Coexistent Thyroid Pathologies and High Rate of Papillary Cancer in Patients with Primary Hyperparathyroidism: Controversies About Minimal Invasive Parathyroid Surgery

Thyroid carcinoma and benign thyroid diseases associated with primary hyperparathyroidism (PHPT) may cause difficulties in the diagnosis, localization and therapy of PHPT. In this study, we analysed coexistent thyroid pathologies in 51 patients who underwent neck exploration with a diagnosis of PHPT between 1999-2002. Five hundred thirteen patients who underwent thyroidectomy for nodular thyroid disease without a parathyroid pathology in histopathological examination served as controls. In patients with PHPT there were 43 cases (84.3%) of coexistent thyroid pathology. Nine patients (17.6 %) had coexistent papillary thyroid cancer. Nine patients (17.6 %) had lymphocytic thyroiditis, two (3.9%) had benign thyroid adenoma and 24 (47%) had nodular hyperplasia. In one patient (2%), there was intrathyroidal metastasis from a parathyroid cancer. One patient had coexistent lymphocytic thyroiditis and multifocal papillary cancer. One of the two cases with thyroid adenomas was Hürthle cell type. In the control group only 28 patients (5.5%) had thyroid malignancy (27 papillary cancer and one follicular cancer). In conclusion, the coexistent thyroid pathologies are highly prevalent in patients with PHPT and pre-and intra-operative thyroid examination should be performed to avoid overlooking important thyroid pathologies.     

Predictive Value of Sonographic Features in Preoperative Evaluation of Malignant Thyroid Nodules in a Multinodular Goiter

BACKGROUND: The primary goal of ultrasonography (US) in the evaluation of a thyroid nodule is to determine its malignancy, although the diagnosis of a malignant nodule on the basis of US alone is nearly impossible. The aim of this prospective study was to evaluate the predictive value of sonographic features in the preoperative diagnosis of malignant thyroid nodules, and to determine the important features of sonography. METHODS: This prospective study included 550 consecutive patients with , thyroid nodules. Nodules were divided into two groups on the basis of pathological diagnosis: group 1 consisted of 1,633 nodules with a benign pathology, and group 2 consisted of 293 nodules with a malignant pathology. RESULTS: Microcalcifications, blurred nodular margins, and solid and hypoechoic appearance were more common in malignant nodules compared to benign nodules (89.1% versus 5%; 64.5% versus 4.7%; 81.6% versus 30.6% ; and 62.5% versus 43.1%, respectively; p < 0.001). There was a positive correlation between the detection of malignant thyroid nodules and microcalcification (rs = 0.791, p = 0.0001), blurred nodular margin (rs = 0.625, p = 0.0001), solid appearance (rs = 0.376, p = 0.0001), and hypoechoic appearance (rs = 0.141, p = 0.0001). Microcalcifications, blurred nodular margins, and solid and hypoechoic appearance were independent determinants of malignancy upon US examination of thyroid nodules (OR: 159, OR: 37, OR: 9.9, and OR: 2.2, respectively). CONCLUSION: Although we did not identify a single feature indicative of malignancy in the sonographic examination of nodules, microcalcification and blurred margin were the strongest correlates for malignancy.     

Atrioesophageal Fistula After Cryoballoon Pulmonary Vein Isolation

Atrioesophageal Fistula After Cryoballoon PV Isolation . The risk of atrioesophageal fistula after cryoballoon pulmonary vein isolation is thought to be much lower than after radiofrequency ablation, seeing that no data exist on this complication so far. We report for the first time on the occurrence of an atrioesophageal fistula 4 weeks after cryoballoon ablation at the site of the left inferior pulmonary vein. We suggest that even when using cryothermal ablation technique, an imaging modality to assess the proximity of esophagus and left atrium should be routinely performed to avoid this fatal complication. (J Cardiovasc Electrophysiol, Vol. 23, pp. 1254–1257, November 2012)     

L-Selenomethionine Does Not Protect Against Testosterone Plus 17β-Estradiol-Induced Oxidative Stress and Preneoplastic Lesions in the Prostate of NBL Rats

