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Iqbal R, Wilson JA, Linn HN, Bajwa AT, Devi K, Devarakonda PK. Cardiac Tamponade in Down's Syndrome Associated With Hypothyroidism: An Uncommon Presentation. Cureus 2024; 16:e59023. [PMID: 38803753 PMCID: PMC11128327 DOI: 10.7759/cureus.59023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2024] [Indexed: 05/29/2024] Open
Abstract
Down syndrome often coincides with hypothyroidism, a condition that may lead to pericardial effusion (PE), though cardiac tamponade remains an infrequent complication. Cardiac tamponade is an emergency that requires immediate diagnosis and treatment. Here, we present a case of a patient who presented to the emergency department (ED) with Down syndrome associated with hypothyroidism and underwent immediate pericardiocentesis and pericardial window placement. A 52-year-old male, with a history of Down's syndrome and hypothyroidism, presented to the ED complaining of shortness of breath and chest pain. He had previously been diagnosed with PE. On examination, he exhibited average heart rate, low blood pressure, decreased heart sounds, and jugular venous distention, with no murmur or frictional rub. Initial investigations revealed normal sinus rhythm on EKG but an enlarged cardiac silhouette on chest X-ray. Laboratory tests showed elevated C-reactive protein and sedimentation rate, suggestive of inflammation, while arterial blood gas showed compensated respiratory alkalosis. Thyroid-stimulating hormone (TSH) was elevated. Despite supplemental oxygen, the patient's condition worsened, prompting a bedside ultrasound revealing cardiac tamponade. A cardiology consultation recommended immediate transfer for treatment. At a different hospital, pericardiocentesis was performed, followed by the placement of a pericardial window to prevent recurrence. Follow-up imaging showed improvement in pleural effusion and resolution of cardiac tamponade. The patient's symptoms improved, and he was discharged with regular follow-up. Down's syndrome is a chromosomal disorder characterized by the trisomy of chromosome 21. It is associated with various cardiac complications. Such patients have an elevated risk of PE due to a variety of reasons, such as viral infections, hypothyroidism, or autoimmune diseases. Although PE has been found, the incidence of cardiac tamponade has rarely been reported. The pathogenesis of PE in hypothyroidism is due to the leakage of fluids from the capillaries and the build-up of fluid in the pericardial space. The treatment of PE is treating hypothyroidism with thyroxine. In rare cases like ours, when the patient develops cardiac tamponade, the patient often needs pericardiocentesis. Our patient had to undergo pericardial window placement, as well to prevent recurrent symptoms. In conclusion, this case report sheds light on the occurrence of cardiac tamponade in a patient with Down's syndrome and hypothyroidism, a relatively rare complication that necessitates prompt recognition and intervention. Through this report, we emphasize the importance of considering cardiac tamponade in the differential diagnosis of patients with Down's syndrome presenting with symptoms suggestive of cardiovascular compromise.
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Affiliation(s)
- Rabia Iqbal
- Medicine, The Brooklyn Hospital Center, Brooklyn, USA
| | - Joshua A Wilson
- Internal Medicine, The Brooklyn Hospital Center, Brooklyn, USA
| | - Hnin Nadi Linn
- Internal Medicine, The Brooklyn Hospital Center, Brooklyn, USA
| | | | - Kanchan Devi
- Internal Medicine, The Brooklyn Hospital Center, Brooklyn, USA
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Sabzwari SRA, Tzou WS. Systemic Diseases and Heart Block. Cardiol Clin 2023; 41:429-448. [PMID: 37321693 DOI: 10.1016/j.ccl.2023.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Systemic diseases can cause heart block owing to the involvement of the myocardium and thereby the conduction system. Younger patients (<60) with heart block should be evaluated for an underlying systemic disease. These disorders are classified into infiltrative, rheumatologic, endocrine, and hereditary neuromuscular degenerative diseases. Cardiac amyloidosis owing to amyloid fibrils and cardiac sarcoidosis owing to noncaseating granulomas can infiltrate the conduction system leading to heart block. Accelerated atherosclerosis, vasculitis, myocarditis, and interstitial inflammation contribute to heart block in rheumatologic disorders. Myotonic, Becker, and Duchenne muscular dystrophies are neuromuscular diseases involving the myocardium skeletal muscles and can cause heart block.
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Affiliation(s)
- Syed Rafay A Sabzwari
- University of Colorado Anschutz Medical Campus, 12631 East 17th Avenue, Mail Stop B130, Aurora, CO 80045, USA
| | - Wendy S Tzou
- Cardiac Electrophysiology, University of Colorado Anschutz Medical Campus, 12401 E 17th Avenue, MS B-136, Aurora, CO 80045, USA.
