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L. Kapotth. University of California, Riverside.

Lawyers can caused by bones pressing on nerves results in disease also represent parents in negotiating an agreement buy generic irbesartan 150mg on-line diabetes type 1 diagnosis, or and that chiropractic treatment restores normal flow cheap 300mg irbesartan overnight delivery diabetes test online uk. Sometimes free legal assis- conventional medical practice (sometimes called allo- tance can be obtained through a local office of the pathic medicine) was dramatically different than it is Legal Services Corporation 300 mg irbesartan with mastercard diabetes pharmacology test questions, or through other local today generic irbesartan 300 mg without a prescription diabetes mellitus medical definition. Many people represent themselves in a child in 1910 and which brought about dramatic reform in custody dispute, but this should be a last resort. In such an environment, 156 Chiropractic Care alternative approaches to healing sprang up. They argue that it is unfair to judge one healing Chiropractic was one of these alternative approaches. Because of this, chiropractors have faced of many complementary and alternative approaches to an uphill battle against the forces of mainstream medi- medicine. For example, chiropractors won an antitrust suit ical rejection of conventional scientific approaches to against the American Medical Association in 1987. Allopathic medicine is a However, the victory was a validation of their right to reductionist approach, focusing on symptoms and practice chiropractic rather than a validation of chiro- attempting to identify their root cause. Nevertheless, this study has been crit- that a vital force infuses every cell in the body, and that icized because chiropractic was not studied under the this belief is not subject to scientific testing. Many of the practic tradition offers a series of principles that are procedures performed were not administered by chiro- philosophical statements, not testable hypotheses. A study published in Consumer Reports practice, and they use terms in ways that are not con- claimed to demonstrate the effectiveness of chiropractic. In chiropractic tradition, dis- To say that chiropractic is ineffective would be ease is both the cause and effect. The proper statement would be that evi- nent of chiropractic, Frank DeGiacomo, maintains that dence supporting the effectiveness of chiropractic is the treatment of any classified disease cannot be chiro- limited. Contrast this idea with the long list of diseases treatment of back and neck pain when compared to no many chiropractors claim to treat or prevent, and the treatment. However, philosophi- studies do not test the basic premises on which chiro- cal inconsistencies abound in conventional medicine as practic is built. In fact, it is the process of questioning traditional As with any profession, chiropractic is evolving. A limited but growing number of chiropractors Chiropractors believe that the vital force is self-evi- recognize the importance of rigorously testing the effec- dent and that their practices are the most effective way tiveness of their techniques. Other plementary and alternative health practices, Energy healing, chiropractors see their healing modality as one among Massage, Physical therapy many that individuals may choose to achieve wellness under specific circumstances. Some chiropractors promote other approaches that Suggested Reading they view as consistent with their field. The health robbers: A close look at to find chiropractors selling vitamins, herbs, and devices quackery in America. The American Holistic Health Association ropractors to subject their practices to close scientific complete guide to alternative medicine. Inside chiropractic: A patients Chiropractors today usually belong to one of three guide. Chiropractic techniques: practors Association are often referred to as straights, Principles and procedures (2nd ed. New York: Churchill because they adhere to Palmers belief that almost all dis- Livingstone. Members of the American Chiropractic Association are known as mixers, because they mix Palmers ideas with other ideas about the causes of diseases. While they may Chiropractors Chiropractors are practitioners of acknowledge the influence of germs and other biological the complementary and alternative medicine approach factors in