Case presentation of the smallest non-functional parathyroid carcinoma and review of the literature.

INTRODUCTION: Non functional parathyroid carcinoma (PC) is one of the rarest malignant neoplasms. Due to the lack of symptoms and laboratory findings, it is mostly diagnosed in late AQ2 stages, when local invasion and dissemination are already present. However, our case is an exception, because it was detected in early stage, with no local invasion present. We present a case of the smallest non-functional PC yet reported and review of the literature. CASE PRESENTATION: A 47-year-old woman was admitted to outpatient Clinic where fine-needle aspiration biopsy (FNAB) of bilateral thyroid nodules (slide 1) and central neck mass (slide 2), which was suspected to be an enlarged lymphatic nodule or parathyroid gland was performed. Results came back as Bethesda I-colloid (slide 1), and Bethesda IV (slide 2), stating that it is hard to distinguish thyroid gland oxyphil lesions from parathyroid cells. Total thyroidectomy was performed as well as excision of the left central neck mass, without any involvement of surrounding structures. Pathological examination revealed bilateral thyroid follicular nodular disease, papillary microcarcinoma, and parathyroid carcinoma with vascular and capsular invasion, measuring 10 × 8 × 7 mm. The immunohistochemical profile included positive PTH, Chromogranin A, and negative TTF1. CONCLUSION: Non-functional PC is usually diagnosed in advanced stages, already involving adjacent structures; however, this case presents a rare example. It is important not to exclude PC as a differential diagnosis in the absence of elevated Ca and PTH serum levels. Follow-up will be difficult, since there are no prognostic parameters to rely on.

Bilateral simultaneous cataract surgery and intraocular lens implantation in an adult female chimpanzee (Pan troglodytes) inducing monovision.

BACKGROUND: Cataract is the major cause of visual impairment in humans. Phacoemulsification with intraocular lens (IOL) implantation is the standard technique for cataract treatment with a high success rate. In a few cases, the surgical cataract procedure and lens implantation have been applied in non-human primates. CASE DESCRIPTION: A +/- 40-year-old female chimpanzee (Pan troglodytes) in captivity was diagnosed with mature cataract optical density (OD) and posterior subcapsular cataract combined with cortical opacities OS after ophthalmic examination. To restore vision and facilitate far- and near sight, phacoemulsification OU with +22.5 diopter (D) IOL implantation OD and + 24 D OS were performed. Despite complicated surgery OD due to posterior capsular rupture, the outcome was successful during 1-year follow-up. The chimpanzee regained adequate vision, normal behavior, and was successfully re-introduced to her group of chimpanzees. CONCLUSION: This is the first case report of a simultaneous bilateral cataract surgery with IOL implantations in both eyes, targeting emmetropia OS and near vision OD resulting in monovision, in a chimpanzee. Vision was restored without postoperative complications.

Calculation of the Hadronic Vacuum Polarization Disconnected Contribution to the Muon Anomalous Magnetic Moment.

We report the first lattice QCD calculation of the hadronic vacuum polarization (HVP) disconnected contribution to the muon anomalous magnetic moment at physical pion mass. The calculation uses a refined noise-reduction technique that enables the control of statistical uncertainties at the desired level with modest computational effort. Measurements were performed on the 48^{3}×96 physical-pion-mass lattice generated by the RBC and UKQCD Collaborations. We find the leading-order hadronic vacuum polarization a_{µ}^{HVP(LO)disc}=-9.6(3.3)(2.3)×10^{-10}, where the first error is statistical and the second systematic.

Occurrence of Macrorhabdus ornithogaster in exotic birds.

Avian gastric yeast (Macrorhabdus ornithogaster) is a microorganism that infects aviary birds worldwide, both captive and wild. A total number of 352 birds, belonging to 18 avian species, were examined from 2019 to 2022 for M. ornithogaster, using fecal smears of live birds or cytological samples of the proventriculus taken at necropsy. These cytological samples were taken from birds that died from different causes. Some of the birds exhibited symptoms such as lethargy, regurgitation, weight loss and anorexia. Faecal samples were collected from all the birds and analysed for gastric yeast using a direct smear and Gram-staining method. The microorganism was diagnosed most frequently in budgerigars (55.5%), the African gray parrot (33.3%), and nymphs (34.3%). The prevalence of M. ornithogaster in canaries was 10%. The infection was detected in 31% of the examined birds, which shows that the occurrence of M. ornithogaster in exotic birds is common. No clinical signs were observed in the vast majority of birds that tested positive for gastric yeast.

Use of acellular collagen matrix for the closure of the open oral wound in bone regeneration.

