Supplementary Material for: Retrospective Analysis of 255 Papillary Thyroid Carcinomas ≤2 cm: Clinicohistological Features and Prognostic Factors

<b><i>Background:</i></b> Papillary thyroid carcinoma (PTC) is the most common thyroid cancer. The widespread use of neck ultrasound (US) and US-guided fine-needle aspiration cytology is triggering an overdiagnosis of PTC. <b><i>Objective: </i></b>To evaluate clinical behavior and outcomes of patients with PTCs ≤2 cm, seeking for possible prognostic factors. <b><i>Methods:</i></b> Clinical records of cases with histological diagnosis of PTC ≤2 cm followed at the Endocrine Department of Instituto Português de Oncologia, Lisbon between 2002 and 2006 were analyzed retrospectively. <b><i>Results:</i></b> We identified 255 PTCs, 111 were microcarcinomas. Most patients underwent near-total thyroidectomy, with lymph node dissections in 55 cases (21.6%). Radioiodine therapy was administered in 184 patients. At the last evaluation, 38 (14.9%) had evidence of disease. Two deaths were attributed to PTC. Median (±SD) follow-up was 74 (±23) months. Multivariate analysis identified vascular invasion, lymph node and systemic metastases significantly associated with recurrence/persistence of disease. In addition, lymph node involvement was significantly associated with extrathyroidal extension and angioinvasion. Median (±SD) disease-free survival (DFS) was estimated as 106 (±3) months and the 5-year DFS rate was 87.5%. Univariate Cox analysis identified some relevant parameters for DFS, but multivariate regression only identified lymph node and systemic metastases as significant independent factors. The median DFS estimated for lymph node and systemic metastases was 75 and 0 months, respectively. <b><i>Conclusions:</i></b> In the setting of small PTCs, vascular invasion, extrathyroidal extension and lymph node and/or systemic metastases may confer worse prognosis, perhaps justifying more aggressive therapeutic and follow-up approaches in such cases

Derrame pleural recidivante e polipose gástrica â Caso clínico

Resumo: Os autores descrevem um caso de doença linfoproliferativa (DLP) com repercussão pleuropulmonar. Trata-se de um linfoma MALT primário do estômago com comportamento agressivo numa mulher de 86 anos internada no serviço de pneumologia do nosso hospital com derrame pleural como forma de apresentação clínica.A pesquisa de Helicobacter pylori foi negativa, situação pouco frequente. A doença apresentou-se disseminada e sem qualquer resposta às múltiplas terapêuticas instituídas, o que não é frequente.Abordam-se as formas de apresentação clínica desta patologia, aspectos diagnósticos e terapêuticos, fazendo-se uma discussão sobre as características particulares deste caso e cotejando-os com os dados existentes na literatura. Realça-se a importância de se incluir a DLP no diagnóstico diferencial dos derrames pleurais de etiologia em estudo. Abstract: The authors present the case of a lymphoproliferative disorder (LPD) with pleuro-pulmonary involvement. It was a very aggressive primary gastric lymphoma of the MALT subtype, diagnosed in an 86-year-old woman admitted in Pulmonology ward at our Hospital with pleural effusion.Helicobacter pylori search was negative, what is infrequent. The disease was already disseminated at the time of the diagnosis and did not respond to various treatment modalities, what is also an uncommon finding.Clinical presentation, diagnosis and management of this disease are reviewed, pointing out its unique features and comparing the particular aspects of this case with the published literature. The authors stress that LPD is an important diagnosis to be held in mind in the case of a pleural effusion of unknown aetiology. Palavras-chave: Linfoma não Hodgkin, linfoma MALT gástrico, Helicobacter pylori, derrame pleural, diagnóstico diferencial, polipose gástrica, Key-words: Non-Hodgkin's lymphoma, gastric MALT lymphoma, Helicobacter pylori, pleural effusion, differential diagnosis, gastric polyposi

