Frequency and severity of globus pharyngeus symptoms in patients undergoing thyroidectomy. A pre-post short term cross-sectional study

Globus pharyngeus is a sensation of a lump or foreign body in the throat, sometimes associated with thyroid diseases and surgery. Previous studies investigated this condition with contradictory results, mainly because not standardized instruments of measure were used. The aim of this study was to evaluate the prevalence and severity of globus pattern symptoms in a population of patients three months after a thyroidectomy, and the reduction or increase of pre-existing symptoms or the onset of new symptoms

HMGB1-Induced Cross Talk between PTEN and miRs 221/222 in Thyroid Cancer

High mobility group box 1 (HMGB1) is an ubiquitous protein that plays different roles in the nucleus, cytoplasm and extra-cellular space. It is an important DAMP molecule that allows communication between damaged or tumor cells and the immune system. Tumor cells exploit HMGB1’s ability to activate intracellular pathways that lead to cell growth and migration. Papillary thyroid cancer is a well differentiated tumor and is often used to study relationships between cells and the inflammatory microenvironment as the latter is characterized by high levels of inflammatory cells and cytokines. Anaplastic thyroid cancer is one of the most lethal human cancers in which many microRNAs and tumor suppressor genes are de-regulated. Up-regulation of microRNAs 221 and 222 has been shown to induce the malignant phenotype in many human cancers via inhibition of PTEN expression. In this study we suggest that extracellular HMGB1 interaction with RAGE enhances expression of oncogenic cluster miR221/222 that in turn inhibits tumor suppressor gene PTEN in two cell lines derived from human thyroid anaplastic and papillary cancers. The newly identified pathway HMGB1/RAGE/miR 221/222 may represent an effective way of tumor escape from immune surveillance that could be used to develop new therapeutic strategies against anaplastic tumors

Migraine and psychiatric comorbidity: a review of clinical findings.

Migraine is an extremely common disorder. The underlying mechanisms of this chronic illness interspersed with acute symptoms appear to be increasingly complex. An important aspect of migraine heterogeneity is comorbidity with other neurological diseases, cardiovascular disorders, and psychiatric illnesses. Depressive disorders are among the leading causes of disability worldwide according to WHO estimation. In this review, we have mainly considered the findings from general population studies and studies on clinical samples, in adults and children, focusing on the association between migraine and psychiatric disorders (axis I of the DSM), carried over after the first classification of IHS (1988). Though not easily comparable due to differences in methodology to reach diagnosis, general population studies generally indicate an increased risk of affective and anxiety disorders in patients with migraine, compared to non-migrainous subjects. There would also be a trend towards an association of migraine with bipolar disorder, but not with substance abuse/dependence. With respect to migraine subtypes, comorbidity mainly involves migraine with aura. Patients suffering from migraine, however, show a decreased risk of developing affective and anxiety disorders compared to patients with daily chronic headache. It would also appear that psychiatric disorders prevail in patients with chronic headache and substance use than in patients with simple migraine. The mechanisms underlying migraine psychiatric comorbidity are presently poorly understood, but this topic remains a priority for future research. Psychiatric comorbidity indeed affects migraine evolution, may lead to chronic substance use, and may change treatment strategies, eventually modifying the outcome of this important disorder

Nulliparity enhances the risk of second primary malignancy of the breast in a cohort of women treated for thyroid cancer

<p>Abstract</p> <p>Background</p> <p>Many studies have reported an increased risk of developing a second primary malignancy (SPM) of the breast in women treated for thyroid cancer. In this study, we investigated several potential risk factors for this association. The aim of this retrospective cohort study was to identify a subgroup of women surgically treated for papillary thyroid cancer that may benefit from more careful breast cancer screening.</p> <p>Methods</p> <p>A total of 101 women surgically treated for papillary thyroid cancer from 1996 to 2009 with subsequent follow-up were interviewed by phone regarding personal risk factors and lifestyle habits. Only 75 questionnaires could be evaluated due to a 25.7% rate of patients not retrieved or refusing the interview. Data analysis was performed using a multivariate logistic model.</p> <p>Results</p> <p>The standardised incidence ratio (SIR) for breast cancer was 3.58 (95% IC 1.14 - 8.37). Our data suggest a protective effect of multiparity on the development of a SPM of the breast (O.R. 0.15; 95% IC 0.25 - 0.86). Significant associations were not found with other known risk factors including Body Mass Index (BMI), age at first tumour, concurrent metabolic diseases, smoking, physical activity and familiarity.</p> <p>Conclusions</p> <p>This study confirms that a higher incidence of SPM of the breast is observed in women treated for papillary thyroid cancer. Additionally, this risk is increased by nulliparity, thus a strict breast screening program for nulliparous women treated for thyroid cancer may be advisable.</p