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3
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Sciacchitano S, Capalbo C, Napoli C, Negro A, De Biase L, Marcolongo A, Anibaldi P, Salvati V, Petrella L, Merlo L, Alampi D, Alessandri E, Loffredo C, Ulivieri A, Lavra L, Magi F, Morgante A, Salehi LB, De Vitis C, Mancini R, Coluzzi F, Rocco M. Nonthyroidal illness syndrome (NTIS) in severe COVID-19 patients: role of T3 on the Na/K pump gene expression and on hydroelectrolytic equilibrium. J Transl Med 2021; 19:491. [PMID: 34861865 PMCID: PMC8640710 DOI: 10.1186/s12967-021-03163-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 11/23/2021] [Indexed: 12/27/2022] Open
Abstract
Background Nonthyroidal Illness Syndrome (NTIS) can be detected in many critical illnesses. Recently, we demonstrated that this condition is frequently observed in COVID-19 patients too and it is correlated with the severity the disease. However, the exact mechanism through which thyroid hormones influence the course of COVID-19, as well as that of many other critical illnesses, is not clear yet and treatment with T4, T3 or a combination of both is still controversial. Aim of this study was to analyze body composition in COVID-19 patients in search of possible correlation with the thyroid function. Methods and findings We report here our experience performed in 74 critically ill COVID-19 patients hospitalized in the intensive care unit (ICU) of our University Hospital in Rome. In these patients, we evaluated the thyroid hormone function and body composition by Bioelectrical Impedance Analysis (BIA) during the acute phase of the disease at admission in the ICU. To examine the effects of thyroid function on BIA parameters we analyzed also 96 outpatients, affected by thyroid diseases in different functional conditions. We demonstrated that COVID-19 patients with low FT3 serum values exhibited increased values of the Total Body Water/Free Fat Mass (TBW/FFM) ratio. Patients with the lowest FT3 serum values had also the highest level of TBW/FFM ratio. This ratio is an indicator of the fraction of FFM as water and represents one of the best-known body-composition constants in mammals. We found an inverse correlation between FT3 serum values and this constant. Reduced FT3 serum values in COVID-19 patients were correlated with the increase in the total body water (TBW), the extracellular water (ECW) and the sodium/potassium exchangeable ratio (Nae:Ke), and with the reduction of the intracellular water (ICW). No specific correlation was observed in thyroid patients at different functional conditions between any BIA parameters and FT3 serum values, except for the patient with myxedema, that showed a picture similar to that seen in COVID-19 patients with NTIS. Since the Na+/K+ pump is a well-known T3 target, we measured the mRNA expression levels of the two genes coding for the two major isoforms of this pump. We demonstrated that COVID-19 patients with NTIS had lower levels of mRNA of both genes in the peripheral blood mononuclear cells (PBMC)s obtained from our patients during the acute phase of the disease. In addition, we retrieved data from transcriptome analysis, performed on human-induced pluripotent stem cell-derived cardiomyocytes (hiPSC-CM)s treated with T3 and we demonstrated that in these cells T3 is able to stimulate the expression of these two genes in a dose-dependent manner. Conclusions In conclusion, we demonstrated that measurement of BIA parameters is a useful method to analyze water and salt retention in COVID-19 patients hospitalized in ICU and, in particular, in those that develop NTIS. Our results indicate that NTIS has peculiar similarities with myxedema seen in severe hypothyroid patients, albeit it occurs more rapidly. The Na+/K+ pump is a possible target of T3 action, involved in the pathogenesis of the anasarcatic condition observed in our COVID-19 patients with NTIS. Finally, measurement of BIA parameters may represent good endpoints to evaluate the benefit of future clinical interventional trials, based on the administration of T3 in patients with NTIS.
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Affiliation(s)
- Salvatore Sciacchitano
- Department of Clinical and Molecular Medicine, Sapienza University, Viale Regina Elena n. 324, 00161, Rome, Italy. .,Laboratory of Biomedical Research, Niccolò Cusano University Foundation, Rome, Italy.
