Pressure-flow relationships of the canine iliac periphery and systemic hemodynamics: Effects of sodiumnitroprusside and adenosine

It has been reported that sodiumnitroprusside (SNP) decreases mean systemic pressure and simultaneously increases pressure pulse amplification towards the iliac periphery (Kenner and van Zwieten 1982). This unexpected finding was suggested to be due to a decrease in iliac peripheral resistance but an increase in iliac differential resistance. In order to investigate this apparent contradiction, the iliac periphery was hemodynamically isolated from the rest of the circulation and perfused with the dog's own blood by means of a pump. Perfusion pressure (P) and flow (F), femoral venous pressure (P_v), systemic pressure (P_s) and cardiac output (CO) were measured. Steady state pressure-flow relations of the isolated bed were obtained during control and during various i.v. infusion rates of SNP and adenosine (ADS) and were found to be straight (meanr=0.99). Their slope (P/F) was defined as differential resistance (R_d). Peripheral resistance (R_p) of the iliac bed was defined as R_p=(P-P_v)/F, calculated at the flow value where perfusion pressure equalled the prevailing systemic pressure. Total peripheral resistance (TPR) was defined as TPR=P_s/CO. The changes of R_d, R_p, P_s, CO and TPR with respect to control show that during low SNP infusion rates R_d and R_p were both increased while TPR was decreased. During all infusion rates of SNP CO did not change while P_s decreased. During low infusion rates of adenosine CO increased while P_s, R_d and R_p did not change and TPR decreased. During high infusion rates of ADS CO decreased again, R_d, R_p and P_s decreased, and TPR remained constant but at a decreased level.It is concluded that: (1) the suggestion of Kenner and van Zwieten is not supported, since SNP (as well as ADS) affects iliac peripheral and iliac differential resistance in a similar way; (2) SNP (as well as ADS) affects iliac peripheral resistance and total peripheral resistance in a differentiated way, and even in an opposite way during low infusion rates of SNP; (3) it is this opposite effect that explains the paradoxical observations of Kenner and van Zwieten; (4) for comparable reductions of TPR, CO is better maintained during infusion of SNP, while P_s is better maintained during infusion of ADS.     

Ultrastructural features of solid/trabecular areas in differentiated thyroid carcinoma

The presence of areas exhibiting a solid/trabecular pattern of growth within an otherwise differentiated thyroid carcinoma represents a source of controversy as regards its proper classification and biologic and prognostic significance. The aim of the current study was to investigate the ultrastructural features of solid/trabecular areas in differentiated thyroid carcinoma and to compare those features with the submicroscopic profile of differentiated, poorly differentiated (insular), and undifferentiated (anaplastic) variants of thyroid cancer. The study series included differentiated carcinoma with solid/trabecular areas (3 cases), conventional papillary carcinoma (4 cases), follicular variant of papillary carcinoma (4 cases), poorly differentiated (insular) carcinoma (3 cases), and undifferentiated (anaplastic) carcinoma (3 cases). It was found that the solid/trabecular areas in differentiated carcinoma and poorly differentiated (insular) carcinoma share similar ultrastructural features and overall retain, even if attenuated, many of the submicroscopic attributes of differentiated carcinomas. In particular, nests of neoplastic cells were observed showing a highly developed cytosecretory apparatus and the presence of numerous abortive/rudimentary follicles, and intercellular and intracellular (intracytoplasmic) lumina/canaliculi of variable morphology. The study supports the hypothesis that the solid/trabecular areas do not merely represent an architectural pattern but rather should be regarded as the expression of a process of reduced differentiation similar to that of poorly differentiated (insular) carcinoma.     

Fluorine-18 fluorodeoxyglucose positron emission tomography in the follow-up of differentiated thyroid cancer

Whole-body fluorine-18 fluorodeoxyglucose (FDG) positron emission tomography (PET) imaging was performed during the follow-up of 33 patients suffering from differentiated thyroid cancer. Among them there were 26 patients with papillary and seven with follicular tumours. Primary tumour stage (pT) was pT1 in six cases, pT2 in eight cases, pT3 in three cases and pT4 in 14 cases. FDG PET was normal in 18 patients. In three patients a slightly increased metabolism was observed in the thyroid bed, assumed to be related to remnant tissue. In one case local recurrence, in ten cases lymph node metastases (one false-positive, caused by sarcoidosis) and in three cases distant metastases were found with FDG PET. In comparison with whole-body scintigraphy using iodine-131 (WBS) there were a lot of discrepancies in imaging results. Whereas three patients had distant metastases (proven with¹³¹I) and a negative FDG PET, in four cases¹³¹I-negative lymph node metastases were detectable with PET. Even in the patients with concordant staging, differences between¹³¹I and FDG were observed as to the exact lesion localization. Therefore, a coexistence of¹³¹I-positive/FDG-negative,¹³¹I-negative/FDG-positive and¹³¹I-positive/FDG-positive malignant tissue can be assumed in these patients. A higher correlation of FDG PET was observed with hexakis (2-methoxyisobutylisonitrile) technetium-99m (I) (MIBI) scintigraphy (performed in 20 cases) than with WBS. In highly differentiated tumours¹³¹I scintigraphy had a high sensitivity, whereas in poorly differentiated carcinomas FDG PET was superior. The clinical use of FDG PET can be recommended in all cases of suspected or proven recurrence and/or metastases of differentiated thyroid cancer and is particularly useful in cases with elevated serum thyroglobulin levels and negative WBS.     

