Outcome after treatment of papillary thyroid microcarcinoma

Patients with thyroid microcarcinoma (TMC) have favourable long-term prognoses. However, recurrences in the neck and distant metastases have been reported. The authors investigated independent factors associated with recurrence in an effort to define therapeutic guidelines. In this study they report the results of a retrospective review of patients followed at one Institution. 120 patients ( 96 females and 24 males; mean age 45.2 years) with a papillary thyroid microcarcinoma (PTC) < or =1 cm in greatest dimension were analyzed. All of them were followed for 5 to 15 years. 106 of them were managed aggressively (total thyroidectomy), the remainder treated with lobectomy alone. Radioiodine therapy was performed in 62/106 patients submitted to total thyroidectomy. Despite the different treatment and the presence of neck node metastases at the time of the diagnosis in 26 of the reported 120 patients (22%) and local invasion beyond the thyroid capsule in 20 (17%), only 1.7% of patients had neck nodal local recurrence. No patient died or developed distant metastases. In this preliminary study the authors conclude that the outcome of PMC is generally favourable, even in presence of lymph-node metastases and local invasion, independently of the primary treatment.     

Breast-conserving surgery in breast cancer

Breast-conserving surgery is the treatment of choice for the breast cancer T < 3 cm. The local recurrence is a problem of diagnosis and consequent treatment. We enrolled, from 1987 to 2004, 1504 breast cancer. In 803 (53.4%) tumor with T < 3 cm we performed conserving surgery. The sentinel lymph node (SN) technique induce to limit the axillary dissection in patients T1a-b to the SN only if non metastatic and located to the first level, the dissection of the 1st level of the axilla in patients T1c-T2 < 3 cm and SN negative, complete axillary dissection in patients with metastatic SN or located to the 2nd level. Our percentage of local recurrence in the follow-up was 3.5% at 5 years and 6% at 10 years.     

Periodontal disease: the influence of metabolic syndrome

Background

Recent evidence suggests that the effects of certain food additives may be synergistic or additive. Aspartame (ASP) and Monosodium Glutamate (MSG) are ubiquitous food additives with a common moiety: both contain acidic amino acids which can act as neurotransmitters, interacting with NMDA receptors concentrated in areas of the Central Nervous System regulating energy expenditure and conservation. MSG has been shown to promote a neuroendocrine dysfunction when large quantities are administered to mammals during the neonatal period. ASP is a low-calorie dipeptide sweetener found in a wide variety of diet beverages and foods. However, recent reports suggest that ASP may promote weight gain and hyperglycemia in a zebrafish nutritional model.

Methods

We investigated the effects of ASP, MSG or a combination of both on glucose and insulin homeostasis, weight change and adiposity, in C57BL/6?J mice chronically exposed to these food additives commencing in-utero, compared to an additive-free diet. Pearson correlation analysis was used to investigate the associations between body characteristics and variables in glucose and insulin homeostasis.

Results

ASP alone (50?mg/Kgbw/day) caused an increase in fasting blood glucose of 1.6-fold, together with reduced insulin sensitivity during an Insulin Tolerance Test (ITT) P?<?0.05. Conversely MSG alone decreased blood triglyceride and total cholesterol (T-CHOL) levels. The combination of MSG (120?mg/Kgbw/day) and ASP elevated body weight, and caused a further increase in fasting blood glucose of 2.3-fold compared to Controls (prediabetic levels); together with evidence of insulin resistance during the ITT (P?<?0.05). T-CHOL levels were reduced in both ASP-containing diets in both genders. Further analysis showed a strong correlation between body weight at 6?weeks, and body weight and fasting blood glucose levels at 17?weeks, suggesting that early body weight may be a predictor of glucose homeostasis in later life.

Conclusions

Aspartame exposure may promote hyperglycemia and insulin intolerance. MSG may interact with aspartame to further impair glucose homeostasis. This is the first study to ascertain the hyperglycemic effects of chronic exposure to a combination of these commonly consumed food additives; however these observations are limited to a C57BL/6?J mouse model. Caution should be applied in extrapolating these findings to other species.     

