Wstępne próby konstrukcji bibliotek peptydowych jako narzędzia w diagnostyce nowotworów złośliwych tarczycy

Introduction: Cancer of thyroid gland is the most common malignancy of the endocrine system. The treatment improvement could be achieved by early diagnosis. The aim of the study was to identify cancer specific antigenes with use of peptide libraries. Material and methods: The material from 6 patients with thyroid cancer (4 with papillary cancer, 1 with follicular cancer and 1 with oxyphilic tumor) were analyzed. It was performed with use of lipophylic peptide libraries by direct comparison of staining of specimens prepared from normal and malignant tissue. Results: Preliminary results confirm practical value of peptide libraries in early diagnostics of thyroid cancer. Conclusions: It is important to optimize construction of peptide libraries by using different staining agents hydrolyzed by proteases.Wstęp: Nowotwory złośliwe tarczycy należą do najczęstszych nowotworów złośliwych układu endokrynnego. Poprawa wyników leczenia wiąże się z postępem wczesnej diagnostyki raka. Celem niniejszych badań jest poszukiwanie wskaźników nowotworowych za pomocą bibliotek peptydowych umieszczonych na podłożu z bibuły. Materiał i metody: Analizie poddano tkanki pobrane od 6 pacjentów: 4 z rakiem brodawkowatym tarczycy, 1 z nowotworem pęcherzykowym oraz 1 pacjenta z rakiem oksyfilnym. Badania wykonywano z wykorzystaniem bibliotek peptydowych lipofilowych, porównując tkankę zdrową i chorą oraz oceniając zmianę zabarwienia w poszczególnych bibliotekach. Wyniki: Wstępne wyniki wskazują, że biblioteki peptydowe można zastosować w diagnostyce nowotworów tarczycy. Wnioski: Niezbędna jest optymalizacja budowy bibliotek peptydowych, gdzie konieczne jest zastosowanie innego barwnika hydrolizowanego przez proteazy

Clinical significance of oxidation and acetylation genetic polymorphism in patients with hyperthyreosis

Introduction: The relationship between genetically determined polymorphic oxidation and acetylation and susceptibility to some disease was aroused much interest. The aim of our study was to evaluate whether patients with hyperthyreosis differ from healthy persons in their ability to oxidize sparteine and acetylate sulphadimidine as model drugs. Oxidation and acetylation were estimated in 48 patients with hiperthyreosis. Material and methods: The control group consisted of 160 healthy volunteers for comparison of oxidation phenotype and 60 healthy volunteers for comparison of acetylation phenotype. The phenotyping of oxidation revealed two distinct populations among 40 patients with hyperthyreosis: 38 persons (95%) were extensive metabolizers (EM) of sparteine and 2 persons (5%) was poor metabolizers (PM). In 160 healthy persons (91.2%) were EM and 14 persons (8.8%) were PM. The difference between frequency distribution of PM and EM in healthy persons and in patients with hyperthyreosis was not statistically significant. Results: The phenotyping of acetylation showed among 48 patients with hyperthyreosis 8 persons (13%) were rapid acetylators (RA) and 40 persons (87%) were slow acetylators (SA). In 60 healthy volunteers the phenotype of rapid acetylation was observed in 31 persons (51%) and slow acetylation in 29 persons (49%). Relative risk (odds ratio) of development of thyroid diseases was 5.34 times higher for SA in comparison to RA. The prevalence of SA among patients with hyperthyreosis in comparison to healthy volunteers was statistically significant (p < 0.0002). Conclusions: The results of our study may suggest that slow acetylation phenotype is associated with increased risk of the development of hyperthyreosis.Wstęp: Badania nad udziałem czynników genetycznych w powstawaniu niektórych chorób prowadzi się w coraz szerszym zakresie. Celem pracy było stwierdzenie, czy między grupą chorych na nadczynność tarczycy a grupą kontrolną zdrowych ochotników istnieje różnica w zdolności utleniania sparteiny i acetylacji sulfadimidyny jako leków modelowych. Materiał i metody: Badaniami objęto 268 osób. W tej grupie 48 osób było chorych na nadczynność tarczycy. Grupę kontrolną dla fenotypu oksydacji stanowiło 160 zdrowych ochotników, natomiast dla fenotypu acetylacji 60 osób zdrowych. Wyniki: Wśród 40 chorych z nadczynnością tarczycy stwierdzono 38 (95%) ekstensywnych metabolizerów (EM, extensive metabolizers) i 2 (5%) słabych metabolizerów (PM, poor metabolizers) sparteiny. W grupie kontrolnej 160 ochotników, 146 (91,2%) okazało się EM, a 14 (8,8%) - PM. Niewielka przewaga częstości występowania PM wśród pacjentów z nadczynnością tarczycy w porównaniu z grupą osób zdrowych nie była statystycznie istotna. Wśród 48 chorych na nadczynność tarczycy wyróżniono 13% szybkich acetylatorów (RA, rapid acetylators) (8 osób) i 87% wolnych acetylatorów (SA, slow acetylators) (40 osób). Natomiast u 60 zdrowych ochotników stwierdzono 51% RA (31 osób) i 49% SA (29 osób). Odsetek szybkich i wolnych acetylatorów w grupie chorych z nadczynnością tarczycy różnił się w sposób statystycznie istotny w porównaniu z odsetkiem w grupie osób zdrowych (p < 0,0002). Względne ryzyko zachorowania na nadczynność tarczycy, wyrażone za pomocą proporcji szans (OR, odds ratio), jest ponad 5 razy większe dla wolnych niż dla szybkich acetylatorów. Wnioski: Wyniki niniejszych badań mogą sugerować, że osoby z fenotypem wolnej acetylacji są predysponowane do zapadalności na nadczynność tarczycy

