Can SPECT change the surgical strategy in patients with primary hyperparathyroidism?

Primary hyperparathyroidism (PHPT) is the most common cause of hypercalcemia in outpatients. It is more common in females, after menopause, and the prevalence is 1 to 4:1000 in the general population. Patients with PHPT have abnormal regulation of PTH secretion, resulting in elevated serum calcium and inappropriately high or normal PTH in relation to the calcium value. Sporadic PTH-secreting adenoma alone accounts for 90% of cases of PHPT, while multiglandular hyperplasia is more common in familial hyperparathyroidism syndromes (5%) and parathyroid carcinomas represent less than 1% of cases. Only after making sure there is functional autonomy of one or more parathyroid glands, localization imaging tests should be performed to guide a possible surgical procedure. It is important to highlight that these tests have limitations and can yield false-positive and false-negative results. There are cases in which the parathyroid gland is difficult to be located, requiring a combination of imaging methods for pre-operative localization, such as (99m)Tc-pertechnetate, SPECT, SPECT/CT, and US. We describe the case of a 50-year-old female patient diagnosed with PHPT, who underwent a surgical procedure without success, with maintenance of hypercalcemia and hyperparathyroidism. In this case, the hyperfunctioning parathyroid was located in the retrotracheal region only after scintigraphy combined with SPECT/CT were used.     

Hepatocyte cryopreservation:Is it time to change the strategy?

Liver cell transplantation presents clinical benefit in patients with inborn errors of metabolism as an alternative,or at least as a bridge,to orthotopic liver transplantation.The success of such a therapeutic approach remains limited by the quality of the transplanted cells.Cryopreservation remains the best option for long-term storage of hepatocytes,providing a permanent and sufficient cell supply.However, isolated adult hepatocytes are poorly resistant to such a process,with a significant alteration both...     

Hepatocyte cryopreservation: Is it time to change the strategy?

Liver cell transplantation presents clinical benefit in patients with inborn errors of metabolism as an alternative,or at least as a bridge,to orthotopic liver transplantation.The success of such a therapeutic approach remains limited by the quality of the transplanted cells.Cryopreservation remains the best option for long-term storage of hepatocytes,providing a permanent and sufficient cell supply.However, isolated adult hepatocytes are poorly resistant to such a process,with a significant alteration both...     

Can we stabilize unstable plaque?

Conclusions From these considerations, successful therapeutic approaches should control multiple aspects of plaque stabilization. Statins fulfill such a requirement, yet combination therapy may be of use in specific clinical settings. Despite remarkable therapeutic achievements in the management of acute coronary syndromes, mortality rates for this disease worldwide still rank first. This means that further effort is needed to extend clinical benefit to a larger proportion of patients.     

Can therapeutic response to IL-1 blockade confirm the diagnosis of Schnitzler syndrome?

Clinical Rheumatology -     

Could fractional flow reserve guide therapeutic strategy in acute coronary syndrome?

Fractional flow reserve, as determined with a pressure-wire, was validated in the assessment of the functional severity of intermediate lesions in a population with stable ischemic cardiopathy. The value of pressure-wire analysis in acute coronary syndrome is unknown. We report two patients with acute coronary syndrome, in which the therapeutic approach was guided by the fractional flow reserve. We discuss the utility of this tool in this context.     

Occupational asthma in the furniture industry: is it due to styrene?

BACKGROUND: Styrene, a volatile monomer, has been reported as a cause of occupational asthma in a few case reports. OBJECTIVE: The aim of this study was to investigate the risk for asthma in relation to exposure to styrene in a large number of workers. METHODS: A total of 47 workers with a history of exposure to styrene were included in the study. To establish whether asthma was present, each patient underwent a clinical interview, pulmonary function testing and bronchial challenge with methacholine. Specific bronchial challenges with styrene and serial peak expiratory flow (PEF) measurement at home and at work were carried out in subjects with a diagnosis of asthma to evaluate the relationship between their asthma and exposure to styrene in the workplace. RESULTS: Among the 47 subjects, 5 workers had given a history of work-related symptoms, and 3 of them had a positive methacholine challenge test. Specific bronchial challenges with styrene and serial PEF measurement were subsequently carried out in these 3 subjects. Although provocation tests with styrene were negative in the 3 workers, 1 worker had PEF rate records compatible with occupational asthma. CONCLUSION: We established one patient with occupational asthma from a group of people who have excessive styrene exposure. This finding may be suggestive but is not conclusive about the causative role of styrene in occupational asthma. Since styrene is a frequently used substance in the furniture industry, it is worth performing further studies to investigate the relationship between styrene and occupational asthma.     

Apoptosis in atherosclerosis. Does it contribute to plaque instability?

Several reports have demonstrated apoptosis in the advanced human atheroma. Most clinical events however, are precipitated by plaque rupture, to a lesser extent erosion, and the development of occlusive thrombi. Whether the extent of apoptosis can influence lesion stability is not precisely known, however, there is emerging data supporting this role. Obvious difficulties arise when studying apoptosis in atherosclerotic plaques because of the complex nature of the disease and lack of an experimental model of plaque instability. This article applies a systematic approach to discuss the issue of apoptosis in context of early disease to complex symptomatic lesions that may become fatal.     

How to evaluate plaque vulnerability in animal models of atherosclerosis?

Prevention of heart attack and stroke depends on detection of vulnerable plaques and development of plaque-stabilizing therapies. In turn, progress in diagnostics and treatment is contingent on our understanding of molecular mechanisms of plaque vulnerability. Animal models are essential for testing mechanistic hypotheses in a controlled manner. Currently, there is no single, golden standard animal model of a vulnerable plaque. However, the whole range of experimental approaches is readily available. It includes traditional models of atherosclerosis combined with new 'vulnerability endpoints', as well as several models featuring spontaneous or induced plaque rupture/thrombosis. This review summarizes current literature on the animal models of vulnerable atherosclerotic plaques.