Synchronous parathyroid adenoma and thyroid papillary carcinoma: a case report

A 51-year-old female patient presented with atypical chest pain, laryngo-oesophageal reflux, increased levels of serum calcium and parathyroid hormone. Ultrasonography showed a multinodular goiter with a prominent solid nodule in the lower left thyroid lobe and a solid hypoechoic nodule outside this area

Hybrid approach of ventricular assist device and autologous bone marrow stem cells implantation in end-stage ischemic heart failure enhances myocardial reperfusion

We challenge the hypothesis of enhanced myocardial reperfusion after implanting a left ventricular assist device together with bone marrow mononuclear stem cells in patients with end-stage ischemic cardiomyopathy. Irreversible myocardial loss observed in ischemic cardiomyopathy leads to progressive cardiac remodelling and dysfunction through a complex neurohormonal cascade. New generation assist devices promote myocardial recovery only in patients with dilated or peripartum cardiomyopathy. In the setting of diffuse myocardial ischemia not amenable to revascularization, native myocardial recovery has not been observed after implantation of an assist device as destination therapy. The hybrid approach of implanting autologous bone marrow stem cells during assist device implantation may eventually improve native cardiac function, which may be associated with a better prognosis eventually ameliorating the need for subsequent heart transplantation. The aforementioned hypothesis has to be tested with well-designed prospective multicentre studies

The impact of depression and anxiety in prognosis of patients undergoing myocardial perfusion imaging with 99mTc tetrofosmin SPECT for evaluation of possible myocardial ischemia

Background: The goal of this study was to evaluate the prevalence of depression and anxiety in patients subjected to myocardial perfusion imaging (MPI) with 99mTc tetrofosmin stress-rest single-photon emission computer tomography (SPECT), and their impact on their cardiological events or disease. Material and Methods: Patients referred to the Nuclear Medicine Department for 99mTc tetrofosmin myocardial MPI-SPECT were asked to fulfill the Zung Self-Rating Depression Scale (ZDS) and Hamilton anxiety questionnaire (HAQ). Among 213 patients who completed the ZDS and HAQ, 80 patients (59 males and 21 females) were selected for this study because they had no known psychological disease, other disease that could influence psychological status, or use of narcotic drugs. Collected data from MPI and psychological status were subsequently analyzed. Results: Among all 80 patients, 52 patients (65%) had abnormal MPI of whom 28/52 (53.8%) exhibited either depression, anxiety or both, and 28 (35%) patients had normal MPI of whom 10/28 (35.7%) had abnormal psychological status. The higher number of patients with abnormal psychological status in association with abnormal MPI was noted predominantly in patients with previously established coronary artery disease. A correlation was also noted between obesity, cardiac heredity and depression or anxiety in patients with abnormal MPI. Conclusions: Patients that exhibit depression, anxiety, or both, have high rates of myocardial ischemia, and thus are at risk for subsequent cardiological events

Polarization transfer at 7.5 ̊and 19.3 ̊for ¹H (d, p) D at 45.4 MeV

Typescript (photocopy).The vector polarization transfer parameter K[y'y] for the 1H(d,p)D stripping reaction has been measured at 7.5° and 19.3° lab for an incident beam energy of 45.4 MeV. A helium polarimeter system was used to monitor the beam polarization and a carbon polarimeter assembly, located at the focal plane of a spectrograph, was used to determine the polarization of the reaction proton. The d-1H vector analyzing power for the tow angles of interest was also measured, as was the 36 MeV p-12C vector analyzing power. The results of the K[y'y] measurement help to complete an angular distribution in a region where two theoretical predictions disagree, placing new constraints on future theoretical calculations

The contribution of radioimmunoassay to the study of interferon's pharmacokinetics in patients with neoplasmas

