calcitriol 0.75 mg once-a-day was started. Follow-up: Our patient actually is asymptomatic with normal calcium level but with low PTH (2.2 pg/ml), being treated nowadays with calcium carbonate 1 g tid and calcitriol 0.75 ng once-a-day. Discussion: IHP is an uncommon condition characterized by the absence of fatty replacement or atrophy of parathyroid glands. It may be familial or sporadic. The Characteristics and biochemical features of IHP include hypocalcaemia, hypophosphatemia and normal alkaline phosphatase. Autoantibodies of cytoplasmic parathyroid tissue are found in 30–70% of patients with IHP. Treatment target is to restore calcium levels. For maintenance and prevention of hypocalcaemia, patients with hypoparathyroidism are treated lifelong with calcium supplements and ergocalciferol or vitamin D-2 (calciferol) to stimulate absorption of calcium and phosphate in the small intestine. A high-calcium and lowphosphorus diet is recommended.
RO
OF
doi:10.1016/j.ejim.2013.08.263
e105
doi:10.1016/j.ejim.2013.08.265
TE
ID: 103 Eco-guided fine needle aspiration of the thyroid by internist. Income assistance L. Mérida-Rodrigoa, A. Muñoz-Morentea, F. Martos-Pereza, J. García-Alegríab a
UN
CO
RR
EC
Internal Medicine, High resolution especialities hospital, Benalmádena, Málaga, Spain b Internal Medicine, Costa del Sol Hospital, Marbella, Málaga, Spain
doi:10.1016/j.ejim.2013.08.264
ID: 99 Brown tumors in secondary hyperparathyroidism: A clinical study of 12 cases N. Mchirgui, S. Barbouch, K. Ben Abdelghani, F. Jaziri, K. Khiari, A. Khedher Internal Medicine A, Charles Nicolle Hospital, Tunis, Tunisia
Objectives: The aim of the study is knowing the results of ecoguided fine needle aspiration of the thyroid by internists and effectiveness in performing this technique on a high-performance query. Methods: Prospective descriptive study. Data collection: January 2012–April 2012. Inclusion criteria: nodules with normal or elevated TSH (if cold nodule suppressed TSH), nodule N5 mm if history of malignancy, microcalcifications (nodule N 1 cm), solid (hypoechoic N 1 cm, iso or hyperechoic N 1.5 cm) and solid–cystic 1–1.5 cm. Be analyzed: nodules characteristics, FNA results, percentage of success in a single act, pathological anatomy results, monitoring and incidentalomas. Fast staining was verified by the presence or absence of material for histological examination. Chi-square was performed and Student's t-test after checking normality. It was considered as statistically significant p b 0.05. Results: We analyzed 61 nodules with FNA criteria. The patient mean age was 41 years, SD (+/−13 years). 86% was women. The causes nodule detection were: 53% perception of the patient, 36% incidentalomas, and 11% altered thyroid hormones. The average size was 23 mm (+/−9 mm). It was necesary eco-guided FNA to obtain material. 75% of the cases (n = 45) required a single FNA to obtain a cytological diagnosis. 14% (n = 9) required two FNA for a diagnosis. 8% (n = 5) took 3 FNA and 3% (n = 2) needed five FNA. Single act was performed in 19 (31%) FNA material obtained in 17 cases (89%). The characteristics were 55% solids, 33% solid–cystic and 4% cystic, and microcalcifications present in 8%. 46% (n = 28) was PAAF compatible with goiter, 33% (n = 20) supports folicular proliferation.
