Kazuistika popisuje náhodně diagnostikovaný medulární karcinom štítné žlázy s familiárním výskytem a poukazuje na význam vyšetření kalcitoninemie u sonograficky podezřelých uzlů.
The case report describes a randomly diagnosed medullary thyroid carcinoma with familial occurrence and points to the importance of serum calcitonin examination in ultrasonically suspected nodes.
- MeSH
- dospělí MeSH
- genetická predispozice k nemoci epidemiologie MeSH
- genetické testování MeSH
- kalcitonin krev MeSH
- lidé MeSH
- lymfadenektomie metody MeSH
- medulární karcinom diagnostické zobrazování genetika chirurgie MeSH
- nádory štítné žlázy genetika chirurgie patologie MeSH
- thyroxin aplikace a dávkování MeSH
- tyreoidektomie MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
Whether nerve fiber loss, a prominent feature of advanced diabetic neuropathy, can be reversed by reestablishment of normal glucose control remains questionable. We present 8-year follow-up data on epidermal nerve fiber (ENF) density and neurological function in patients with type 1 diabetes after simultaneous pancreas and kidney transplantation (SPK) with long-term normoglycemia. Distal thigh skin biopsies with ENF counts, vibration perception thresholds (VPTs), autonomic function testing (AFT) and electrophysiological examinations were performed at time of SPK and 2.5 and 8 years after SPK in 12 patients with type 1 diabetes. In comparison to controls, baseline ENF density, VPT and AFT results of patients indicated severe neuropathy. At follow-up, all SPK recipients were insulin independent with excellent glycemic control and kidney graft function; however, the severe ENF depletion present at baseline had not improved, with total ENF absence in 11 patients at 8-year follow-up. Similarly, no amelioration occurred in the VPT and AFT results. Numerical improvement was seen in some electrophysiological parameters; however, statistical significance was achieved only in median motor nerve conduction velocity. ENF loss and functional deficits in advanced diabetic peripheral neuropathy are rarely reversible, even by long-term normoglycemia, which underscores the importance of neuropathy prevention by early optimal glycemic control.
- MeSH
- diabetes mellitus 1. typu chirurgie MeSH
- diabetické nefropatie etiologie patologie MeSH
- hodnoty glomerulární filtrace MeSH
- kůže inervace patologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- následné studie MeSH
- nervová vlákna patologie MeSH
- pooperační komplikace MeSH
- přežívání štěpu MeSH
- prognóza MeSH
- rejekce štěpu etiologie patologie MeSH
- rizikové faktory MeSH
- transplantace ledvin škodlivé účinky MeSH
- transplantace slinivky břišní škodlivé účinky MeSH
- vyšetření funkce ledvin MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
Two different methods of graft venous drainage are used in pancreas transplantation: portal (PVD) and systemic (SVD). PVD is considered to be more physiologic due to its similarity to venous outflow of the native pancreas. The aim of our study was to compare glucose metabolism in Type 1 diabetic recipients of kidney and pancreatic grafts with PVD versus SVD by intravenous glucose tolerance test (IVGTT). We examined 28 insulin-independent patients after simultaneous pancreas and kidney transplantation: 14 recipients with PVD of the pancreatic graft and 14 with SVD after a mean post-transplant period of 1 year. All recipients had stable good function of the kidney graft. Fasting glycemia, insulin levels, glycosylated hemoglobin (HbA1c), and standard IVGTT with coefficient of glucose assimilation (KG) calculation were assessed. Insulin sensitivity and production were evaluated using the homeostasis model assessment (homeostasis model assessment of insulin resistance [HOMA-IR], homeostasis model assessment of B-cell function [HOMA-B]). Total C-peptide and insulin secretions were calculated as areas under the curves (AUCs) from the serum levels during the IVGTT. PVD and SVD groups did not differ in age, body mass index (BMI) and duration of post-transplantation period (P ≥ .05). We did not find any significant difference in fasting glycemia, HbA1c, KG, HOMA-IR, parameters of C-peptide level, fasting insulin level, and response during IVGTT. HOMA-B and AUC of insulin level were higher in the SVD group (45.1 ± 35.1 versus 19.8 ± 15.5, P =.03 and 1075 ± 612 versus 1799 ± 954 mIU/L/60 minutes, P < .03, respectively). In the PVD group, 1 patient had an abnormal response to the glucose stimulus, 8 patients had an impaired glucose tolerance, and 5 patients had a normal glucose tolerance. In the SVD group, an abnormal response was present in none, impaired glucose tolerance in 4, and normal glucose tolerance in 10 recipients. Athough this was not a prospectively randomized trial, we conclude that the change of surgical technique from SVD to PVD did not lead to any substantial change in terms of glucose tolerance.
- MeSH
- C-peptid krev MeSH
- diabetes mellitus 1. typu metabolismus MeSH
- dospělí MeSH
- glukosa metabolismus MeSH
- glukózový toleranční test MeSH
- glykovaný hemoglobin analýza MeSH
- homeostáza MeSH
- inzulin krev MeSH
- lidé středního věku MeSH
- lidé MeSH
- regulační B-lymfocyty imunologie MeSH
- transplantace ledvin * MeSH
- transplantace slinivky břišní * MeSH
- vena portae MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