Migraine and psychiatric comorbidity: a review of clinical findings

Migraine is an extremely common disorder. The underlying mechanisms of this chronic illness interspersed with acute symptoms appear to be increasingly complex. An important aspect of migraine heterogeneity is comorbidity with other neurological diseases, cardiovascular disorders, and psychiatric illnesses. Depressive disorders are among the leading causes of disability worldwide according to WHO estimation. In this review, we have mainly considered the findings from general population studies and studies on clinical samples, in adults and children, focusing on the association between migraine and psychiatric disorders (axis I of the DSM), carried over after the first classification of IHS (1988). Though not easily comparable due to differences in methodology to reach diagnosis, general population studies generally indicate an increased risk of affective and anxiety disorders in patients with migraine, compared to non-migrainous subjects. There would also be a trend towards an association of migraine with bipolar disorder, but not with substance abuse/dependence. With respect to migraine subtypes, comorbidity mainly involves migraine with aura. Patients suffering from migraine, however, show a decreased risk of developing affective and anxiety disorders compared to patients with daily chronic headache. It would also appear that psychiatric disorders prevail in patients with chronic headache and substance use than in patients with simple migraine. The mechanisms underlying migraine psychiatric comorbidity are presently poorly understood, but this topic remains a priority for future research. Psychiatric comorbidity indeed affects migraine evolution, may lead to chronic substance use, and may change treatment strategies, eventually modifying the outcome of this important disorder

Vitiligo, autoimmune thyroiditis: A rare thyroid cancer arising with bone metastates on maxillofacial area

An association between vitiligo and autoimmune thyroid disorders had previously been postulated. Thyroid disorders were found in 18.5% of 15,126 patients with vitiligo, on the basis of the anamnestic data. Then, we investigated 255 healthy relatives in whom we tested only T3, T4 and TSH. With the immunological investigation we detected a higher incidence of TMA in vitiligo patients and in the family members. Therefore, on the basis of the immunologic and thyroid pathology functional data, we observed a thyroid pathology in 25% of the 890 vitiligo patients and in 21.1% of their first degree relatives. Then, clinical observation enabled to discover that 3 of 15,126 patients had undergone exeresis for a thyroid carcinoma and in the 890 vitiligo patients, who had undergone particular investigations, we found a thyroid carcinoma in 3 subjects. In one case lymphnodal involvement and bone metastases in the maxillary district were found. The purpose of this work is to evaluate the incidence of thyrosis and of thyroid carcinoma in vitiligo patients observed for 20 years

Clinical and biological relationship between chronic lymphocytic thyroiditis and papillary thyroid carcinoma

The association between chronic lymphocytic thyroiditis and papillary thyroid carcinoma has been investigated for several years from different perspectives but with few attempts to design a common frame of reference to understand the complex mutual interactions between the various pathways of inflammatory response and of thyroid tumor induction and progression. This article reviews the current knowledge and research on this topic according to epidemiologic, immunobiologic, pathologic, and biomolecular points of view, highlighting achievements and lack of knowledge. It draws some conclusions and points at possible future directions for research. Copyright © 2009 Cognizant Comm. Corp

Il valore di FT3 è un possibile indicatore di rischio per pazienti sottoposti a chirurgia vascolare

È stato condotto uno studio in un gruppo di 28 pazienti sottoposto a chirurgia vascolare con gli scopi di confermare il decremento postoperatorio dei livelli sierici dell’ FT3, studiare la correlazione fra l’Euthyroid Sick Syndrome (ESS) e le complicanze post-operatorie infiammatorie nella chirurgia vascolare, mettere in evidenza una possibile correlazione fra indicatori di gravità dell’ aterosclerosi ed ESS. La differenza fra FT3 pre-operatorio e post-operatorio in 1° giornata è risultata significativa, benchè lieve (3,88 ± 0,73 vs 3,32 ± 1,07 p 0,05), mentre non sono state rilevate differenze significative quanto ai valori pre/post-operatori di FT4 e TSH. Nei 6 pazienti complicati per insorgenza di Systemic Inflammatory Response Syndrome, il decremento di FT3 è stato più marcato che nei non complicati (valore in 1° giornata postop 3,60 ± 1,05 vs 2,47 ± 0,61), anche se non ha raggiunto la significatività statistica (p = 0,06). Infine è stata osservata una forte correlazione lineare negativa fra fibrinogeno preoperatorio e FT3 preoperatorio (r = -0,48). Sembra effettivamente fondata l’ idea di utilizzare i valori di FT3 come indicatore dell’ entità dello stress chirurgico post-operatorio, in particolar modo per quello che riguarda l’ attivazione infiammatoria sistemica. Il valore pre-operatorio di FT3 si è inoltre dimostrato inversamente correlato ad indici di infiammazione ed aterosclerosi, soprattutto col valore del fibrinogeno plasmatico. Clin Ter 2009; 160(3):e35-e3

Significato clinico delle calcificazioni nei noduli tiroidei

Il valore predittivo delle calcificazioni tiroidee ecograficamente accertate e le loro eventuali caratteristiche suggestive di neoplasia sono state studiate in una serie di 175 pazienti operati (30 carcinomi papilliferi, 145 gozzi multinodulari). Le calcificazioni sono risultate molto più frequenti nei tumori che nei gozzi (40% vs 20,7% p<0,05), mentre le loro caratteristiche (dimensioni, numero, posizione nel nodulo e disposizione nel contesto ghiandolare) non sono risultate chiaramente differenti fra tumori e gozzi. La frequenza delle calcificazioni è stata significativamente più alta nei pazienti più anziani (età media 58,7±13,3 per i pazienti con calcificazioni v s 51,1±12,7 per i pazienti senza calcificazioni, p<0,001) e ciò potrebbe implicare che la loro insorgenza sia dipen - dente dalla durata di malattia. In conclusione, le calcificazioni possono essere un utile indicatore di rischio aumentato, da prendere in considerazione nel processo com - plessivo di “decision-making” chirurgico