Head and Neck Diseases by Alexandros G.Sfakianakis: 11/05/16

Σάββατο 5 Νοεμβρίου 2016

Endoscopic resection of a periampullary gangliocytic paraganglioma of the duodenum: A case report.

Endoscopic resection of a periampullary gangliocytic paraganglioma of the duodenum: A case report.

Int J Surg Case Rep. 2016 Oct 27;29:39-43

Authors: Paasch C, Hünerbein M, Theissig F

Abstract
INTRODUCTION: The gangliocytic paraganglioma (GP) is an extremely rare neuroendocrine tumour originating from the second part of the duodenum. Generally GP shows benign clinical behaviour. The GP is typically characterized by consisting of three tumour components: the epithelioid, the spindle-shaped and the ganglion-like cells.
PRESENTATION OF CASE: We present a female patient at the age of 65, who underwent a routine gastroscopy due to known gastro-oesophageal reflux. Accidentally a 2×1,5cm sized mass of unknown entity was revealed in the duodenum. The magnet resonance tomography neither detected distant metastasis nor any local lymphadenopathy. After endosonographically guided punctures of the submucosal mass, a malignant tumour could not be diagnosed thus the decision to perform an endoscopical resection was made and successfully conducted. Immunohistochemical examination revealed a total resected GP.
DISCUSSION: In literature malignant transformation with distant metastasis and local recurrences has been described. Furthermore the clinical manifestation and location varies. The GP has often been misdiagnosed as a neuroendocrine tumour (NET) G1.
CONCLUSION: Due to published cases of metastasising GPs, we recommend a long term follow-up. In a non-metastatic stage the endoscopic resection should be the therapy of choice in order to prevent unnecessary major surgical interventions. In this case report we will discuss the clinical appearance, behaviour and differential diagnosis of GP.

PMID: 27810610 [PubMed - as supplied by publisher]

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Our experience with surgery in situs inversus: Open peptic perforation repair and laparoscopic cholecystectomy in 1 patient and 3 patients respectively.

Our experience with surgery in situs inversus: Open peptic perforation repair and laparoscopic cholecystectomy in 1 patient and 3 patients respectively.

Int J Surg Case Rep. 2016 Oct 19;29:34-38

Authors: Ahmed Z, Khan SA, Chhabra S, Yadav R, Kumar N, Vij V, Saxena D, Talera D, Kankaria J, Gupta S, Bugalia RP, Goyal A, Yadav BL, Jenaw RK

Abstract
INTRODUCTION: Situs inversus is a rare autosomal recessive condition associated with complete transposition of abdominal+/- thoracic organs. Surgical diagnosis and surgical procedures in patients with situs inversus is tricky because of the mirror image anatomy of intra-abdominal organs.
MATERIALS AND METHODS: A retrospective analysis of 2152 and 1497 patients who underwent laparoscopic cholecystectomy and open peptic perforation repair respectively from June 2014-June 2016 was done. 1 patient and 3 patients with situs inversus underwent open peptic perforation repair and laparoscopic cholecystectomy respectively. A 10mm left para-median port 5cm caudally from xiphoid was used for grasping the infundibulum. Two 5mm ports placed 10cm caudally from costal margin in the mid-clavicular and anterior axillary line were used for dissecting and retracting fundus respectively. A 10mm supra-umbilical camera port was used.
RESULTS: A 40year male with situs inversus totalis underwent open peptic perforation repair. Laparoscopic cholecystectomy was done in 3 female patients with situs inversus aged 33-46year (mean 41year). Mean operative time for laparoscopic cholecystectomy was 59min (39-93). There were no intraoperative or post-operative complications. Histopathology revealed chronic inflammation in peptic perforation and cholecystitis.
CONCLUSION: Perforation peritonitis in situs inversus can cause diagnostic confusion with free gas under the left hemi diaphragm. Laparoscopic cholecystectomy in situs inversus is ergonomically inconvenient and technically difficult for right handed surgeons. We describe an ergonomically convenient port placement for right handed surgeons in situs inversus.

PMID: 27810609 [PubMed - as supplied by publisher]

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Rapid progression of a pregnancy-associated intra-abdominal desmoid tumor in the post-partum period: A case report.

Rapid progression of a pregnancy-associated intra-abdominal desmoid tumor in the post-partum period: A case report.

Int J Surg Case Rep. 2016 Oct 26;29:30-33

Authors: Hanna D, Magarakis M, Twaddell WS, Alexander HR, Kesmodel SB

Abstract
INTRODUCTION: The clinical behavior of desmoid tumors can be unpredictable, particularly when they arise in the ante-partum or post-partum period. We present a case of an intra-abdominal desmoid tumor that was identified in the ante-partum period, progressed rapidly in the post-partum period, and was subsequently resected.
PRESENTATION OF CASE: The patient is a 19 year-old female who was found to have a 12cm intra-abdominal mass on a fetal assessment ultrasound. The decision was made to observe the patient and monitor the mass for growth. However, the mass rapidly grew in the post-partum period. The patient was transferred to our institution after an exploratory laparotomy revealed a large intra-abdominal mass emanating from the small bowel mesentery. The 30cm×24cm×16cm mass was successfully resected with negative margins, and the pathologic diagnosis of desmoid tumor was confirmed. The patient had an uncomplicated post-operative course and was discharged on post-operative day 6.
DISCUSSION: The majority of pregnancy-associated desmoid tumors are in the abdominal wall, arising from the rectus abdominus muscle or from previous Cesarean section scars. These tumors may spontaneously regress in the post-partum period and therefore, patients with these tumors are often observed. Close follow-up is important so that rapid tumor progression, which may lead to unresectability, can be identified and managed appropriately.
CONCLUSION: A patient with a rare case of a giant pregnancy-associated, intra-abdominal desmoid tumor that rapidly progressed in the post-partum period and was successfully treated with surgical resection with negative margins.

PMID: 27810608 [PubMed - as supplied by publisher]

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Thyroid carcinoma with extensive tumor thrombus in the superior vena cava: A case report.

Thyroid carcinoma with extensive tumor thrombus in the superior vena cava: A case report.

Int J Surg Case Rep. 2016 Oct 25;29:25-29

Authors: Kawano F, Tomita M, Tanaka H, Nagahama H, Tashiro K, Nakao H, Kataoka H, Nakamura K

Abstract
INTRODUCTION: Venous tumor thrombus of thyroid cancer that extend to the great vein is rare, and management criteria for venous thrombus have not been established yet. We report a surgical case of thyroid carcinoma with extensive tumor thrombus in the superior vena cava (SVC) and consider the appropriate treatment strategy for venous thrombus.
PRESENTATION OF CASE: A 75-year-old woman consulted our hospital because of thyroid carcinoma with an extensive tumor thrombus. Computed tomography (CT) revealed a solitary thyroid mass with extensive continuous tumor thrombus in the left internal jugular vein, innominate vein, and SVC. We planned complete tumor resection. During operation, the tumor thrombus in the SVC disappeared, suggesting that pulmonary embolism occurred. Therefore, she underwent total thyroidectomy with extensive phlebectomy (the innominate and internal jugular veins). Although she had some morbidities during her postoperative course, she was followed up for 6 months without progression of thyroid cancer.
DISCUSSION AND CONCLUSION: Intravascular tumor extension of thyroid carcinoma is rare, but is a life-threatening complication. For patients with thyroid tumor with venous tumor thrombus, segmental resection and thrombectomy should be considered if radical operation is possible. Therefore, preoperative correct imaging evaluation and operative planning are necessary to perform safe and effective operations. We suggest a management criteria for patients with thyroid carcinoma with venous tumor thrombus.

PMID: 27810607 [PubMed - as supplied by publisher]

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Capsular nevus versus metastatic malignant melanoma - a diagnostic dilemma.

Capsular nevus versus metastatic malignant melanoma - a diagnostic dilemma.

Int J Surg Case Rep. 2016 Oct 18;29:20-24

Authors: Davis J, Patil J, Aydin N, Mishra A, Misra S

Abstract
INTRODUCTION: A positive finding of metastatic melanoma in a sentinel lymph node is an ominous sign and a strong predictor of overall survival. In contrast, current data trends have shown that patients with benign nevus cells in the sentinel nodes do not require additional therapy since their prognosis has been shown to be similar to that of patients with negative lymph nodes. Distinguishing between benign capsular nevi and metastatic melanoma often proves to be diagnostically problematic.
CASE PRESENTATION: In this case report we present two cases of melanoma in which sentinel lymph node biopsies proved to be difficult in distinguishing metastatic melanocytes from capsular nevus cells. In both cases, further workup was necessary for accurate diagnoses.
DISCUSSION: A lack of standardized distinctions of benign nevus cell from melanoma pose a diagnostic pitfall. Assigning a diagnosis of malignant melanoma might seem like the safer approach to avoid a false negative, but the resultant treatment, including the possibility of additional surgical complications, may cause anxiety, discomfort, and financial instability for the patient. Current methods of distinguishing the two based solely on histology may be insufficient due to similar pathologic patterns.
CONCLUSION: To avoid misdiagnosing a patient and performing unnecessary therapy, it would be beneficial to get a second opinion by additional histopathologists at a high volume center. Additionally, immunohistochemical staining should be carefully employed due to some overlap in commonly used markers. Using tissue morphology in conjunction with immunohistochemical staining may be the best way to make the most accurate diagnosis.

PMID: 27810606 [PubMed - as supplied by publisher]

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Spontaneous intracerebral hemorrhage in hemophiliacs-A treatment dilemma.

Spontaneous intracerebral hemorrhage in hemophiliacs-A treatment dilemma.