disease, they still tend to consider disturbance of known as chiropractic. This group requires members to used his hands to thrust on a bump on the neck of his sign a written pledge to openly renounce the foundational janitor and in the process cured the janitors deafness. The pledge one examines the distribution of the cranial nerves and also requires members to limit their work to neuromuscu- discovers that the auditory nerve does not extend to the loskeletal conditions of a nonsurgical nature. But chiropractors have not historically empha- Chiropractors today often seek to be primary care sized conventional scientific approaches to knowledge. Despite claims to the contrary, evi- aligned joints (subluxations) disrupt the flow of the life dence for the effectiveness of chiropractors in treating force. He further believed that using the hands to mani- most medical conditions has yet to be demonstrated pulate various joints of the bodyespecially those in the under conventional scientific standards. However, cus- spinal columncould restore disruptions of the life force tomer satisfaction appears strong. As with other comple- States, chiropractic education was caught in conflict mentary and alternative medical practices, the potential among competing ideas until it was finally standardized chiropractic patient is best advised to learn about a chi- in the late 1950s and early 1960s. Most chiropractic ropractors approach to healing and obtain references schools now require at least 2 years of undergrad- before entering into a therapeutic relationship. Despite the standardization of chiropractic edu- cation, chiropractors are not trained in the same kinds Suggested Reading of diagnostic tests and treatments that physicians and Barrett, S. Principles and practice of chiropractic infection may develop pain and swelling of the scrotum (2nd ed. Because of this, it is recommended that all pregnant women be tested for chlamydia. Uncomplicated infection which responds readily to Chlamydia Infection with Chlamydia trachomatis several antibiotics. The most common regimens include is the most common sexually transmitted disease in the doxycycline given for 7 days, or single-dose therapy United States and the most frequently reported infec- with azithromycin. The latter drug offers the advantage tious disease; an estimated 3 million cases occur annu- of better compliance, but is more expensive. The symptoms of chlamy- and have significant overlap in their clinical presenta- dia, which usually occur within 721 days of infection, tion, it is standard to test for and treat both when one can be very mild. Women may Utilizing safe sex practices, including latex con- notice an abnormal vaginal discharge, and men may doms, may prevent chlamydia. Women with risk factors have a discharge from the penis, or pain while urinat- such as multiple sexual partners, and those who are not ing. Chlamydia can also cause inflammation of the consistently using barrier methods of birth control rectum. Although often asymptomatic in women, should be tested annually for chlamydia infection. The chlamydia infection can produce chronic low-grade Centers for Disease Control and Prevention has devel- inflammation leading to scarring of the fallopian tubes oped recommendations for the prevention and man- and infertility. Other complications are discussed agement of chlamydia for all providers of health care. These recommendations call for screening of all sexu- The diagnosis of infection with C. All women with infection of the cervix and all methods to detect chlamydia based on antigen detec- pregnant women should be tested. Triglycerides are fats floating freely in the women in the United States is heart disease resulting blood. Although heart attack and angina allowed to sit in a tube, after a while a thick whitish used to be thought of as a male disease, that is no layer of fat will rise to the top. Over 500,000 women in 2000 died from risk factor for heart disease, although the reason is not heart disease while about 440,000 men died from the as well understood as it is for cholesterol. The chance of a second heart attack within 6 years of the first one is 35% for women but 18% for Atherosclerosis is a slow progressive disease in men. It is essential to understand these staggering sta- which cholesterol deposits form within the wall of tistics in order to grasp the importance of tackling the blood vessels.