| | - Carlo Capalbo
- Department of Medical Oncology, Sant'Andrea University Hospital, 00189, Rome, Italy.,Department of Molecular Medicine, Sapienza University, Rome, Italy
| | - Christian Napoli
- Department of Clinical and Surgical Translational Medicine, Sapienza University, Rome, Italy
| | - Andrea Negro
- Department of Clinical and Molecular Medicine, Sapienza University, Viale Regina Elena n. 324, 00161, Rome, Italy
| | - Luciano De Biase
- Heart Failure Unit, Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | | | - Paolo Anibaldi
- Health Management Director, Sant'Andrea Hospital, Rome, Italy
| | - Valentina Salvati
- Scientific Direction, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Lea Petrella
- Department of Methods and Models for Economics, Territory and Finance (MEMOTEF), Sapienza University of Rome, Rome, Italy
| | - Luca Merlo
- Department of Statistical Sciences, Sapienza University of Rome, Rome, Italy
| | - Daniela Alampi
- Department of Clinical and Surgical Translational Medicine, Sapienza University, Rome, Italy.,Unit of Anesthesia, Intensive Care and Pain Medicine, Sant'Andrea University Hospital, Rome, Italy
| | - Elisa Alessandri
- Unit of Anesthesia, Intensive Care and Pain Medicine, Sant'Andrea University Hospital, Rome, Italy
| | - Chiara Loffredo
- Unit of Anesthesia, Intensive Care and Pain Medicine, Sant'Andrea University Hospital, Rome, Italy
| | - Alessandra Ulivieri
- Laboratory of Biomedical Research, Niccolò Cusano University Foundation, Rome, Italy
| | - Luca Lavra
- Laboratory of Biomedical Research, Niccolò Cusano University Foundation, Rome, Italy
| | - Fiorenza Magi
- Laboratory of Biomedical Research, Niccolò Cusano University Foundation, Rome, Italy
| | - Alessandra Morgante
- Laboratory of Biomedical Research, Niccolò Cusano University Foundation, Rome, Italy
| | - Leila B Salehi
- Laboratory of Biomedical Research, Niccolò Cusano University Foundation, Rome, Italy.,U.O.C. of Medical Genetics, Policlinic of Tor Vergata, Rome, Italy
| | - Claudia De Vitis
- Department of Clinical and Molecular Medicine, Sapienza University, Viale Regina Elena n. 324, 00161, Rome, Italy
| | - Rita Mancini
- Department of Clinical and Molecular Medicine, Sapienza University, Viale Regina Elena n. 324, 00161, Rome, Italy
| | - Flaminia Coluzzi
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy
| | - Monica Rocco
- Department of Clinical and Surgical Translational Medicine, Sapienza University, Rome, Italy.,Unit of Anesthesia, Intensive Care and Pain Medicine, Sant'Andrea University Hospital, Rome, Italy
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Abstract
Systemic diseases can cause heart block owing to the involvement of the myocardium and thereby the conduction system. Younger patients (<60) with heart block should be evaluated for an underlying systemic disease. These disorders are classified into infiltrative, rheumatologic, endocrine, and hereditary neuromuscular degenerative diseases. Cardiac amyloidosis owing to amyloid fibrils and cardiac sarcoidosis owing to noncaseating granulomas can infiltrate the conduction system leading to heart block. Accelerated atherosclerosis, vasculitis, myocarditis, and interstitial inflammation contribute to heart block in rheumatologic disorders. Myotonic, Becker, and Duchenne muscular dystrophies are neuromuscular diseases involving the myocardium skeletal muscles and can cause heart block.
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5
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Cianciulli TF, Morita LA, Saccheri MC, Zylberman M. Hypothyroid cardiomyopathy: A reversible phenocopy of hypertrophic cardiomyopathy. Echocardiography 2021; 38:1673-1677. [PMID: 34510529 DOI: 10.1111/echo.15183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 07/22/2021] [Accepted: 08/09/2021] [Indexed: 11/30/2022] Open
Abstract
We present the case of a 46-year-old patient with hypothyroidism secondary to Hashimoto's thyroiditis who was admitted with decompensation in the form of myxedema. A 2-D echocardiogram shows a septal asymmetric hypertrophy, with low-voltage QRS complex in the ECG and a bull's-eye map of longitudinal strain with preserved apical strain with reduction of mid and basal strain that results in "cherry on the top" pattern, similar to the most frequent phenocopy of hypertrophic cardiomyopathy, as is the cardiac amyloidosis, and that, unlike this pathology, reverted after the patient reached the euthyroid state.
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Affiliation(s)
- Tomás F Cianciulli
- Cardiology Department, Hospital of the Government of the City of Buenos Aires "Dr. Cosme Argerich", Buenos Aires, Argentina
| | - Luis A Morita
- Cardiology Department, Hospital of the Government of the City of Buenos Aires "Dr. Cosme Argerich", Buenos Aires, Argentina
| | - María C Saccheri
- Cardiology Department, Hospital of the Government of the City of Buenos Aires "Dr. Cosme Argerich", Buenos Aires, Argentina
| | - Marcelo Zylberman
- Internal Medicine Department, Hospital of the Government of the City of Buenos Aires "Dr. Cosme Argerich", Buenos Aires, Argentina
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6
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Khatiwada S, Boro H, Farooqui FA, Alam S. Endocrine causes of heart failure: A clinical primer for cardiologists. Indian Heart J 2020; 73:14-21. [PMID: 33714404 PMCID: PMC7961238 DOI: 10.1016/j.ihj.2020.11.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 07/30/2020] [Accepted: 11/03/2020] [Indexed: 12/30/2022] Open
Abstract
Heart failure (HF) may be a presenting manifestation of a few endocrine disorders and should be considered in evaluation of heart failure causes. This clinically oriented review is an attempt to highlight the protean manifestations of heart failure in endocrine diseases which could present either as acute or chronic heart failure. Acute heart failure manifests as hypertensive crisis, Takotsubo syndrome, or as tachy/brady cardiomyopathies. Chronic heart failure could masquerade with features of hyperdynamic heart failure, or hypertrophic, restrictive or dilated cardiomyopathy. Rarely constrictive features or resistant heart failure could be the presenting feature. Isolated presentation as pulmonary hypertension and right heart failure are also documented. Good history-taking and physical examination with targeted investigations will help in the timely management for reversing the pathophysiology to a significant extent by appropriated management.
