The preoperative prediction of postoperative symptomatic hypocalcemia in patients with Graves\u27 disease.

In Graves\u27 disease, one of the postoperative complications of surgical treatment is symptomatic hypocalcemia, which is defined as symptoms of hypocalcemia such as tetany, paresthesia, and muscle cramps. The aim of this study was to evaluate the preoperative factors predicting the development of symptomatic hypocalcemia after thyroidectomy in Graves\u27 patients. One hundred nine patients with Graves\u27 disease underwent surgery between January 2005 and August 2010 in our department. We investigated the relationship between postoperative symptomatic hypocalcemia and the serum levels of preoperative thyroid hormones, preoperative biochemical tests, and operating states in these patients. A univariate analysis determined that the preoperative serum free triiodothyronine (T3), free thyroxin (T4), and alkaline phosphatase (ALP) levels before the administration of potassium iodide were significantly higher in the symptomatic hypocalcemia patients. A multivariate analysis shows the preoperative serum free T4 level before the administration of potassium iodide to also be significantly higher in the symptomatic hypocalcemia patients. In conclusion, the preoperative serum free T4 level before the administration of potassium iodide was thus determined to be a risk factor for developing postoperative symptomatic hypocalcemia

The impact of no placement of drains in hemithyroidectomy on the postoperative course: A single-institutional study in Japanese patients

Background: Recently, the placement of drains in thyroidectomy has been debated. In this study, we evaluated the efficacy and safety of no placement of drains in hemithyroidectomy. Methods: After obtaining approval from the Institutional Review Board, we started not placing drains during surgery in adult patients who underwent hemithyroidectomy with or without central neck lymph node dissection for benign thyroid nodules or well-differentiated thyroid cancer, with informed consent being obtained. We compared the clinical data of the patients without drain placement (n=19) to the historical data of consecutive patients with a suction drain (n=20). Results: The operative wound and amount and characteristics of the drainage fluid were monitored every 2 h after the operation until the following morning, in addition to monitoring the oxygen saturation and an electrocardiogram. The proportion of patients undergoing cervical lymph node dissection was identical between the groups. The drain was removed on Day 1 after surgery in 19 patients and on Day 2 after surgery in 1 patient. The patients without a drain showed a significantly shorter postoperative hospital stay than those with a drain (4.0 vs. 4.5 days, respectively, p=0.03). No patients in either group experienced postoperativebleeding or seroma or wound infection. Conclusion: The hemithyroidectomy patients without a drain were able to be discharged earlier than those with a drain and without any adverse events, provided they received close monitoring after surgery

Perineuronal Oligodendrocytes Protect against Neuronal Apoptosis through the Production of Lipocalin-Type Prostaglandin D Synthase in a Genetic Demyelinating Model

The genetic demyelinating mouse "twitcher" is a model of the human globoid cell leukodystrophy, caused by galactosylceramidase (GALC) deficiency. Demyelination in the twitcher brain is secondary to apoptotic death of oligodendrocytes (OLs). Lipocalin-type prostaglandin (PG) D synthase (L-PGDS), a protein expressed in mature OLs, was progressively upregulated in twitcher OLs; whereas expression of OL-associated proteins such as carbonic anhydrase II, myelin basic protein, and myelin-associated glycoprotein was downregulated during demyelination in twitcher brains. The upregulation of L-PGDS was more remarkable in perineuronal OLs than in interfascicular OLs. A larger number of L-PGDS-positive OLs was found in selected fiber tracts of twitcher brains where fewer apoptotic cells were detected. The distribution of L-PGDS-positive OLs was inversely related to the severity of demyelination, as assessed by accumulation of scavenger macrophages. Mice doubly deficient for L-PGDS and GALC disclosed a large number of apoptotic neurons, which were never seen in twitcher brains, in addition to an increased number of apoptotic OLs. A linear positive correlation was observed between the population of L-PGDS-positive OLs in the twitcher brain and the ratio of apoptotic nuclei in the double mutant versus those in the twitcher, suggesting a dose-dependent effect of L-PGDS against apoptosis. These lines of evidence suggest that L-PGDS is an anti-apoptotic molecule protecting neurons and OLs from apoptosis in the twitcher mouse. This is a novel example of OL-neuronal interaction

Accuracy of thyroid cancer diagnosis and surgery in patients with thyroid cancer may be affected by the Semipalatinsk Nuclear Test Site: A collaboration between Nagasaki (Japan) and Semipalatinsk (Kazakhstan) medical centers