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There were also regional differences irbesartan 150mg on line comparative effectiveness diabetes medications, with the from National Ambulatory Medical Care Survey highest rates occurring in the South order irbesartan 150mg amex diabetes 99. The visit visit rate for a primary diagnosis of bladder stones rate was 43% higher in 2000 than it was in 1992 buy generic irbesartan 300 mg line diabetes prevention objectives. The rates peaked in the 65-to 74-year nearly 2 million visits in 2000 by patients with age group and then declined order irbesartan 150mg free shipping diabetes type 1 vegetarian diet. In 1995 and 1998, the rates were higher for translates into a rate of 731 per 100,000 population. Thus, the vast majority offce visit rates slightly widened in all three years of of visits for urolithiasis (74%) are for urolithiasis as study, but the relative differences in geographic and the primary diagnosis (Tables 15 and 17). However, the data do not represent all decreased between 1999 and 2001 (Table 19). This outpatient procedures performed in a population, 24 25 Urologic Diseases in America Urolithiasis 24 25 Urologic Diseases in America Urolithiasis Table 19. The available data regarding ambulatory surgery During the years studied, the male-to-female for urolithiasis in children are too scant to provide ratio varied from 1. Regional differences were apparent: the highest rates were consistently seen in the Southeast; 28 29 Urologic Diseases in America Urolithiasis Table 22. Ureteroscopy of the Holmium laser in 1995 rendered virtually all remained stable over time and comprised 40% to stones amenable to fragmentation if they could be 42% of the procedures. Open stone surgery made up accessed endoscopically (14); however, this new only 2% of the total procedures in 1994 and dropped technology may have not yet reached widespread use to less than 1% in 2000. In database of commercially insured patients (Table both 1995 and 1998, the rates were highest among 24). Each inpatient or outpatient encounter determine whether this represented a sharp increase involves a variety of cost sources, including physician or simply year-to-year variability. In general, the professional fees, radiographic studies, room and rate for males was twice that for females. It is noted board, laboratory, pharmacy, and operating room that the confdence intervals for these estimates are costs. Among Medicare benefciaries, the rate always be easily arrived at or consistently applied. There were clear regional variations, for those without a claim relating to urolithiasis (Table with rates highest in the South. Hence, a $4,472 difference per covered individual 32 33 Urologic Diseases in America Urolithiasis 32 33 Urologic Diseases in America Urolithiasis Table 27. Expenditures for urolithiasis and share of costs, by type of service (in millions of $) Year 1994 1996 1998 2000 Totala 1,373. Average drug spending for urolithiasis-related conditions is estimated at $4 million to $14 million annually for the period 1996 to 1998. Evaluation 100% of regional differences in medical expenditures 90% suggests that overall higher expenditures for the 80% group without urolithiasis-related claims were found 70% in the South and West, whereas in the urolithiasis 60% group, expenditures were highest in the Midwest 50% and South. As prescription drug costs showed 40% little regional variation, the geographic differences 30% 20% in expenditures are likely related to direct medical 10% expenditures or possibly due to differences in the age 0% distributions of the regions. Percent share of costs for urolithiasis by type was spent on treating urolithiasis in 2000, based solely of service, 19942000. That these fgures are somewhat should be accounted for by expenditures either lower than the $1. Total expenditures (excluding as primary hyperparathyroidism, chronic diarrheal outpatient prescription drug costs) increased by syndrome due to bowel disease, etc. During that time period, non-inpatient differences (such as comorbidities) between those services (including physician offce visits, emergency with and without stone disease. When stratifed by of total expenditures for emergency room services age, the expenditures of those without a urolithiasis- also increased, from 15% in 1992 to 24% in 2000. In contrast, the peak total Medicare population also increased signifcantly over medical expenditure for the group with a urolithiasis- time. However, given the higher incidence of stone on outpatient prescription drugs for the treatment disease in men (a factor of 2 to 3), one might expect of urolithiasis in 19961998 ranged from $4 million a greater impact of gender in the group with stones. Expenditures for Medicare benefciaries age 65 and over for treatment of urolithiasis (in millions of $) Year 1992 1995 1998 Total 613. Expenditures In addition to the direct medical costs of in 2001 were nearly twice as high among infants (0 treatment, the economic effects of urolithiasis include to 2 years of age) as they were among children ages labor market outcomes such as absenteeism and work 3 to 10 or 11 to 17 and twice as high among African limitations. The setting for urolithiasis are diffcult to estimate, largely because of both the acute care and the surgical management of the paucity of data. However, some data are available patients with stones has