Serum calcitonin negative Medullary thyroid carcinoma

BACKGROUND: Medullary thyroid carcinomas (MTC) constitute about 5 to 7 % of thyroid neoplasms. They originate from parafollicular C cells which produce Calcitonin, a hormone which has an impact on calcium metabolism and represents the biochemical activity of MTC. In rare cases pre-operative serum calcitonin can be negative. CASE PRESENTATION: We report on a 73-year-old female patient with a rare case of a serum calcitonin negative medullary thyroid carcinoma who suffered fulminant post-operative course and died of multiple metastasis. CONCLUSION: This case shows that in very rare cases MTCs do not secrete calcitonin making diagnosis and tumour follow-up difficult. To this date, only few reports describing this combination of circumstances were found in the English literature

Elektronen-Spin-Resonanz-Spektroskopie (ESR) von Albumin bei Patienten mit benignen und malignen kolorektalen Erkrankungen

Die ESR weist strukturelle Veränderungen des Albumins nach, wobei die Spektren Änderungen der Albuminkonformation reflektieren. Untersucht wurde, ob sich solche Veränderungen beim KRK finden. 104 an KRK (n=43), Sigmadivertikulitis (n=32) oder kolorektalem Adenom (n=29) behandelte Patienten wurden untersucht. Konformationsänderungen des Albumins wurden mittels ESR von Serum mit spinmarkierten Fettsäuren durchgeführt. Als Wert aus der Analyse der Spektren wurde der Koeffizient DR bestimmt. Patienten mit KRK hatten signifikant niedrigere DR-Werte (DR -0,09 +/- 0,98 vs. 0,61 +/-1,43) als Patienten mit benignen Erkrankungen. Mit fortschreitendem Tumorstadium waren dabei ausgeprägtere Veränderungen zu messen. Patienten mit benignen kolorektalen Erkrankungen wiesen einheitliche Spektralwellenmuster auf. Schlussfolgernd lässt sich sagen, dass die Albumin-ESR sich zur Detektion von Patienten mit KRK eignet, wobei die Konformationsänderungen mit fortschreitendem UICC-Stadium korrelieren

A randomised, open-label trial to assess the optimal treatment strategy in early diffuse cutaneous systemic sclerosis: the UPSIDE study protocol

Introduction Systemic sclerosis (SSc) is a chronic, autoimmune connective tissue disease associated with high morbidity and mortality, especially in diffuse cutaneous SSc (dcSSc). Currently, there are several treatments available in early dcSSc that aim to change the disease course, including immunosuppressive agents and autologous haematopoietic stem cell transplantation (HSCT). HSCT has been adopted in international guidelines and is offered in current clinical care. However, optimal timing and patient selection for HSCT are still unclear. In particular, it is unclear whether HSCT should be positioned as upfront therapy or rescue treatment for patients refractory to immunosuppressive therapy. We hypothesise that upfront HSCT is superior and results in lower toxicity and lower long-term medical costs. Therefore, we propose this randomised trial aiming to determine the optimal treatment strategy for early dcSSc by comparing two strategies used in standard care: (1) upfront autologous HSCT versus (2) immunosuppressive therapy (intravenous cyclophosphamide pulse therapy followed by mycophenolate mofetil) with rescue HSCT in case of treatment failure.Methods and analysis The UPSIDE (UPfront autologous hematopoietic Stem cell transplantation vs Immunosuppressive medication in early DiffusE cutaneous systemic sclerosis) study is a multicentre, randomised, open-label, controlled trial. In total, 120 patients with early dcSSc will be randomised. The primary outcome is event-free survival at 2 years after randomisation. Secondary outcomes include serious adverse events, functional status and health-related quality of life. We will also evaluate changes in nailfold capillaroscopy pattern, pulmonary function, cardiac MR and high-resolution CT of the chest. Follow-up visits will be scheduled 3-monthly for 2 years and annually in the following 3 years.Ethics and dissemination The study was approved by the Dutch Central Committee on Research Concerning Human Subjects (NL72607.041.20). The results will be disseminated through patient associations and conventional scientific channels.Trial registration numbers NCT04464434; NL 8720