Barogenic rupture of esophagus (Boerhaave syndrome) as diagnostic and therapeutic challenge requiring rapid and effective interdisciplinary cooperation – case report

We describe a 47-year-old male who was admitted to our centre from a local emergency unit with septic shock due to suspected Boerhaave syndrome. After the diagnosis was confirmed, the patient underwent emergency surgery. Postoperatively, the patient had symptoms of acute alcoholic delirium, and developed an oesophagomediastinal fistula as the most serious local complication. Successful conservative treatment enabled complete healing of the fistula, leading to patient recovery. No late complications like oesophageal stenosis were found at 6 months from discharge

Ciśnieniowe pęknięcie przełyku (zespół Boerhaavego) jako diagnostyczne i terapeutyczne wyzwanie wymagające szybkiej i skutecznej współpracy międzyklinicznej. Raport przypadku z regionalnego ośrodka specjalizującego się w chorobach przełyku

Prezentujemy opis przypadku 47-letniego mężczyzny przyjętego do naszego ośrodka z powiatowego Szpitalnego Oddziału Ratunkowego z objawami wstrząsu septycznego i podejrzeniem zespołu Boerhaavego. Po potwierdzeniu rozpoznania pacjenta operowano w trybie ostrego dyżuru. W przebiegu pooperacyjnym wystąpiły objawy alkoholowego zespołu abstynencyjnego oraz przetoki przełykowo-śródpiersiowej – najpoważniejszego powikłania miejscowego w tym schorzeniu. W efekcie leczenia zachowawczego uzyskano wygojenie się przetoki i powrót chorego do zdrowia. W kontrolnym badaniu po 6 miesiącach od wypisu nie stwierdzono powikłań odległych, w szczególności zwężenia przełyku

Clinical and histopathological characteristics of patients with incidental and nonincidental thyroid cancer

Introduction: Thyroid nodules (TNs) are a common pathology. Their prevalence increases with age. Some of them are suspected of malignancy and qualified for surgery. Sometimes their malignant nature is detected incidentally after a surgical procedure. The aim of the study is to analyze clinical and histopathological characteristics of patients with incidental and nonincidental thyroid carcinoma (ITC vs. NITC). Material and methods: The case records of 3,241 patients with solitary and multiple TNs who were treated consecutively between 2008 and 2014 were analyzed retrospectively. After the final selection 235 (7.25%) patients were included in the study (202 females and 33 males, mean age: 52.9 +16.5 years). Seventy-five (31.91%) cases were incidentally diagnosed and 160 (68.09%) were diagnosed before surgery. Results : We did not observe any differences in age, gender or stage of disease at the time of diagnosis between the patients with ITC and NITC (p = 0.366, p = 0.850, p = 0.226 respectively). The occurrence of solitary nodules in patients with NITC was significantly higher compared to patients with ITC (p < 0.0001). There were no differences in histopathological types of thyroid cancer (TC). The logistic regression analysis showed that solitary TC was an independent predictor of NITC (p < 0.0001). Conclusions : There are no differences in gender, age or histopathological type of cancer in patients with ITC and NITC. Papillary TC is the predominant type in both groups. Incidence of TC in a solitary nodule is significantly higher in NITC than ITC. Solitary type of TC is an independent predictor of NITC. The prevalence of ITC is associated with multifocal type of TC

Diagnostics of Thyroid Malignancy and Indications for Surgery in the Elderly and Younger Counterparts: Comparison of 3,749 Patients