changed over time: inpatient in the medical and fnancial records of the National admissions and length of stay have decreased as Table 30. Annual use of outpatient prescription drugs for the treatment of urolithiasis, 19961998 All Persons with Urolithiasis Conditional on Rx Use Number with % with Rx Claim Mean Number of Mean Rx Gender Urolithiasis for Urolithiasis Prescriptions Expenditures (in $) Male 676,144 29. Work loss is based on reported absences contiguous to the admission and discharge dates of each hospitalization or the date of the outpatient visit. The trends medical evaluation to determine the etiology of in distribution of surgical treatment modalities stone formation? How frequently are preventive measures however, shock wave lithotripsy remains the most recommended? What is the rate of adherence to medical stones, followed by ureteroscopy and percutaneous recommendations, and how does this change over nephrostolithotomy. What are the national recurrence rates, and how the use of open surgery, which is now less than 2% of are they affected by demographic factors? The cost of urolithiasis is estimated at nearly $2 billion annually and appears to be Imaging modalities in the diagnosis and follow-up of increasing over time, despite the shift from inpatient patients with upper tract urolithiasis to outpatient procedures and the shorter length of 1. What is the optimal imaging modality for hospital stays, perhaps because the prevalence of monitoring patients with a history of stone disease is increasing. What is the optimal urological management of the associated procedures, it would be helpful to acute renal colic? How have practice patterns evolved in the upon the site of pathology in the ureter. How have practice patterns evolved in the From a clinical perspective, prevention is balance between ureteroscopy vs percutaneous essential to reduce costs and morbidity. Primary nephrostomy in the management of upper prevention is not practical at this time, but aggressive ureteral stones? Is upper tract urolithiasis a risk factor for other expended a great deal of time and effort to obtain conditions (e. We propose the following topics for investigation to improve the understanding of urolithiasis. How frequently are metabolic evaluations performed for patients with urolithiasis? Time trends in reported prevalence of kidney stones in the United States: 1976-1994. A prospective study of dietary calcium and other nutrients and the risk of symptomatic kidney stones. Comparison of dietary calcium with supplemental calcium and other nutrients as factors affecting the risk for kidney stones in women. Ureteroscopic treatment of lower pole calculi: comparison of lithotripsy in situ and after displacement. Lower pole I: a prospective randomized trial of extracorporeal shock wave lithotripsy and percutaneous nephrostolithotomy for lower pole nephrolithiasis-initial results. Calhoun, PhD Assistant Professor of Urology Northwestern University Feinberg School of Medicine Chicago, Illinois Steven J. It is associated with progressive lower urinary tract symptoms and affects nearly Benign prostatic hyperplasia is characterized three out of four men during the seventh decade pathologically by a cellular proliferation of the of life.

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Hellmark T discount 300mg irbesartan overnight delivery diabetic recipes chicken, Burkhardt H irbesartan 150 mg fast delivery diabetes type 2 description, Wieslander J irbesartan 150 mg otc diabetes test parameters, Goodpasture dis- controlled for by always checking for background reactiv- ease buy irbesartan 300 mg fast delivery diabetes diet low calorie. Goodpasture auto- assays and false-positive test typically exhibit results close to antibodies unmask cryptic epitopes by selectively disso- the cutoff level for positive results. Arch Immunol Ther Exp (Warsz) 2004; Standard therapy includes extracorporeal removal of auto- 52: 96103. Anti- additional treatment sessions are often needed to prevent glomerular basement membrane antibodies in the diagnosis rebounding titers. Cyclophosphamide therapy is usually of goodpasture syndrome: a comparison of different assays. However, these criteria have low sensitivity and specificity and therefore, other clinical and laboratory features may be helpful in establishing the diagnosis, especially for cases of atypical or incomplete Kawasaki disease. Prognosis depends on the extent of cardiac involvement; coronary aneurysms develop in 2025% of untreated patients, which may lead to myocardial infarction and sudden death. Treatment with high-dose intravenous immuno- globulin is effective in reducing the risk of coronary aneurysms in most cases, and together with aspirin, is the treatment of choice for initial Kawasaki disease. Clinical Manifestations Epidemiology (Percentages of appearance enclosed in brackets) (3). However, many studies have failed to identify also be observed at the early stages of the disease. It has also not been mately 1 or 2 months after the onset of fever, small transverse proved to be related to exposure to any drug or as a grooves across fingernails may appear (Beaus lines). Thrombocytosis scarlatiniform and micropustular, and erythroderma can typically develops in the second or third week of also appear. It can be seen during the acute phase of illness, lipid profile alterations (decrease in cholesterol and high- often