Background: From 1949 to 1989, 456 nuclear tests were conducted at the Semipalatinsk Nuclear Test Site (SNTS). Exposure was primarily from the first test in August 1949, an atomic bomb test in 1951, and a thermonuclear bomb test in 1953 that affected the Semipalatinsk region. Surgical procedures for patients with thyroid cancer in Semipalatinsk remain unclear. Assessing the clinical behavior of thyroid cancer in patients affected by the SNTS is crucial for confirming an accurate diagnosis and establishing standardized surgery. The first author has been collaborating with the Semey Oncology Center since 1999 to establish an optimal method to diagnose and perform thyroidectomy and lymph node dissection.Objective: To assess the change in the diagnostic accuracy and thyroid surgery from 1999 to 2008 at Semey Oncology Center in collaboration with the Nagasaki University and Nagasaki Medical Center.Materials and Methods: In this cross-sectional study, 169 patients with thyroid cancer who underwent thyroid surgery at the Semey Oncology Center from 1999 to 2008 were evaluated; 125 patients with papillary thyroid cancer were assessed.Results: Before 2001, there were few preoperatively diagnosed thyroid cancer cases; since 2002, the number of preoperatively diagnosed papillary cancer cases increased. From 1999 to 2001, thyroid surgery, including cervical lymph node dissection, was not performed. Partial lobectomy was mainly performed until 2001. Since 2002, total lobectomy was most commonly performed; total thyroidectomy and lymph node dissection were rarely performed.Conclusion: The optimal method for diagnosing thyroid cancer was performed, and an accurate diagnosis changed the surgical procedure

A new role for lipocalin prostaglandin d synthase in the regulation of brown adipose tissue substrate utilization.

In this study, we define a new role for lipocalin prostaglandin D synthase (L-PGDS) in the control of metabolic fuel utilization by brown adipose tissue (BAT). We demonstrate that L-PGDS expression in BAT is positively correlated with BAT activity, upregulated by peroxisome proliferator-activated receptor γ coactivator 1α or 1β and repressed by receptor-interacting protein 140. Under cold-acclimated conditions, mice lacking L-PGDS had elevated reliance on carbohydrate to provide fuel for thermogenesis and had increased expression of genes regulating glycolysis and de novo lipogenesis in BAT. These transcriptional differences were associated with increased lipid content in BAT and a BAT lipid composition enriched with de novo synthesized lipids. Consistent with the concept that lack of L-PGDS increases glucose utilization, mice lacking L-PGDS had improved glucose tolerance after high-fat feeding. The improved glucose tolerance appeared to be independent of changes in insulin sensitivity, as insulin levels during the glucose tolerance test and insulin, leptin, and adiponectin levels were unchanged. Moreover, L-PGDS knockout mice exhibited increased expression of genes involved in thermogenesis and increased norepinephrine-stimulated glucose uptake to BAT, suggesting that sympathetically mediated changes in glucose uptake may have improved glucose tolerance. Taken together, these results suggest that L-PGDS plays an important role in the regulation of glucose utilization in vivo

Prostaglandin D2-Mediated Microglia/Astrocyte Interaction Enhances Astrogliosis and Demyelination in twitcher

Prostaglandin (PG)

Predictive factors for intraoperative excessive bleeding in Graves\u27 disease

Background: In Graves\u27 disease, because a thyroid tends to have extreme vascularity, the amount of intraoperative blood loss (AIOBL) becomes significant in some cases. We sought to elucidate the predictive factors of the AIOBL. Methods: A total of 197 patients underwent thyroidectomy for G raves\u27 disease between 2002 and 2012. We evaluated clinical factors that would be potentially related to AIOBL retrospectively. Results: The median period between disease onset and surgery was 16 months (range: 1-480 months). Conventional surgery was performed in 125 patients, whereas video-assisted surgery was performed in 72 patients. Subtotal and near-total/total thyroidectomies were performed in 137 patients and 60 patients, respectively. The median weight of the thyroid was 45 g (range: 7.3-480.0 g). Univariate analysis revealed that the strongest correlation of AIOBL was noted with the weight of thyroid (p < 0.001). Additionally, AIOBL was correlated positively with the period between disease onset and surgery (p < 0.001) and negatively with preoperative free T4 (p < 0.01). Multivariate analysis showed that only the weight of the thyroid was independently correlated with AIOBL (p < 0.001). Four patients (2.0%) needed blood transfusion, including two requiring auto-transfusion, whose thyroids were all weighing in excess of 200 g. The amount of drainage during the initial 6 hours and days until drain removal was correlated positively with AIOBL (p < 0.001, each). Occurrences of postoperative complications, such as recurrent laryngeal nerve palsy or hypoparathyroidism, and postoperative hospital stay were not correlated with AIOBL. Conclusion: A huge goiter presented as a predictive factor for excessive bleeding during surgery for Graves\u27 disease, and preparation for blood transfusion should be considered in cases where thyroids weigh more than 200 g