Int J Surg Case Rep. 2016 Oct 25;29:17-19

Authors: Hegde A, Nair R, Upadhyaya S

Abstract
BACKGROUND: Spontaneous Intracerebral hemorrhage is a rare and challenging condition to treat, especially in haemophiliacs. With their innate predilection to bleed following trivial trauma, surgical management of such cases have been individualised and no treatment protocols exist. Often they are managed with craniotomy and evacuation under cover of AHF.
DISCUSSION: Here we discuss the nuances, clinical and treatment dilemma that one faces while treating a patient, diagnosed with haemophilia, with spontaneous subdural haematoma. While routine management strategy would be a craniotomy and evacuation of the haematoma, in our case, we chose to closely monitor the patient under cover of AHF, to convert the acute haematoma into a chronic subdural hematoma. We then managed it with a burr hole evacuation under cover of antihemophilic factor.
CONCLUSION: Treatment protocols are hard to formulate in such rare entities, however we would like to recommend the following; conservative management of an acute subdural to convert it into a chronic subdural when there are no financial constraints, there by obviating the complication of rebleed following craniotomy.

PMID: 27810605 [PubMed - as supplied by publisher]

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Corrigendum to "Esophageal remnant cancer 35 years after acidic caustic injury: A case report" [Int. J. Surg. Case Rep. 25 (2016) 215-217].

Corrigendum to "Esophageal remnant cancer 35 years after acidic caustic injury: A case report" [Int. J. Surg. Case Rep. 25 (2016) 215-217].

Int J Surg Case Rep. 2016 Oct 27;29:16

Authors: Ntanasis-Stathopoulos I, Triantafyllou T, Xiromeritou V, Bliouras N, Loizou C, Theodorou D

PMID: 27810604 [PubMed - as supplied by publisher]

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Overdrainage after ventriculoperitoneal shunting in a patient with a wide depressed skull bone defect: The effect of atmospheric pressure gradient.

Overdrainage after ventriculoperitoneal shunting in a patient with a wide depressed skull bone defect: The effect of atmospheric pressure gradient.

Int J Surg Case Rep. 2016 Oct 15;29:11-15

Authors: Zhou L, Yu J, Sun L, Han Y, Wang G

Abstract
INTRODUCTION: In patients with traumatic brain injury, an effective approach for managing refractory intracranial hypertension is wide decompressive craniectomy. Postoperative hydrocephalus is a frequent complication requiring cerebrospinal fluid (CSF) diversion.
PRESENTATION OF CASE: A 50-year-old male who underwent decompressive craniectomy after traumatic brain injury. He developed hydrocephalus postoperatively, and accordingly we placed a ventriculoperitoneal shunt. However, an imbalance between the intra- and extra-cranial atmospheric pressures led to overdrainage, and he suffered cognitive disorders and extremity weakness. He remained supine for 5days to avoid the effect of gravity on CSF diversion. After 20days, we performed a cranioplasty using a titanium plate. The postoperative course was uneventful, and the patient achieved satisfactory recovery.
DISCCUSION: The gravitational effect and the atmospheric pressure gradient effect are two factors associated in the ventriculoperitoneal (VP) shunt treatment of hydrocephalus for the patient who had decompressive craniectomy. These effects can be eliminated by supine bed rest and cranioplasty.
CONCLUSION: We herein emphasize the efficacy of VP shunt, supine bed rest and cranioplasty in treating hydrocephalus patients who have undergone craniectomy. A flexible application of these procedures to change the gravitational effect and the atmospheric pressure gradient effect should promote a favorable outcome.

PMID: 27810603 [PubMed - as supplied by publisher]

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Early functional results using the nitibond prosthesis in stapes surgery.

Early functional results using the nitibond prosthesis in stapes surgery.

Acta Otolaryngol. 2016 Nov 4;:1-6

Authors: Canu G, Lauretani F, Russo FY, Ferrary E, Lamas G, Sterkers O, De Seta D, Bernardeschi D

Abstract
CONCLUSION: The NiTiBOND(®) prosthesis allows early results to be obtained similar to those with a manually crimped prosthesis fitted by experienced surgeons, thus reducing the learning curve in this critical step of the procedure.
OBJECTIVE: To analyze the 1-month results using the nitinol NiTiBOND(®) prosthesis in primary otosclerosis surgery and to compare the results with those obtained with fully fluoroplastic or fully titanium pistons.
MATERIALS AND METHODS: Fifty consecutive cases operated on with the NiTiBOND(®) prosthesis (nitinol group) were compared with 50 cases operated on with a fully fluoroplastic piston (fluoroplastic group), and with 131 cases operated on with a fully titanium piston (first titanium group), and also with 50 cases operated on with the same titanium piston just before using the NiTiBOND(®) piston (last titanium group). Pure-tone and speech audiometry was performed 1 month after surgery for the nitinol group. Comparison was made between the early hearing results of the four groups.
RESULTS: The mean air-bone gap closure for the nitinol group was 16 ± 1.0 dB (mean ± SEM, n = 50); an air-bone gap of <15 dB and <10 dB was obtained in 100% and 84% of cases, respectively. These hearing results were similar to the last titanium group and significantly better than those observed in the fluoroplastic and first titanium groups.

PMID: 27809651 [PubMed - as supplied by publisher]

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Serum 1,25-dihydroxyvitamin D as a biomarker of the absence of hypercalciuria in postsurgical hypoparathyroidism.

Serum 1,25-dihydroxyvitamin D as a biomarker of the absence of hypercalciuria in postsurgical hypoparathyroidism.

J Clin Endocrinol Metab. 2016 Nov 4;:jc20162987

Authors: García-Pascual L, Barahona MJ, Perea V, Simó R

Abstract
CONTEXT: Hypercalciuria is an adverse event of postsurgical hypoparathyroidism treatment which can lead to renal complications. The collection of 24-hour urine to detect hypercalciuria is often considered unreliable.
OBJECTIVE: To find useful predictive biomarkers of hypercalciuria in patients with permanent postsurgical hypoparathyroidism under treatment with oral calcium and calcitriol supplements.
DESIGN: Prospective cross-sectional study.
SETTING: Outpatient hospital clinic.
PATIENTS: Fifty-four consecutive observations from 34 stable outpatients with postsurgical hypoparathyroidism taking oral calcium and calcitriol supplements, and 17 adult controls without hypoparathyroidism.
INTERVENTION: There were no interventions.
MAIN OUTCOME MEASURE: Hypercalciuria was defined as 24-hour urine calcium above 300 mg.
RESULTS: Patients without hypercalciuria (n=21) vs. those with hypercalciuria (n=33) had lower levels of serum 1,25-dihydroxyvitamin D (33.5+11.9 pg/ml vs. 45.8+9.5 pg/ml; p<0.001), similar albumin-corrected serum calcium (8.3+0.5 mg/dl vs. 8.6+0.5 mg/dl; p:ns), and serum parathyroid hormone (12.5+5.7 vs. 10.7+6.8; p:ns). Multiple linear regression analysis showed an independent relationship between 1,25-dihydroxyvitamin D and urinary calcium excretion (B= 6.2+1.423; p<0.001). A cut-off value of 33.5 pg/ml for serum 1,25-dihydroxyvitamin D to predict the absence of hypercalciuria had 100% sensitivity and 63.6% specificity, and the area under the ROC curve was 0.797. No patients with serum 1,25-dihydroxyvitamin D under 33.5 pg/ml presented hypercalciuria, whatever the level of albumin-corrected serum calcium.
CONCLUSIONS: Routine measurement of serum 1,25-dihydroxyvitamin D may be useful as a biomarker to predict the absence of hypercalciuria in patients with permanent postsurgical hypoparathyroidism under treatment with oral calcium and calcitriol supplements.

PMID: 27813709 [PubMed - as supplied by publisher]

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Vertebral fractures and bone mineral density in patients with idiopathic hypoparathyroidism on long term follow-up.

Vertebral fractures and bone mineral density in patients with idiopathic hypoparathyroidism on long term follow-up.

J Clin Endocrinol Metab. 2016 Nov 4;:jc20163292

Authors: Chawla H, Saha S, Kandaswamy D, Sharma R, Sreenivas V, Goswami R

Abstract
CONTEXT: Bone mineral density (BMD) is increased in patients with idiopathic hypoparathyroidism (IH). PTH deficiency, hypocalcemic seizures and anticonvulsants could compromise skeletal health in IH leading to vertebral fractures. However, there is limited information on the prevalence of vertebral fractures in hypoparathyroidism.
OBJECTIVE: To assess the prevalence of vertebral fractures and related factors in a cohort of patients with IH and change in BMD during long-term follow-up.
DESIGN: Vertebral fractures were assessed using quantitative vertebral morphometry of thoracic and lumbar spine. BMD was assessed by DXA at lumbar spine, hip and forearm. Change in BMD was assessed in subset of 27 patients after 10 years follow-up interval.
SETTING: The Endocrine clinic of All India Institute of Medical Sciences, New Delhi, Patients and other participants: 104 patients with IH and 64 healthy controls. Hypocalcemia, hyperphosphatemia, normal blood urea and serum creatinine and low serum intact-PTH levels were used as diagnostic criteria for IH.
RESULTS: Vertebral fractures were observed in 18.3% patients with IH and in 4.7% of controls (OR, 4.54, 95% CI=1.28-16.04). Longer use of anticonvulsants and menopause were significantly associated (P < 0.05) with vertebral fractures. Mean BMD at lumbar spine and hip were higher by 21.4% and 8.6 % in IH than controls (P <0.001). BMD significantly increased during follow-up at all three sites. Change in BMD correlated with serum calcium/phosphorus ratio maintained during follow-up.
CONCLUSIONS: Despite increased BMD, prevalence of vertebral fractures is more in patients with IH especially in post-menopausal women and in those on anticonvulsant therapy.

PMID: 27813708 [PubMed - as supplied by publisher]

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Increased Proliferation of the Pancreatic Duct Gland Compartment in Type 1 Diabetes.

Increased Proliferation of the Pancreatic Duct Gland Compartment in Type 1 Diabetes.

