伴象皮腿样结节性粘液性水肿的Basedow综合征1例

甲状腺毒症伴胫前牯液性水肿和肢端粗厚(acropachy)不多见，而Basedow综合征(结节性甲状腺肿伴甲亢)伴发严重的全身性粘液性水肿、杵状指、突眼更少见，现报告1例。

Association of Basedow’s Disease and Comorbidities at the Abass Ndao Hospital Center (Senegal)

Introduction: Graves’ disease associated with comorbidities can increase morbidity and mortality. Our objective was to describe the epidemiological, clinical, therapeutic and evolutionary aspects of comorbidities associated with Graves’ disease at the Abass hospital center, Ndao. Methods: This was a cross-sectional and descriptive study conducted from January 2020 to December 2020. It focused on patients followed for Graves’ disease at Abass hospital, Ndao de Dakar. Epidemiological, clinical, therapeutic and evolutionary data were evaluated. Results: Three hundred and three eighteen (318) cases were collected, 70 of which had comorbidities (51.15%). The average age was 38.45 years with extremes ranging from 15 to 71 years. Women represented 91.42% of patients. A consultation delay of more than one year was noted in 24.29%. Cardiovascular comorbidities were dominated by hypertension with 30%. Graves’ disease was associated with an evolving pregnancy in 10 women. Endocrine comorbidities were dominated by type 1 diabetes noted in 8.57% each. Biermer’s disease was noted in 2 patients. Female gender was the most common etiological factor of Graves’ disease noted in 64 patients (91.42%). A hereditary predisposition existed in 4 patients (5.71%), stress was noted in 7 patients (10%). 43 patients were under thyrozol (61.42%), 41 patients were on propranolol (58.57%), 14 patients were on carbimazole (20%). A good balance was noted in 44 cases (68.75%) after 9 months of treatment. Conclusion: Graves’ disease is a public health problem with nonspecific signs. It requires screening and treating comorbidities to reduce morbidity and mortality.

毒性弥漫性甲状腺肿(Graves病)中医诊疗

毒性弥漫性甲状腺肿(Graves病,Graves Disease,GD)治疗目的是有效控制及改善临床症状,最终使甲状腺功能恢复至正常状态,并减少复发;目前治疗方法有抗甲状腺药物治疗,放射性碘治疗及甲状腺手术治疗。GD属中"瘿病"、"瘿气"范畴,"瘿者,由忧恚气结所生",证侯分布依次为肝肾阴虚、心肝火旺、脾虚湿盛、脾肾阳虚、痰火内扰;无论病情轻重,肝肾阴虚和心肝火旺都是最主要的证型,均以肝肾阴虚为主。中医药治疗优势独特,可减少西药剂量及副作用,有效降低甲状腺抗体水平,提高患者生活质量并且减少复发。动物实验证实富碘中药可有效恢复缺碘机体甲状腺肿,效果优于单纯补碘,可能与富碘中药在补充碘的同时又增强了抗氧化能力有关;富碘中药安全性仍有争议。GD有冬轻夏重特点,治疗还应注重季节性。针灸治疗GD注重调理脏腑功能,同时调理气血经络。Graves眼病(Graves Ophthalmopathy,GO)分非浸润性眼病和浸润性眼病,"肿胀如杯"、"状如鱼胞"、"鹤眼凝睛",为肝火亢盛、脾虚痰阻、肝肾阴虚、痰瘀内阻等,治疗以滋阴降火为主,佐以养肝明目,活血化瘀,利水消肿;针灸治疗以活血通络,散结消肿为基本大法,亦可取得较好疗效。有待改进的是中医药治疗辨证分型差异较大,很难统一,中药煎服不便;期待采用现代科学手段研究。

巴泽多体育教育思想研究

在综合巴泽多教育理论前期研究基础上,对巴泽多体育教育观进行了探讨,并认为,巴泽多的教育思想的主要脉络为:通过泛爱主义培养"幸福的人"。根据这个思路,巴泽多的体育教育思想概括为"身体健壮是幸福的人之第一要素"。与此主线相关联其他观点是:体育是每日必须的课程;严禁体罚学生;直观教学法;爱国主义教育观。对中国学校体育深化改革具有借鉴与启示的观点是:劳作与体育在学校课程中的重要性;鼓励取代惩罚,注重体育道德发展;适应儿童的自然体育;采用经验、直观体育教学法;快乐体育的学习。

内分泌疾病

日本厚生劳动省间脑垂体功能障碍调查研究组于2006年制定了《亚临床Cushing病诊断和治疗指南》,同时修订了《Cushing病诊断和治疗指南》。关于Cushing病的药物疗法,有报告称生长抑素5型受体激动剂(SOM230,pasireotide)有效。日本用GH治疗成人GH分泌缺乏症得到认可,Basedow病治疗指南、放射性碘内服疗法指南已经制定。对于潜在性甲状腺功能低下症相关的缺血性疾病、脑血管疾病的发病率和死亡率,目前正在研究探讨中,继发性甲状腺功能亢进治疗的Ca受体激动剂正在研发。

Correlation between ^99mTcO₄<sup style="margin-left:-7px;">-</sup>Thyroid Scintigraphy and Blood Test in Primary Hyperthyroidism

Background: The 99mTcO4- thyroid scintigraphy is commonly used for hyperthyroidism diagnosis. Uptake value of 99mTcO4- on thyroid scintigraphy is an indicator of hyperthyroidism activity. Although, the correlation between free T3 value and free T4 value is not necessary clear in primary hyperthyroidism. Introduction: This study investigated the correlation between results of blood test and uptake of 99mTcO4- on thyroid scintigraphy in primary hyperthyroidism. Methodlogy: In this retrspective study, uptake was calculated in patients diagnosed with primary hyperthyroidism (Graves’ disease/Basedow’s disease) based on clinical findings, blood tests, thyroid ultrasound, and 99mTcO4- thyroid scintigraphy (uptake ≥3%) at St. Marianna University School of Medicine Hospital between 1 January 2010 and 31 December 2019. This uptake of 99mTcO4- was compared with results of blood tests. Results: Fifty-four consecutively arriving patients at the hospital (12 men, 42 women;mean age 43.0 ± 14.0 years) were selected. Free T3 (n = 54) was 14.6 ± 6.8 pg/mL, free T4 (n = 53) was 5.0 ± 2.3 ng/mL, and uptake on thyroid scintigraphy was 10.0% ± 7.1%. The correlation coefficients were 0.60 (p < 0.01) between free T4 (all case), 0.39 (p < 0.01) between free T4 (under 7 ng/mL), 0.12 (p = 0.70) between free T4 (above 7 ng/mL) and 99mTcO4- thyroid scintigraphy uptake. Conclusion: In primary hyperthyroidism (Graves’ disease), there is a correlation between free T4 value and 99mTcO4- thyroid scintigraphy uptake, but there is no correlation in patients with high free T4 level.