Management of papillary microcarcinoma of the thyroid gland

DESIGN: To investigate the frequency, treatment and clinical behaviour of differentiated microcarcinoma of the thyroid gland (PTMC). PATIENTS AND METHODS: Out of 376 patients submitted to surgical treatment for differentiated thyroid cancer from June 1980 to October 2003, 77 had been identified has having a PTMC (63 females, 14 males; mean age 43+/-13 years). Sixty-seven patients (87%) met the AMES risk definition for low (group I) and 10 (13%) for high-risk (group II) definition. The surgical procedures were lobo-isthmusectomy (n=14) or subtotal thyroidectomy (n=20) and total thyroidectomy (n=43) with node dissection in 15 cases. Follow-up ranging from 9 to 274 months (mean 124+/-84). RESULTS: Overall patient survival rates were 100 and 94% at 20 years in groups I and II, respectively (p=ns). There were no significant differences in surgical complications and in survival in patients submitted to total thyroidectomy when compared to partial thyroid resection. The presence of cervical node metastasis did not affect patient survival (p=0.8). The overall mean survival time was 266 months. CONCLUSIONS: Despite the overall excellent prognosis, PTMC was associated with a 1% disease-related mortality, a 2.5% local recurrence rate, 1% lymph-node recurrence rate, and 1% distant metastasis rate. We recommend total thyroidectomy accompanied by modified neck dissection if enlarged nodes are diagnosed.     

分化型甲状腺癌45例再次手术临床分析

目的：探讨分化型甲状腺癌再次手术的原因及对策。方法：回顾性分析本科2000年1月。2007年1月收治的甲状腺手术后病理证实为分化型甲状腺癌需再次手术治疗的45例临床病理资料。结果：45例再次手术患者原因为将甲状腺癌误诊为甲状腺良性病变35例（77．7％）,首次手术时25例术前未行定性检查,8例病理误诊为良性。首次手术术式选择不当33例（73‘3％）,术后病理证实癌残留19例（42．2％）,术后复发2例f4．4％）。发生短暂喉返神经损伤2例,短暂低钙抽搐2例,发生术后窒息1例,全组无手术死亡。再次手术者术后随访3～7年,平均随访5年,1例手术后34个月死于肺及骨转移,5年生存率为97．77％。结论：甲状腺癌的临床及病理误诊,手术切除范围不够是造成再次手术的主要原因,提高对甲状腺癌的认识水平,强调术前B超＋穿刺细胞学检查,常规术中快速冰冻切片,选择正确的手术方式是避免甲状腺癌再次手术的重要环节,熟练掌握再次手术的人路及技巧是确保再次手术成功的关键。     

18F-FDG PET/CT显像偶发甲状腺癌的葡萄糖代谢与临床病理学的相关性研究

背景与目的：18F-FDG PET/CT的广泛应用导致偶发甲状腺癌的比例明显增加,偶发甲状腺癌灶的糖代谢与甲状腺癌病理学的相关性尚不清楚。研究因非甲状腺疾病行18F-FDG PET/CT显像、偶发甲状腺癌的患者,分析甲状腺癌灶的糖代谢与肿瘤的分化程度、淋巴结转移的相关性。方法：回顾性分析18F-FDG PET/CT显像偶发甲状腺瘤患者195例,53例患者手术病理诊断为甲状腺癌。分别测量甲状腺癌灶的最大标准摄取值(SUVmax)、病变大小、病变个数,同时测量患者正常甲状腺组织的SUVmax。通过病理分析病理学分型、淋巴结转移,患者分为G1组(分化型甲状腺癌)、G2组(非分化型甲状腺癌)、G3组(甲状腺癌无淋巴结转移)和G4组(甲状腺癌有淋巴结转移)。分析G1组与G2组、G3组与G4组间甲状腺癌灶的糖代谢的差异。结果：53例患者中,PET显像发现甲状腺癌灶53个。病理学发现甲状腺癌灶62个,乳头状甲状腺癌37例,滤泡状甲状腺癌4例,髓样癌9例,低分化癌3例。正常甲状腺组织的SUVmax为1.51±0.30,G1组(41例)SUVmax为4.25±1.70,G2组(12例)SUVmax为6.34±2.45,G1组和G2组的SUVmax均显著高于正常甲状腺组织(t=11.0,t=7.10,P<0.01),但G1组与G2组的SUVmax差异无统计学意义(t=3.61,P>0.05)。G3组(29例)的SUVmax为4.77±2.15,G4组(24例)的SUVmax为4.67±2.02,差异无统计学意义(t=0.33,P=0.56)。结论：18F-FDG PET/CT显像偶发癌分化型甲状腺癌、非分化型甲状腺癌均具有高糖代谢改变;不同分化程度、淋巴结转移能力的甲状腺癌灶的糖代谢水平差异无统计学意义。     

