Giant thymoma - case report.

Efst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinnÆxli í hóstarkirtli eru yfirleitt góðkynja og staðsett í framanverðu miðmæti. Hér er lýst afar sjaldgæfu risaæxli í hægra brjóstholi sem reyndist vaxið út frá hóstarkirtli. Æxlið sem mældist 15 x 8 cm reyndist hóstarkirtilsæxli (thymoma) af gerð AB og tókst að fjarlægja það með skurðaðgerð. Tveimur árum eftir aðgerð er sjúklingur einkennalaus og án merkja um endurkomu sjúkdóms. Inngangur Hóstarkirtilsæxli eru misleitur hópur æxla með fjölbreytileg einkenni og horfur. Þau eru sjaldgæf en engu að síður algengustu æxli upprunnin í miðmæti.1 Í íslenskri rannsókn var aldursstaðlað nýgengi 0,28/100.000 íbúa og reyndist svipað fyrir bæði kyn.2 Meðalstærð hóstarkirtilsæxla í þeirri rannsókn var 6,5 cm og var stærsta æxlið 9,5 cm.2Risaæxlum í hóstarkirtli hefur verið lýst í erlendum rannsóknum3 og hér er slíku tilfelli lýst í fyrsta skipti á Íslandi.Thymomas are usually benign tumors and are most often found in the anterior mediastinum. We report a rare case of a giant tumor in the right hemithorax that originated in the thymus. The tumor was 15x8 cm and histology revealed a type AB thymoma. The tumor was removed and the patient is doing well and is without symptoms two years after the operation. Key words: Thymoma, abdominal pain, giant tumor, mediastinum

Case of the month. An elderly woman with dyspnea and stridor

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/Ope

Hlutabrottnám á nýra vegna nýrnafrumukrabbameins. Lýðgrunduð rannsókn á nýrnastarfsemi eftir nýrnabrottnám

Introduction: The aim of this retrospective study was to compare renal function in a population-based cohort of renal cell carcinoma (RCC) patients who underwent partial (PN) or radical nephrectomy (RN). Materials and methods: Forty-four consecutive RCC patients (mean age 60 years, 64% male) who underwent PN in Iceland between 2000 and 2010 were compared with 44 TNM-matched controls (mean age 65 years, 52% male) who underwent RN during the same period. Estimated glomerular filtration rate (eGFR) and survival were calculated, and predictors of chronic kidney disease (CKD) were evaluated with multivariate analysis. Results: In 16 cases (36%), PN was performed for imperative reasons (single kidney, reduced kidney function, or bilateral kidney tumours) but 28 patients had a normal contralateral kidney. The groups were similar regarding preoperative eGFR, median follow-up, and TNM stage, but age and ASA score were significantly higher in the RN group. Six months after surgery, eGFR was significantly higher in the PN group. By multivariate analysis, RN contributed negatively to eGFR six months after surgery (-12.6 mL/1.73 m2, p <0.001) and increased the risk of new-onset chronic kidney disease (CKD) compared to PN (OR=3.07, 95% CI: 1.03–9.79, p=0.04). At a median follow-up of 44 months, no patients in either group had a recurrence of RCC. The 5-year overall survival (Kaplan-Meier) was 100% in the PN group and 65% in the RN group (log-rank test, p <0.001). Conclusion: eGFR was significantly lower after RN, and these patients were three times more likely to develop new-onset CKD. Our findings suggest that PN successfully preserves kidney function compared to RN with good oncological outcome and survival

Giant thymoma - case report.

Efst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinnÆxli í hóstarkirtli eru yfirleitt góðkynja og staðsett í framanverðu miðmæti. Hér er lýst afar sjaldgæfu risaæxli í hægra brjóstholi sem reyndist vaxið út frá hóstarkirtli. Æxlið sem mældist 15 x 8 cm reyndist hóstarkirtilsæxli (thymoma) af gerð AB og tókst að fjarlægja það með skurðaðgerð. Tveimur árum eftir aðgerð er sjúklingur einkennalaus og án merkja um endurkomu sjúkdóms. Inngangur Hóstarkirtilsæxli eru misleitur hópur æxla með fjölbreytileg einkenni og horfur. Þau eru sjaldgæf en engu að síður algengustu æxli upprunnin í miðmæti.1 Í íslenskri rannsókn var aldursstaðlað nýgengi 0,28/100.000 íbúa og reyndist svipað fyrir bæði kyn.2 Meðalstærð hóstarkirtilsæxla í þeirri rannsókn var 6,5 cm og var stærsta æxlið 9,5 cm.2Risaæxlum í hóstarkirtli hefur verið lýst í erlendum rannsóknum3 og hér er slíku tilfelli lýst í fyrsta skipti á Íslandi.Thymomas are usually benign tumors and are most often found in the anterior mediastinum. We report a rare case of a giant tumor in the right hemithorax that originated in the thymus. The tumor was 15x8 cm and histology revealed a type AB thymoma. The tumor was removed and the patient is doing well and is without symptoms two years after the operation. Key words: Thymoma, abdominal pain, giant tumor, mediastinum

Case of the month. An elderly woman with dyspnea and stridor

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/Ope

Small renal cell carcinomas and synchronous metastases.

