Preoperative Clinical and Sonographic Predictors for Lateral Cervical Lymph Node Metastases in Sporadic Medullary Thyroid Carcinoma.

Preoperative Clinical and Sonographic Predictors for Lateral Cervical Lymph Node Metastases in Sporadic Medullary Thyroid Carcinoma.

Thyroid. 2018 Jan 19;:

Authors: Oh HS, Kwon H, Song E, Jeon M, Song DE, Kim TY, Lee JH, Hong SJ, Kim WB, Shong Y, Baek JH, Kim WG

Abstract
<b><i>Background</i></b> Total thyroidectomy and cervical lymph node (LN) dissection is generally recommended in patients with medullary thyroid carcinoma (MTC). However, there is no clear evidence for whom to perform prophylactic lateral neck dissection in MTC patients without evident lateral cervical lymph node (LCLN) metastasis in preoperative images. This study evaluated the preoperative features for predicting the LCLN metastasis of MTC. <b><i>Methods</i></b> We included 26 MTC patients with LCLN metastasis at initial surgery (N1b group) and 47 MTC patients without any LN metastasis or recurrence of disease (N0-NED group). We evaluated the association between LCLN metastasis and preoperative clinical and sonographic characteristics (size, location, solid component, shape, margin, echogenicity, calcification, and subcapsular location of the tumor). <b><i>Results</i></b> There were no significant differences in age and sex between the N1b and N0-NED groups. Preoperative serum levels of calcitonin (Ctn) above 65 pg/mL were associated with LCLN metastasis (p < 0.001). In preoperative neck ultrasonography (US), patients in the N1b group were more commonly found with a larger tumor (>1.5 cm) of irregular shape with a spiculated margin and a subcapsular location than those in the N0-NED group (p = 0.029, p < 0.001, p < 0.001, and p < 0.001, respectively). Increases in the number of these LCLN metastasis-related features were significantly associated with higher risk for LCLN metastasis (p < 0.001). The presence of two or more predictors was an appropriate cut-off point for predicting LCLN metastasis of MTC with 73.1% sensitivity and 91.5% specificity. <b><i>Conclusions</i></b> MTC tumors with high preoperative Ctn levels (>65 pg/mL), larger size (>1.5 cm), irregular shape, spiculated margins, and subcapsular locations in the neck US are at higher risk for LCLN metastasis. MTC patents with less than two predictors might be suitable for treatment without prophylactic LCLN dissection.

PMID: 29350102 [PubMed - as supplied by publisher]

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Effects of Mifepristone on Nonalcoholic Fatty Liver Disease in a Patient with a Cortisol-Secreting Adrenal Adenoma.

Effects of Mifepristone on Nonalcoholic Fatty Liver Disease in a Patient with a Cortisol-Secreting Adrenal Adenoma.

Case Rep Endocrinol. 2017;2017:6161348

Authors: Ragucci E, Nguyen D, Lamerson M, Moraitis AG

Abstract
Cushing syndrome (CS), a complex, multisystemic condition resulting from prolonged exposure to cortisol, is frequently associated with nonalcoholic fatty liver disease (NAFLD). In patients with adrenal adenoma(s) and NAFLD, it is essential to rule out coexisting endocrine disorders like CS, so that the underlying condition can be properly addressed. We report a case of a 49-year-old woman with a history of hypertension, prediabetes, dyslipidemia, biopsy-confirmed steatohepatitis, and benign adrenal adenoma, who was referred for endocrine work-up for persistent weight gain. Overt Cushing features were absent. Biochemical evaluation revealed nonsuppressed cortisol on multiple 1-mg dexamethasone suppression tests, suppressed adrenocorticotropic hormone, and low dehydroepiandrosterone sulfate. The patient initially declined surgery and was treated with mifepristone, a competitive glucocorticoid receptor antagonist. In addition to improvements in weight and hypertension, substantial reductions in her liver enzymes were noted, with complete normalization by 20 weeks of therapy. This case suggests that autonomous cortisol secretion from adrenal adenoma(s) could contribute to the metabolic and liver abnormalities in patients with NAFLD. In conclusion, successful management of CS with mifepristone led to marked improvement in the liver enzymes of a patient with long-standing NAFLD.

PMID: 29348947 [PubMed]

http://ift.tt/2DsFjcF

Effects of Mifepristone on Nonalcoholic Fatty Liver Disease in a Patient with a Cortisol-Secreting Adrenal Adenoma.

Effects of Mifepristone on Nonalcoholic Fatty Liver Disease in a Patient with a Cortisol-Secreting Adrenal Adenoma.