J Clin Endocrinol Metab. 2016 Nov 4;:jc20163001

Authors: Md Moin AS, Butler PC, Butler AE

Abstract
CONTEXT: Pancreatic duct glands (PDGs) have been proposed as a source of regeneration in response to exocrine pancreas injury, and thus may serve as an organ stem cell niche. There is evidence to suggest ongoing beta-cell formation in longstanding type 1 diabetes (T1D), but the source is unknown.
OBJECTIVE: To investigate the pancreatic duct gland (PDG) compartment of the pancreas in humans with T1D for evidence of an active regenerative signature (presence of progenitor cells and increased proliferation) and, in particular, as a potential source of beta-cells.
DESIGN, SETTING AND PARTICIPANTS: Pancreas from 46 brain dead organ donors (22 with T1D, 24 nondiabetic controls) were investigated for activation (increased proliferation) and markers of pancreatic exocrine and endocrine progenitors.
RESULTS: PDG cell replication was increased in T1D (6.3 ± 1.6 vs. 0.6 ± 0.1%, p < 0.001, T1D vs. ND), most prominently in association with pancreatic inflammation. There were increased progenitor-like cells in PDGs of T1D, but predominantly with an exocrine fate.
CONCLUSION: The PDG compartment is activated in T1D consistent with a response to ongoing inflammation, and via resulting ductal hyperplasia may contribute to local obstructive pancreatitis and eventual pancreatic atrophy characteristic of T1D. However, there is no evidence of effective endocrine cell formation from PDGs.

PMID: 27813705 [PubMed - as supplied by publisher]

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Fetal/neonatal Thyrotoxicosis in a Newborn From a Hypothyroid Woman With Hashimoto's Thyroiditis.

Fetal/neonatal Thyrotoxicosis in a Newborn From a Hypothyroid Woman With Hashimoto's Thyroiditis.

J Clin Endocrinol Metab. 2016 Nov 4;:jc20162999

Authors: Kiefer FW, Klebermass-Schrehof K, Steiner M, Worda C, Kasprian G, Diana T, Kahaly GJ, Gessl A

Abstract
CONTEXT: Fetal/neonatal thyrotoxicosis is a rare but potentially life-threatening condition. It is most commonly observed in poorly controlled Graves' disease during pregnancy.
CASE DESCRIPTION: Here we describe the first reported case of thyrotoxicosis in a fetus/newborn from a woman with Hashimoto's thyroiditis and levothyroxine-treated hypothyroidism. Transplacental passage of stimulating TSH-receptor antibodies, measured by a cell-based bioassay, was the underlying mechanism of fetal/neonatal thyrotoxicosis even though the mother had no history of hyperthyroidism.
CONCLUSION: Diagnosis and management of fetal hyperthyroidism can be challenging. TSH receptor antibody testing should be considered in pregnant women with any history of autoimmune thyroid disease and symptoms of fetal hyperthyroidism.

PMID: 27813690 [PubMed - as supplied by publisher]

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Table of Contents.

Table of Contents.

J Clin Endocrinol Metab. 2016 Nov;101(11):7A-11A

Authors:

PMID: 27809723 [PubMed - in process]

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Letter to the Editor: Models Developed Using Small Datasets Should be Appropriately Evaluated.

Letter to the Editor: Models Developed Using Small Datasets Should be Appropriately Evaluated.

J Clin Endocrinol Metab. 2016 Nov;101(11):L104-L105

Authors: Collins GS, Le Manach Y

PMID: 27809722 [PubMed - in process]

http://ift.tt/2fnqbjZ

Letter to the Editor Response.

Letter to the Editor Response.

J Clin Endocrinol Metab. 2016 Nov;101(11):L106-L107

Authors: León-Justel A, Cano DA, Leal-Cerro A

PMID: 27809721 [PubMed - in process]

http://ift.tt/2fnohA0

Letter to the Editor Response.

Letter to the Editor Response.

J Clin Endocrinol Metab. 2016 Nov;101(11):L103

Authors:

PMID: 27809720 [PubMed - in process]

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Letter to the Editor: The J-Shaped 25-Hydroxyvitamin D Concentration/CVD-Mortality Relation is an Artifact Caused by Lack of Correction due to Age.

Letter to the Editor: The J-Shaped 25-Hydroxyvitamin D Concentration/CVD-Mortality Relation is an Artifact Caused by Lack of Correction due to Age.

J Clin Endocrinol Metab. 2016 Nov;101(11):L99

Authors: Ahrenkiel S

PMID: 27809719 [PubMed - in process]

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Response to the Letter by G. M. H. Swaen and R. Otter.

Response to the Letter by G. M. H. Swaen and R. Otter.

J Clin Endocrinol Metab. 2016 Nov;101(11):L110-L111

Authors: Hunt PA, Sathyanarayana S, Fowler PA, Trasande L

PMID: 27809718 [PubMed - in process]

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Letter to the Editor Response: The J-shaped 25-hydroxyvitamin D concentration/CVD-mortality relation is an artifact caused by lack of correction due to age, by Steen Ahrenkiel.

Letter to the Editor Response: The J-shaped 25-hydroxyvitamin D concentration/CVD-mortality relation is an artifact caused by lack of correction due to age, by Steen Ahrenkiel.

J Clin Endocrinol Metab. 2016 Nov;101(11):L100

Authors: Schwarz P

PMID: 27809717 [PubMed - in process]

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Letter to the Editor: Methodological comments on the study by Negro et al. entitled "Impact of Levothyroxine in Miscarriage and Preterm Delivery Rates in First Trimester Thyroid Antibody-Positive Women with TSH

Letter to the Editor: Methodological comments on the study by Negro et al. entitled "Impact of Levothyroxine in Miscarriage and Preterm Delivery Rates in First Trimester Thyroid Antibody-Positive Women with TSH<2.5mIU/L".

J Clin Endocrinol Metab. 2016 Nov;101(11):L101-L102

Authors: Korevaar TI, Peeters RP

PMID: 27809716 [PubMed - in process]

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Letter to the Editor: Phthalates and Endometriosis.

Letter to the Editor: Phthalates and Endometriosis.

J Clin Endocrinol Metab. 2016 Nov;101(11):L108-L109

Authors: Swaen GM, Otter R

PMID: 27809715 [PubMed - in process]

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Determination of 17OHPreg and DHEAS by LCMSMS: Impact of Age, Sex, Pubertal Stage and BMI on the Δ5-steroid-pathway.

Determination of 17OHPreg and DHEAS by LCMSMS: Impact of Age, Sex, Pubertal Stage and BMI on the Δ5-steroid-pathway.

J Clin Endocrinol Metab. 2016 Nov 3;:jc20162849

Authors: Kulle AE, Reinehr T, Simic-Schleicher G, Hornig NC, Holterhus PM

Abstract
BACKGROUND: Dehydroepiandrosterone-sulfate (DHEAS) and 17-hydroxypregnenolone (17OHPreg) are important for understanding the Δ5-pathway, e.g. in adrenarche and obesity. While mass spectrometry has become the state-of-the-art method for quantifying steroids, there are few comprehensive age-, sex- and pubertal stage-specific reference ranges for children.
AIMS: To develop a sensitive and reliable UPLC-MS/MS method for simultaneous quantification of DHEAS and 17OHPreg, and establish the entire age-, sex- and pubertal stage-specific reference ranges in children.
METHODS: 684 children, 453 with normal BMI (<90(th)) (243 f, 210 m) and 231 obese subjects (>97(th)) (132 f, 99 m), were categorized into eleven age groups and age- and Tanner stage (PH)-specific reference ranges were determined.
RESULTS: The method was linear up to 600 nmol/L (17OHPreg) and 6000 nmol/L (DHEAS) with limits of detection of 0.05 nmol/L and 0.5 nmol/L respectively. Both steroids declined after the neonatal period. Comparisons with RIA-assays (Siemens (DHEAS); in-house kit (17OHPreg) revealed 0.95 and 0.93 as coefficients of determination. While DHEAS - generally higher in boys - increased continuously starting at 3-6 years, 17OHPreg remained largely constant. In obese patient both were significantly elevated, also in part after alignment to Tanner stages (PH).
CONCLUSIONS: UPLC-MS/MS is sensitive and reliable for quantifying DHEAS and 17OHPreg. Our data support differential maturation of CYP17 during adrenarche with successively increasing 17/20 lyase activity but largely constant 17α-activity. Endocrine interpretation of 17OHPreg and DHEAS must consider differential patterns for age, gender, pubertal stage and BMI.

PMID: 27809697 [PubMed - as supplied by publisher]

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ITM2A Expands Evidence for Genetic and Environmental Interaction in Graves' Disease Pathogenesis.

ITM2A Expands Evidence for Genetic and Environmental Interaction in Graves' Disease Pathogenesis.

J Clin Endocrinol Metab. 2016 Nov 3;:jc20162625

Authors: Ye XP, Yuan FF, Zhang LL, Ma YR, Zhang MM, Liu W, Sun F, Wu J, Lu M, Xue LQ, Shi JY, Zhao SX, Song HD, Liang J, Zheng CX, China Consortium for the Genetics of Autoimmune Thyroid Disease

Abstract
CONTEXT: Graves' disease (GD) is a common autoimmune disease triggered by genetic predisposition and environmental factors. However, the mechanisms of interaction between genetic and environmental factors contributing to the development of GD remain unknown.
OBJECTIVE: To identify GD susceptibility variants and genes on Xq21.1 locus and interpret the contribution of interaction between genetic predisposition on Xq21.1 and environmental factors to GD.
DESIGN: We performed refining study on Xq21.1 in a two-stage study and carried out eQTL analysis of the best association signal with GD.
SETTING AND PARTICIPANTS: 4,316 GD patients and 4,374 sex-matched controls were collected from the Chinese Han population by cooperation with multiple hospitals.
RESULTS: We identified rs3827440 or its linkage SNPs was probably the causal variant in the Xq21.1 locus, with the most significant association with GD in our combined cohorts (P=2.45×10(-15)). The genotypes of rs3827440 were correlated with the expression of ITM2A in monocytes and PBMCs from healthy volunteers. Notably, the expression of ITM2A in monocytes after lipopolysaccharide (LPS) and interferon-γ (INF-γ) stimulation showed significant difference among the volunteers carried different genotypes of rs3827440 (P=9.40×10(-7) and P=1.26×10(-5), for 24h LPS and INF-γ stimulation, respectively). Moreover, ITM2A expression was significantly decreased in PBMCs from untreated GD patients than that from controls.
CONCLUSION: The results suggest that ITM2A might be a susceptibility gene for GD in the Xq21.1 locus, and environmental factors, such as viral and bacterial infections, probably contribute to GD pathogenesis by interacting with the risk SNP rs3827440 mediating the regulation of ITM2A expression.

