Ocena czynników ryzyka w odmianie wysokokomórkowej przerzutowego/ /nawrotowego raka brodawkowatego tarczycy

Introduction. Papillary thyroid carcinoma (PTC) is the most common malignant thyroid tumor. A great majority of the cases live a disease-free life with quite favorable prognosis. There are lots of variants of PTC and a few of them exhibit aggressive behaviour. Typical example is the tall cell variant (TCV). Patients experience a greater incidence of recurrence, nodal and extranodal metastases, tumor associated mortality than other variants of PTC. Studies related to TCV almost always compared it with its patient population of PTC according to risk factors and clinicopathologic features. The aim of this study is to evaluate the risk factors in metastatic/recurrent TCV. Materials and Methods. This is a retrospective cohort study of 1813 patients with differentiated thyroid carcinoma treated with radioiodine between 1992 and 2011. 56 of these patients are TCV. 34 of them developed metastasis/recurrence and 22 lived a disease-free life during the 23-year follow-up. We evaluated the risk factors in these metastatic and nonmetastatic subgroups. Results. We found tumor size, preablation thyroglobulin level, vascular invasion, preablation central and lateral cervical lymph node metastasis, preablation lung metastasis and stage independent risk factors. However age, preablation thyroglobulin level and stage appeared together as striking factors impacting metastasis in multivariate analysis. Conclusion. Higher ablation doses up to 250-300 mCi should be administered to TCV patients having advanced stage (III,IV), pretty high preablation thyroglobulin level (over 400 ng/ml) and older age (over 52 years) especially with large tumor size (over 3.5 cm) and initial cervical lymph node metastasis.Wstęp. Rak brodawkowaty tarczycy (papillary thyroid carcinoma, PTC) jest najczęstszym nowotworem złośliwym tego narządu. U przeważającej większości chorych możliwe jest całkowite wyleczenie, a rokowanie jest dobre. Występuje wiele odmian PTC, spośród których nieliczne są bardziej agresywne. Typowym przykładem takich nowotworów jest odmiana wysokokomórkowa (tall cell variant, TCV). Cechuje się ona częstszym występowaniem wznów, przerzutów do węzłów chłonnych i pozawęzłowych oraz większą śmiertelnością z powodu choroby nowotworowej niż inne odmiany PTC. Badania dotyczące TCV niemal zawsze mają na celu porównanie tej grupy chorych z populacją chorych na PTC w odniesieniu do czynników ryzyka oraz parametrów klinicznych i patomorfologicznych. Celem niniejszego badania jest ocena czynników ryzyka w przerzutowym/nawrotowym TCV. Materiał i metody. Było to retrospektywne badanie kohortowe obejmujące 1813 chorych ze zróżnicowanym rakiem tarczycy leczonych jodem promieniotwórczym w latach 1992–2011. U 56 osób z tej grupy rozpoznano TCV. U 34 z nich stwierdzono przerzut/nawrót, a w przypadku 22 chorych potwierdzono przeżycie wolne od choroby przez okres 4–23 lat. Autorzy ocenili czynniki ryzyka w podgrupach chorych z przerzutami i bez przerzutów. Wyniki. Stwierdzono, że niezależnymi czynnikami ryzyka są wielkość guza, stężenie tyreoglobuliny przed ablacją, unaczynienie guza, przerzuty to węzłów chłonnych szyjnych środkowych i tylnych oraz do płuc przed ablacją, a także stopień zaawansowania choroby. Jednak najważniejszymi czynnikami ryzyka przerzutów w analizie wieloczynnikowej okazały się wiek, stężenie tyreoglobuliny przed ablacją i stopień zaawansowania choroby nowotworowej. Wnioski. U chorych z TCV w zaawansowanym stadium (III, IV), z wysokimi stężeniami tyreoglobuliny (> 400 ng/ml) i w starszym wieku (> 52 lata), a zwłaszcza u osób z dużym rozmiarem guza (> 3,5 cm) i obecnymi przerzutami do węzłów chłonnych szyjnych, należy stosować wyższe dawki ablacyjne wynoszące do 250–300 mCi.

Case report: Spinal drop metastasis of IDH-mutant, 1p/19q-codeleted oligodendroglioma

BackgroundSymptomatic spinal metastases of oligodendroglioma are rare. Moreover, none of the previously published cases demonstrated the typical IDH mutation and 1p/19q-codeletion for this glial tumor. This case presents an IDH mutant, 1p/19q-codeleted oligodendroglioma with multiple spinal drop metastases.Case descriptionWe report a case of a 55-year-old woman with left frontal grade 3 oligodendroglioma diagnosed 3 years ago. No tumor recurrence was observed in post-operative follow-up MRI examinations. However, she was admitted to our institution again with severe low back pain. Gadolinium enhanced MRI of the spine revealed an intradural, extramedullary metastatic lesion between T11–L1 levels and multiple enhancing metastatic tumor deposits around cauda equine roots between L4–S1. T11–T12 midline laminectomy was performed and gross total resection of metastatic lesions was achieved. Final histological diagnosis of the spinal lesions was WHO Grade 3 Oligodendroglioma, IDH-mutant, 1p/19q-codeleted.ConclusionThis case is the first molecularly-defined spinal metastatic oligodendroglioma. The possibility of drop metastasis should be kept in mind in oligodendroglioma patients with spinal cord-related symptoms. There is no standard approach for the diagnosis and treatment of spinal metastases of this type of glial tumor