P = 0.040). Conclusions: These findings suggest that yoga may be an effective treatment for sexual dysfunction in women with MS as well as for metabolic risk factors. doi:10.1016/j.ejim.2013.08.261
ID: 43 Obesity and insulin resistance in patients with non-alcoholic fatty liver disease diagnosed by non invasive diagnostic methods T. Novakovica, LJ. Jovicevicb, Z. Mirkovica, B.I. Kosticc, S. Milinica a
OF
Department of Internal Medicine, Medical Faculty Pristina/Kosovska Mitrovica, University of Pristina, Kosovska Mitrovica, Serbia b Department of Epidemiology, Health Centre, Bar, Montenegro c Department of Internal Medicine, Health Centre, Gracanica, Serbia
Objectives: The insulin resistance is the common factor connecting obesity, diabetes, hypertension and dyslipidemia with fatty liver. The aim of this study was to analyze incidence obesity and insulin resistance in patients with fatty liver. Material and methods: The study included 130 examinees, 72 of them had fatty liver diagnosed by non-invasive diagnostic methods and they made a study group. A control group was made of 58 persons with normal weight and without finding that refers to fatty liver. Alcohol intake was assessed by a questionnaire. Regular biochemical analyses were done by usual laboratory procedure. Measuring the level of insulin was done to all examinees while their stomachs were empty. Furthermore, insulin resistance was assessed by using the HOMA-index, as well as biochemical tests and abdominal ultrasonography. Results: In the study group, fatty liver was demonstrated by ultrasound in 72 (55.38%) subjects and in the control group there were 58 respondents (44.62%) without pathological findings of ultrasound and with the level of p b 0.001. The values of BMI (34.56 ± 6.05 kg/m2 vs 24.47 ± 3.51 kg/m2; p b 0.001), waist circumference (110.13 ± 11.22 vs 88.63 ± 10.32 cm; p b 0.001), level of glucose (6.23 ± 0.95 vs 4.82 ± 0.38 mmol/l; p b 0.00), level of insulin (16.56 ± 3.89 vs 7.37 ± 2.30 mU/I; p b 0.001) and HOMA-IR (4.16 ± 1.20 vs 1.6 ± 0.65; p b 0.001) were significantly higher. Conclusions: These results confirm that obesity and insulin resistance are associated with fatty liver infiltration.
EC
TE
DP
before), was attended in our hospital because of 3-week clinical profile of asthenia, acute confusional syndrome, myalgia and muscles cramps and fasciculations. This clinical picture started shortly after increasing dose of atorvastatine 40 to 80 mg/day later on the refered ictus, and after associating sitagliptin with metformin because of poor glycemic control. The physical examination evidenced muscles fasciculations. The laboratory investigations showed: urea of 49.3 mg/dL; creatinine 1.45 mg/dL; sodium 145.2 mg/dL; potassium 3.3 mg/dL; calcium 4.9 mg/dL; P 5.1 mg/dL; magnesium 0.9 mg/dL; creatin phosphokinase (CK) 1253 IU/L; lactic dehydrogenase (LDH) 352 mg/dL; total proteins 6.6 mg/dL; albumin 2.6 mg/dL; uric acid 9.2 mg/dL; and D-vitamin 43.0 ng/mL. 24-hour test: normal. Anti-nuclear antibodies were negative; HIV serology was negative as well; TSH and PTH values were normal. The patient was treated at first with calcium 10% gluconate (iv) and oral lactate magnesium (60 mg/day). When we got calcemia levels aroud 8–9 mg/dL, treatment with oral calcium carbonate (3 g/day) was continued. Clinical and analytical improvements were observed seven days after the treatment with sitagliptin and atorvastatin was interrupted, and calcium, magnesium, uric acid, CK and LDH levels got back to the normality. By contrast, kidney function has not completely recovered and serum creatinine values around 1.3 mg/dL persist. To date, the patient is treated with atorvastatin (40 mg/day) and metformin and glargine insulin. Conclusions: Rhabdomyolysis is a well documented complication in treatments with statins, mainly when high doses are used. Nevertheless, the association between sitagliptin and myopathy is excepcional, and we have only found one previous case in the international literature review (MEDLINE database and EMBASE). It is supposed that sitagliptin is nephrotoxic and that statin renal excretion is reduced because it. We cannot allow that the clinical profile is entirely caused by sitagliptin, because of the fact that the patient was treated with full-dose atorvastatin from some weeks before, as well as sitagliptin. In any case, we should remember that rhabdomyolysis and acute kidney failure can happen when statin doses are increased, mainly if the patient is treated with sitagliptin at the same time. In all this cases clinical and analytical monitoring to rule out myopathy should be done.