Mioblastoma do pulmão

RESUMO: O Mioblastoma de pulmão é um tumor raro, com origem nas células de Schwann, cujo modo de apresentação mais comum é a tosse e a toracalgia. Pode ser um achado radiológico ou endoscópico.O caso que apresentamos referese a um doente de sexo masculino, 55 anos de idade, carpinteiro, exfumador (52 UMA), com história de bronquite crónica (BC), que referia toracalgia esquerda desde há alguns meses, ouvindo-se na auscultação pulmonar um sibilo fixo na base do hemitórax esquerdo. A telerradiografia do tórax revelou apenas âpaquipleurite residual na base do hemitórax direitoâ. A TAC torácica (com cortes nnos) mostrou âdiscreta imagem nodular no apical do lobo inferior esquerdo (B6) e paquipleurite residual na base do hemitórax direitoâ. A broncofibroscopla revelou âsinais de BC e no segmento mais posterior do apical do lobo inferior esquerdo o esporão está um pouco esbranquiçado mas sem outras lesõesâ. Realizou biópsias a este nível que mostraram âtumor de celulas granulares-Mioblastomaâ, pelo que foi submetido a lobectomia inferior esquerda cujo exame anatomopatológico da peça ressecada confirmou o diagnóstico. Desde então, o doente é seguido na nossa consulta mantendo a sua BC controlada e sem qualquer evidência de recidiva tumoral.A propósito fazem-se algumas considerações sobre este tipo de neoplasia do pulmão, cuja histogénese é desconhecida.REV PORT PNEUMOL 2000; VI (4): 323-330 ABSTRACT: Granular Cell Myoblastoma is a very rare lung tumor arising from Schwann cells. Cough and chest pain are the most frequent presenting symptoms. It can be also a X-ray or endoscopic finding.The present case is about a 55 years old carpenter, ex-smoker (52 pack-years), with chronic bronchitis. A left side chest pain lasting for several months was his main complain. A fixed wheeze could be beard on phisical observation in the base of the left hemithorax. The chest radiograph shows âresidual paquipleuritis on the base of the right lower lobeâ. The chest CT Scan shows âsmall nodule on the B6 (apical) left Inferior lobe and residual paquipleuritis on the base of the right lower lobeâ. On bronchoscopy there were âsigns of Chronic Bronchitis and the bifurcation of the posterior segment of the left inferior lobar bronchi bad a whitish appearenceâ. Several biopsies of that bifurcation showed a Granular Cell Myoblastoma Tumor. He was submited to a left inferior lobectomy. The histology confirmed the diagnosis. Ever since the patient is followed in our out door department. After 3 years of follow-up there is no evidence or tumor recurrency. Tha case ends up with theoretical considerations about this rare neoplasm wich histogenesis is not known.REV PORT PNEUMOL 2000; VI (4): 323-330 Palavras chave: tumor de células granulares, mioblastoma, mioblastoma de células granulares, neoplasia do pulmão, Key-words: Granular cell tumor, myoblastoma, granular cell myoblastoma, lung neoplas

Revista Portuguesa de Pneumologia: Ano em Revisão 2009

Resumo: A Revista Portuguesa de Pneumologia (RPP) tem como um dos seus principais objectivos o de contribuir de forma significativa e relevante para a literatura médica portuguesa. Os presentes editores consideraram que seria importante a análise e comentário da informação mais relevante publicada em cada uma das áreas da Pneumologia no passado ano de 2009. Os membros do Conselho Editorial convidados fi zeram uma avaliação e evidenciaram os artigos mais relevantes publicados na RPP. Abstract: The Portuguese Journal of Pulmonology is progressively achieving an important status in Portuguese medical literature. The present editors thought it would be an enriching task to revise the main topics published during 2009. The invited members of the Editorial Board covered and commented the most relevant articles and gave us an important picture of the quality of the science it was published in Portuguese Pulmonology. PALAVRAS-CHAVE: Revista Portuguesa de Pneumologia, 2009, Artigos, KEYWORDS: Portuguese Journal of Pulmonology, 2009, Article

Occupational exposure to environmental tobacco smoke in hospitality venues: are genetic- or proteomics-based biomarkers predictive of respiratory diseases?