血清甲状腺球蛋白联合131I全身显像在分化型甲状腺癌病情评估中的临床价值

目的 探讨甲状腺球蛋白（Tg）联合治疗剂量131I全身显像（131I-WBS）在已行131I清除残余甲状腺组织的分化型甲状腺癌（DTC）患者中监测肿瘤复发或转移的临床价值.方法 66例接受甲状腺全切或大部切除并已行131I清除残余甲状腺治疗的DTC患者,进行血清Tg测定和治疗剂量的131I全身显像.结果 对DTC复发或转移灶诊断的灵敏度、特异度和准确性：Tg分别为78.7%、84.2%和80.3%;131I-WBS分别为85.1%、100.0%和89.4%;Tg联合131I-WBS分别为91.5%,84.2%和89.4%.结论 血清Tg测定联合治疗剂量的131I全身显像在已行131I清除残余甲状腺治疗的DTC患者病情评估中有互补作用,对监测复发和转移病灶有重要的临床价值.     

Stimulation of hydrogen peroxide production by drinking water contaminants in HL-60 cells sensitized by retinoic acid

Chemical carcinogens, such as chloroform and trichloroethylene, are present in drinking water in Japan. As these contaminants are believed to have a role in carcinogenesis, we examined if chloroform and trichloroethylene, as well as methylene chloride, xylene, benzene, and ethanol, have the ability to generate hydrogen peroxide (H₂O₂) in human polymorphonuclear leukocytes (PMN) and human leukemia (HL-60) cells. Methylene chloride, benzene, xylene, trichloroethylene, and ethanol did not increase cellular H₂O₂: production as measured by flow cytometry nor as observed by confocal laser microscopy. In PMN and RAuntreated HL-60 cells chloroform did not significantly affect H₂O₂ levels. However, in HL-60 cells sensitized by pretreatment of 10 nM retinoic acid (RA) for 12 h, chloroform induced a significant increase in H₂O₂, but the increase induced by trichloroethylene was not significant. The observed increase in fluorescence was confirmed using a confocal laser microscope. These results indicate that chloroform and trichloroethylene may stimulate H₂O₂ production in HL60 cells sensitized by pretreatment of RA. Our method may be useful to test if weak stimulants can stimulate intracellular H₂O₂ production.     

131I治疗前刺激性Tg在分化型甲状腺癌风险评估及治疗决策中的意义

甲状腺球蛋白(Tg)是分化型甲状腺癌(DTC)患者长期随访的重要指标之一。DTC患者的血清Tg监测包括刺激性Tg(sTg)(TSH>30μIU/ml刺激状态下的Tg水平)和非刺激性Tg (TSH抑制状态下的Tg水平)测定,前者对于DTC患者的病情监测具有更高的灵敏度和特异度。目前,"清甲"治疗后sTg是DTC患者病情监测的重要手段;而131I治疗前sTg (ps-Tg)由于受残余甲状腺组织的影响,在DTC病情评估及治疗决策方面的意义尚存在争议。自2009年美国甲状腺协会的相关指南中指出ps-Tg水平可能对DTC患者的疾病状态有一定的预测作用后,近5年来有关ps-Tg与131I治疗后疾病状态与预后间关系的研究备受关注。笔者主要就ps-Tg在DTC风险评估及治疗决策中的意义进行综述。     

Differentiated Thyroid Cancer and Pregnancy

Thyroid cancer is second most common malignancy diagnosed during pregnancy. Differentiated thyroid cancer (DTC) is more common in reproductive age group due to its association with oestrogen and human chorionic gonadotropin. Evaluation and management of DTC has changed from an aggressive approach, now, to a more conservative approach. Management of DTC must be coordinated among the different specialists which include the surgeon, endocrinologist, radiologist, pathologist and, in pregnant patients, the obstetrician. Generally, DTC can be postponed till delivery, but exceptions include airway compromise, aggressive cytologic features, invasion of surrounding tissue, extracapsular spread and poor prognostic factors.