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Affiliation(s)
- Saurav Khatiwada
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - Hiya Boro
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India.
| | - Faraz Ahmed Farooqui
- Department of Cardiology, Holy Heart Advanced Cardiac Care and Research Centre, Rohtak, 124001, Haryana, India
| | - Sarah Alam
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
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7
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Chahine J, Ala CK, Gentry JL, Pantalone KM, Klein AL. Pericardial diseases in patients with hypothyroidism. Heart 2019; 105:1027-1033. [PMID: 30948517 DOI: 10.1136/heartjnl-2018-314528] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Revised: 01/07/2019] [Accepted: 02/25/2019] [Indexed: 01/08/2023] Open
Abstract
Hypothyroidism is a well-known cause of pericardial effusion (with an incidence of 3%-37%) and can cause cardiac tamponade in severe cases. In this review, we present the current knowledge on the epidemiology of hypothyroid-induced pericardial diseases, the mechanism through which low thyroid hormone levels affect the pericardium, the associated clinical manifestations, diagnostic tests and management options. Hypothyroidism causes pericardial effusion through increased permeability of the epicardial vessels and decreased lymphatic drainage of albumin, resulting in accumulation of fluid in the pericardial space. Interestingly, autoimmunity does not seem to play a major role in the pathophysiology, and a majority of effusions are asymptomatic due to slow fluid accumulation. The diagnosis is generally made when the pericardial disease is associated with an elevated thyroid-stimulating hormone level, and other secondary causes are excluded. Management consists of thyroid replacement therapy, along with pericardial drainage in case of tamponade.In conclusion, hypothyroidism-induced pericardial diseases are underdiagnosed. Initiating treatment early in the disease process and preventing complications relies on early diagnosis through systematic screening per guidelines.
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Affiliation(s)
- Johnny Chahine
- Department of Medicine, Cleveland Clinic, Fairview Hospital, Cleveland, Ohio, USA
| | - Chandra K Ala
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - James L Gentry
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Allan L Klein
- Center for the Diagnosis and Treatment of Pericardial Diseases, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
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8
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Eisenmann R, Toto PD, O'Malley JJ. Mucopolysaccharides in the Oral Mucosa of the Thyroidectomized Rat. J Dent Res 2016. [DOI: 10.1177/00220345630420011001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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9
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10
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Seol SH, Kim DI, Park BM, Kim DK, Song PS, Kim KH, Jin HY, Seo JS, Jang JS, Yang TH, Kim DK, Kim DS. Complete Atrioventricular Block Presenting With Syncope Caused by Severe Hypothyroidism. Cardiol Res 2012; 3:239-241. [PMID: 28348695 PMCID: PMC5358139 DOI: 10.4021/cr221w] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2012] [Indexed: 11/28/2022] Open
Abstract
A 75-year-old man was admitted to our hospital with syncope. Electrocardiogram showed complete atrioventricular block and bradycardia with the minimum heart rate of 22 beats/ min. There was a possible indication for temporary cardiac pacemaker implantation. Laboratory data on admission revealed high TSH level with low free T4 level. To rule out functional atrioventricular block, we treated several days with thyroxine. A follow-up electrocardiogram showed improved heart rate without any atrioventricular block. We found that severe hypothyroidism caused a complete atrioventricular block with syncope, and thyroxine replacement completely improved these conditions.