RO
e104
doi:10.1016/j.ejim.2013.08.260
RR
ID: 25 Effects of yoga on sexual function in women with metabolic syndrome H-N Kim, K-S Kim, S-W Kim
CO
Department of Family Medicine, St. Vincent Hospital, College of Medicine, The Catholic University of Korea, Suwon, South Korea
UN
Objective: Female sexual dysfunction is an important public health issue; it has a high global prevalence, but no effective and safe treatment options. The prevalence of sexual dysfunction is higher in women with metabolic syndrome (MS) than in the general population. We investigated the efficacy of yoga as a treatment for sexual dysfunction in women with MS. Methods: In this randomized, controlled study, 41 women with MS were assigned to a 12-week yoga exercise group (n = 20) or a wait-listed control group (n = 21). Outcome measures were changes in total and individual domain scores on the Female Sexual Function Index. Results: The 12-week yoga intervention resulted in significant improvement in arousal (0.74 ± 1.18 vs. 0.16 ± 0.82, respectively; P = 0.042) and lubrication (0.72 ± 1.12 vs. 0.06 ± 0.87, respectively; P = 0.008) compared with the control group. Systolic blood pressure showed significantly greater improvement in the yoga exercise group than in the control group at the 12-week follow up (−3.5 ± 13.7 vs. 2.0 ± 14.7, respectively;
doi:10.1016/j.ejim.2013.08.262
ID: 69 Birds of the same feather flock together H. Vieira Dias, B. Pedro, F. Roque Medicine 3, Hospital de Santarem EPE, Santarem, Portugal
Objective: Autoimmune polyendocrine syndromes (APS) are rare polyendocrinopathies, characterized by the coexistence of immunologically mediated disease in endocrine glands, which may be associated with other endocrine autoimmune diseases. There are four types: I, II, III and IV. The type III APS is characterized by the absence of adrenal involvement. The authors present two clinical cases of type III APS with different organ envolvement. Material and methods: Case 1: A 76 year old woman with diabetes diagnosed 15 years ago developed progressively thyroiditis, myasthenia gravis and pernicious anemia. The immunology study showed positive antithyroid peroxidase antibodies (anti-TPO antibodies), thyrotropin receptor antibodies (TRAbs) and thyroglobulin antibodies; parietal
Abstracts
cell antibody and intrinsic factor antibody were positive as well as antiacetylcholine receptor (AChR); Islet cell antibodies (ICA) and anti Glutamic acid decarboxylase (GAD2); the diagnose of latent autoimmune diabetes in adult (LADA) was then made. Case 2: A 65 old woman with thyroiditis diagnosed 10 years ago, who developed iron deficiency anemia with no other symptom. In the investigation positive antibodies anti-gliadin IgG and IgA and anti transglutaminase IgA were found and celiac disease was diagnosed. Conclusion: In recent years the study of APS has received a great impulse thanks to improved knowledge of autoimmune diseases and their natural history. This has allowed identifying patients with APS in the potential or subclinical phase and starting an early adequate treatment. The authors review the literature apropos of these cases.
Objective: Brown tumors are unusual but serious complications of renal osteodystrophy. Methods: Our study is retrospective and included 12 cases of secondary hyperparathyroidism (HPT) associated with brown tumors. Results: The patients were 4 males and 8 females with a mean age of 39.92 years (range from 19 to 61 years). The renal diagnosis was nephroangiosclerosis in 4 cases, interstitial renal involvement in 5 cases, glomerular renal involvement in one case and undetermined in two cases. All patients but one were undergoing chronic haemodialysis. All patients suffered of bone pain and bone deformation was observed in seven cases. The biological serum mean data were the following: calcium = 2.33 mmol/l (range 2–2.77), phosphate = 2.12 mmol/l (range 1.16–3.26), bone alkaline phosphates = 1527 IU/l (range 568– 2880), and intact PTH = 1771 pg/ml (range 682–3687). All patients have brown tumors with mandibular bone involvement in two cases, maxillary bone involvement in 3 cases, long bones involvement in 3 cases and multiple bone involvement in 3 cases. Histopathologic examination performed in two cases demonstrated a giant cell tumor. We performed partial parathyroidectomy successfully in all patients but one who needed a repeated surgical resection. A progressive decrease in the size of the brown tumor was observed in almost all cases. A surgical resection of a mandibular and maxillary brown tumor was performed in 2 cases. Conclusion: Our serie is one of the greatest study reported in the literature, that lies on the rarity of the disease. The most useful treatment for these patients is surgical therapy for secondary HPT and sometimes a surgical excision of bone lesions is necessary.