The use of interferon alpha is currently established for the treatment of certain neoplastic diseases and among them for the management of malignant melanoma. Considering the extremely high cost of this product and the existing relationship between the therapeutical results and the levels of the drug in the serum, the individualization of dose becomes a necessity. The pharmacokinetics of interferon alpha was studied in ten consecutive patients suffering from malignant melanoma who were hospitalized at the First Chemotherapy Clinic of "Theagenion" Cancer Institute. Two methods for identifying the levels of the substance in the serum were used: The inhibition of the enzyme 2’5 oligo (A) synthetase and the radioimmunoassay (RIA). The aim of this study was to check if the RIA, due to its simplicity and rapidness can be used as a routine substituting the well known and widely used for year’s enzymatic method. All the patients were included for the first time in an interferon protocol with 5 to 10 X10⁶ International Units of interferon alpha (Intron A), administered by intramuscular injection. Blood samples were drawn before and then in specific time intervals six, twelve and twenty four hours after the administration of the drug. A wide distribution of the values between the different patients was observed, even when they received the same dose. The coefficient of variance was excellent (R²=0.98) when the mean values of the estimations in the different time intervals were compared. Concerning the RIA, the observed by previous investigators luck of sensitivity in the low interferon levels was not evident in this study. As a conclusion it can be stated that RIA can be utilized for the estimation of the interferon's levels in the sera of the patients suffering from malignant melanoma who receive therapeutic doses of this medicine. The quite good sensitivity which is obvious either at the low titers, combined with the other unequivocal advantages such as the simplicity, rapidness and the specificity make the RIA the method of choice. Additionally it identifies only the interferon alpha and is not influenced by the other kinds of interferons. It is a method that can be used in any Nuclear Medicine Department with elementary instrumentation for in vitro exams and can provide results only in few hours after the withdraw of the blood sample. On the other hand, the clinician is interested mainly in the maximal level of the drug and when this is achieved, because these factors will specify the therapeutic result. These parameters can be easily and accurately be identified by RIA, because high titers as such are obviously among the limits of the method.Η χρήση της ιντερφερόνης άλφα έχει σήμερα καθιερωθεί για την αντιμετώπιση ορισμένων νεοπλασματικών νόσων, μεταξύ των οποίων συγκαταλέγεται και το κακόηθες μελάνωμα. Λόγω του ιδιαίτερα μεγάλου κόστους του φαρμάκου και της εξάρτησης του θεραπευτικού αποτελέσματος από το επίπεδο της ιντερφερόνης στον ορό, υπάρχει επιτακτική ανάγκη εξατομίκευσης της δόσης, που επιτυγχάνεται μόνο μετά από μελέτη της φαρμακοκινητικής του φαρμάκου σε κάθε ασθενή ξεχωριστά. Η φαρμακοκινητική της ιντερφερόνης άλφα μελετήθηκε σε δέκα ασθενείς με κακόηθες μελάνωμα, που νοσηλεύτηκαν στην Α' χημειοθεραπευτική κλινική του Θεαγένειου Αντικαρκινικού Νοσοκομείου. Χρησιμοποιήθηκαν δύο μέθοδοι ανίχνευσης της ουσίας στον ορό: η μέθοδος της αναστολής του ενζύμου 2'5όλιγο (Α) συνθετάση και η ραδιοανοσολογική μέθοδος (RIA). Σκοπός της εργασίας ήταν να ελεγχθεί εάν και κατά πόσο η RIA με τα γνωστά πλεονεκτήματα της συντομίας και απλότητάς της θα μπορούσε να χρησιμοποιηθεί ως μέθοδος ρουτίνας, αντικαθιστώντας την ήδη γνωστή και από χρόνια χρησιμοποιούμενη μέθοδο της αναστολής του ενζύμου. Στη μελέτη αυτή επιλέχτηκαν αποκλειστικά και μόνο ασθενείς με κακόηθες μελάνωμα με σκοπό τη διατήρηση όσο το δυνατόν μεγαλύτερης ομοιογένειας στο υλικό, επειδή αναφέρεται στη βιβλιογραφία ότι υπάρχει μεγάλη διακύμανση στις βασικές τιμές της ενδογενούς ιντερφερόνης στα διάφορα νεοπλάσματα και η φαρμακοκινητική της χορηγούμενης ιντερφερόνης άλφα σ’ αυτά ποικίλλει. Όλοι οι ασθενείς έλαβαν για πρώτη φορά ιντερφερόνη άλφα (Intron Α) σε δόση που κυμάνθηκε από 5 έως 10 Χ 10⁶ Διεθνείς Μονάδες σε βαθιά ενδομυϊκή χορήγηση. Δείγματα αίματος πάρθηκαν σε χρονικά διαστήματα που τηρήθηκαν με ακρίβεια και ήταν πριν από τη χορήγηση του φαρμάκου και ακολούθως μετά από έξι, δώδεκα και είκοσι τέσσερις ώρες μετά απ' αυτήν. Παρατηρήθηκε σημαντικά μεγάλη διακύμανση στις τιμές μεταξύ των διάφορων ασθενών, ακόμη και μεταξύ αυτών που έλαβαν την ίδια δόοη. Ο συντελεστής συσχέτισης των δύο μεθόδων για το μέσο όρο των μετρήσεων πριν από τη χορήγηση και στα διαστήματα μετά από αυτήν ήταν πολύ ικανοποιητικός (R²=0,98). Παρατηρήθηκε ότι η RIA δεν εμφανίζει την έλλειψη ευαισθησίας στις χαμηλές τιμές που είχε αναγερθεί από προηγούμενους ερευνητές πιθανόν λόγω των βελτιωμένων αντιδραστηρίων και της μεθόδου του διαδοχικού κορεσμού που χρησιμοποιήθηκε. Συμπερασματικά θα μπορούσε να λεχθεί ότι η ραδιοανοσολογική μέθοδος μπορεί να χρησιμοποιηθεί ασφαλώς για τη μέτρηση των επιπέδων της ιντερφερόνης άλφα στον ορό των ασθενών με κακόηθες μελάνωμα που λαμβάνουν θεραπευτικά το φάρμακο αυτό. Η ικανοποιητική ευαισθησία που παρουσιάζει ακόμη και στους χαμηλούς τίτλους σε συνδυασμό με τα άλλα σαφή πλεονεκτήματα, όπως η συντομία, η ευκολία και η ειδικότητα, την καθιστούν σήμερα μέθοδο εκλογής. Επιπρόσθετα η RIA ανιχνεύει αποκλειστικά και μόνο την ιντερφερόνη άλφα και δεν επηρεάζεται από τις άλλες μορφές ιντερφερονών. Είναι μέθοδος που μπορεί να υιοθετηθεί από κάθε εργαστήριο Πυρηνικής Ιατρικής που διαθέτει στοιχειώδη εξοπλισμό για in vitro εξετάσεις και να παρέχει τα αποτελέσματα των μετρήσεων λίγες ώρες μετά την αιμοληψία απευθείας σε Διεθνείς Μονάδες. Άλλωστε, όσον αφορά το θεραπευτικό αποτέλεσμα, αυτό που ενδιαφέρει άμεσα τον κλινικό γιατρό είναι το ύφος και ο χρόνος της μέγιστης επιτυγχανόμενης στάθμης. Αυτές τις δύο παραμέτρους μπορεί να καθορίσει με ακρίβεια, συντομία και ευκολία η ραδιοανοσολογική μέθοδος, επειδή οι τιμές αυτές είναι ευχερώς μέσα στα όρια της ευαισθησίας της