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Affiliation(s)
- Sang-Hoon Seol
- Division of Cardiology, Department of Internal Medicine, Inje University College of Medicine, Haeundae Paik Hospital, Busan, Korea
| | - Doo-Il Kim
- Division of Cardiology, Department of Internal Medicine, Inje University College of Medicine, Haeundae Paik Hospital, Busan, Korea
| | - Bo-Min Park
- Division of Cardiology, Department of Internal Medicine, Inje University College of Medicine, Haeundae Paik Hospital, Busan, Korea
| | - Dong-Kie Kim
- Division of Cardiology, Department of Internal Medicine, Inje University College of Medicine, Haeundae Paik Hospital, Busan, Korea
| | - Pil-Sang Song
- Division of Cardiology, Department of Internal Medicine, Inje University College of Medicine, Haeundae Paik Hospital, Busan, Korea
| | - Ki-Hun Kim
- Division of Cardiology, Department of Internal Medicine, Inje University College of Medicine, Haeundae Paik Hospital, Busan, Korea
| | - Han-Young Jin
- Division of Cardiology, Department of Internal Medicine, Inje University College of Medicine, Busan Paik Hospital, Busan, Korea
| | - Jeong-Sook Seo
- Division of Cardiology, Department of Internal Medicine, Inje University College of Medicine, Busan Paik Hospital, Busan, Korea
| | - Jae-Sik Jang
- Division of Cardiology, Department of Internal Medicine, Inje University College of Medicine, Busan Paik Hospital, Busan, Korea
| | - Tae-Hyun Yang
- Division of Cardiology, Department of Internal Medicine, Inje University College of Medicine, Busan Paik Hospital, Busan, Korea
| | - Dae-Kyeong Kim
- Division of Cardiology, Department of Internal Medicine, Inje University College of Medicine, Busan Paik Hospital, Busan, Korea
| | - Dong-Soo Kim
- Division of Cardiology, Department of Internal Medicine, Inje University College of Medicine, Busan Paik Hospital, Busan, Korea
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11
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Haubrich J. Tierexperimentelle histologisch-histochemische Untersuchungen zur Formalgenese der hypothyreotisch bedingten Schwerhörigkeit. Acta Otolaryngol 2009. [DOI: 10.3109/00016487509124913] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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12
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Tamura S, Takahashi M, Kawamura S, Ishihara T. Basophilic degeneration of the myocardium: histological, immunohistochemical and immuno-electronmicroscopic studies. Histopathology 1995; 26:501-8. [PMID: 7545141 DOI: 10.1111/j.1365-2559.1995.tb00268.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
We studied basophilic degeneration of heart muscle cells in 100 consecutive autopsies (74 males, 26 females). Except for two infants, the age of individuals whose tissue was studied ranged from 10 to 90 years (mean age, 68.3). Using histochemical and immunohistochemical methods, we found the frequency and extent of basophilic degeneration and the materials in type IV glycogenosis (Andersen's disease) were reactive to monoclonal antibodies raised against polyglucosan extracted from the myocardium of a patient with Lafora's disease. Basophilic degeneration was found in 98% of the entire study population and in 100% of those aged over 60. The reactivity for polyglucosan became more intense after diastase digestion. Immuno-electronmicroscopy using an immunogold method showed that the fibril-like structures of basophilic degeneration were specifically labelled by the monoclonal antibodies to polyglucosan.
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Affiliation(s)
- S Tamura
- First Department of Pathology, Yamaguchi University School of Medicine, Japan
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13
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Grossmann G, Wieshammer S, Keck FS, Göller V, Giesler M, Hombach V. Doppler echocardiographic evaluation of left ventricular diastolic function in acute hypothyroidism. Clin Endocrinol (Oxf) 1994; 40:227-33. [PMID: 8137522 DOI: 10.1111/j.1365-2265.1994.tb02473.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVE Left ventricular diastolic dysfunction is an important cause of symptomatic heart failure. Previous studies suggest that thyroid dysfunction affects left ventricular diastolic function but the underlying mechanisms remain controversial. The study was undertaken to asses the influence of acute hypothyroidism on left ventricular diastolic function and to elucidate possible underlying mechanisms by means of Doppler echocardiography in a group of athyreotic patients, whose thyroid state depended only on external thyroid hormone supply and could therefore easily be controlled. PATIENTS Eleven patients (5 men, 6 women, aged 20-55 years), who had had total thyroidectomy, were investigated during mild hyperthyroidism and during acute hypothyroidism. Additionally, 11 healthy control subjects aged 25-51 years were included in the study. DESIGN M-mode echocardiography of the left ventricle and pulsed-wave Doppler echocardiography of the transmitral flow velocity pattern were carried out. RESULTS Acute hypothyroidism produced a decrease of left ventricular end-diastolic diameter from 48 +/- 5 to 46 +/- 5 mm (mean +/- SD P < 0.05), of peak velocity of early diastolic filling from 0.52 +/- 0.10 to 0.42 +/- 0.05 m/s (P < 0.05), of peak velocity of late diastolic filling from 0.42 +/- 0.10 to 0.36 +/- 0.09 m/s (P < 0.05), and a decreased time-velocity integral of early diastolic filling (6.2 +/- 1.8 vs 5.1 +/- 0.7 cm, P < 0.05). The other M-mode and Doppler echocardiographic parameters did not differ between the hyperthyroid and the hypothyroid states. CONCLUSIONS The observed changes of the trans-mitral flow velocity pattern during acute hypothyroidism can be attributed to a reduction of pre-load. There is no direct evidence that acute hypothyroidism affects the intrinsic diastolic properties of the left ventricle.