ID: 90 Idiopathic hypoparathyroidism: A rare cause of hypocalcemia J Marti, B Lasa, L Sarasola Internal Medicine, Hospital Zumarraga, Guipuzkoa, Spain
DP
Introduction: Idiopathic hypoparathyroidism (IHP) is a rare condition (incidence of approximately 0.02%) which can occur as an isolated disorder or as an autoimmune condition. The onset of IHP may be at any age and it is present lifelong. We report a case of idiopathic hypoparathyroidism. Case: A 47 year-old woman, without past medical history, was admitted because of paresthesias in hands, fatigue, weakness, muscle aches and cramps affecting arms and shoulders. Physical examination discards abnormalities. Laboratory tests: normal blood cell count, calcium 5.9 mg/dl, phosphorus 5.58 mg/dl, and magnesium 1.8 mg/dl. Albumin 4.2 g/dl, alkaline phosphate 72 U/L, ALAT 45 U/L, ASAT 22 U/L, BUN 27 mg/dl, pH 7.45, bicarbonate 22 mEq/L, PTH 3.7 pg/ml, D3-vitamine 17 ng/ml, and calcitonin b4. Thyroid and adrenal functions were normal. IgA antibodies to gliadin and transglutaminase, TPO-Ab, autoantibodies to cytoplasmic parathyroid cells, parietal cells and 21-hidroxilasa were negative. Full body CT was normal. Treatment with calcium carbonate 2 g tid and calcitriol 0.75 mg once-a-day was started. Follow-up: Our patient actually is asymptomatic with normal calcium level but with low PTH (2.2 pg/ml), being treated nowadays with calcium carbonate 1 g tid and calcitriol 0.75 ng once-a-day. Discussion: IHP is an uncommon condition characterized by the absence of fatty replacement or atrophy of parathyroid glands. It may be familial or sporadic. The Characteristics and biochemical features of IHP include hypocalcaemia, hypophosphatemia and normal alkaline phosphatase. Autoantibodies of cytoplasmic parathyroid tissue are found in 30–70% of patients with IHP. Treatment target is to restore calcium levels. For maintenance and prevention of hypocalcaemia, patients with hypoparathyroidism are treated lifelong with calcium supplements and ergocalciferol or vitamin D-2 (calciferol) to stimulate absorption of calcium and phosphate in the small intestine. A high-calcium and lowphosphorus diet is recommended.
RO
OF
doi:10.1016/j.ejim.2013.08.263
e105
doi:10.1016/j.ejim.2013.08.265
TE
ID: 103 Eco-guided fine needle aspiration of the thyroid by internist. Income assistance L. Mérida-Rodrigoa, A. Muñoz-Morentea, F. Martos-Pereza, J. García-Alegríab a
UN
CO
RR
EC
Internal Medicine, High resolution especialities hospital, Benalmádena, Málaga, Spain b Internal Medicine, Costa del Sol Hospital, Marbella, Málaga, Spain
doi:10.1016/j.ejim.2013.08.264
ID: 99 Brown tumors in secondary hyperparathyroidism: A clinical study of 12 cases N. Mchirgui, S. Barbouch, K. Ben Abdelghani, F. Jaziri, K. Khiari, A. Khedher Internal Medicine A, Charles Nicolle Hospital, Tunis, Tunisia
Objectives: The aim of the study is knowing the results of ecoguided fine needle aspiration of the thyroid by internists and effectiveness in performing this technique on a high-performance query. Methods: Prospective descriptive study. Data collection: January 2012–April 2012. Inclusion criteria: nodules with normal or elevated TSH (if cold nodule suppressed TSH), nodule N5 mm if history of malignancy, microcalcifications (nodule N 1 cm), solid (hypoechoic N 1 cm, iso or hyperechoic N 1.5 cm) and solid–cystic 1–1.5 cm. Be analyzed: nodules characteristics, FNA results, percentage of success in a single act, pathological anatomy results, monitoring and incidentalomas. Fast staining was verified by the presence or absence of material for histological examination. Chi-square was performed and Student's t-test after checking normality. It was considered as statistically significant p b 0.05. Results: We analyzed 61 nodules with FNA criteria. The patient mean age was 41 years, SD (+/−13 years). 86% was women. The causes nodule detection were: 53% perception of the patient, 36% incidentalomas, and 11% altered thyroid hormones. The average size was 23 mm (+/−9 mm). It was necesary eco-guided FNA to obtain material. 75% of the cases (n = 45) required a single FNA to obtain a cytological diagnosis. 14% (n = 9) required two FNA for a diagnosis. 8% (n = 5) took 3 FNA and 3% (n = 2) needed five FNA. Single act was performed in 19 (31%) FNA material obtained in 17 cases (89%). The characteristics were 55% solids, 33% solid–cystic and 4% cystic, and microcalcifications present in 8%. 46% (n = 28) was PAAF compatible with goiter, 33% (n = 20) supports folicular proliferation.