PMID: 27809695 [PubMed - as supplied by publisher]

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Liver Fat and Insulin Sensitivity Define Metabolite Profiles During a Glucose Tolerance Test in Young Adult Twins.

Liver Fat and Insulin Sensitivity Define Metabolite Profiles During a Glucose Tolerance Test in Young Adult Twins.

J Clin Endocrinol Metab. 2016 Nov 3;:jc20153512

Authors: Rämö JT, Kaye SM, Jukarainen S, Bogl LH, Hakkarainen A, Lundbom J, Lundbom N, Rissanen A, Kaprio J, Matikainen N, Pietiläinen KH

Abstract
CONTEXT: The associations of BMI and liver fat (LF) with circulating prandial metabolomic markers are incompletely understood.
OBJECTIVE: To characterize circulating metabolite excursions during an oral glucose tolerance test (OGTT), and evaluate whether the metabolomic signatures of BMI-discordance co-associate with LF content.
DESIGN, SETTING AND PARTICIPANTS: We measured 80 metabolite parameters by nuclear magnetic resonance, together with glucose and insulin, during a 2-hour OGTT in 64 monozygotic and 73 dizygotic twin pairs (aged 22.8-36.2 years). Metabolite excursions during the OGTT were compared within BMI-discordant (intrapair difference, BMI>=3kg/m(2)) co-twins separately within monozygotic and dizygotic pairs. Insulin-based indices were calculated from the OGTT. LF was measured by magnetic resonance spectroscopy in 25 BMI-discordant monozygotic pairs. Metabolite profiles were compared with respect to LF discordance (ΔLF%>=2%).
RESULTS: We replicated many previously reported OGTT-induced metabolite excursions in all 274 individuals and report novel lipoprotein excursions. The associations between some metabolite excursions and BMI differed in monozygotic and dizygotic twins. In BMI-discordant monozygotic pairs (mean ΔBMI 4.9kg/m(2)) who were concordant for LF (Δ0.2%), few metabolites differed between the co-twins: VLDL cholesterol and apolipoprotein B were elevated, and HDL size and concentration were decreased in the co-twins with higher BMI. In contrast, in BMI-discordant monozygotic pairs (ΔBMI 6.1kg/m(2)) who were discordant for LF (Δ6.8%), co-twins with higher BMI exhibited lower insulin sensitivity and widespread metabolomic differences: elevations in small VLDL and LDL particles, fatty acids, and isoleucine. Within all 64 monozygotic twin pairs, lower insulin sensitivity associated with higher levels of VLDLs, triglycerides, fatty acids, and isoleucine.
CONCLUSIONS: BMI-discordant monozygotic twin pairs who also are discordant for LF have more pronounced within-pair differences in metabolomics profiles during an OGTT than BMI-discordant pairs without LF discordance.

PMID: 27809652 [PubMed - as supplied by publisher]

http://ift.tt/2fnuDis

Erythropoietin and Soluble Erythropoietin Receptor: A Role for Maternal Vascular Adaptation to High Altitude Pregnancy.

Erythropoietin and Soluble Erythropoietin Receptor: A Role for Maternal Vascular Adaptation to High Altitude Pregnancy.

J Clin Endocrinol Metab. 2016 Nov 3;:jc20161767

Authors: Wolfson G, Vargas E, Browne VA, Moore LG, Julian CG

Abstract
CONTEXT: An imbalance of pro- and anti-angiogenic factors is thought to be central to the widespread vascular dysfunction characteristic to preeclampsia (PreE). Erythropoietin (Epo), a pleiotrophic cytokine known for its erythropoietic effects, has important angiogenic and vasoactive properties, however its contribution to impaired maternal vascular responses in PreE is unknown.
OBJECTIVE(S): Since chronic hypoxia raises the incidence of PreE we asked whether the chronic hypoxia of high altitude (HA) increased maternal Epo and soluble Epo receptor (sEpoR) levels, and whether such effects differed between PreE cases and normotensive controls at HA.
DESIGN, SETTING AND PARTICIPANTS: Longitudinal studies were conducted in pregnant, Andean HA (n=28; 3600 m) or sea level (SL, n=16; 300 m) residents. Cross-sectional studies included 34 gestational-age matched Andean PreE cases (n=17) and controls (n=17) in La Paz-El Alto, Bolivia (3600m - 4100m).
RESULTS: HA augmented the pregnancy-associated rise in Epo relative to SL (P=0.002), despite a similar reduction of Hb concentration across pregnancy at each altitude (7-9%, both P<0.001). HA PreE cases had equivalent circulating Epo levels compared to normotensive controls, but greater sEpoR values (P<0.05) and reduced hemoglobin (P=0.06, trend).
CONCLUSION(S): Chronic hypoxia augments the pregnancy-associated rise in Epo but has no effect on maternal sEpoR, an effect that may be important for successful vascular adaptation to pregnancy at HA. In contrast, we speculate that elevated sEpoR observed in PreE cases vs. controls at HA impedes Epo-stimulated angiogenesis, vasodilation and the maintenance of endothelial function and may thereby be of pathophysiological relevance for increased incidence of PreE at HA.

PMID: 27809650 [PubMed - as supplied by publisher]

http://ift.tt/2fNF53u

Initial and Dynamic Risk Stratification of Pediatric Patients with Differentiated Thyroid Cancer.

Initial and Dynamic Risk Stratification of Pediatric Patients with Differentiated Thyroid Cancer.

J Clin Endocrinol Metab. 2016 Nov 3;:jc20162666

Authors: Sung TY, Jeon MJ, Lee YH, Lee YM, Kwon H, Yoon JH, Chung KW, Kim WG, Song DE, Hong SJ

Abstract
BACKGROUND: The objective of this study was to evaluate the usefulness of American Thyroid Association (ATA) risk classification and dynamic risk stratification (DRS) based on the response to initial therapy in pediatric patients with differentiated thyroid cancer (DTC).
METHODS: This historical cohort study included 77 pediatric patients with DTC who underwent thyroid surgery. Clinical outcomes during median 5.3 years of follow-up were assessed according to three ATA risk groups and four DRS groups.
RESULTS: In ATA risk classification, 22%, 48%, and 30% of patients were low, intermediate and high risk group. There was no significant difference in disease-free survival (DFS) between indeterminate and low risk group. The risk of recurrent/persistent disease was significantly higher only in high risk group (HR=18.4, p=0.005). In DRS, 49%, 13%, 6% and 31% of patients were classified in excellent, indeterminate, biochemical incomplete, and structural incomplete response group, respectively. The risk of recurrent/persistent disease was significantly higher in indeterminate group (HR=10.2, p=0.045), and structural incomplete group (HR=98.7, p=0.005) compared by excellent response group.
CONCLUSION: DRS based on the response to initial therapy could be useful in addition to initial ATC pediatric risk classification to predict recurrent/persistent disease in pediatric patients with DTC.

PMID: 27809646 [PubMed - as supplied by publisher]

http://ift.tt/2eJadwM

Loss of Functional Osteoprotegerin: More Than a Skeletal Problem.

Loss of Functional Osteoprotegerin: More Than a Skeletal Problem.

J Clin Endocrinol Metab. 2016 Nov 3;:jc20162905

Authors: Grasemannn C, Unger N, Hövel M, Arweiler-Harbeck D, Herrmann R, Schündeln MM, Müller O, Schweiger B, Lausch E, Meissner T, Kiewert C, Hauffa BP, Shaw NJ

Abstract
INTRODUCTION: Juvenile Pagets disease (JPD), an ultra-rare, debilitating bone disease stemming from unopposed RANKL action due to loss of functional osteoprotegerin (OPG) is caused by recessive mutations in TNFRSF11B. A genotype-phenotype correlation spanning from mild to very severe forms is described.
AIM: To describe the complexity of the human phenotype of OPG deficiency in more detail and to investigate heterozygous mutation carriers for clinical signs of JPD.
PATIENTS AND METHODS: 3 children with JPD from families of Turkish, German and Pakistani descent and 19 family members (14 heterozygous) were investigated.
RESULTS: A new disease-causing 4 bp-duplication: c.[25-28dup];[25-28dup] in exon 1 was detected in the German patient and a homozygous microdeletion including TNFRFSF11B in the Pakistani patient. Skeletal abnormalities in all affected children included bowing deformities and fractures, contractures, short stature and skull involvement. Complex malformation of the inner ear and vestibular structures (in 2 patients) resulted in early deafness. Patients were found to be growth hormone deficient (2) displayed elevated inflammatory markers (2), nephrocalcinosis (1) gross motor (3) and mental (1) retardation. No retinal changes were observed in any of the patients. Heterozygous family members displayed low osteoprotegerin levels (12), elevated bone turnover markers (7) and osteopenia (6). Short stature (1), visual impairment (2) and hearing impairment (1) were also present.
CONCLUSION: Diminished osteoprotegerin levels cause complex changes affecting multiple organ systems, including pituitary function, in children with JPD and may cause osteopenia in heterozygous family members. Diagnostic and therapeutic measures should aim to address the complex phenotype.