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/OpenInngangur: Horfur lítilla nýrnafrumukrabbameina eru almennt taldar góðar og mælt er með hlutabrottnámi ef æxli eru undir 4 cm. Markmið þessarar rannsóknar var að rannsaka tíðni fjarmeinvarpa frá litlum nýrnafrumukrabbameinum en þau hafa ekki verið rannsökuð áður hér á landi. Efniviður og aðferðir: Af 1102 sjúklingum sem greindust með nýrnafrumukrabbamein á tímabilinu 1971-2010 var litið sérstaklega á 257 æxli ≤4 cm og sjúklingar með meinvörp við greiningu bornir saman við sjúklinga án meinvarpa. Upplýsingar fengust úr sjúkraskrám og vefjagerð, TNM-stig og sjúkdómasértæk lifun var borin saman í hópunum. Niðurstöður: Hlutfall lítilla nýrnafrumukrabbamein hækkaði úr 9% fyrsta áratuginn í 33% þann síðasta (p<0,001) á sama tíma og hlutfall tilviljanagreiningar jókst úr 14% í 39%. Alls greindust 25 af 257 sjúklingum (10%) með lítil nýrnafrumukrabbamein með fjarmeinvörp, oftast í lungum og beinum. Sjúklingar með meinvörp voru 1,9 árum eldri, æxlin 0,2 cm stærri og oftar staðsett í hægra nýra. Vefjagerð var sambærileg í báðum hópum en æxli greindust síður fyrir tilviljun hjá sjúklingum með meinvörp, blóðrauði þeirra var lægri og bæði Fuhrman-gráða og T-stig hærra. Fimm ára lifun sjúklinga með meinvörp var 7% borið saman við 94% hjá viðmiðunarhópi (p<0,001). Ályktun: Við greiningu eru 10% sjúklinga með lítil nýrnafrumukrabbamein með fjarmeinvörp. Þetta er óvenju hátt hlutfall en í flestum öðrum rannsóknum hefur aðeins verið litið á sjúklinga sem gengist hafa undir skurðaðgerð. Sjúklingar með meinvörp eru marktækt eldri, greinast oftar með einkenni sjúkdómsins, hafa stærri frumæxli og verri lifun. Lítil nýrnafrumukrabbamein geta því verið útbreiddur sjúkdómur við greiningu og verður að taka alvarlega.The incidence of renal cell carcinoma (RCC) is rising in part due to small tumors (≤4cm) detected incidentally with abdominal imaging. Survival for small RCCs has been regarded as favorable and guidelines recommend partial rather than total nephrecteomy. We studied the frequency of synchronous metastasis in patients with small RCCs in Iceland. A retrospective study on 257 patients with RCC ≤4cm out of 1102 RCC patients diagnosed in Iceland 1971-2010. Patients with metastasis were compared to those with localized disease. Hospital charts were reviewed and histology, TNM-stage and disease-specific survival compared between groups. The proportion of small tumors increased from 9% in 1971-1980 to 33% in 2001-2010 (p<0,001) and incidental detection increased from 14% to 39% during the same period. Out of the 257 patients with small RCCs, 25 (10%) had synchronous metastases, most frequently in lungs or bones. Patients with metastases were on average 1.9 years older, their tumors were 0.2 cm larger and more often located in the right kidney, their hemoglobin was lower and nuclear grade and T-stage higher. Histology was similar in both groups. Five-year survival of patients with and without metastases was 7 vs. 94%, respectively (p<0.001). One out of ten patients with small RCC has synchronous metastases at diagnosis. This is higher than in most previous reports that usually include surgical patients only. Patients with metastases are significantly older, more often symptomatic, their tumor are larger and their prognosis worse. Our results indicate that small RCC is a potentially systemic disease at diagnosis that has to be taken seriously

Small renal cell carcinomas and synchronous metastases.

