Completion thyroidectomy of well-differentiated thyroid cancer — a prospective, miserandomised study

Wstęp: Rozpoznanie po operacjach pierwotnie niedoszczętnych raka brodawkowatego lub pęcherzykowego tarczycy wymaga radykalizacjileczenia operacyjnego i usunięcia całego gruczołu tarczowego. W zmienionych przez tkankę bliznowatą warunkach anatomicznychradykalność tych zabiegów może być niezadowalająca i w konsekwencji wpływać na wyniki tarapii.Celem pracy była ocena korzyści wynikających z zastosowania ręcznego gamma nawigatora w zabiegach wtórnie całkowitych w przypadkachdobrze zróżnicowanych raków tarczycy.Materiał i metody: W pracy przedstawiono 75 przypadków chorych z dobrze zróżnicowanymi rakami tarczycy, zakwalifikowanych doradykalizacji leczenia operacyjnego. W 43 przypadkach (grupa I) śródoperacyjnie zastosowano ręczny gamma nawigator (NavigatorGPS), 32 chorych reoperowano bez użycia wyżej wymienionego urządzenia (grupa II). W celu oceny radykalności wtórnie całkowitegozabiegu w obu grupach chorych badano pooperacyjnie stężenie tyreoglobuliny (Tg) oraz oceniano wyniki badania scyntygrafii całegociała (I131) — jodochwytność. W obu grupach porównano również wystąpienie powikłań po zabiegach wtórnie radykalnych.Wyniki: Podczas radykalizacji we wszystkich przypadkach wykonano całkowite wycięcie gruczołu tarczowego wraz z wycięciem węzłówchłonnych przedziału centralnego. Pooperacyjne średnie stęzenie Tg oraz jodochwytność były niższe w grupie I w porównaniu z grupąII: (3,32 ± 2,09 v. 4,58 ± 2,5 ng/ml, [p = 0,021] jodochwytność: 6,9 ± 3,38 (grupa I) v. 7,31 ± 2,29 ng/ml (grupa II) [p = 0,187]). Użycienawigatora nie miało wpływu na częstość wystąpienia pooperacyjnych powikłań w obu grupach chorych (p = 0,109).Wnioski: Śródoperacyjne zastosowanie nawigatora może być pomocne w osiągnięciu lepszej radykalności pierwotnie nieradykalnychoperacji, chociaż obserwowane wyniki pozwalają na stwierdzenie, że zabieg ten wykonywany przez doświadczonego operatorapozwala na osiągnięcie porównywalnej radykalności niezależnie o d śródoperacyjnej detekcji izotopowej.(Endokrynol Pol 2013; 64 (5): 335–339)Introduction: Postoperatively diagnosed papillary or follicular thyroid cancer in subtotally thyroidectomised patients requires a completionthyroidectomy. Re-operation with a gamma probe can be particularly useful in these patients.The aim of this study was to evaluate the benefits of using an intraoperative hand-held gamma detector during completion thyroidectomyin patients with well-differentiated thyroid cancer (WTC).Material and methods: 75 patients with WTC qualified for total re-thyroidectomy. In 43 patients, Group I (Nav), a hand-held gammaprobe (Navigator GPS) was used intraoperatively. 32 patients were re-operated without the gamma probe (Group II). In Group I, thyroidremnants were removed based on counted gamma signals. To estimate the radicality of reoperation in both groups, thyroglobulin (Tg)levels were determined and total body scanning (TBS) — I131 uptake — was performed.Results: Total thyroidectomy with central lymphadenectomy was performed in 75 cases. The average level of Tg and iodine uptake afterradicalisation was lower in Group I (Nav) than in Group II (3.32 ± 2.09 v. 4.58 ± 2.5 ng/mL, respectively, for Tg [p = 0.021] and 6.29 ±3.38 v. 7.31 ± 2.29 ng/mL, respectively, for iodine uptake [p = 0.187]). Additionally, the frequency of postoperative complications wascomparable, the difference in both groups was not significant, despite the use of the gamma probe (p = 0.109).Conclusions: The intraoperative use of a hand-held gamma detector can help to improve the radicality of a completion thyroidectomyprocedure after an incomplete primary thyroid resection, but the results of this procedure in the hands of an experienced surgeon arecomparable whether or not the gamma detector is used. (Endokrynol Pol 2013; 64 (5): 335–339

The correlation of protein peroxidation with morphological changes in experimental oestradiol-induced carcinogenesis