Could the Majority of the Greek and Cypriot Population Be Vitamin D Deficient?

OBJECTIVE: Hypovitaminosis D is prevalent in epidemic proportions in many developed countries. The aim of this study is to investigate the prevalence of adequate 25-hydroxyvitamin D [25(OH)D] levels in two Mediterranean countries, Greece and Cyprus. METHODS: Data such as 25(OH)D, the month of blood sample collection, and demographic information were blindly collected from 8780 Greek and 2594 Cypriot individuals over 5 years. Comorbidities were also recorded for 839 Greek subjects. Univariate and multivariate analyses were used to examine the relationship between these variables and 25(OH)D levels. RESULTS: In the samples studied, 72.7% of the Greek and 69.3% of the Cypriot population sample had inadequate levels of 25(OH)D. The mean level for the Greek subjects was 25.1 ng/mL and for Cypriots 25.8 ng/mL. For both samples, only month and gender were significantly associated with 25(OH)D levels, and the highest mean levels were recorded in September. For the recorded diseases, the lowest levels were recorded in sickle cell anaemia 13.6 ± 10.2 ng/mL, autoimmune diseases 13.0 ± 8.4 ng/mL, and cancer 22.6 ± 9.5 ng/mL. CONCLUSIONS: The prevalence of vitamin D deficiency is paradoxically high in both Mediterranean countries

Infection of cardiac prosthetic valves and implantable electronic devices: early diagnosis and treatment

There has been a recent rise in the use of implantable cardiac devices, mostly valves but also electronic ones, such as pacemakers, and implantable defibrillators. The increasing use of these devices had as a consequence the raised incidence of endocarditis, an infrequent but morbid complication of these procedures. Thus, early diagnosis of the implantable cardiac devices related infection and endocarditis became pivotal for appropriate management. For diagnostic purposes, the modified Duke criteria are widely used, which are based on clinical and imaging findings, in addition to serological analyses and blood cultures. 18F-fluoro-2-deoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) is a recently employed method in order to improve the early diagnosis of endocarditis as well as infection of the implantable device. It is likely, that combining the modified Duke criteria with the FDG PET/CT, will increase the sensitivity and specificity of diagnosis and will guide the treating physician to an early and appropriate management

Recombinant Human Thyrotropin-Aided Radioiodine Therapy in Tracheal Obstruction by an Invading Well-Differentiated Thyroid Carcinoma

Papillary thyroid carcinomas (PTCs) usually extend to lymph nodes in the neck and mediastinum. Rarely, they invade the neighboring upper airway anatomical structures. We report a 56-year-old woman who presented with symptoms of upper airway obstruction. Imaging studies revealed a lesion derived from the thyroid which invaded and obstructed the trachea, which appeared to be a highly differentiated PTC. Total thyroidectomy was performed, with removal of the endotracheal part of the mass along with the corresponding anterior tracheal rings. Two months later, a whole body I131 scan after recombinant human thyroid-stimulating hormone (rh-TSH) administration was performed and revealed a residual mass in upper left thyroid lobe. Subsequently, 150 mCi I131 were given following rh-TSH administration. Nine months later, there was no sign of residual tumor. This case is the first one reported in the literature regarding rh-TSH administration prior to RAI ablation in a PTC obstructing the trachea