during the first 5 days of fever. It usually begins shortly after with pleocytosis; glucose and protein levels are normal. A mild acute iridocyclitis or anterior uveitis may also be Echocardiography noted by a slit lamp (4). There has to be should be performed at least while diagnosis, at weeks 2 at least one adenopathy! If untreated, these symptoms liver enlargement and jaundice have also been reported. Transient sensorineural hearing been treated with immunoglobulin, fever disappears, loss and facial paralysis are rarely present (6). Laboratory acute phase or convalescence, which affects both small and tests may show marked thrombocytosis and anemia, large joints. Induration and erythema at the site of a pre- with normalization of leukocytosis and acute-phase vious vaccination with Bacille Calmatte-Guerin has also reactants. Convalescence phase: Most patients are asymptomatic at ditis occur during the acute phase of illness, whereas cor- this stage, although Beau lines may be observed in onary aneurysms are formed in later stages. Blood tests return to normal and coronary aneurysm could either disappear or not, and they may become symptomatic in the form of myocardial Laboratory Findings infarction. However, some investigations can be performed to Diagnostic Criteria help with the diagnosis. Changes in extremities: Scarlet fever Acute phase: erythema of palms and soles, and edema of hands and feet Infectious mononucleosis Subacute phase: desquamation of fingers and toes. Changes in lips and oral mucosa: erythematous and cracked lips, Rheumatic diseases Polyarteritis nodosa strawberry tongue, and oral and pharyngeal hyperemia. Systemic lupus erythematosus c Rheumatic fever Exclusion of other diseases with similar findings. Once the fever has disappeared in the 4872 h have both low sensitivity and specificity. Recommended under one year of age are more frequently affected with doses are 2 gr/kg in an 812 h infusion. For those still unresponsive, there are other optional therapies that have been effective in series of cases. Prob- ably, the most accepted one would be to administer pulsed Differential Diagnosis intravenous methylprednisolone (30 mg/Kg for 13 days). Acute febrile mucocutaneous syndrome with lymphoid involvement with specific desquamation of the fin- Although the exact mechanism of action is not clear, effec- gers and toes in children [in Japanese]. Kawasaki syndrome Fever, Endocarditis, and Kawasaki Disease, Council on Car- and the eye. High-dose gammaglobulin therapy for Kawa- composition in patients with Kawasaki disease. Curr Treat health professionals from the Committee on Rheumatic Options Cardiovasc Med 2007; 9(2):148158. The time interval between ocular and audiovestibular involvement may be as long as 2 years. Another group includes patients with more than 2 years between the onset of the ophthalmogic symptoms and the audiovestibular manifestations. A third group includes patients with typical ocular manifestations associated, within 2 years, with audiovestibular symptoms different from Meniere-like episodes. Keywords Autoimmunity progressive hearing loss interstitial keratitis when both eye and ear findings were noted) was 38 years Introduction (range 970 years) (6). The earliest description of nonsyphilitic keratitis coexisting with vestibuloauditory disturbances was published by Morgan and Baumgarther in 1934 (1). This opinion and Williams called attention to the systemic manifesta- has been supported by the findings of antibodies against tions of this syndrome (3). Interestingly, tinnitus, vertigo and hearing loss, which is usually bilateral only 5% of the patients were initially presented with both (4). Hearing loss may initially fluctuate with repeated vestibuloauditory and ophthalmologic symptoms. In this attacks but generally develops progresses to irreversible series, 47% of patients presented initially with only vestibu- bilateral deafness in 5285% of patients (6, 12). In their loauditory signs and 33% had only ophthalmologic symp- review, Gluth et al. In most patients (85%), both vertigo (90%), tinnitus (80%), ataxia (53%) and oscillopsia vestibuloauditory and ophthalmologic symptoms developed (25%). Additionally, physical examination Ophthalmic Manifestations revealed spontaneous and/or gaze-induced nystagmus at some point of their disease in 20% of the patients. In most cases, both eyes are affected during the disease Systemic Manifestations course, with great variability in symptoms from one eye to the other, and from day to day. Cardiovascular involvement is present in 10% of tapered slowly and continued for 26 months. Recent reports suggested that, in cases of relapse tis and Wageners granulomatosis (11). Patients with profound hearing loss after unsuccess- Laboratory and Radiological Data ful treatment with anti-inflammatory drugs are candidates for cochlear implantation. Low titers of rheu- Unlike other systemic collagen or autoimmune diseases, matoid factor, antinuclear antibodies and cryoglobulins it is not associated with a specific autoantibody. The other difficulty in gathering diag- Treatment nostic criteria arises from the low incidence of reported cases of the disease. The time interval between ocular and rapid initiation of high-dose corticosteroids (11. Cogan Infectious syndrome: studies in Thirteen patients, long-term follow-up, Congenital and acquired syphilis and a review of the literature.

