Učinak terapije metimazolom na patohistološki izgled tkiva štitnjače koji može oponašati maligne promjene

Diffuse toxic goiter, as the most common cause of hyperthyroidism, is usually initially treated with thyrostatic drugs such as methimazole, followed by radioiodine therapy or surgery which may be indicated as definitive treatment. Radioactive iodine therapy has a known association with various histopathologic features including cytologic atypia, but herein we present a rare example of morphological thyrocyte changes induced by long-term pharmacological treatment with methimazole that mimicked thyroid malignancy in a pathohistological sample.Difuzna toksična struma, kao najučestaliji uzrok hipertireoze, se uglavnom liječi tireostaticima kao što je metimazol a nakon početne farmakološke terapije, ukoliko ne dođe do spontane remisije bolesti, liječenje se nastavlja primjenom radioaktivnog joda (I-131) ili kirurškim zahvatom. Primjena radioaktivnog joda dovodi do brojnih histopatoloških izmjena u parenhimu štitnjače, uključujući i staničnu atipiju, no u našem radu prikazujemo rijedak slučaj utjecaja dugotrajne farmakološke terapije metimazolom na izmjenu morfologije tireocita koja može oponašati izgled malignih stanica na histološkom uzorku tkiva štitnjače

Pristup liječenju tumorskog tromba folikularnog karcinoma štitnjače u unutarnjoj jugularnoj i brahiocefaličnoj veni

Thyroid gland carcinoma causing tumor thrombus in the great veins of the neck and mediastinum is a rare condition with poor prognosis. Invasion of the internal jugular vein by thyroid gland carcinoma has been occasionally reported, but tumor thrombi extending to the great veins of the mediastinum are reported extremely rarely. We present a treatment approach in a case of follicular thyroid carcinoma intravascular tumor thrombus in the left internal jugular and left brachiocephalic vein.Karcinom štitnjače koji uzrokuje tumorske trombe u velikim venama vrata i medijastinuma je rijedak i ima lošu prognozu. Invazija unutarnje jugularne vene karcinomom štitnjače se povremeno opisuje u člancima, ali tumorski trombi koji zahvaćaju velike vene medijastinuma su iznimno rijetko opisani. Prikazujemo pristup liječenjuintravaskularnog tumorskog tromba folikularnog karcinoma štitnjače u lijevoj unutranjoj jugularnoj i lijevoj brahiocefaličnoj veni

Symptomatology of Detrimental Effects of Pesticides - Literature Review

Poljoprivrednici koji su kronično izloženi niskim razinama pesticida rijetko pokazuju klinički značajne znakove i simptome. Trovanje pesticidima može biti akutno i kronično. Primarna ciljna tkiva toksičnosti su krvotvorni sustav, kardiovaskularni sustav, reprodukcijski sustav i živčani sustav. Kod izloženih osoba pesticidi mogu uzrokovati mutacije gena i poremećaje kromosoma. Blaži, prolazni simptomi trovanja su često glavobolja, mučnina, povraćanje, omaglica, proljev, bolovi u trbuhu, bolovi u mišićima, salivacija, zbunjenost, umor itd. Od bitne je važnosti pravodobno prepoznati štetno djelovanje pesticida, čime se omogućava primjena odgovarajuće terapije što je ranije moguće.Farm workers chronically exposed to low levels of pesticides seldom show signs and symptoms of clinical significance. Pesticide poisoning can be acute and chronic. The primary targets of toxicity are the hematopoietic system, the cardiovascular system, the reproductive system and the nervous system. Pesticides can cause gene mutations and chromosomal aberrations in exposed individuals. Mild temporary symptoms of poisoning including headache, nausea, vomiting, dizziness, diarrhea, abdominal pain, myalgia, salivation, mental confusion, fatigue, etc., may quite frequently occur. It is essential to recognize detrimental effects of pesticides timely, thus enabling the earliest possible administration of appropriate treatment