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Affiliation(s)
- G Grossmann
- Department of Cardiology, University Hospital of Ulm, Germany
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14
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Wieshammer S, Keck FS, Waitzinger J, Kohler J, Adam W, Stauch M, Pfeiffer EF. Left ventricular function at rest and during exercise in acute hypothyroidism. BRITISH HEART JOURNAL 1988; 60:204-11. [PMID: 3179136 PMCID: PMC1216555 DOI: 10.1136/hrt.60.3.204] [Citation(s) in RCA: 30] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The effect of hypothyroidism on left ventricular function at rest and during exercise was studied in nine patients without demonstrable cardiovascular disease who had had total thyroidectomy and ablative radioiodine treatment for thyroid cancer. Radionuclide ventriculography and simultaneous right heart catheterisation were performed while the patients were hypothyroid two weeks after stopping triiodothyronine treatment (to permit routine screening for metastases) and while they were euthyroid on thyroxine replacement treatment. When the patients were hypothyroid, cardiac output, stroke volume, and end diastolic volume at rest were all lower and peripheral resistance was higher than when they were euthyroid. Pulmonary capillary wedge pressure, right atrial pressure, heart rate, left ventricular ejection fraction, and the systolic pressure:volume relation of the left ventricle, which was used as an estimate of the contractile state, were not significantly different when the patients were hypothyroid or euthyroid. During exercise, heart rate, cardiac output, end diastolic volume, and stroke volume were higher when the patients were euthyroid than when they were hypothyroid. Again, pulmonary capillary wedge pressure, ejection fraction, and the systolic pressure:volume relation were similar in both thyroid states. The data suggest that the alterations in cardiac performance seen in short term hypothyroidism are primarily related to changes in loading conditions and exercise heart rate; they do not suggest that acute thyroid hormone deficiency has a major effect on the contractile properties of the myocardium.
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Affiliation(s)
- S Wieshammer
- Department of Internal Medicine, University of Ulm Medical Centre, Federal Republic of Germany
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15
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Chanson P, Joly V, Contrepois A, Garaud JJ, Bauchet J, Mohler J, Nguyen PC, Carbon C. Alteration of gentamicin and cefazolin kinetics with control of the hypothyroid state in humans. Antimicrob Agents Chemother 1987; 31:635-7. [PMID: 3606068 PMCID: PMC174795 DOI: 10.1128/aac.31.4.635] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
We studied the effect of the control of the hypothyroid state in humans on the pharmacokinetic parameters of cefazolin and gentamicin after a single intravenous injection. These two antibiotics were chosen because of their different patterns of binding to serum albumin (0% for gentamicin and 82% for cefazolin). In hypothyroidism, the behavior of cefazolin only was altered, with a decrease in the total body clearance, possibly due to reduced urinary excretion, and a decrease in the volume of distribution without a significant alteration of cefazolin binding to serum protein.
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16
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Microlaryngoscopic and histopathological studies in hypothyroidism and goitres. Indian J Otolaryngol Head Neck Surg 1985. [DOI: 10.1007/bf02994948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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17
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Abstract
Myxedema megacolon is a rare manifestation of hypothyroidism. It may respond to appropriate treatment but is sometimes irreversible, resulting in fatal complications. Two possible mechanisms to explain the colonic atony include (1) myxomatous infiltration of the submucosa with separation of the muscular fibers from the ganglia of Auerbach's plexus, and (2) severe autonomic neuropathy affecting the extrinsic nerves to the colon and the myenteric plexus. Histology from our case supports the first proposed mechanism. Urecholine challenge and manometric measure response may help predict reversibility of colonic atony. Treatment should be individualized and should include factors such as age, duration of symptoms, and other medical illness. Low-dose oral or intravenous triiodothyronine is effective. Hypothyroidism following external radiation of the neck for lymphoma is not uncommon, and the risk increases following one or more lymphangiograms. Such patients should be followed up with regular TSH estimations for at least three years.
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Fouron JC, Bourgin JH, Letarte J, Dussault JH, Ducharme G, Davignon A. Cardiac dimensions and myocardial function of infants with congenital hypothyroidism. An echocardiographic study. Heart 1982; 47:584-7. [PMID: 7082506 PMCID: PMC481185 DOI: 10.1136/hrt.47.6.584] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
This study was undertaken to evaluate the cardiac dimensions and various indices of myocardial function, determined by echocardiography, in a group of 12 infants with congenital hypothyroidism. Left ventricular systolic and diastolic dimensions, posterior wall thickness, enddiastolic and systolic volumes were all significantly lower in the hypothyroid infants compared with 25 normal infants of the same age. No pericardial effusion was found. Hypothyroid infant had a lower heart rate with a reduced cardiac output. The mean velocity of circumferential fibre shortening and the shortening fraction of the left ventricle were normal. The pre-ejection period of the left ventricle (PEP), however, was abnormally prolonged as well as the ratio PEP over left ventricular ejection time (PEP/ET). This ratio correlated inversely with the end-diastolic volume, suggesting that the increased PEP/ET could be partly the result of decreased preload.