Coeliac disease: Oral ulcer prevalence, assessment of risk and association with gluten-free diet in children

AIMS: Oral mucosal lesions may be markers of chronic gastrointestinal disorders, such as those causing malabsorption. Our objectives were to assess the prevalence of recurrent oral aphthous-like ulcers in coeliac disease patients living in the Mediterranean area, and to evaluate the impact of a gluten-free diet. METHODS: A test group of 269 patients (age range 3-17 years) with coeliac disease confirmed both serologically and histologically was compared with a control group of 575 otherwise clinically healthy subjects for the presence, or a positive history of aphthous-like ulcers. Coeliac disease patients with aphthous-like ulcers were re-evaluated 1-year after starting a gluten-free diet. RESULTS: Aphthous-like ulcers were found significantly more frequently in coeliac disease, in 22.7% (61/269) of patients with coeliac disease versus 7.1% (41/575) of controls (p=<0.0001; chi-square=41.687; odds ratio=4.3123; 95% confidence interval=2.7664:6.722). Most coeliac disease patients with aphthous-like ulcers and adhering strictly to gluten-free diet (71.7%; 33/46) reported significant improvement on gluten-free diet, with no or reduced episodes of aphthous-like ulcers (p=0.0003; chi-square=13.101; odds ratio=24.67; 95% confidence interval=2.63:231.441). CONCLUSIONS: The epidemiological association found between coeliac disease and aphthous-like ulcers suggests that recurrent aphthous-like ulcers should be considered a risk indicator for coeliac disease, and that gluten-free diet leads to ulcer amelioration.     

In vivo-in vitro correlations with various aspirin formulations

In vivo evaluation of gastric irritation as determined by gastric transmural potential difference (GPD) and in vitro characterization of four formulations have been made. The four formulations were: (A) highly buffered, (B) cytoprotective, (C) microencapsulated and (D) a plain tablet. The GPD results showed C to be much less irritating than A or D, and slightly less-irritating than B. The release from all formulations was well represented by dissolution efficiency (DE%) and mean time of dissolution. When correlation coefficients were calculated, significant relationships were found between DE% and the GPD parameters area under the baseline (AUB) and the Reiz Index (RI), and between the mean time of dissolution and the GPD parameters AUB, mean potential drop (MD) and RI.     

Giant left atrium and mitral valve replacement: risk factor analysis

Giant left atrium (GLA) associated with mitral valve disease (MVD) has been reported as a significant risk factor in mitral valve surgery with mortality ranging from 8%-32%. Plication of the left atrium has been suggested to reduce postoperative left ventricular failure, respiratory failure and mortality. The 203 consecutive patients with MVD operated upon between 1980 and 1986 were reviewed and divided in two groups: group A without GLA (165 patients) and group B with GLA (38 patients = 19%). The pertinent preoperative and intraoperative notes and the early and late postoperative course were reviewed and correlated. The hospital mortality was 2.4% in group A and 2.6% in group B. Late mortality, at a mean follow-up of 54 months was 4.3% in group A and 5.4% in group B. In this series, GLA was not a significant risk factor in MVR and did not affect early and late results as compared with cases without GLA. Plication may not be required in absence of extracardiac signs of compression.     

Ultrasound imaging for external-beam prostate treatment setup and dosimetric verification

Ultrasound (US) image-guided patient positional verification was performed daily on four prostate cancer patients using the BAT system (NOMOS® Corporation, CA). The BAT system has shown that the prostate can shift by as much as 1 cm from its intended position in any direction. Furthermore, the daily shifts measured by the BAT system were included into the treatment planning system to assess changes in prostate dose coverage. Dose volume histograms were used to compare the dosimetry between the ideal patient set-up situation (prostate always positioned correctly) and that taking all patient daily shifts into consideration. Daily patient shifts on the order of magnitudes measured, can significantly and adversely affect dosimetric coverage, therefore an US-based patient positioning system is required for improving the therapeutic ratio.