Značenje kvantitativnog scintigrama kosti u prognostici zaraštanja prijeloma

Studies of fracture healing are aimed at differentiating normal from delayed bone union. Delayed union, nonunion with the development of pseudarthrosis, and infection are complications of fracture healing. In the present study, quantitative analysis by three-phase bone scintigraphy was evaluated in the early prognosis of the course of fracture healing, to assess its potential in the early detection and therapy of healing complications. In 105 patients with long bone fractures, three-phase bone scintigraphy was performed early (day 4-7), and 3 weeks, 3 months and 6 months of injury. Based on clinical, laboratory and radiological findings, patients were retrospectively divided into four groups of normal healing, pseudarthrosis, delayed union, and healing with infection. The region of interest method was used to analyze all three scintigraphy phases, i.e. perfusion, vascular space image, and static scintigram at 3 h of injection. Comparison of impulse count in the fracture area with the contralateral, intact side produced a relative index for each step of three-phase scintigraphy. Infection at the fracture site can be suspected on the basis of perfusion index in the earliest stages following injury. Delayed bone union can also be predicted very early, within three weeks of injury, by use of perfusion index. Quantitative analysis of the vascular space phase and late static scintigrams can contribute to the diagnosis of complications, however, only in later stages of disease, which in part limits their clinical relevance. Three-phase bone scintigraphy is a valuable study when expecting problems in the process of bone union.Ispitivanje zarastanja prijeloma ima za cilj razlikovanje normalnog od usporenog zarastanja kosti. Odloženo zarastanje, nezarastanje s razvojem pseudoartroze te infekcija komplikacije su zarastanja prijeloma. S ciljem što ranijeg otkrivanja, a time i ranije terapije komplikacija, željeli smo ispitati mogućnosti kvantitativne analize troetapne scintigrafije kosti u ranoj prognozi tijeka zarastanja prijeloma. U 105 ispitanika s prijelomima dugih kostiju učinjena je troetapna scintigrafija kosti neposredno nakon traume (4.-7. dan nakon traume), te 3 tjedna, 3 i 6 mjeseci nakon traume. Ispitanici su na osnovi kliničkih, laboratorijskih i radioloških nalaza retrospektivno podijeljeni u četiri skupine: normalno zarastanje, pseudoartroza, odloženo zarastanje i zarastanje uz infekciju. Metodom regije interesa (ROI) analizirali smo sve tri faze scintigrama: perfuziju, snimku vaskularnih prostora, te statički scintigram 3 sata nakon injiciranja. Uspoređujući broj impulsa područja frakture s kontralateralnom, zdravom stranom dobili smo relativne indekse (RI) za svaku fazu troetapne scintigrafije. U najranijim stadijima nakon povrede moguće je, na temelju indeksa perfuzije, posumnjati na infekciju na mjestu frakture. Odloženo zarastanje također se može predskazati indeksom perfuzije vrlo rano, unutar tri tjedna od prijeloma. Kvantitativna analiza faze vaskularih prostora i kasnih statičkih scintigrama može doprinijeti dijagnostici komplikacija, ali u kasnim fazama bolesti, što donekle umanjuje njihovo kliničko značenje. Troetapna scintigrafija kosti vrijedna je pretraga u slučajevima kada se očekuju problemi zarastanja kosti

Thyroid Hormones Are Not Associated with Plasma Osteocalcin Levels in Adult Population with Normal Thyroid Function

Thyroid hormones (THs) play an indispensable role in skeletal development and bone remodeling. Some studies have reported associations of THs with serum osteocalcin (OC) levels, but the results are quite inconsistent and the molecular mechanism of their simultaneous or interdependent activity on bone is almost unknown. Therefore, the aim of this study was to determine the possible associations of plasma THs with plasma OC levels and the possible mediating effect of OC on the relationship between THs and bone mineral density (BMD). For this purpose, out of the initial 1981 participants, we selected healthy euthyroid participants controlled for available confounding factors that can affect thyroid function and bone metabolism (N = 694). Given our results, we could not confirm any associations of THs with plasma OC levels nor the mediating effect of OC on the relationship between THs and BMD in euthyroid population. In the group of women controlled for menopause status (N = 396), we found a significant negative association of body mass index (BMI) with OC levels (β = −0.14, p = 0.03). We also found a negative association of free triiodothyronine (fT3) (β = −0.01, p = 0.02) and age (β = −0.003, p < 0.001) with BMD, and a positive association of BMI (β = 0.004, p < 0.001) and male gender (β = 0.1, p < 0.001) with BMD. In addition, we found significantly higher plasma OC levels and lower values of BMD in postmenopausal euthyroid women compared with premenopausal euthyroid women. In our opinion, the results of previous studies suggesting an association between circulating THs and serum OC levels may be influenced by an inconsistent selection of participants and the influence of confounding factors

Guillain-Barre Syndrome in Patients with Seroconversion of IgG Antibodies to Borrelia Burgdorferi sensu lato

A case of polyneuroradiculitis (Guillain-Barre Syndrome) is presented, which was diagnosed in a 62 year-old man after progressive weakness in the legs and arms and double vision, preceded by severe pain in the back. Diagnosis was made on the basis of electromioneurography, a specific finding of cerebrospinal fluid (albumino-citological dissociation), and the clinical course of the disease. Serological analysis of serum included Borellia Burgdorferi sensu lato (BBSL). Positive findings (slowing of conduction velocity of sensor and motor neurones, and marked albumino-citological dissociation), together with the dynamics of these findings on the 33rd, 67th and 101st days and one year and a half after the first clinical signs of disease, indicated the possibility of BBSL infection. Because of the absence of clear clinical and serological signs of other infections it was assumed that BBSL might be the possible trigger for Guillain-Barre Syndrome. The fact that there were no obvious clinical signs of infection with BBSL, only serological, suggests that in the case of unclear aetiology of Guillain-Barre Syndrome BBSL should not be excluded