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Parving HH, Helin G, Garbarsch C, Johansen AA, Jensen BA, Helin P, Lund P, Lyngsøe J. Acid glycosaminoglycans in myxoedema. Clin Endocrinol (Oxf) 1982; 16:207-10. [PMID: 6461440 DOI: 10.1111/j.1365-2265.1982.tb03166.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Acid glycosaminoglycans were measured in the tissues of a virtually untreated 83-year-old woman with myxoedema. Intercellular oedema was demonstrated histologically in the tongue, myocardium, striated muscles, and in the skin. Tissue oedema was absent in two female control patients. All tissues from the patient with myxoedema, apart from the stomach, showed high concentrations of hyaluronic acid, but there was no consistent elevation of chondroitin-4,6-sulphate, heparan sulphate or dermatan sulphate. The accumulation of hyaluronic acid might contribute to the oedema formation in myxoedema.
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Santos AD, Miller RP, Mathew PK, Wallace WA, Cave WT, Hinojosa L. Echocardiographic characterization of the reversible cardiomyopathy of hypothyroidism. Am J Med 1980; 68:675-82. [PMID: 6445682 DOI: 10.1016/0002-9343(80)90253-3] [Citation(s) in RCA: 55] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Nineteen patients with untreated hypothyroidism were evaluated by M-mode echocardiography. Asymmetric septal hypertrophy (ASH), defined as a ratio of interventricular septal thickness to left ventricular posterior wall thickness (IVS/LVPW) equal to or greater than 1.3, was identified in 17 cases. Additional abnormalities recognized by echocardiography included reduced amplitude of systolic septal excursion (SSex) [13 patients], reduced per cent of systolic septal thickening (%SST)[19 patients], reduced left ventricular outflow tract dimension (LVOT)[five patients] and systolic anterior motion of the mitral valve (SAM)[five patients]. These findings are similar to some of the echocardiographic features of idiopathic hypertrophic subaortic stenosis (IHSS). In 10 patients who returned to euthyroid state with L-thyroxine therapy, these abnormalities resolved. We conclude that long-standing hypothyroidism leads to a reversible cardiomyopathy, manifested by asymmetric septal hypertrophy with or without other echocardiographic features of a hypertrophic obstructive cardiomyopathy. This previously unrecognized features of hypothyroidism has important diagnostic and therapeutic implications.
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Parving HH, Hansen JM, Nielsen SL, Rossing N, Munck O, Lassen NA. Mechanisms of edema formation in myxedema--increased protein extravasation and relatively slow lymphatic drainage. N Engl J Med 1979; 301:460-5. [PMID: 460364 DOI: 10.1056/nejm197908303010902] [Citation(s) in RCA: 137] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
We assessed extravascular accumulation of albumin and fluid in primary myxedema by measuring metabolic turnover and transcapillary escape of 131I-labeled human albumin in seven patients. In the hypothyroid state, we found a low plasma volume (P less than 0.05), a reduced rate of albumin synthesis and catabolism (P less than 0.01), an increased transcapillary escape rate of albumin (P less than 0.01), a remarkable increase in the extravascular mass of albumin (1500 micronmol; P less than 0.01) and a longer mean transit time through the extravascular spaces in primary myxedema than in other states of generalized edema (P less than 0.05). All variables returned to normal during l-thyroxine treatment. The extravascular accumulation of albumin, and presumably of all other plasma proteins, is important in the generalized edema typically found in myxedema. Inadequate lymphatic drainage may also explain the formation of exudates in the serous cavities that are well known in myxedema.
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Ross RS, Bulkley BH, Hutchins GM, Harshey JS, Jones RA, Kraus H, Liebman J, Thorne CM, Weinberg SB, Weech AA, Weech AA. Idiopathic familial myocardiopathy in three generations: a clinical and pathologic study. Am Heart J 1978; 96:170-8. [PMID: 676978 DOI: 10.1016/0002-8703(78)90082-0] [Citation(s) in RCA: 42] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
A peculiar non-hypertrophic myocardiopathy is described which occurred in three and possibly five generations of a single family. Clinical features included systolic murmurs, electrocardiographic abnormalities, and sudden cardiac death with a paucity of symptoms of cardiac dysfunction. Pathological studies in three generations showed a striking similarity of cardiac findings including globular and dilated ventricles, endocardial fibroelastosis, and mitral valve thickening. Myocardium in two showed basophilic degeneration and fibrosis. A retrospective genealogic analysis and a prospective clinical evaluation of living family members suggested an autosomal dominant mode of inheritance with variable penetrance. The cause of this heritable myocardiopathy is presumably a mutant gene; the biochemical defect to which the mutant gene gives rise remains unknown.