Case Rep Endocrinol. 2017;2017:6161348

Authors: Ragucci E, Nguyen D, Lamerson M, Moraitis AG

Abstract
Cushing syndrome (CS), a complex, multisystemic condition resulting from prolonged exposure to cortisol, is frequently associated with nonalcoholic fatty liver disease (NAFLD). In patients with adrenal adenoma(s) and NAFLD, it is essential to rule out coexisting endocrine disorders like CS, so that the underlying condition can be properly addressed. We report a case of a 49-year-old woman with a history of hypertension, prediabetes, dyslipidemia, biopsy-confirmed steatohepatitis, and benign adrenal adenoma, who was referred for endocrine work-up for persistent weight gain. Overt Cushing features were absent. Biochemical evaluation revealed nonsuppressed cortisol on multiple 1-mg dexamethasone suppression tests, suppressed adrenocorticotropic hormone, and low dehydroepiandrosterone sulfate. The patient initially declined surgery and was treated with mifepristone, a competitive glucocorticoid receptor antagonist. In addition to improvements in weight and hypertension, substantial reductions in her liver enzymes were noted, with complete normalization by 20 weeks of therapy. This case suggests that autonomous cortisol secretion from adrenal adenoma(s) could contribute to the metabolic and liver abnormalities in patients with NAFLD. In conclusion, successful management of CS with mifepristone led to marked improvement in the liver enzymes of a patient with long-standing NAFLD.

PMID: 29348947 [PubMed]

http://ift.tt/2DsFjcF

Differential White Matter Regional Alterations in Motor Subtypes of Early Drug-Naive Parkinson's Disease Patients.

Differential White Matter Regional Alterations in Motor Subtypes of Early Drug-Naive Parkinson's Disease Patients.

Neurorehabil Neural Repair. 2018 Jan 01;:1545968317753075

Authors: Wen MC, Heng HSE, Lu Z, Xu Z, Chan LL, Tan EK, Tan LCS

Abstract
BACKGROUND: Parkinson's disease (PD) can be classified into tremor dominant (TD) and postural instability and gait difficulty (PIGD) subtypes with TD considered as the benign subtype. The neural alterations of the 2 subtypes in the early stages before administration of medications remain elusive.
OBJECTIVE: This study assessed the subtype-related white matter (WM) microstructural features in newly diagnosed and drug-naive PD patients from the Parkinson's Progression Markers Initiative (PPMI).
METHODS: Sixty-five early PDs with stable subtypes (52 TD and 13 PIGD patients) and 61 controls underwent diffusion tensor imaging (DTI) scanning and clinical assessment. Tract-based special statistics (TBSS), graph-theoretical and network-based analyses were used to compare WM regional and network features between groups.
RESULTS: No differences in disease stages and duration were found between the 2 patient groups. TD patients showed increased fractional anisotropy (FA), but decreased radial and axial diffusivities (RD and AD) in several projection, association, and commissural tracts, compared with PIGD patients and controls. Motor severity had mild-to-moderate correlations with FA and RD of the corpus callosum (genu) in TD, but strong correlations with FA and RD of multiple association tracts in PIGD. Conversely, no significant network changes were noted.
CONCLUSIONS: TD patients showed regionally increased FA but decreased diffusivities, implying neural reorganization to compensate PD pathology in early stages. PIGD patients, despite having similar disease stages and duration, exhibited more WM degradation. These results demonstrate differential WM regional features between the 2 subtypes in early PD and support the notion of TD being a benign subtype.

PMID: 29347868 [PubMed - as supplied by publisher]

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[Female patient with pulsatile tinnitus].

[Female patient with pulsatile tinnitus].

HNO. 2018 Jan 19;:

Authors: Biber F, Nolte CH, Albers AE

PMID: 29350238 [PubMed - as supplied by publisher]

http://ift.tt/2BhuST9

Long-term changes in multimodal intensive tinnitus therapy : A 5‑year follow-up.

Long-term changes in multimodal intensive tinnitus therapy : A 5‑year follow-up.

HNO. 2018 Jan 19;:

Authors: Brüggemann P, Otto J, Lorenz N, Schorsch S, Szczepek AJ, Böcking B, Mazurek B

Abstract
BACKGROUND: We present 5‑year follow-up data for tinnitus-specific and comorbid depressive symptoms as well as stress-related outcome variables of an intensive multimodal 7‑day tinnitus therapy.
METHOD: Tinnitus burden (Tinnitus Questionnaire), stress (Perceived Stress Questionnaire), and depressive symptomatology (General Depression Scale) were measured at the 5‑year follow-up after a multimodal intensive 7‑day intervention. In all, 94 patients participated in the study.
RESULTS: All outcome variables showed significant improvement at the end of the 7‑day intensive treatment. These effects remained significant after 5 years.
CONCLUSION: The results of the present study support the effectiveness of the 7‑day multimodal intensive therapy for tinnitus. Posttreatment improvements were related to both tinnitus burden as well as stress and depressive symptoms and were maintained at the 5‑year follow-up.

PMID: 29350237 [PubMed - as supplied by publisher]

http://ift.tt/2mYqCnz

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