Environmental tobacco smoke (ETS) is recognized as an occupational hazard in the hospitality industry. Although Portuguese legislation banned smoking in most indoor public spaces, it is still allowed in some restaurants/bars, representing a potential risk to the workers’ health, particularly for chronic respiratory diseases. The aims of this work were to characterize biomarkers of early genetic effects and to disclose proteomic signatures associated to occupational exposure to ETS and with potential to predict respiratory diseases development. A detailed lifestyle survey and clinical evaluation (including spirometry) were performed in 81 workers from Lisbon restaurants. ETS exposure was assessed through the level of PM 2.5 in indoor air and the urinary level of cotinine. The plasma samples were immunodepleted and analysed by 2D-SDSPAGE followed by in-gel digestion and LC-MS/MS. DNA lesions and chromosome damage were analysed innlymphocytes and in exfoliated buccal cells from 19 cigarette smokers, 29 involuntary smokers, and 33 non-smokers not exposed to tobacco smoke. Also, the DNA repair capacity was evaluated using an ex vivo challenge comet assay with an alkylating agent (EMS). All workers were considered healthy and recorded normal lung function. Interestingly, following 2D-DIGE-MS (MALDI-TOF/TOF), 61 plasma proteins were found differentially expressed in ETS-exposed subjects, including 38 involved in metabolism, acute-phase respiratory inflammation, and immune or vascular functions. On the other hand, the involuntary smokers showed neither an increased level of DNA/chromosome damage on lymphocytes nor an increased number of micronuclei in buccal cells, when compared to non-exposed non-smokers. Noteworthy, lymphocytes challenge with EMS resulted in a significantly lower level of DNA breaks in ETS-exposed as compared to non-exposed workers (P<0.0001) suggestive of an adaptive response elicited by the previous exposure to low levels of ETS. Overall, changes in proteome may be promising early biomarkers of exposure to ETS. Likewise, alterations of the DNA repair competence observed upon ETS exposure deserves to be further understood. Work supported by Fundação Calouste Gulbenkian, ACSS and FCT/Polyannual Funding Program.Fundação Calouste Gulbenkian, ACSS and FCT/Polyannual Funding Program

Nitrogen but not phosphorus addition affects symbiotic N2 fixation in grasslands located on four continents

Background and aims The amount of nitrogen (N) derived from symbiotic N2 fixation by legumes in grasslands might be affected by anthropogenic N and phosphorus (P) inputs, but the underlying mechanisms are not known. Methods We evaluated symbiotic N2 fixation in 17 natural and semi-natural grasslands on four continents that are subjected to the same full-factorial N and P addition experiment, using the 15N natural abundance method. Results N as well as combined N and P (NP) addition reduced aboveground legume biomass by 65% and 45%, respectively, compared to the control, whereas P addition had no significant impact. Addition of N and/or P had no significant effect on the symbiotic N2 fixation per unit legume biomass. In consequence, the amount of N fixed annually per grassland area was less than half in the N addition treatments compared to control and P addition, irrespective of whether the dominant legumes were annuals or perennials. Conclusion Our results reveal that N addition mainly impacts symbiotic N2 fixation via reduced biomass of legumes rather than changes in N2 fixation per unit legume biomass. The results show that soil N enrichment by anthropogenic activities significantly reduces N2 fixation in grasslands, and these effects cannot be reversed by additional P amendment

Nitrogen but not phosphorus addition affects symbiotic N2 fixation by legumes in natural and semi-natural grasslands located on four continents

Background and aims The amount of nitrogen (N) derived from symbiotic N2 fixation by legumes in grasslands might be affected by anthropogenic N and phosphorus (P) inputs, but the underlying mechanisms are not known. Methods We evaluated symbiotic N2 fixation in 17 natural and semi-natural grasslands on four continents that are subjected to the same full-factorial N and P addition experiment, using the 15N natural abundance method. Results N as well as combined N and P (NP) addition reduced aboveground legume biomass by 65% and 45%, respectively, compared to the control, whereas P addition had no significant impact. Addition of N and/or P had no significant effect on the symbiotic N2 fixation per unit legume biomass. In consequence, the amount of N fixed annually per grassland area was less than half in the N addition treatments compared to control and P addition, irrespective of whether the dominant legumes were annuals or perennials. Conclusion Our results reveal that N addition mainly impacts symbiotic N2 fixation via reduced biomass of legumes rather than changes in N2 fixation per unit legume biomass. The results show that soil N enrichment by anthropogenic activities significantly reduces N2 fixation in grasslands, and these effects cannot be reversed by additional P amendment