Previous animal studies examining dietary selenium effects on prostatic carcinogenesis did not show preventive benefit, including 1 study in a rat model involving testosterone (T) and estradiol (E2)-induced prostatic oxidative stress. Here, we examined modulation of T + E2-induced prostatic oxidative stress, dysplasia, and inflammation by L-selenomethionine at 1.5 or 3.0 mg selenium/kg in NIH-07 diet in Noble (Nbl)/Crl rats treated with T + E2 for 16 wk. Hormone treatment increased immunohistochemical staining for 8-hydroxydeoxyguanosine (8-OHdG) in the prostatic sites of T + E2-induced preneoplasia (P < 0.05), but selenomethionine did not attenuate 8-OHdG staining and dysplasia in the lateral prostate. Glutathione-peroxidase activity (P < 0.05) and mRNA expression were induced by T + E2 (P < 0.0001) but not changed by selenomethionine. Selenomethionine did not cause significant responses in expression and activity of glutathione-peroxidase and MnSOD, except for a reduction of MnSOD protein expression in the lateral prostate (P < 0.01). The absence of reduction of oxidative stress and dysplasia and the minimal effects on antioxidant enzymes caused by selenomethionine are consistent with the null effects observed in selenium supplementation animal studies and clinical trials. Significant (P < 0.01) opposite apoptosis/cell proliferation balance responses to selenomethionine and to T + E2 occurred in the lateral and dorsal prostate, explaining why T + E2 induces lesions selectively in the lateral lobe of NBL rats.     

The effect of oral contraceptives on current wheezing in young women

BackgroundEmerging evidence suggests that sex steroid hormones may influence respiratory symptoms. The existing literature about the role of oral contraceptive pill (OCP) on respiratory disease is scarce and conflicting especially during the adolescent period. In this study, we aimed to investigate the effect of OCPs on current wheezing among adolescents and young adults.MethodsA questionnaire was administered face-to-face to adolescents and young women by a physician. The questionnaire included ISAAC survey-comprised questions on ever wheezing, current wheezing, allergic diseases, smoking history (active or passive), and family history of allergic diseases and questions on OCP usage status. The effect of OCPs on wheezing was evaluated by logistic regression analysis.ResultsA total of 487 subjects aged between 11.3 and 25.6 years participated in the study and 196 (40.2%) reported that they had used OCPs. 7.4% of the participants had physician-diagnosed asthma and 10.3% of them were active smokers. It was detected that OCPs were associated with increased risk for current wheezing (odds ratio, 2.36; 95% CI, 1.25–4.47 adjusted for asthma and current smoker) and this risk was related with the usage during the past year.ConclusionYoung women taking oral contraceptives had a higher rate of current wheezing, suggesting that sex steroids may be of importance for respiratory health.     

Genotyping of the reduced folate carrier‐1 c.80G>A polymorphism by pyrosequencing technology: Importance of PCR and pre‐PCR optimization

When developing a genotyping assay by Pyrosequencing^? technology for the RFC1 (SLC19A1) c.80G>A polymorphism (rs1051266), unequal peak heights in the pyrograms were observed, probably due to unequal amplification of the mutated and wild‐type alleles. This rarely occurring problem could potentially render assignment of heterozygous genotypes uncertain. When the PCR conditions were studied, it was found that substitution of the dGTP nucleotide in the master mix by dGTP and dITP in proportion 1:1 largely overcame this problem. Heat denaturation of the DNA at 95°C before PCR also counteracted the problem. A combination of these two modifications of the standard pyrosequencing PCR protocol gave the best results. We conclude that, with these modifications, the RFC1 c.80G>A SNP can be reliably assayed by pyrosequencing.     

Wound management for 287 patients with chronic leg ulcers demands 12 full-time nurses Leg ulcer epidemiology and care in a well-defined population in southern Sweden

Objective. To investigate quality of life, measured by the SF-36 scales, in a population-based sample of women who have survived cancer at any site and, specifically, breast cancer. Design. A representative cohort of women was observed over 24 years with regard to cancer prevalence, incidence, and quality of life. Setting. Gothenburg, Sweden. Subjects. A total of 1462 women aged 38–60 years at baseline. Main outcome measures. Differences in quality of life between cancer survivors and cancer-free controls measured by the SF-36 Short Form Health Survey, with adjustment for age and additionally for social status, and history of major disease (diabetes, stroke, and myocardial infarction) at follow-up in 1992–93. Results. In women who had survived cancer, a lower feeling of general health was the only score found to be significantly associated with having had cancer. Similar analysis was conducted separately for breast cancer cases. Survivors of breast cancer reported lower vitality and when controlled for major disease also lower general health compared with women who had not had cancer. All other results were independent when adjusted for social status, and also for history of major disease. Conclusions. Women who have survived cancer report lowered general health, and breast cancer cases lowered vitality, but considering the non-significant results for the other scores and summary scales it can be concluded that the well-being of women who have survived a cancer on the whole did not differ profoundly from that of other women.