Amiodarone-induced hyperthyroidism has on most instances been reported as mild, and thyroid functions return to normal after discontinuation of the drug. Nevertheless, life-threatening amiodarone-induced thyrotoxicosis has also been described. Conventional treatments such as antithyroid drugs (thionamide) and corticosteroids are essentially ineffective or fail to alter the dramatic course of the thyroid crisis. This limited effectiveness of medical therapy, particularly in patients with previously neglected or unknown thyroid disease, prompted us to intervene surgically. We report a series of nine patients who underwent total or near-total thyroidectomy as a first-line therapy for five of them. Surgery resulted in rapid resolution of thyrotoxicosis with an uneventful postoperative course. This approach has the advantage of immediate effectivity, low risk of relapse, and appears to be the only treatment that permits continued therapy with amiodarone when the drug appears needed to control a life-threatening arrhythmia.
PurposeTo describe the use of antimuscarinic drugs to treat overactive bladder (OAB) in Denmark, Sweden, and the United Kingdom (UK).MethodsWe identified new users of darifenacin, fesoterodine, oxybutynin, solifenacin, tolterodine, and trospium aged 18 years or older from the Danish National Registers (2004–2012), the Swedish National Registers (2006–2012), and UK Clinical Practice Research Datalink (2004–2012). Users were followed until disenrollment, cancer diagnosis, death, or study end. Treatment episodes, identified by linking consecutive prescriptions, were described with respect to duration, drug switch, and drug add-on.ResultsMean age of OAB drug users was 66 years in Denmark (n = 72,917) and Sweden (n = 130,944), and 62 years in the UK (n = 119,912); 60% of Danish and Swedish patients and 70% of UK patients were female. In Denmark, of 224,680 treatment episodes, 39% were with solifenacin, and 35% with tolterodine; 2% were with oxybutynin. In Sweden, of 240,141 therapy episodes, 37% were with tolterodine and 35% with solifenacin; 5% were with oxybutynin. In the UK, of 245,800 treatment episodes, 28% were with oxybutynin, 27% with solifenacin, and 26% with tolterodine. In the three countries, 49%-52% of treatment episodes comprised one prescription and over 80% of episodes ended because of no refill; less than 20% ended because of a switch to another antimuscarinic. During the study years, we observed a change in OAB treatment preference from tolterodine to solifenacin.ConclusionsIn these cohorts, persistence with antimuscarinic drugs was low. By 2012, the preferred drug was solifenacin; oxybutynin use was marginal in Nordic countries compared with the UK.
A historical review of the literature concerning replantation and transplantation of reproductive organs has included studies from this laboratory, using rats, over the past 25 years. From the basic observation of ischemic and traumatic injury due to the transplantation, syngeneic testicle transplants, resulting in a partner's impregnation and histological restoration of the testicles, led to human testicular transplantation. As to the ovarian transplants, granulosa-theca cell tumors may transform into malignancies if followed for a prolonged period as intrasplenic ovaries, and high doses (15 to 20 mg/kg b.w.) of azathioprine can produce such malignant tumors in a shorter period. By caval-portal shunt, ovarian hormones enter directly into the portal blood stream and no typical granulosa-theca cell tumors were produced, owing to the fact that the liver cannot degrade all the hormones secreted by both ovaries. While en-bloc vagino-utero-ovarian transplantation in the rat is possible, no impregnation has been yet achieved. Finally, it is hypothesized that those who have acquired microsurgical techniques and have a full understanding of the anatomy of the reproductive system will not only be able to perform replantation of the penis, but also will be capable of allogeneic transplantation of genital organs, whether ethically approved or not, and sooner than one may think. In such cases a penile part may be obtained at a sex-change surgery or from a cadaveric donor, similar to other vital organ transplantation practices.
BackgroundBlocking muscarinic receptors could have an effect on cardiac function, especially among elderly patients with overactive bladder (OAB).Study ObjectiveTo investigate the risk of cardiovascular (CV) events in users of antimuscarinic drugs to treat OAB.Design, Setting, and ParticipantsCohort study of new users of darifenacin, fesoterodine, oxybutynin, solifenacin, tolterodine, or trospium, 18 years or older, in the United Kingdom's Clinical Practice Research Datalink (CPRD), 2004–2012.Outcome Measurements and Main ResultsUsing tolterodine as the reference, we estimated propensity‐score–stratified incidence rate ratios (IRRs) for acute myocardial infarction, stroke, CV mortality, major adverse cardiac events (MACE, a combined end point of the previous three), and all‐cause death for individual antimuscarinic drugs. The study cohort included 119,912 new users of OAB drugs. The mean age at cohort entry was 62 years, 70% were female, and the mean follow‐up was 3.3 years. The adjusted IRR for MACE and current use of oxybutynin compared with current use of tolterodine was 1.14 (95% confidence interval [CI] 1.01–1.30). In contrast, the IRR was 0.65 (CI 0.56–0.76) for current use of solifenacin compared with tolterodine. In this study, performed with health care data, the distribution of risk factors was relatively similar across users of different OAB drugs and, although our analyses controlled for a range of measured potential confounders, residual confounding cannot be ruled out.ConclusionsIn an observational comparative study of users of medications to treat OAB conducted in routine clinical practice, the risk for CV side effects was increased in users of oxybutynin and decreased in users of solifenacin compared with users of tolterodine.
Abstract. The case reports of three patients who received cancer-bearing organs at this institution are presented. A fourth recipient, who was to be transplanted with a cancerous kidney, was spared this disastrous complication. The relevant data regarding the donors is also alluded to, with special reference to the type and site of the primary malignancy. Following these case reports, the implications of these issues, their possible prevention, and further management are discussed. Key words:Malignancy, donor -Organs, donors, malignancy -Donors, malignancy Organ transplantation, a "miraculous" surgical procedure that occupies an increasingly important niche in the future of surgery, comes with a nasty package of unwelcome problems. The resolution of the technical aspects of the procedure, coupled with the increasing number of indications for organ transplantation, has led to a surge in the number of newer complications in the field. At present we not only have a perennial donor organ shortage but also a myriad of complications related to immunosuppression. One of the rare complications that must be addressed is the transferral of malignancy by grafting cancerous organs into recipients. The aim of this report is to highlight the issues related to the detection of the malignancy during organ procurement and other events that are intimately related to the donor operation. In addition, the variability in the management of these recipients post-transplantation is revealed. We hope this report will help to revive an interest in the search for such "malignant" donors. This "gray area" in transplantation needs greater exposure, for its presence shall be felt for years to come. Case reports Donor IDonor 1 was a 30-year-old female who succumbed to cerebral hemorrhage of nontraumatic origin. The salient and relevant past medical history included: (a) hyperandrogenism under treatment with corticosteroids, (b)the appearance of migraine headaches 1 year before death, and (c) the presence of intermittent hemoptysis 6 weeks before she presented as an organ donor. Her serum electrolytes were within normal limits and her renal and hepatic function profiles were normal too. A selective right carotid angiographic series disclosed a lesion occupying an avascular space in the right frontal region, supratentorially. A second finding of interest was the presence of premature basilar vein filling in the absence of grossly identifiable vascular malformation.After obtaining consent for the multiorgan harvest, the liver and left kidney were explanted following standard organ procurement principles and techniques. The right kidney was rejected, owing to the presence of major congenital vascular and urological abnormalities. No other obvious intra-abdominal pathology was encountered at the time of organ procurement. Necropsy, which was performed the following day, revealed a nodule, 3 cm in diameter, in the rejected right kidney and three other hemorrhagic nodules located in the right lung. Their histopathological features were consistent w...
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