The Relation of Dependency and the Predictive Potential of Several Factors Possibly Involved in Determining Pulmonary Hypertension in Graves’ Disease

Abstract

Objectives:To establish a possible relation of dependency between pulmonary hypertension (PHT) and several factors, with the evaluation of their predictive potential, in Graves’ disease.Methods:For identifying the factors implied in producing PHT and for evaluating its reversibility, we made echocardiography exams, sessions of monitoring the blood pressure during 24 hours and biological test in a group of 42 patients with Graves’ disease (group H), comparing them with themselves in a euthyroid status (group E, n=25) and with a control group (group C, n=25). In order to analyse the relation of dependency between pulmonary hypertension (PHT) and the factors identified in the H group, we used both the simple linear regression method (polynomial of degree 1) and the non-linear regression method (polynomial of degree 2, 3) for establishing one model of functional dependency. We used the values of the coefficients of correlation r (degree of dependency) and of determination R2 (the type of dependency). The statistical test (F-test, AIC criterion, test t) was applied by choosing the most appropriate model of determination, with a higher predictive potential.Results:We identified PHT at 47.6% of the patients with Graves’ disease. Once the euthyroidism status is obtained, PHT is normalized. While inducing PHT, we identified a strong relationship of dependency on several possible new factors such as: pre-treatment period, age, level of the thyroid stimulating hormone receptor antibody and values of systolic blood pressure, besides the already known ones (high level of thyroids hormones, cardiac output, pulmonary vascular resistance).Conclusions:The non-linear model best explains the relation of determination between pulmonary pressure and those factors having a better predictive potential (from 51% to 90%), compared with the linear model, the only exception being the age factor and the systolic blood pressure, where both models seems to be appropriate.

Treatment of Lower Pole Renal Stones-Extracorporeal Shock Wave Lithotripsy vs Endourology. A literature review

“…Endourological maneuvers may cause more frequently cardiovascular complications (retroperitoneal hematoma) or iatrogenic ureteral perforations [70,71]. Following treatment of lower pole lithiasis by flexible ureteroscopy or percutaneous nephrolithotomy, convalescence is higher than ESWL [62].…”

“…Following treatment of lower pole lithiasis by flexible ureteroscopy or percutaneous nephrolithotomy, convalescence is higher than ESWL [62]. Another disadvantage of flexible ureteroscopy is the need for fragile and expensive instruments, requiring frequent repair due to the rapidly degrading active deflection mechanism [71].…”

“…In terms of operating time, ESWL has an advantage, with an average operating time of approximately 44.7 min compared to 106.2 minutes for URS or 84.6 minutes for PNL [71,72]. Also, in the favor of extracorporeal lithotripsy is the rapid learning curve [73,74].…”

Treatment of Lower Pole Renal Stones-Extracorporeal Shock Wave Lithotripsy vs Endourology. A literature review

“…Endourological maneuvers may cause more frequently cardiovascular complications (retroperitoneal hematoma) or iatrogenic ureteral perforations [70,71]. Following treatment of lower pole lithiasis by flexible ureteroscopy or percutaneous nephrolithotomy, convalescence is higher than ESWL [62].…”

“…Following treatment of lower pole lithiasis by flexible ureteroscopy or percutaneous nephrolithotomy, convalescence is higher than ESWL [62]. Another disadvantage of flexible ureteroscopy is the need for fragile and expensive instruments, requiring frequent repair due to the rapidly degrading active deflection mechanism [71].…”