Oestradiol-induced male Syrian hamster carcinogenesis is a well-known experimental model of human cancer of the breast, ovary and uterus. The pathomechanism postulated in this model is 4-hydroxylation of oestradiol and further free radical formation. The same process is suspected in human breast cancer. Dynamic changes in protein peroxidation were reported during the tumour induction. In this paper we try to correlate the protein peroxidation markers with the histopathological progression of the changes. The biochemical and histopathological evaluations were performed after 1, 3, 6 and 9 months of the hormone exposition. Significant protein peroxidation was observed as soon as after 1 month and increased further until the 6th month. After 9 months however, it was not significantly different from the control. The discrete histopathological changes after 1 month, progressed into tubular and interstitial hyperplasias after 3 and 6 months. After 9 months several dysplastic areas, sometimes with features of carcinoma in situ, were observed. The severe 9-month histopathological changes did not correlate with the protein peroxidation

Association of low ficolin-2 concentration in cord serum with respiratory distress syndrome in preterm newborns

IntroductionFicolin-2 is a serum pattern recognition molecule, involved in complement activation via the lectin pathway. This study aimed to investigate the association of ficolin-2 concentration in cord blood serum with complications related to premature birth.Methods546 premature neonates were included. The concentration of ficolin-2 in cord blood serum was determined by a sandwich TRIFMA method. FCN2 genetic variants were analysed with RFLP-PCR, allele-specific PCR, Sanger sequencing or allelic discrimination using TaqMan probes method.FindingsCord blood serum ficolin-2 concentration correlated positively with Apgar score and inversely with the length of hospitalisation and stay at Neonatal Intensive Care Unit (NICU). Multivariate logistic regression analysis indicated that low ficolin-2 increased the possibility of respiratory distress syndrome (RDS) diagnosis [OR=2.05, 95% CI (1.24-3.37), p=0.005]. Median ficolin-2 concentration was significantly lower in neonates with RDS than in premature babies without this complication, irrespective of FCN2 gene polymorphisms localised to promoter and 3’untranslated regions: for patients born <33 GA: 1471 ng/ml vs. 2115 ng/ml (p=0.0003), and for patients born ≥33 GA 1610 ng/ml vs. 2081 ng/ml (p=0.012). Ficolin-2 level was also significantly lower in neonates requiring intubation in the delivery room (1461 ng/ml vs. 1938 ng/ml, p=0.023) and inversely correlated weakly with the duration of respiratory support (R=-0.154, p<0.001). Interestingly, in the neonates born at GA <33, ficolin-2 concentration permitted differentiation of those with/without RDS [AUC=0.712, 95% CI (0.612-0.817), p<0.001] and effective separation of babies with mild RDS from those with moderate/severe form of the disease [AUC=0.807, 95% CI (0.644-0.97), p=0.0002].ConclusionLow cord serum ficolin-2 concentration (especially in neonates born at GA <33 weeks) is associated with a higher risk of developing moderate/severe RDS, requiring respiratory support and intensive care

Introduction of new technique of single-port transgastric access for repeated debridement of infected pancreatic necrosis

In this article we introduce a novel technique of repeated single-port transgastric debritment of walledoff pancreatic necrosis using TriPort ™ Access System. The presented technique seems an appealing and innovative approach to the treatment of walled-off pancreatic necrosis in acute pancreatitis patients. Studies proving feasibility, safety and efficiency are necessary to elucidate real value of the techniqu

Changes in lipids composition and metabolism in colorectal cancer: a review

Abstract Altered metabolism of lipids is currently considered a hallmark characteristic of many malignancies, including colorectal cancer (CRC). Lipids are a large group of metabolites that differ in terms of their fatty acid composition. This review summarizes recent evidence, documenting many alterations in the content and composition of fatty acids, polar lipids, oxylipins and triacylglycerols in CRC patients’ sera, tumor tissues and adipose tissue. Some of altered lipid molecules may be potential biomarkers of CRC risk, development and progression. Owing to a significant role of many lipids in cancer cell metabolism, some of lipid metabolism pathways may also constitute specific targets for anti-CRC therapy