Background. It seems valuable for clinicians to know if diagnostics of thyroid malignancy (TM) and indications for surgery in the elderly patients differ from these in younger counterparts. Materials and Methods. Retrospective analysis of the medical records of 3,749 patients surgically treated for thyroid tumor. Data of patients with histopathology confirmed TM (n=309) were studied. Results. The rate of cytological prediction to malignancy was more than three times higher in elderly women. Compression was a main reason for surgery in the elderly (p<0.0001). The final diagnosis of malignancy was significantly higher in older women (p=0.002). Clinical suspicion of malignancy was positively correlated with histopathological diagnosis in total group of women (r=0.543, p<0.001) and total group of men (r=0.560, p<0.001). The subgroup of the eldest TM patients included a significantly higher number of subjects with advanced cancer and primary tumor progression (p<0.0001). Distant metastases were significantly more presented among the elderly patients (p=0.032). Conclusions. The rate of cytological prediction to malignancy in elderly women is high. Tracheal compression is a common surgical indication in the elderly patients. The final diagnoses of malignancy predominate in elderly women. The oldest TM patients present a higher number of advanced thyroid tumors and distant metastases

MRI sagittal scan showing area of high signal (arrows) corresponding to spinal metastasis of ITC in a 61-year-old female.

<p>MRI sagittal scan showing area of high signal (arrows) corresponding to spinal metastasis of ITC in a 61-year-old female.</p

MRI transverse scan of the vertebral column showing a low signal area (arrows) of ITC metastasis in a 61-year-old female.

<p>MRI transverse scan of the vertebral column showing a low signal area (arrows) of ITC metastasis in a 61-year-old female.</p

Should the Prevalence of Incidental Thyroid Cancer Determine the Extent of Surgery in Multinodular Goiter?

<div><p>Background</p><p>The most appropriate surgical procedure for multinodular goiter (MNG) remains under debate. Incidental thyroid carcinoma (ITC) is often identified on histopathological examination after thyroidectomy performed for presumed benign MNG.</p><p>Aim of the study</p><p>The aim of the study was to determine the value of radical surgery for MNG patients considering the prevalence of ITC diagnosed postoperatively.</p><p>Materials and Methods</p><p>We conducted retrospective analysis of the medical records of 2,306 patients surgically treated for MNG between 2008 and 2013 at one center. None of the patients presented with any suspicion of malignancy, history of familial thyroid cancer, multiple endocrine neoplasia syndrome or previous head or neck radiation exposure.</p><p>Results</p><p>Among the 2,306 MNG patients, ITC was detected in 49 (2.12%) (44 women and 5 men, with average ages of 52.2 (21–79) and 55.6 (52–62), respectively). Papillary thyroid carcinoma was significantly more frequently observed than other types of ITC (p<0.00001). Among the MNG patients, 866 (37.5%) underwent total/near total surgery, 464 (20.1%) received subtotal thyroidectomy, and 701 (30.3%) received the Dunhill operation. The remaining 275 (11.9%) patients underwent a less radical procedure and were classified as "others." Among the 49 (100%) patients with ITC, 28 (57.1%) underwent radical surgery. Another 21 (42.9%) patients required completion surgery due to an insufficient primary surgical procedure. A total of 21 (2.42%) patients in the total/near total surgery group were diagnosed with ITC, as well as 16 (2.48%) in the subtotal thyroidectomy group and 12 (1.71%) in the Dunhill operation group; 21 (100%), 4 (25%) and 3 (25%) of these patients, respectively, underwent radical surgery; thus, 0 (0%), 12 (75%) and 9 (75%) required completion surgery. The prevalence rates of ITC were comparable between the radical and subtotal surgery groups (2.42% and 3.44%, respectively, p = 0.4046), and the prevalence was higher in the radical surgery group than in the Dunhill operation group (2.42% and 1.71%, respectively, p = 0.0873). A significant difference was observed between the group of patients who underwent total/near total surgery, among whom all of the patients with ITC (100%) received primary radical surgery, and the groups of patients who received the subtotal and Dunhill operations, among whom only 25% of the patients with ITC in each group received primary radical surgery (p<0.0001).</p><p>Conclusions</p><p>More radical procedures for MNG result in a lower risk of reoperation for ITC. The prevalence of ITC on postoperative histopathological examination should determine the extent of surgery in MNG patients. In the future, total/near total thyroidectomy should be considered for MNG patients due to the increased prevalence of ITC to avoid the necessity for reoperation.</p></div

Type of procedure (radical/non-radical) according to necessity for completion of primary surgery (total or near total, subtotal, and Dunhill operation).

<p>Type of procedure (radical/non-radical) according to necessity for completion of primary surgery (total or near total, subtotal, and Dunhill operation).</p