PMID: 27809640 [PubMed - as supplied by publisher]

http://ift.tt/2fnmydG

Low-level laser therapy associated to a resistance training protocol on bone tissue in diabetic rats.

Low-level laser therapy associated to a resistance training protocol on bone tissue in diabetic rats.

Arch Endocrinol Metab. 2016 Oct;60(5):457-464

Authors: Patrocínio-Silva TL, Souza AM, Goulart RL, Pegorari CF, Oliveira JR, Fernandes KR, Magri AM, Pereira RM, Ribeiro DA, Nagaoka MR, Rennó AC

Abstract
Objective: The present study aimed to evaluate the in vivo response of a resistance training and low-level laser therapy (LLLT) on tibias and femurs of rats with diabetes mellitus (DM).
Materials and methods: Forty male Wistar rats were randomly distributed into four experimental groups: control group (CG), diabetic group (DG), diabetic trained group (TG) and diabetic trained and laser irradiated group (TLG). DM was induced by streptozotocin (STZ) and after two weeks laser and resistance training started, performed for 24 sessions, during eight weeks. At the end of the experiment, animals were euthanized and tibias and femurs were removed for analysis. Histological, histomorphometrical, immunohistochemistry and mechanical analyses were performed.
Results: Trained groups, with or without laser irradiation, showed increased cortical area, bone density and biomechanical properties. The immunohistochemical analysis revealed that TG and TLG demonstrated an increased RUNX2 expression. RANK-L immunoexpression was similar for all experimental groups.
Conclusion: In conclusion, it can be suggested that the resistance exercise program stimulated bone metabolism, culminating in increased cortical tibial area, bone mineral content, bone mineral density and biomechanical properties. Furthermore, the association of physical exercises and LLLT produced higher values for bone mineral content and stiffness. Consequently, these data highlight the potential of physical exercise in the management of bone loss due to DM and the possible extra osteogenic stimulus offered by lasertherapy. Further long-term studies should be carried out to provide additional information.

PMID: 27812609 [PubMed - in process]

http://ift.tt/2fm9Lps

Evolution to permanent or transient conditions in children with positive neonatal TSH screening tests in Sergipe, Brazil.

Evolution to permanent or transient conditions in children with positive neonatal TSH screening tests in Sergipe, Brazil.

Arch Endocrinol Metab. 2016 Oct;60(5):450-456

Authors: Matos DM, Ramalho RJ, Carvalho BM, Almeida MA, Passos LF, Vasconcelos TT, Melo EV, Oliveira CR, Santos EG, Resende KF, Aguiar-Oliveira MH

Abstract
Objectives: To assess the evolution to permanent or transient conditions in children with positive neonatal TSH tests in Sergipe, Brazil, from 2004 to 2010.
Subjects and methods: Out of 193,794 screened newborns, 713 presented a neonatal TSH level higher than the local cutoff (5.2 µU/mL). From the confirmatory serum TSH values, the children were diagnosed with initial congenital hypothyroidism (CH) or suspect CH. From the evolution, they were classified as permanent CH, hyperthyrotropinemia, or transient TSH elevation. The mean incidence of each final condition was calculated for the total period of time.
Results: The initial diagnosis included 37 CH (18.1%) and 167 suspect CH (81.9%) cases. The final diagnosis included 46 cases of permanent CH (22.5%), 56 of hyperthyrotropinemia (27.5%), and 102 of transient TSH elevation (50.0%). Out of the 37 cases of initial CH, 23 (62.2%) had permanent CH, nine (24.3%) had hyperthyrotropinemia, and five (13.5%) had transient TSH elevation. Out of the 167 suspect CH cases, 23 (13.8%) had permanent CH, 47 (28.1%) had hyperthyrotropinemia and 97 (58.1%) had transient TSH elevation. The mean incidence after the follow up was 1:4,166 for permanent CH, 1:3,448 for hyperthyrotropinemia, and 1:1,887 for transient TSH elevation. Eighty-six percent of the children with an initial diagnosis of CH and 41.9% with suspect CH had a permanent condition (CH or hyperthyrotropinemia).
Conclusions: The follow-up of children with an initial diagnosis of CH or suspect CH is necessary to determine whether the disorder is permanent because predicting the evolution of the condition is difficult.

PMID: 27812608 [PubMed - in process]

http://ift.tt/2fFm0Bn

The role of oxidative stress in streptozotocin-induced diabetic nephropathy in rats.

The role of oxidative stress in streptozotocin-induced diabetic nephropathy in rats.

Arch Endocrinol Metab. 2016 Oct;60(5):443-449

Authors: Fernandes SM, Cordeiro PM, Watanabe M, Fonseca CD, Vattimo MF

Abstract
Objective: The objective of this study was to evaluate the role of oxidative stress in an experimental model of streptozotocin-induced diabetic nephropathy in rats.
Materials and methods: Wistar, adult, male rats were used in the study. Animals were divided in the following groups: Citrate (control, citrate buffer 0.01M, pH 4.2 was administrated intravenously - i.v - in the caudal vein), Uninephrectomy+Citrate (left uninephrectomy-20 days before the study), DM (streptozotocin, 65 mg/kg, i.v, on the 20th day of the study), Uninephrectomy+DM. Physiological parameters (water and food intake, body weight, blood glucose, kidney weight, and relative kidney weight); renal function (creatinine clearance), urine albumin (immunodiffusion method); oxidative metabolites (urinary peroxides, thiobarbituric acid reactive substances, and thiols in renal tissue), and kidney histology were evaluated.
Results: Polyphagia, polydipsia, hyperglycemia, and reduced body weight were observed in diabetic rats. Renal function was reduced in diabetic groups (creatinine clearance, p < 0.05). Uninephrectomy potentiated urine albumin and increased kidney weight and relative kidney weight in diabetic animals (p < 0.05). Urinary peroxides and thiobarbituric acid reactive substances were increased, and the reduction in thiol levels demonstrated endogenous substrate consumption in diabetic groups (p < 0.05). The histological analysis revealed moderate lesions of diabetic nephropathy.
Conclusion: This study confirms lipid peroxidation and intense consumption of the antioxidant defense system in diabetic rats. The association of hyperglycemia and uninephrectomy resulted in additional renal injury, demonstrating that the model is adequate for the study of diabetic nephropathy.

PMID: 27812607 [PubMed - in process]

http://ift.tt/2fmcFdY

Association of the conicity index with diabetes and hypertension in Brazilian women.

Association of the conicity index with diabetes and hypertension in Brazilian women.

Arch Endocrinol Metab. 2016 Oct;60(5):436-442

Authors: Andrade MD, Freitas MC, Sakumoto AM, Pappiani C, Andrade SC, Vieira VL, Damasceno NR

Abstract
Objective: The goal of this study was evaluate the conicity index (C index) in women and its association with hypertension (SAH) and diabetes mellitus (DM).
Subjects and methods: This was a cross-sectional study, with 573 women between 20 and 59 years of age. After analysis of clinical and demographic characteristics, anthropometric variables were measured and used to calculate the C index. Plasma glucose and lipid profile were evaluated by standard methods. The analysis of the results was based on logistic regression and the odds ratio (OR) was calculated, which was used to assess the association of the variable outcome with the variable exposure using two logistic regression models that tested the possible influence of the C index in the chance of developing SAH or DM. A confidence interval of 95% was used.
Results: In the crude and adjusted models, the OR confirmed the association of the C index with DM and SAH. Compared with women that showed C index p < 75, the risk of women with C index (p ≥ 75) developing DM and SAH was 1.72 and 1.75, respectively. Results demonstrated that the negative impact of age on these associations significantly raised the odds of women having DM and SAH. The high C index was also linked to low HDL-C.
Conclusion: The C index is an important tool in estimating the risk of diabetes and hypertension in women. Besides, high C indexes are negatively associated with HDL-C, an important lipid marker related to cardiovascular risk.

PMID: 27812606 [PubMed - in process]

http://ift.tt/2fFfdb4

Paraoxonase 1 (PON1) Q192R genotypes and their interaction with smoking strongly increase atherogenicity and the Framingham risk score.

Paraoxonase 1 (PON1) Q192R genotypes and their interaction with smoking strongly increase atherogenicity and the Framingham risk score.

Arch Endocrinol Metab. 2016 Oct;60(5):426-435

Authors: Souza-Nogueira A, Camargo AE, Remondi FA, Paoliello MM, Richter RJ, Furlong CE, Barbosa DS, Maes M, Moreira EG

Abstract
Objective: Paraoxonase 1 (PON1) polymorphisms are associated with an increased susceptibility to cardiovascular disease. PON1 Q192R polymorphism (rs662) partially determine PON1 hydrolytic activity and protect against oxidation of LDL and HDL. This study aimed to delineate the association of PON1 status (functional 192 genotype and plasma activity levels) and atherogenicity in urbans residents aged 40 years or more.
Materials and methods: Anthropometric data, lipid profiles, the atherogenic index of the plasma (AIP) and Framingham score risk were measured. Three kinetic assays were conducted to assay PON1 status using phenylacetate and 4-(chloromethyl)phenyl acetate as substrates.
Results: Smoking per se did not significantly impact the AIP but the interaction PON1 genotype by smoking significantly increased the AIP. In subjects with the RR genotype smoking increased the AIP index from (estimated mean ± SEM) -0.038 ± 0.039 to 0.224 ± 0.094. The QR genotype increased the Framingham risk index by around 1.3 points. Smoking by RR genotype carriers significantly increased the Framingham risk score (17.23 ± 2.04) as compared to smoking (13.00 ± 1.06) and non-smoking (7.79 ± 0.70) by QQ+QR genotype carriers. The interaction RR genotype by smoking was a more important predictor (odds ratio = 7.90) of an increased Framingham risk score (> 20) than smoking per se (odds ratio = 2.73). The interaction smoking by RR genotype carriers significantly increased triglycerides and lowered HDL cholesterol.
Conclusion: Smoking per se has no (AIP) or a mild (Framingham risk score) effect on atherogenicity, while the interaction smoking by PON1 RR genotype has a clinically highly significant impact on atherogenicity.