Elementary school teachers' opinions on a learning object repository in Turkey

The aim of this paper is to investigate elementary teachers' opinions on a learning object repository in an elementary school. For this purpose, a learning object repository is constructed including digital learning resources accessible to teachers, students, and other potential users. In the paper we introduce and describe properties of a new learning object repository developed specifically for teachers at the elementary school level in Turkey. Qualitative research model with an open-ended questionnaire was used assess how elementary teachers integrate a learning object repository into their educational environment. The study consists of a sample of 11 elementary school teachers in Turkey. Initial findings reveal that learning resources such ELOR can used effectively by teachers, especially when they become active participants of a learning environment by adding a learning object into the repository they have

The effects of calcium dobesilate and micronized purified flavonoid fractions on myocardial protection

Background: We aimed to investigate the effects of calcium dobesilate (DOBE) and micronized purified flavonoid fractions (MPFF) on the functions of rat hearts following ischemia and reperfusion

Signs of Bruxism and Temporomandibular Disorders among Patients with Bipolar Disorder

Background/Aim: There is an abundance of data regarding temporomandibular disorders (TMD) and bruxism specific to patients with bipolar disorder (BD). This study aimed to investigate the prevalence of TMD signs in subjects with and without BD. Material and Methods: The case group included 242 adult patients (103 men and 139 women) with BD and and the control group included 187 subjects without BD (89 men and 98 women). The case and control groups were compared for the presence of bruxism and the signs of TMD including muscle and temporomandibular joint (TMJ) tenderness to palpation, limitation of maximum mouth opening, and TMJ sounds. Results: The frequency of at least one sign of TMD was significantly higher in patients with BD (191 ⁄242, 78.9%) than the control group (95 ⁄187, 50.8%) (p<0.001). Statistically significant differences were found between the case and control groups in terms of joint pain on palpation (p<0.05), masseter muscle pain on palpation (p<0.01), joint clicks (p<0.001) and limited mouth opening (p<0.001). Bruxism was significantly higher in patients with BD (49.6%) than the control group (19.8%) (p<0.001). Conclusions: Patients with BD appear to be more prone to having TMD signs and bruxism compared to the control group, but this comorbidity should be better understood by further studies

Radiografia torácica e bacteriologia na fase inicial de tratamento de 800 pacientes masculinos com tuberculose pulmonar

OBJETIVO: Avaliar radiografias de tórax de pacientes com tuberculose pulmonar e determinar se a extensão das lesões radiográficas correlaciona-se com os parâmetros bacteriológicos. MÉTODOS: Neste estudo descritivo e retrospectivo; foram avaliadas radiografias de tórax, baciloscopias para BAAR e culturas de escarro para Mycobacterium tuberculosis no momento basal e durante os dois primeiros meses de tratamento. A amostra foi composta por 800 pacientes masculinos internados entre 1995 até o presente em um hospital com 250 leitos no noroeste da Turquia. RESULTADOS: A VHS média inicial foi de 58 ± 37 mm/h. Inicialmente, a baciloscopia e as culturas de escarro tiveram resultado positivo em 83,8% e em 89,5% dos pacientes, respectivamente. Após o primeiro mês do tratamento, a proporção de culturas positivas foi maior nos pacientes com doença cavitária do que naqueles sem doença cavitária (53,7% vs. 37,7%; p < 0,001). Não houve correlação do número de zonas afetadas com idade, duração de sintomas, contato com paciente com tuberculose ativa, diabetes concomitante (p &gt; 0.05 para todos), mas houve correlação positiva com VHS (r = 0,23, p < 0,001). Durante o primeiro e o segundo mês de tratamento, a negativação da baciloscopia foi menos frequente nos pacientes com comprometimento bilateral do que naqueles com comprometimento unilateral (p < 0,001 e p = 0,002 para os meses 1 e 2, respectivamente). A extensão da doença não se correlacionou com idade, duração dos sintomas, contato com paciente com tuberculose ativa e diabetes concomitante, mas sim com a recuperação bacteriológica atrasada. CONCLUSÕES: Radiografias de tórax e bacteriologia são ferramentas valiosas na avaliação de tuberculose pulmona

Clinical significance of fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography in the follow-up of colorectal cancer: searching off approaches increasing specificity for detection of recurrence

Nearly 40% of colorectal cancer (CRC) recurs within 2 years after resection of primary tumor. Imaging with fluorine-18-fluorodeoxyglucose (l8F-FDG) positron emission tomography/computed tomography (PET/CT) is the most recent modality and often applied for the evaluation of metastatic spread during the follow-up period. Our goal was to study the diagnostic importance of 18F-FDG-PET/CT data of maximum standardized uptake value (SUVmax), total lesion glycolysis (TLG) and the difference of SUVmax on dual-time imaging in CRC