The coexistence of hyperparathyroidism complicating thyrotoxicosis is quite rare. We report the case of one patient who presented with thyrotoxicosis, (total thyroxine of 15.1 micrograms/dl (5-13), free thyroxine index of 18 (4-15) and triiodothyronine by RIA of 305 ng/dl (70-230) and asymptomatic hypercalcemia of 15 mg/dl (8.5-10.6), who was also initially noted to have an elevated (C-terminal) serum immunoreactive parathyroid hormone (iPTH) level of 8,800 pg/ml (50-340). With propylthiouracil and propranolol, however, this patient became normocalcemic with a decrease in iPTH values to 714 pg/ml. As the patient was tapered from medication, after being rendered euthyroid, a recurrence of hypercalcemia with rising iPTH levels occurred. PTH levels should be helpful in defining coexisting hyperparathyroidism in patients with thyrotoxicosis since in the latter iPTH is usually suppressed. Our findings support the recommendation that in patients suspected of having both hyperparathyroidism and hyperthyroidism, a diagnosis of the former can only be made with certainty after the patient has been rendered euthyroid with persistently elevated serum calcium and iPTH levels. While there are no clinical features which permit the easy identification of patients who present with dual lesions, the determination of iPTH values may be the most consistently helpful test initially, whereas other parameters such as vitamin D, serum phosphate are less reliable.
BACKGROUND: In accordance with the current regulations, preclinical evaluation of the effectiveness of plasma substitutes for acute blood loss is carried out mainly on large laboratory animals (dogs, pigs) using a wide range of methods for assessing the structural and functional state of organs and systems of a biological object. It requires large expenditure of material resources and time, which is impractical at the stage of screening the effectiveness of newly developed infusion agents. In this regard, an urgent task is to develop a standardized model of acute blood loss on small laboratory animals for screening evaluation of the specific activity of infusion solutions with a subsequent research involving large laboratory animals. It is advisable to use laboratory rats as a biological object as they are the most suitable of the group of small laboratory animals for similarity of physiological laboratory indicators with humans. AIM: To develop a model of acute blood loss using small laboratory animals for screening evaluation of specific infusion solution activity. MATERIALS AND METHODS: Experiments were carried out on rats of the Vistar line with a weight of 330 41 g. The animals were divided into 3 groups: 1 experimental (20 individuals with acute blood loss simulation without treatment), 2 experimental (20 individuals with acute blood loss simulation and its replacement with Rheopolyglucin), intact (10 individuals without modeling of blood loss). The study design included: general anesthesia (intramuscular injection Zoletil 100 and Xylazin 2% in a ratio of 1 : 5 at the rate of 0.01 ml/kg of weight), catheterization of the femoral artery followed by controlled hardware exfusion of blood at a rate of 0.5 ml/min until the establishment of persistent (for 2 minutes) arterial hypotension; hardware synchronous monitoring of mean arterial pressure (MAP) (by direct tonometry through the contralateral femoral artery); calculation of the percentage of blood loss from the estimated circulating blood volume (CBV) equal to 5% of the animals weight; heart rate (HR) (by electrocardiogram) during the first three hours after blood exfusion. In its capacity as a test drug Rheopolyglucin, which was administered through an arterial femoral catheter immediately after blood exfusion in volume and speed, equal to volume and speed of exfusion, was used. Additionally, for a comprehensive assessment of the mechanisms of maintaining hemodynamic parameters individual dynamic calculated indicators for each individual are proposed: the reduced shock volume of blood and the infusion efficiency indicator. RESULTS: All rats in the experimental group died, 25% of which 1720 minutes after blood exfusion, 75% in range from 45 to 90 minutes. Rheopoliglyukin infusion reduced the death of animals by up to 35% and delayed the average death time to 4555 minutes. A single exfusion of blood in rats resulted in loss of 79 ml of blood (4651% of circulating blood volume), which was accompanied by a decrease in mean arterial pressure and heart rate. Compensation for the decrease in circulating blood volume, including due to infusion, was manifested by an increase in these indicators. A sign of inefficiency of compensation was a slight increase of mean arterial pressure with dynamically increasing heart rate. It is proved that an increase in the values of calculated indicators (the given stroke volume of blood and the infusion efficiency indicator) are benchmarks for effective compensation of hemodynamic disorders, including as a result of infusion of hemodynamic drugs. CONCLUSIONS: The acute blood loss model with the calculation of the reduced shock volume of blood and the infusion efficiency index is advisable to use to assess the specific activity of infusion solutions in acute blood loss.
Objective. Generalization of management decision-making experience and analysis of organizational measures taken during the preparation of a multidisciplinary hospital for mass admission of infectious patients with COVID-19. Materials and methods. The materials of the study included the generalized data on the results of work of a multidisciplinary hospital in conditions of mass admission of patients with COVID-19. The current guidelines, defining the key spheres of work of the head of medical organization and practical results of their implementation are analyzed. Results. The article analyzes the main activities of a multidisciplinary hospital in conditions of mass admission of patients with COVID-19. It is established that a set of measures, including preparatory preventive solutions, timely planning, re-profiling into a multidisciplinary infectious hospital with reserve beds (including resuscitation beds), creation of mobile teams to provide medical care in the foci of the territorial area of medical responsibility, timely training and reallocation of medical personnel to maximize the effective use of staff resources, reasonable routing of infectious patients, introduction of a three-level system for providing medical care to patients with COVID-19, made it possible to effectively use the available forces and resources of a multidisciplinary hospital during the COVID-19 pandemic. Conclusions. The measures taken proved to be effective, allowing a full provision of emergency medical care throughout the epidemic period, and resuming the provision of planned care in a full volume without reducing the safety of patients' stay in the hospital. Differentiation of patients flows, constant monitoring of the body temperature in both patients and medical workers themselves, constant use of PPE and motivated disinfection, regular check of employees for coronavirus infection (nasopharyngeal smear for COVID-2019 as well as blood ELISA for this infection) permitted to minimize the risks of spreading coronavirus infection in conditions of medical organization.
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