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In addition there seems to be a more pronounced T3 decrease in direct relation with the severity of depression (Stipcevi et al 300mg irbesartan for sale diabetes symptoms full list, 2008; Saxena et al irbesartan 300 mg lowest price diabetes test in pregnancy. Reported T4 levels in depression are also contradictory generic 150 mg irbesartan amex diabetic juice fast, since there is evidence showing a rise as well as a decrease of T4 during depressive episodes buy irbesartan 150 mg free shipping free diabetes test las vegas. Nevertheless, many authors have seen that a subgroup of depressive patients manifest a subclinical hypothyroidism and this might be a negative prognostic factor (Fountoulakis et al. It has been proposed that in them exist a blunted response due to the raise of circulating cortisol, associated to hypothalamic- pituitary-adrenal axis hyperactivity. This issue is relevant in patients suffering depressive disorders, related with reduction in mono amine neurotransmission such as serotonin (reviewed in Belmaker&Agam 2008). A positive correlation between serotonin levels and circulating T3 has been described in humans. Indirect evidences showed that brain serotonin is increased in hyperthyroidism and decreased in hypothyroidism (Singhal et al. In depressed subjects, the decrease in serotoninergic tone could be related to lower brain T3 levels, perhaps due to a reduction of deiodinases activity. Furthermore, an imbalance in T3 conversion could account for depressive disorder and/or clinical outcome to antidepressants therapy. Interestingly, T4 concentrations were significantly lowered after administration of the antidepressant but, serum T3 levels were significantly reduced only after toxic dosis of desipramine. Patients carrying the T allele of D1-rs11206244 showed a significant response to 8 week of antidepressant treatment in comparison with non-carriers of the allele. Additionally, there was no effect of T allele on sertraline response, suggesting that the polymorphism is not associated to antidepressant effect (Cooper-Kazaz et al. As we mentioned, the T allele of D1-rs11206244 showed lower T3 and higher rT3 than non-T carriers (de Jong et al. Thus, it seems that patients genetically characterized by poor conversion of T4 to T3, are better responders to T3-antidepressant co-treatment (Cooper-Kazaz et al. Another study evaluated whether baseline thyroid function and D2 rs225014 (D2-Thr92Ala) predict response to paroxetine. However, up to date there is no study evaluating the influence of T3 and D2 polymorphisms on antidepressant response. Based on these observations, we evaluated the presence of D2 polymorphism related with a lower activity of the enzyme: D2-Thr92Ala (T/C). We concluded that Thr92Ala polymorphism of D2 gene could be considered a predictive marker of clinical response to fluoxetine, and hence of pharmacological therapy, but more studies are needed to confirm this preliminary results. The presence of these polymorphisms could influence basal activity of type 2 deiodinase, and therefore of T3 bioavailability in the brain. Use of thyroid hormone in depression Several studies using thyroid hormones in the management of patients with mood disorders have been reported since the early seventies. In patients receiving electroconvulsive therapy, those treated with T3 required less sessions and presented less memory loss compared with placebo treated group (Stern et al. T3 has been employed in initial combination therapy, and T3 or T4 in refractary depression or non responder patients. T3 in doses of 20 to 50 g is able to enhance the effect of tricyclic antidepressants and shorten the depression period but, many studies have not demonstrated differences in the number of patients recovered (Prange et al. A meta-analysis showed that when T3 was used in refractary depression in addition to tricyclic antidepressant therapy, patients treated with it were twice as likely to respond as controls, decreasing depression severity scores (Aronson et al. All those cases were treated mainly with fluoxetine in a daily dose of 20 to 40 mg/ and 25-50 g of T3, with few side effects. Some authors have suggested that T4 augmentation is less effective than T3 (Joffe&Singer, 1990) and that supra physiological