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Kaliner G. Intracytoplasmic myocardial inclusions in chickens. ZENTRALBLATT FUR VETERINARMEDIZIN. REIHE A 1974; 21:774-8. [PMID: 4372834 DOI: 10.1111/j.1439-0442.1974.tb01360.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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25
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26
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Singh JB, Starobin OE, Guerrant RL, Manders EK. Reversible atrioventricular block in myxedema. Chest 1973; 63:582-5. [PMID: 4695358 DOI: 10.1378/chest.63.4.582] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
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27
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Abstract
In a combined radioactive isotope study, Nae, Ke, bromine space and total body water were measured in a group of fourteen hypothyroid subjects. These were compared with a ‘control’ group. Total body water and Nae were found to be increased in the hypothyroid subjects. In seven subjects, the measurements were repeated after treatment with thyroid hormone. Most of the subjects lost weight and showed a decrease in total body water, but changes in Nae, Ke and bromine space were variable. The cause and nature of the fluid and electrolyte retention in myxoedema are discussed and reasons are advanced for the apparent inconsistencies in the results obtained in this and other studies.
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Cejková J, Brettschneider I. On the influence of fixations on the normal hydration of rabbit cornea and the total amount of acid mucopolysaccharides in the stroma. Histochemical and biochemical study. HISTOCHEMIE. HISTOCHEMISTRY. HISTOCHIMIE 1969; 17:108-20. [PMID: 4243544 DOI: 10.1007/bf00277776] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Takatsu T, Kawai C, Tsutsumi J, Inoue K. A case of idiopathic myocardiopathy with deposits of a peculiar substance in the myocardium; diagnosis by endomyocardial biopsy. Am Heart J 1968; 76:93-104. [PMID: 4232286 DOI: 10.1016/0002-8703(68)90300-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Aber CP, Noble RL, Thompson GS, Jones EW. Serum lactic dehydrogenase isoenzymes in "myxoedema heart disease". BRITISH HEART JOURNAL 1966; 28:663-73. [PMID: 5916476 PMCID: PMC459101 DOI: 10.1136/hrt.28.5.663] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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31
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32
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Rossin HW, Kadian G, Hamburger JI. Management of thyroid problems in the geriatric patient. J Am Geriatr Soc 1966; 14:557-65. [PMID: 4160798 DOI: 10.1111/j.1532-5415.1966.tb04086.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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33
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Ferrans VJ, Hibbs RG, Walsh JJ, Burch GE. Cardiomyopathy, cirrhosis of the liver and deposits of a fibrillar polysaccharide. Report of a case with histochemical and electron microscopic studies. Am J Cardiol 1966; 17:457-69. [PMID: 5929653 DOI: 10.1016/0002-9149(66)90236-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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34
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Über Veränderungen des Mesenchymstoffwechsels durch Umweltfaktoren, durch Hormone und bei rheumatischen Erkrankungen. ACTA ACUST UNITED AC 1965. [DOI: 10.1007/978-3-642-45798-2_4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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35
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Histochemical peculiarities of carbohydrate metabolism in experimental hypothyroidism. Bull Exp Biol Med 1963. [DOI: 10.1007/bf00786738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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CRISPELL KR, WILLIAMS G, HOLLIFIELD G, PARSON W. Alterations of protein metabolism in myxedema. ACTA ACUST UNITED AC 1961; 14:507-14. [PMID: 13882239 DOI: 10.1016/0021-9681(61)90016-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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42
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44
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Holmes JM, Houghton CR, Woolf AL. A MYOPATHY PRESENTING IN ADULT LIFE WITH FEATURES SUGGESTIVE OF GLYCOGEN STORAGE DISEASE. J Neurol Neurosurg Psychiatry 1960; 23:302-11. [PMID: 21610895 PMCID: PMC497429 DOI: 10.1136/jnnp.23.4.302] [Citation(s) in RCA: 35] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- J M Holmes
- Midland Centre for Neurosurgery, Smethwick
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CAIN H, ASSMANN W. Bedeutung und Problematik enzymatischer Gewebs- und Serumbefunde beim frischen Myokardinfarkt. ACTA ACUST UNITED AC 1960; 38:433-9. [PMID: 13806815 DOI: 10.1007/bf02341625] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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48
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SYMMERS WS. Amyloidosis; five cases of primary generalized amyloidosis and some other unusual cases. J Clin Pathol 1956; 9:212-28. [PMID: 13357619 PMCID: PMC1023945 DOI: 10.1136/jcp.9.3.212] [Citation(s) in RCA: 33] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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50
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Altmann HW. Allgemeine morphologische Pathologie des Cytoplasmas. Die Pathobiosen. DAS CYTOPLASMA 1955. [DOI: 10.1007/978-3-642-86043-0_9] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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