PMID: 27812605 [PubMed - in process]

http://ift.tt/2eokIVn

Experience with a third-generation parathyroid hormone assay (BIO-PTH) in the diagnosis of primary hyperparathyroidism in a Brazilian population.

Experience with a third-generation parathyroid hormone assay (BIO-PTH) in the diagnosis of primary hyperparathyroidism in a Brazilian population.

Arch Endocrinol Metab. 2016 Oct;60(5):420-425

Authors: Bonanséa TC, Ohe MN, Brandão C, Ferrer CF, Santos LM, Lazaretti-Castro M, Vieira JG

Abstract
Objective: To evaluate the usefulness of a third-generation PTH assay in the diagnosis of primary hyperparathyroidism (PHPT).
Subjects and methods: Forty-one PHPT patients (4 men and 37 women) with 61.2 ± 10.9 (mean ± SD) years, were studied and had PTH levels measured with two different methods using the same immunochemiluminescent assay plataform (Elecsys 2010 System, Roche). We compared a second-generation assay (I-PTH) with a third-generation PTH assay (Bio-PTH). Two populations of 423 and 120 healthy adults with serum 25OHD levels above 25 ng/mL were used to define normal values in the I-PTH and Bio-PTH assays respectively.
Results: Normal PTH values based in the healthy adults population were 24.2-78.0 pg/mL for the I-PTH assay and 19.9-58.5 pg/mL for Bio-PTH assay. In PHPT patients, PTH values ranged from 67 to 553 pg/mL (median: 168 pg/mL) using the I-PTH assay and from 55 to 328 pg/mL (median: 111 pg/mL) using the Bio-PTH assay. Results obtained with the Bio-PTH assay were significantly lower (p < 0.0001, Wilcoxon). In general I-PTH and Bio-PTH showed highly significant correlation (r = 0.952, p < 0.0001). Passing-Bablok analysis gave a regression equation of Bio PTH = 13.44 + 0.59 x intact PTH. PHPT patients had 25OHD levels ranging from 4 to 36 ng/mL (mean 16.2 ng/mL); 35 subjects (85.3%) had values bellow 25 ng/mL.
Conclusion: Our results demonstrate that both second and third generation PTH methods are strongly correlated in PHPT patients and control subjects. Lower results with Bio-PTH tests are expected in function of the assay specificity determined by the amino-terminal antibody used.

PMID: 27812604 [PubMed - in process]

http://ift.tt/2fmaY04

Transsphenoidal pituitary surgery by microscopic or endoscopic approach: the still unsolved question of superiority.

Transsphenoidal pituitary surgery by microscopic or endoscopic approach: the still unsolved question of superiority.

Arch Endocrinol Metab. 2016 Oct;60(5):409-410

Authors: Vellutini EA

PMID: 27812603 [PubMed - in process]

http://ift.tt/2fFgdMh

A systematic review of overall survival in pediatric primary glioblastoma multiforme of the spinal cord.

A systematic review of overall survival in pediatric primary glioblastoma multiforme of the spinal cord.

J Neurosurg Pediatr. 2016 Nov 4;:1-10

Authors: Konar SK, Bir SC, Maiti TK, Nanda A

Abstract
OBJECTIVE The incidence of primary spinal cord glioblastoma multiforme (GBM) in the pediatric age group is very rare. Only a few case series and case reports have been published in the literature; therefore, overall survival (OS) outcome and the as-yet poorly defined management options are not discussed in detail. The authors performed a cumulative survival analysis of all reported cases of pediatric spinal cord GBM to identify the predictive factors related to final survival outcome. METHODS A comprehensive search for relevant articles was performed on PubMed's electronic database MEDLINE for the period from 1950 to 2015 using the search words "malignant spinal cord tumor" and "spinal glioblastoma multiforme." This study was limited to patients younger than 18 years of age. Survival rates for children with various tumor locations and treatments were collected from the published articles and analyzed. RESULTS After an extensive literature search, 29 articles met the study inclusion criteria. From the detailed information in these articles, the authors found 53 children eligible for the survival analysis. The majority (45%) of the children were more than 12 years old. Thirty-four percent of the cases were between 7 and 12 years of age, and 21% were younger than 7 years. In the Kaplan-Meier survival analysis, children younger than 7 years of age had better survival (13 months) than the children older than 7 years (7-12 years: 10 months, > 12 years: 9 months; p = 0.01, log-rank test). Fifty-five percent of the children were female and 45% were male. A cervical tumor location (32%) was the most common, followed by thoracic (28.3%). Cervicothoracic (18.9%) and conus (18.8%) tumor locations shared the same percentage of cases. Cervical tumors had a worse outcome than tumors in other locations (p = 0.003, log-rank test). The most common presenting symptom was limb weakness (53%), followed by sensory disturbances (25%). Median OS was 10 months. The addition of adjuvant therapy (radiotherapy [RT] and/or chemotherapy [CT]) after surgery significantly improved OS (p = 0.01, log-rank test). Children who underwent gross-total resection and RT had better outcomes than those who underwent subtotal resection and RT (p = 0.04, log-rank test). Cerebrospinal fluid spread, hydrocephalus, brain metastasis, and spinal metastasis were not correlated with OS in primary spinal GBM. CONCLUSIONS Adjuvant therapy after surgery had a beneficial effect on overall outcome of spinal GBM in the pediatric age group. Gross-total resection followed by RT produced a better outcome than subtotal resection with RT. Further large-scale prospective study is required to establish the genetic and molecular factors related to OS in primary GBM of the spinal cord in pediatric patients.

PMID: 27813458 [PubMed - as supplied by publisher]

http://ift.tt/2eaPnug

Ventricular catheter entry site and not catheter tip location predicts shunt survival: a secondary analysis of 3 large pediatric hydrocephalus studies.

Ventricular catheter entry site and not catheter tip location predicts shunt survival: a secondary analysis of 3 large pediatric hydrocephalus studies.

J Neurosurg Pediatr. 2016 Nov 4;:1-11

Authors: Whitehead WE, Riva-Cambrin J, Kulkarni AV, Wellons JC, Rozzelle CJ, Tamber MS, Limbrick DD, Browd SR, Naftel RP, Shannon CN, Simon TD, Holubkov R, Illner A, Cochrane DD, Drake JM, Luerssen TG, Oakes WJ, Kestle JR, for the Hydrocephalus Clinical Research Network

Abstract
OBJECTIVE Accurate placement of ventricular catheters may result in prolonged shunt survival, but the best target for the hole-bearing segment of the catheter has not been rigorously defined. The goal of the study was to define a target within the ventricle with the lowest risk of shunt failure. METHODS Five catheter placement variables (ventricular catheter tip location, ventricular catheter tip environment, relationship to choroid plexus, catheter tip holes within ventricle, and crosses midline) were defined, assessed for interobserver agreement, and evaluated for their effect on shunt survival in univariate and multivariate analyses. De-identified subjects from the Shunt Design Trial, the Endoscopic Shunt Insertion Trial, and a Hydrocephalus Clinical Research Network study on ultrasound-guided catheter placement were combined (n = 858 subjects, all first-time shunt insertions, all patients < 18 years old). The first postoperative brain imaging study was used to determine ventricular catheter placement for each of the catheter placement variables. RESULTS Ventricular catheter tip location, environment, catheter tip holes within the ventricle, and crosses midline all achieved sufficient interobserver agreement (κ > 0.60). In the univariate survival analysis, however, only ventricular catheter tip location was useful in distinguishing a target within the ventricle with a survival advantage (frontal horn; log-rank, p = 0.0015). None of the other catheter placement variables yielded a significant survival advantage unless they were compared with catheter tips completely not in the ventricle. Cox regression analysis was performed, examining ventricular catheter tip location with age, etiology, surgeon, decade of surgery, and catheter entry site (anterior vs posterior). Only age (p < 0.001) and entry site (p = 0.005) were associated with shunt survival; ventricular catheter tip location was not (p = 0.37). Anterior entry site lowered the risk of shunt failure compared with posterior entry site by approximately one-third (HR 0.65, 95% CI 0.51-0.83). CONCLUSIONS This analysis failed to identify an ideal target within the ventricle for the ventricular catheter tip. Unexpectedly, the choice of an anterior versus posterior catheter entry site was more important in determining shunt survival than the location of the ventricular catheter tip within the ventricle. Entry site may represent a modifiable risk factor for shunt failure, but, due to inherent limitations in study design and previous clinical research on entry site, a randomized controlled trial is necessary before treatment recommendations can be made.

PMID: 27813457 [PubMed - as supplied by publisher]

http://ift.tt/2eJdv3k

[One Year Treatment of Nose Bleeding in the ENT Emergency Departments of East Thuringia].

[One Year Treatment of Nose Bleeding in the ENT Emergency Departments of East Thuringia].

Laryngorhinootologie. 2016 Nov 3;

Authors: Weigel K, Volk GF, Müller A, Guntinas-Lichius O

Abstract
Objective: Aim of the study was to analyse the medical care situation of patients suffering from epistaxis in everyday clinical practice in ENT emergency departments. Material and Methods: In the year 2009, 690 patients with 862 occurrences of epistaxis sought help in the 2 East Thuringian ENT emergency departments in Jena and Gera (60% male, average age: 60 years). The patients' characteristics were evaluated retrospectively with a focus on comorbidity, long-term medication and treatment measures. Results: The incidence of epistaxis treatment in the ENT emergency departments was 121 28 per 100 000 habitants of East Thuringia. Die Inzidenz für die Epistaxisbehandlung in den Notfallambulanzen der Ostthüringer Kliniken lag bei 121 28 pro 100 000 Einwohner Ostthüringens The most common comorbidity was hypertension (68% of all patients). 27% of all patients were taking antiplatelet drugs and 19% anticoagulants. We identified the 3-fold combination of a medication with anticoagulant and antiplatelet drugs (p=0.015), Morbus Osler (p=0.011) and thrombocytopaenia (p=0.009) as independent risk factors for recurrent epistaxis. The therapeutic measures the patients led to success rates of more than 90%. Conclusion: The actual ENT emergency treatment of epistaxis seems to be efficient. The escalation of anticoagulant long-term drug therapy has resulted in more admittance to the inpatient sector. More analyses of medical care situations and factors have to be carried out to develop a patient stratification for the daily clinical practice as well as a general guideline for the management of epistaxis.