Acute cholecystitis in patients with diabetes mellitus - systematic review

Introduction: According to the WHO, an estimated 422 million people are suffering from diabetes worldwide. Among them, the incidence of cholelithiasis is higher than in the healthy population. The aim of this literature review was to summarize the available evidence about acute cholecystitis in patients with diabetes. Materials and methods: This study adhered to the PRISMA guidelines. The course of hospitalization of patients with and without diabetes who underwent cholecystectomy due to acute cholecystitis was compared. Following information was abstracted from original studies: general study information, patient characteristics, complications, and recommendations for patients with diabetes. Results: Initial search provided 1632 results. After full text assessment, 40 studies met the inclusions criteria. Operative and postoperative complication rates were significantly higher among the diabetic patients. Diabetes is a risk factor for conversion from laparoscopic to open cholecystectomy method. The authors' opinions on elective surgery before the onset of acute cholecystitis symptoms are divided. Conclusions: Diabetic patients are at greater risk of developing complications. An individualized screening and treatment approach, as well as proper preparation of the diabetic patient for an elective cholecystectomy could have a positive effect on the outcome. However, the low quality of the data from the systematic review does not allow for meta-analysis, which is why we cannot draw strong conclusions

Costs of elective vs emergency cholecystectomy in diabetic patients

Introduction: Hospitalization costs of diabetic patients are estimated to be higher than non-diabetic. Literature on the topic is however limited. The aim of this study was to compare the costs of elective and emergency cholecystectomy of diabetic and non-diabetic patients. Material and methods: A retrospective analysis involved diabetic versus non-diabetic age- and sex-matched patients who underwent emergency and elective cholecystectomy at a single center in Poland between 2016-2019. Results: The total costs of an elective cholecystectomy were 739.31 ± 423.07 USD for diabetic patients and 797.14 ± 772.24 USD for non-diabetic patients (p = 0.51). Whereas emergency cholecystectomy total costs were 3950.72 ± 2856.83 USD (diabetic patients) and 2464.31 ± 1718.21 USD (non-diabetic patients) (p = 0.04). The difference in total costs between elective cholecystectomy vs emergency cholecystectomy in both groups (diabetic vs non-diabetic patients) was statistically significant (p < 0.01 vs p < 0.05 respectively). Conclusions: In this study we demonstrated that emergency cholecystectomy is associated with a significant increase in hospitalization costs, particularly in diabetic patients. This suggests that early qualification of diabetic patients for an elective cholecystectomy could be beneficial for both diabetic patients and public health insurers

Individual variability of vascularization of the anterior papillary muscle within the right ventricle of human heart.

BACKGROUND:To date there is scarce published evidence reporting the dual blood supply reaching anterior papillary muscle (APM), which descends from both major coronary arteries. Such a vascular configuration can prevent the dysfunction of right ventricular entire valvular system in case of the occlusion of proximal part of either right coronary artery (RCA) or left coronary artery (LCA). The aim of our study was to determine the vascular pattern of APM blood supply which originates from two main coronary arteries, in the context of the APM and septomarginal trabecula (SMT) topography. METHODS:The study was carried out using tissue obtained from 36 human hearts. The material was divided into four morphological types of SMT/APM arrangement. Vascularization and blood supply pattern of papillary muscle was investigated following the analysis of multiple tissue cross sections. The origin of APM arterial supply was traced back to both main coronary arteries. Cross-sectional area of the arteries was estimated at the base of APM and compared within mixed male-female population, aged 18-76. RESULTS:We noted that as much as 78% of entire APM material had a blood supply vasculature originating from both LCA and RCA branches. In contrast, 22% of cases APM was supplied by a single coronary artery, while in each case it proved to be LCA. We have never found APM arterial supply provided exclusively by RCA. In case of double AMP blood supply an average of total cross-section area of the arteries branching from LCA, was noted to be in excess of two and a half times bigger in type III and more than two times bigger in type IV, as compared with the arteries originating from RCA. CONCLUSIONS:Our research confirm the possibility of double blood supply which vascularizes APM, but the finding does not necessarily apply in all cases. However, APM seems to be predominantly vascularized by arteries deriving from LCA, regardless of their morphological type

Obesity in work-up of kidney transplant candidates – review of clinical practice guidelines

Background: Incidence of morbid obesity is rising worldwide. Current clinical practice guidelines for the pre-transplant evaluation of end-stage kidney disease (ESKD) patients lack clear recommendations on morbid obesity. Material and methods: The aim of this review was to summarize the current guidelines on the role and treatment of obesity in kidney transplant recipients. Eight current national and international clinical practice guidelines were identified in a comprehensive literature search. Results: All guidelines underline early detection of obesity and obesity-related comorbidities in ESKD patients. Only two guidelines explored the role of weight-loss surgery, however due to the lack of sufficient evidence no formal recommendation of surgical procedure was given. Conclusions: Diagnosis and treatment of obesity remains underappreciated in the current guidelines, most of which do not include pharmacological and surgical interventions. High-quality evidence is warranted to assess the role of weight-loss including surgery in ESKD patients and to update the recommendations in future guidelines