Determinants of thyroid volume in healthy young adults of Dalmatia

Background and purpose: The aim of this study was to investigate thyroid volume (TV) and its determinants in healthy young adults without present or previous thyroid disease. Materials and methods: The study was performed in a sample of 145 healthy young participants aged 19-29 years, living in an iodine-sufficient area of Dalmatia. Dimensions of the thyroid gland were obtained by ultrasound and used to determine TV. Anthropometric data was collected, and measurements of serum TSH, fT4, Tg, TgAb, and TPOAb levels were determined. Correlations between TV and other continuous variables were determined using the Pearson correlation test, while multivariate linear regression analysis was used to determine the associations of the potential predictors for the TV. Results: TV in men was larger than in women (p=3.53x10-8) and was positively correlated with anthropometric measurements, with the highest correlation coefficient for height (r=0.53, p=6.36x10-12), then body surface area, BSA (r=0.48, p=1.68x10-9), weight (r=0.43, p=8.28x10-8) and body mass index, BMI (r=0.17, p=0.04). Age and cigarette smoking did not appear to be significantly associated with TV (p=0.13 and p=0.95, respectively). Univariate analysis showed TV correlated with fT4 plasma levels (r=0.35, 1.73x10-5), while multivariate analysis showed height and fT4 levels to be important parameters with a significant role in TV. Conclusions: We confirmed previously observed association of TV with sex and anthropometric parameters and reported a significant correlation between TV and fT4 levels. Furthermore, fT4 levels and height were found to be the important parameters for predicting TV.</p

Učestalost RET mutacije u papilarnom karcinomu štitnjače i korelacija s kliničko-patološkim karakteristikama

The purpose of this study was to analyze the possible prognostic value of RET mutation in papillary thyroid carcinoma and its incidence in the past few decades in our population, due to the increasing incidence of papillary thyroid carcinoma. The present study included 180 patients operated for papillary thyroid carcinoma. The clinical and histopathologic characteristics were analyzed. Paraffin sections of the selected histologic slides were cut again and immunohistochemically stained by the Clone 3F8 P (HIER) from Novocastra (Vision Bio Systems Europe, Newcastle upon Tyne, UK) monoclonal antibody to RET oncoprotein. Univariate analysis indicated sex (p=0.01), histologic subtype (p=0.075) and capsular invasion (p=0.010) to be statistically significant predictors of lymph node metastases, whereas age (p=0.796), tumor size (p=0.556) and intraglandular dissemination (p=0.131) showed no such correlation. The presence of RET mutation (p=0.704) was not a statistically significant predictor of the tumor metastasizing potential. RET mutation (p=0.500) showed no statistically significant correlation with papillary thyroid carcinoma classifed into prognostic groups according to clinicopathologic features either. RET mutation was detected in 30% of 180 papillary thyroid carcinomas. This is the first large study demonstrating that RET mutation incidence in papillary thyroid carcinoma in Croatian population is consistent with the classic distribution of sporadic cases, despite the increased prevalence of papillary thyroid carcinoma in the past few decades.Cilj ovoga rada bio je ispitati moguće prognostičko značenje RET mutacije u papilarnom karcinomu štitnjače i učestalost mutacije u odnosu na porast učestalosti papilarnog karcinoma štitnjače u posljednjih nekoliko desetljeća. U istraživanje je bilo uključeno 180 bolesnika operiranih zbog papilarnog karcinoma štitnjače. Analizirane su kliničke i patohistološke osobitosti. Histološki rezovi iz parafinskih blokova odabranih uzoraka imunohistokemijski su obojani monoklonskim protutijelom na RET onkoprotein Clone 3F8 P (HIER) proizvođača Novocastra (Vision Bio Systems Europe, Newcastle upon Tyne, UK). Univarijatnom analizom utvrđena je statistički značajna povezanost spola (p=0,01), histološkog podtipa (p=0,075) i kapsularne invazije (p=0,010) kao prediktora pojave metastaza u limfne čvorove vrata, dok takva povezanost nije zabilježena za dob (p=0,796), veličinu tumora (p=0,556) i intraglandularnu diseminaciju tumora (p=0,131). Prisutnost RET mutacije nije bila statistički značajan prediktor metastatskog potencijala tumora (p=0,704). Također, RET mutacija nije bila statistički značajno povezana s prognostičkim skupinama papilarnog karcinoma koje su sastavljene na temelju kliničko-patološkh osobitosti (p=0,500). RET mutacija bila je prisutna u 30% od 180 papilarnih karcinoma štitnjače. Ovo je prvo veće istraživanje kojim je dokazano da je RET mutacija u papilarnom karcinomu štitnjače u Hrvatskoj u skladu s učestalošću pojave spontane mutacije, iako se bilježi porast učestalosti papilarnog karcinoma štitnjače tijekom posljednjih desetljeća