PMID: 27813041 [PubMed - as supplied by publisher]

http://ift.tt/2fpli7Q

Laparoscopic-Assisted Altemeier's Procedure for Recurrent Strangulated Rectal Prolapse: A Case Report.

Laparoscopic-Assisted Altemeier's Procedure for Recurrent Strangulated Rectal Prolapse: A Case Report.

Am J Case Rep. 2016 Nov 04;17:827-829

Authors: Al-Ameen WM, Privitera A, Al-Ayed A, Sabr K

Abstract
BACKGROUND Rectal prolapse is an uncommon disease that usually requires surgical intervention. Several techniques have been described with either an abdominal or perineal approach, the latter having a higher recurrence rate. In case of irreducible and strangulated full-thickness prolapse, a perineal approach is necessary, and efforts should be made to reduce recurrence rates. CASE REPORT A 39-year-old mentally retarded woman presented with a painful, recurrent, strangulated sigmoid prolapse following a perineal recto-sigmoidectomy (Altemeier's procedure) for strangulated rectal prolapse 2 months previously. Examination revealed a 10-cm strangulated, prolapsed sigmoid. A laparoscopic-assisted perineal sigmoid resection with colo-anal anastomosis was carried out. The patient made an uneventful recovery and was discharged on the 6th postoperative day. CONCLUSIONS This is the second report in the literature highlighting the role of laparoscopy in Altemeier's procedure for strangulated prolapse. Laparoscopy aids assessment of sigmoid length, allows colonic mobilization, and assures that all redundant bowel is excised. This approach can reduce recurrence rate and need of further surgical interventions.

PMID: 27811832 [PubMed - in process]

http://ift.tt/2f45wkv

Prophylactic exercises among head and neck cancer patients during and after swallowing sparing intensity modulated radiation: adherence and exercise performance levels of a 12-week guided home-based program.

Prophylactic exercises among head and neck cancer patients during and after swallowing sparing intensity modulated radiation: adherence and exercise performance levels of a 12-week guided home-based program.

Eur Arch Otorhinolaryngol. 2016 Nov 3;

Authors: Cnossen IC, van Uden-Kraan CF, Witte BI, Aalders YJ, de Goede CJ, de Bree R, Doornaert P, Rietveld DH, Buter J, Langendijk JA, Leemans CR, Verdonck-de Leeuw IM

Abstract
The background and purpose of this paper is to investigate adherence, exercise performance levels and associated factors in head and neck cancer (HNC) patients participating in a guided home-based prophylactic exercise program during and after treatment [swallowing sparing intensity modulated radiation therapy (SW-IMRT)]. Fifty patients were included in the study. Adherence was defined as the percentage of patients who kept up exercising; exercise performance level was categorized as low: ≤1, moderate: 1-2, and high: ≥2 time(s) per day, on average. Associations between 6- and 12-week exercise performance levels and age, gender, tumour site and stage, treatment, intervention format (online or booklet), number of coaching sessions, and baseline HNC symptoms (EORTC-QLQ-H&N35) were investigated. Adherence rate at 6 weeks was 70% and decreased to 38% at 12 weeks. In addition, exercise performance levels decreased over time (during 6 weeks: 34% moderate and 26% high; during 12 weeks: 28% moderate and 18% high). The addition of chemotherapy to SW-IMRT [(C)SW-IMRT] significantly deteriorated exercise performance level. Adherence to a guided home-based prophylactic exercise program was high during (C)SW-IMRT, but dropped afterwards. Exercise performance level was negatively affected by chemotherapy in combination with SW-IMRT.

PMID: 27812787 [PubMed - as supplied by publisher]

http://ift.tt/2fm6NS5

An overview on different strategies for the stemness maintenance of MSCs.

An overview on different strategies for the stemness maintenance of MSCs.

Artif Cells Nanomed Biotechnol. 2016 Nov 3;:1-17

Authors: Saei Arezoumand K, Alizadeh E, Pilehvar-Soltanahmadi Y, Esmaeillou M, Zarghami N

Abstract
Recent evidence suggests that mesenchymal stem cells (MSCs) have promising therapeutic potential for a broad range of diseases. Because the percentage of MSCs obtained from tissues is very low for cell therapy applications, ex vivo expansion of MSCs is necessary, but aging, loss of stemness and undesired differentiation of them during in vitro cultivation reduces their effectiveness. For achieving ideal therapeutic potential of MSCs in tissue regenerative purposes, it is necessary to retain their stemness properties in vitro. This review emphasis on the last updates in preserving the self-renewal capability of stem cells through in vitro expansion with different parameters.

PMID: 27809596 [PubMed - as supplied by publisher]

http://ift.tt/2eaN4HI

Clinical Efficacy of an Ultrasound-Guided Greater Occipital Nerve Block at the Level of C2.

Clinical Efficacy of an Ultrasound-Guided Greater Occipital Nerve Block at the Level of C2.

Reg Anesth Pain Med. 2016 Nov 2;

Authors: Pingree MJ, Sole JS, Oʼ Brien TG, Eldrige JS, Moeschler SM

Abstract
BACKGROUND AND OBJECTIVES: The purpose of this prospective open-label study was to investigate the analgesic effects of an ultrasound-guided greater occipital nerve (GON) block at the level of C2, as the nerve courses superficially to the obliquus capitis inferior muscle.
METHODS: Patients with a diagnosis of occipital neuralgia or cervicogenic headache were recruited for the study. Ultrasound-guided GON blocks at the level of C2 were performed by experienced clinicians according to a standardized protocol. Numeric rating scale pain scores were recorded preinjection and at 30 minutes, 2 weeks, and 4 weeks after injection.
RESULTS: A total of 14 injections were performed with a mean procedure time of 3.75 minutes. Anesthesia in the GON distribution was achieved for 86% of patients at 30 minutes postinjection. Compared with baseline, numeric rating scale scores decreased by a mean of 3.78 at 30 minutes (P < 0.001), 2.64 at 2 weeks (P = 0.006), and 2.21 at 4 weeks (P = 0.01). There were no significant adverse events reported during the study period.
CONCLUSIONS: This prospective open-label study demonstrated successful blockade of the GON at the level of C2 using a novel ultrasound-guided technique. Significant reductions in pain scores were observed over the 4-week study period, and no adverse events were reported. The observations from this study provide important preliminary data for future randomized trials involving patients with occipital neuralgia and cervicogenic headache.

PMID: 27811528 [PubMed - as supplied by publisher]

http://ift.tt/2eJdYCy

A Cadaveric Study Evaluating the Feasibility of an Ultrasound-Guided Diagnostic Block and Radiofrequency Ablation Technique for Sacroiliac Joint Pain.

A Cadaveric Study Evaluating the Feasibility of an Ultrasound-Guided Diagnostic Block and Radiofrequency Ablation Technique for Sacroiliac Joint Pain.

Reg Anesth Pain Med. 2016 Nov 2;

Authors: Roberts SL, Burnham RS, Agur AM, Loh EY

Abstract
BACKGROUND AND OBJECTIVES: Ultrasound (US)-guided diagnostic block/radiofrequency ablation (RFA) along the lateral sacral crest (LSC) has been proposed for managing sacroiliac joint (SIJ) pain. We sought to investigate (1) ease of visualization of bony landmarks using US; (2) consistency of US-guided needle placement along the LSC; and (3) percentage of the posterior sacral network (PSN) innervating the SIJ complex that would be captured if an RFA strip lesion were created between the needles.
METHODS: In 10 cadaveric specimens, 3 needles were placed bilaterally along the LSC from the first to third transverse sacral tubercles (TSTs) using US guidance. The PSN, SIJ, and needles were exposed, digitized, and modeled 3-dimensionally. Ease of visualization of bony landmarks, frequency of needle placement along the LSC, and percentage of the PSN that would be captured if an RFA strip lesion were created between the needles were determined.
RESULTS: The LSC, TST2, TST3, and first to third posterior sacral foramina were easily visualized using US; TST1 was somewhat obscured by the iliac crest in some specimens. Needles were placed along the LSC in 18 of 20 specimens; in the first 2 of 20 specimens, needle 1 was placed at the L5/S1 facet joint. On average, 93% (95% confidence interval, 87%-98%) of the PSN would be captured if an RFA strip lesion were created between the needles.
CONCLUSIONS: The findings suggest that US-guided needle placement along the LSC is consistent and could capture most or all of the PSN. A clinical study evaluating the outcomes of this technique is in progress.

PMID: 27811527 [PubMed - as supplied by publisher]

http://ift.tt/2eJeq3N

Prospective, Double-Blind, Randomized Study to Evaluate Single-Injection Adductor Canal Nerve Block Versus Femoral Nerve Block: Postoperative Functional Outcomes After Total Knee Arthroplasty.

Prospective, Double-Blind, Randomized Study to Evaluate Single-Injection Adductor Canal Nerve Block Versus Femoral Nerve Block: Postoperative Functional Outcomes After Total Knee Arthroplasty.