doses (250-600 ug/day) are needed, as has been demonstrated in patients with resistant major depression or refractary uni and bipolar disorders (Baumgartner et al. These results support the theory of a reduced deiodination of T4 compatible with an inhibition of the D2 or a stimulation of the D3 in brain tissues resulting in reduced local T3 concentration. Main limitations of the studies are: small number of cases, lack of a placebo group, heterogeneity in diagnosis criteria, differences in observational period and in antidepressant therapy. We studied the effect of adding T3 in a dose of 50 ug per day (n=11) or placebo (n=10), to the standard antidepressant therapy with fluoxetine during 8 weeks. The difference between initial and 2 month was highly significant in both groups (using paired t tests). Although, we could not demonstrated in this particular group, a significant antidepressant effect. They have been employed to image and quantify brain perfusion, flow and metabolism in several conditions as well as the radionuclide techniques have been used to map neurotransmissors, receptors, drug actions and many metabolic pathways. Functional imaging in mood disorders may show abnormalities at different brain levels that could normalize with therapy. Several serotonin and adrenergic markers have also been employed to study negative emotional stimuli response in mood disorders. For instance: thalamic activity was increased by reboxetine, whereas citalopram primarily affected ventrolateral prefrontal regions. It would be interesting to have a method able to predict therapy responses to either noradrenergic or serotoninergic antidepressants (Carey et al. It is also known that even mild hypothyroidism may produce changes in brain regions modulating attention, motor speed, memory and visual-spatial processing. Hypothyroidal patients were also significantly more depressed, anxious and psychomotor slowered than euthyroidal subjects (Nagamachi et al. Brain metabolism and flow are usually decreased in major depression and bipolar disease being metabolism inversely associated with the severity of depression. Changes are variable and as we mentioned earlier, could reverse with adequate therapy. Subgenual prefrontal cortex presents abnormal blood flow and metabolism in the depressed state. Prefrontal cortex and limbic structures are involved in emotion regulation and amygdale is involved in emotional memory formation (Buchsbaum et al. Morphometric studies have evaluated hippocampus volume association with response to treatment. Patients who remit have larger pretreatment hippocampus volumes bilaterally compared with those who do not remit. A recent work demonstrated a significantly thinner posterior cingulate cortex in non-remitters than in remitters, and also significant decrease in perfusion in frontal lobes and anterior cingulate cortex in non-remitters compared with healthy controls, at baseline (MacQueen, 2009; Jrnum et al. Changes in amygdala activation when processing negative faces expressions might serve as an indicator for improved frontolimbic control required for clinical response (Ruh, 2011). We did not observe significant neocortical perfusion change after 2 months of standard dose of fluoxetine therapy. Only a small difference was found at deep structure level that could imply diverse brain mechanism involved [data not published]. These findings are in agreement with other reports showing relative normalization of perfusion and metabolism that were abnormally increased at baseline in patients with mood disorders. The amygdala and limbic structures have been associated with face recognition and emotional processing. It is well known that there is increased perfusion and metabolism in specific brain areas, reflecting molecular abnormalities in neurotransmitter systems. The development of new molecular imaging methods could help in the individualization of antidepressant therapies (Chen et al. Conclusions Depressive and thyroid disorders are important public health problems. It is also accepted that overt hyper or hypothyroidism are not found frequently among mood disorders patients except in those with bipolar disorders, indicating that in most cases the underlying abnormality is at cellular or molecular levels.

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