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/OpenInngangur: Horfur lítilla nýrnafrumukrabbameina eru almennt taldar góðar og mælt er með hlutabrottnámi ef æxli eru undir 4 cm. Markmið þessarar rannsóknar var að rannsaka tíðni fjarmeinvarpa frá litlum nýrnafrumukrabbameinum en þau hafa ekki verið rannsökuð áður hér á landi. Efniviður og aðferðir: Af 1102 sjúklingum sem greindust með nýrnafrumukrabbamein á tímabilinu 1971-2010 var litið sérstaklega á 257 æxli ≤4 cm og sjúklingar með meinvörp við greiningu bornir saman við sjúklinga án meinvarpa. Upplýsingar fengust úr sjúkraskrám og vefjagerð, TNM-stig og sjúkdómasértæk lifun var borin saman í hópunum. Niðurstöður: Hlutfall lítilla nýrnafrumukrabbamein hækkaði úr 9% fyrsta áratuginn í 33% þann síðasta (p<0,001) á sama tíma og hlutfall tilviljanagreiningar jókst úr 14% í 39%. Alls greindust 25 af 257 sjúklingum (10%) með lítil nýrnafrumukrabbamein með fjarmeinvörp, oftast í lungum og beinum. Sjúklingar með meinvörp voru 1,9 árum eldri, æxlin 0,2 cm stærri og oftar staðsett í hægra nýra. Vefjagerð var sambærileg í báðum hópum en æxli greindust síður fyrir tilviljun hjá sjúklingum með meinvörp, blóðrauði þeirra var lægri og bæði Fuhrman-gráða og T-stig hærra. Fimm ára lifun sjúklinga með meinvörp var 7% borið saman við 94% hjá viðmiðunarhópi (p<0,001). Ályktun: Við greiningu eru 10% sjúklinga með lítil nýrnafrumukrabbamein með fjarmeinvörp. Þetta er óvenju hátt hlutfall en í flestum öðrum rannsóknum hefur aðeins verið litið á sjúklinga sem gengist hafa undir skurðaðgerð. Sjúklingar með meinvörp eru marktækt eldri, greinast oftar með einkenni sjúkdómsins, hafa stærri frumæxli og verri lifun. Lítil nýrnafrumukrabbamein geta því verið útbreiddur sjúkdómur við greiningu og verður að taka alvarlega.The incidence of renal cell carcinoma (RCC) is rising in part due to small tumors (≤4cm) detected incidentally with abdominal imaging. Survival for small RCCs has been regarded as favorable and guidelines recommend partial rather than total nephrecteomy. We studied the frequency of synchronous metastasis in patients with small RCCs in Iceland. A retrospective study on 257 patients with RCC ≤4cm out of 1102 RCC patients diagnosed in Iceland 1971-2010. Patients with metastasis were compared to those with localized disease. Hospital charts were reviewed and histology, TNM-stage and disease-specific survival compared between groups. The proportion of small tumors increased from 9% in 1971-1980 to 33% in 2001-2010 (p<0,001) and incidental detection increased from 14% to 39% during the same period. Out of the 257 patients with small RCCs, 25 (10%) had synchronous metastases, most frequently in lungs or bones. Patients with metastases were on average 1.9 years older, their tumors were 0.2 cm larger and more often located in the right kidney, their hemoglobin was lower and nuclear grade and T-stage higher. Histology was similar in both groups. Five-year survival of patients with and without metastases was 7 vs. 94%, respectively (p<0.001). One out of ten patients with small RCC has synchronous metastases at diagnosis. This is higher than in most previous reports that usually include surgical patients only. Patients with metastases are significantly older, more often symptomatic, their tumor are larger and their prognosis worse. Our results indicate that small RCC is a potentially systemic disease at diagnosis that has to be taken seriously

Complex patterns of cell growth in the placenta in normal pregnancy and as adaptations to maternal diet restriction.

The major milestones in mouse placental development are well described, but our understanding is limited to how the placenta can adapt to damage or changes in the environment. By using stereology and expression of cell cycle markers, we found that the placenta grows under normal conditions not just by hyperplasia of trophoblast cells but also through extensive polyploidy and cell hypertrophy. In response to feeding a low protein diet to mothers prior to and during pregnancy, to mimic chronic malnutrition, we found that this normal program was altered and that it was influenced by the sex of the conceptus. Male fetuses showed intrauterine growth restriction (IUGR) by embryonic day (E) 18.5, just before term, whereas female fetuses showed IUGR as early as E16.5. This difference was correlated with differences in the size of the labyrinth layer of the placenta, the site of nutrient and gas exchange. Functional changes were implied based on up-regulation of nutrient transporter genes. The junctional zone was also affected, with a reduction in both glycogen trophoblast and spongiotrophoblast cells. These changes were associated with increased expression of Phlda2 and reduced expression of Egfr. Polyploidy, which results from endoreduplication, is a normal feature of trophoblast giant cells (TGC) but also spongiotrophoblast cells. Ploidy was increased in sinusoidal-TGCs and spongiotrophoblast cells, but not parietal-TGCs, in low protein placentas. These results indicate that the placenta undergoes a range of changes in development and function in response to poor maternal diet, many of which we interpret are aimed at mitigating the impacts on fetal and maternal health