Reg Anesth Pain Med. 2016 Nov 2;

Authors: Macrinici GI, Murphy C, Christman L, Drescher M, Hughes B, Macrinici V, Diab G

Abstract
BACKGROUND AND OBJECTIVES: Despite multiple clinical trials comparing the adductor canal block (ACB) with femoral nerve block (FNB) for total knee arthroplasty, none looked at the aforementioned nerve blocks from early functional results to up to 6 months after surgery.
METHODS: For this prospective, double-blind, randomized, single-center trial, we enrolled 98 patients set to undergo total knee arthroplasty. The patients were randomized, with 93 patients included in the intention-to-treat analysis. Subjects received injections of both ACB and an FNB, with 1 containing 30 mL of saline (placebo) and the other 30 mL of local anesthetic (treatment) depending on randomization. Adductor canal block and FNB were compared using percentage of baseline maximum voluntary isovolumetric contraction (MVIC) of the quadriceps muscle retained at 6 (primary endpoint), 24, and 48 hours and 6 months postoperatively. Secondary endpoints also included Timed Up and Go, range of motion, 6-minute walking test, pain score, and postoperative pain medication use.
RESULTS: Percent MVIC retained was significantly higher in ACB patients at 6 (P < 0.0001) and 24 hours (P < 0.0001). Comparing Timed Up and Go results yielded significant difference between treatment groups at 6 hours (P = 0.0213) and 24 hours (P = 0.0424). Pain scores, pain medication intake, range of motion, and 6-minute walking test were not significantly different between the treatment groups. A linear relationship exists between the change in quadriceps MVIC and pain score in the ACB group, with increasing pain leading to a decreased MVIC (P = 0.0039).
CONCLUSIONS: The ACB showed better preservation of quadriceps muscle strength and improved ambulation in the first 24 hours postoperatively without compromising pain control.

PMID: 27811526 [PubMed - as supplied by publisher]

http://ift.tt/2eJbX9m

"Med Oral Patol Oral Cir Bucal"[jour]; +18 new citations

18 new pubmed citations were retrieved for your search. Click on the search hyperlink below to display the complete search results:

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Effects of Low-Level Laser Therapy in Orthodontic Patients on Immediate Inflammatory Response After Mini-Implants Insertion: A Preliminary Report.

Effects of Low-Level Laser Therapy in Orthodontic Patients on Immediate Inflammatory Response After Mini-Implants Insertion: A Preliminary Report.

Photomed Laser Surg. 2016 Nov 3;

Authors: Yanaguizawa MS, Suzuki SS, Martinez EF, Suzuki H, Pelegrin MC, Garcez AS

Abstract
BACKGROUND: The primary stability of a mini-implant is crucial to treatment sequence since most orthodontic mini-implant failures occur at an early stage. Irritation or inflammation of peri-implant tissues has been related to decreasing mini-implant success.
PURPOSE: This study evaluates the effect of low-level laser therapy on initial inflammation after orthodontic mini-implants installation.
METHODS: Ten volunteers received two mini-implants (1.3 mm diameter, 7 mm length). One mini-implant was inserted on each side of the maxilla following manufacturer recommendation. On the right side, low-level laser therapy (LLLT) was applied (diode laser 660 nm, 40 mW, 1 min, 2.4 J of total energy). Peri-implant crevicular fluid (PGF) was obtained after 24 h (T1), 48 h (T2), and 72 h (T3) to identify levels of interleukin (IL)-6 and IL-8 around mini-implants and around upper first premolars.
RESULTS: An increase in interleukin levels was observed for both groups, compared to upper first premolar. PGF around nonirradiated mini-implants showed higher levels of IL-8. Levels of IL-6 24 h after mini-implant insertion were higher for laser group.
CONCLUSIONS: LLLT modulates the initial inflammation after the insertion of mini-implant, possibly increasing the mini-implant success prognostic and decreasing patient discomfort.

PMID: 27813716 [PubMed - as supplied by publisher]

http://ift.tt/2eogqgV

Er,Cr:YSGG Laser Application for the Treatment of Periodontal Furcation Involvements.

Er,Cr:YSGG Laser Application for the Treatment of Periodontal Furcation Involvements.

Photomed Laser Surg. 2016 Nov 3;

Authors: Ge L, Zhang Y, Shu R

Abstract
OBJECTIVE: The purpose of this study was to evaluate the clinical use of an erbium, chromium: yttrium-scandium-gallium-garnet (Er,Cr:YSGG) laser in the management of root furcation involvements.
BACKGROUND DATA: It has been suggested that the use of laser radiation within the periodontal pocket may be effective in periodontal treatment. However, very limited data from clinical trials exist directly comparing the use of the Er,Cr:YSGG laser to conventional root planing.
MATERIALS AND METHODS: Thirty patients with chronic periodontitis were recruited. A total of 128 teeth with degree II or III furcation involvement were included in a split-mouth design such that the teeth on one side of the mouth were established as Group A and treated with the Er,Cr:YSGG laser and the teeth on the other side were established as Group B and treated with manual subgingival debridement. Changes in probing depth (PD), bleeding on probing (BOP), clinical attachment loss (CAL), and visual analogue scale (VAS) pain scores were compared between Groups A and B and within individuals over time at 6 and 12 weeks after treatment, testing the null hypothesis that there would be no clinical difference between treatment modalities.
RESULTS: Both treatments significantly reduced the PD, CAL, and BOP in the diseased teeth with degree II or III furcation involvement. The reduction of PD and BOP at weeks 6 and 12 was significantly higher in Group A (laser treated) than in Group B. The VAS pain score was significantly lower in Group A than in Group B (p < 0.01).
CONCLUSIONS: Pocket debridement with Er,Cr:YSGG laser is a safe, comfortable, and clinically effective means of subgingival debridement in periodontal therapy.

PMID: 27809724 [PubMed - as supplied by publisher]

http://ift.tt/2fNGNSq

Focus on Extracellular Vesicles: New Frontiers of Cell-to-Cell Communication in Cancer.

Focus on Extracellular Vesicles: New Frontiers of Cell-to-Cell Communication in Cancer.

Int J Mol Sci. 2016 Feb 06;17(2):175

Authors: Ciardiello C, Cavallini L, Spinelli C, Yang J, Reis-Sobreiro M, de Candia P, Minciacchi VR, Di Vizio D

Abstract
Extracellular Vesicles (EVs) have received considerable attention in recent years, both as mediators of intercellular communication pathways that lead to tumor progression, and as potential sources for discovery of novel cancer biomarkers. For many years, research on EVs has mainly investigated either the mechanism of biogenesis and cargo selection and incorporation, or the methods of EV isolation from available body fluids for biomarker discovery. Recent studies have highlighted the existence of different populations of cancer-derived EVs, with distinct molecular cargo, thus pointing to the possibility that the various EV populations might play diverse roles in cancer and that this does not happen randomly. However, data attributing cancer specific intercellular functions to given populations of EVs are still limited. A deeper functional, biochemical and molecular characterization of the various EV classes might identify more selective clinical markers, and significantly advance our knowledge of the pathogenesis and disease progression of many cancer types.

PMID: 26861306 [PubMed - indexed for MEDLINE]

http://ift.tt/2f3V3Fs

Liver Surface Nodularity Score Allows Prediction of Cirrhosis Decompensation and Death.

Liver Surface Nodularity Score Allows Prediction of Cirrhosis Decompensation and Death.

Radiology. 2016 Nov 3;:160799

Authors: Smith AD, Zand KA, Florez E, Sirous R, Shlapak D, Souza F, Roda M, Bryan J, Vasanji A, Griswold M, Lirette ST

Abstract
Purpose To determine whether use of the liver surface nodularity (LSN) score, a quantitative biomarker derived from routine computed tomographic (CT) images, allows prediction of cirrhosis decompensation and death. Materials and Methods For this institutional review board-approved HIPAA-compliant retrospective study, adult patients with cirrhosis and Model for End-Stage Liver Disease (MELD) score within 3 months of initial liver CT imaging between January 3, 2006, and May 30, 2012, were identified from electronic medical records (n = 830). The LSN score was measured by using CT images and quantitative software. Competing risk regression was used to determine the association of the LSN score with hepatic decompensation and overall survival. A risk model combining LSN scores (<3 or ≥3) and MELD scores (<10 or ≥10) was created for predicting liver-related events. Results In patients with compensated cirrhosis, 40% (129 of 326) experienced decompensation during a median follow-up period of 4.22 years. After adjustment for competing risks including MELD score, LSN score (hazard ratio, 1.38; 95% confidence interval: 1.06, 1.79) was found to be independently predictive of hepatic decompensation. Median times to decompensation of patients at high (1.76 years, n = 48), intermediate (3.79 years, n = 126), and low (6.14 years, n = 152) risk of hepatic decompensation were significantly different (P < .001). Among the full cohort with compensated or decompensated cirrhosis, 61% (504 of 830) died during the median follow-up period of 2.26 years. After adjustment for competing risks, LSN score (hazard ratio, 1.22; 95% confidence interval: 1.11, 1.33) and MELD score (hazard ratio, 1.08; 95% confidence interval: 1.06, 1.11) were found to be independent predictors of death. Median times to death of patients at high (0.94 years, n = 315), intermediate (2.79 years, n = 312), and low (4.69 years, n = 203) risk were significantly different (P < .001). Conclusion The LSN score derived from routine CT images allows prediction of cirrhosis decompensation and death. (©)RSNA, 2016 Online supplemental material is available for this article.

PMID: 27809664 [PubMed - as supplied by publisher]

http://ift.tt/2fpjHz0

Plexiform schwannoma of the thoracolumbar spine a rare clinical entity - a case report.

Plexiform schwannoma of the thoracolumbar spine a rare clinical entity - a case report.

Br J Neurosurg. 2016 Nov 4;:1-3

Authors: Lam Shin Cheung V, Provias J, Cenic A

Abstract
Plexiform schwannomas are peripheral nerve sheath tumours rarely found in the spine. We present a case of a 65-year-old male with a spinal plexiform schwannoma in order to add to the general fund of knowledge regarding the natural history, diagnosis and surgical management of this extremely rare clinical entity.

PMID: 27809595 [PubMed - as supplied by publisher]

http://ift.tt/2fNKmrW

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Σάββατο 5 Νοεμβρίου 2016

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