Mucograft is collagen matrix was designed for use in open healing situations due to its compact outer layer. The technique presented in this article is an attempt to avail this attribute for covering open oral wound in guided bone regeneration (GBR) procedure. The essential idea of this technique is to avoid scoring of periosteum, submucosa and muscle layer for buccal flap advancement. Therefore, we used mucograft to cover bone substitute and barrier membrane in GBR surgical procedure. Thus, we avoided periostal-releasing incisions (PRI) and gained reposition of the flap to original level without impairing the attached keratinized gingiva. Buccal flap advancement in situations of shallow vestibulum, shortly attached gingiva and strong muscle pull may reduce or eliminate attached gingiva with an adverse effect on extended survival of placed implants. This technique promises to be beneficial for the preservation of the soft tissue around dental implants after GBR procedure.

Extranodal marginal zone B-cell lymphoma most probably of MALT type appearing in CNS as parasagittal extracerebral tumor.

A 63 years old male patient with systemic extranodal marginal zone lymphoma, most probably originating from mucosa associated lymphoid tissue (MALT) involving central nervous system (CNS) is presented. The usual site of origin of this type of lymphoma was not identified. The diagnosis was stated after neurosurgery according to histopathology, immunohistochemistry and additional haematologic examination. Postoperative therapy included local irradiation (30Gy) of rest tumor, combined by Rituximab-CHOP (R-CHOP) protocol, which resulted in complete remission lasting three years up to now.

[Diagnostic image (299). An oncology patient suffering from conjunctivitis]. / Diagnose in beeld (299). Een oncologische patiënt met conjunctivitis.

A 64-year-old man with a small-cell bronchus carcinoma and metastases was treated with chemotherapy and developed conjunctivitis and necrosis of the eyelids caused by Pseudomonas aeruginosa.

The genetic basis of uveal melanoma.

Uveal melanoma (UM) is the most common intraocular malignancy in adults with an incidence of about 1/100,000 new cases per year in the Western world. Risk factors are having a light skin, blond hair and blue eyes. As some UM patients have a young age at diagnosis or an affected family history for UM or other malignancies, there may be an underlying genetic basis. This review discusses known or suspected risk factors for UM, the cancer risk in UM patients and their family members, and the genes that have been reported to predispose to UM (germline mutations) and tumor development (somatic mutations).

Reactivity of monoclonal antibodies OK-CLL (anti-CD5) with peripheral blood cells of patients with B cell lymphoproliferative disorders.

Reactivity of OK-CLL monoclonal antibodies that can identify CD5 antigen on peripheral blood mononuclear cells, was investigated in 172 patients with B cell chronic lymphocytic leukemia (B-CLL) in clinical stages RAI O-I and RAI II-IV and in patients with non-Hodgkin's lymphomas, classified according to the Working formulation into high and low grade histologic type. The OK-CLL reactivity with B-CLLs in the initial (RAI O-I), as well as in advanced stages of disease (RAI II-IV) was significantly higher than in controls. Peripheral blood cells of lymphoma patients, regardless of histological type, showed a much lower values of the CD5 positive population than chronic lymphocytic leukemia (CLL) patients, and a non significant discrepancy between the number of cells stained with anti-CD5 and those stained with other T cell markers. In spite of the showed considerable decrease of CD5 positive cells in CLL patients during therapy, elevated number of this population compared to normal individuals, after chemotherapy, was found. However, in lymphoma patients of both types of malignancies, CD5 positive population increased concomitantly with therapy. These results may suggest that analysis of CD5 antigen expression on peripheral blood cells of patients with B cell lymphoproliferative malignancies may have diagnostic, or, in correlation with some relevant clinical parameters, a potential predictive value in the treatment of those patients.

The absence of correlation between immunoregulatory T cells and induced lymphoproliferative response in treated B-chronic lymphocytic leukemia patients.

BACKGROUND: Many data suggest T cell functional impairment in B-cell chronic lymphocytic leukemia (B-CLL). The mechanism responsible for this phenomenon is still unresolved. METHODS: In 88 B-CLL patients (RAI II-IV) the relationship between immunoregulatory T cells and PHA induced lymphoproliferative response (LPR) was analysed before and after the therapy. The number of peripheral blood CD3+, CD4+ and CD8+ T lymphocytes was determined by indirect immunofluorescence assay using monoclonal antibodies. LPR was estimated in whole blood culture method. RESULTS: The absolute number of CD3+, CD4+ and CD8+ cells in untreated CLL patients was much higher than in healthy controls (n = 26), but the percentages of these subpopulations, CD4/CD8 ratio and LPR to PHA were significantly (p < 0.00001) decreased. The chemotherapy induced a significant rise of CD3+ and CD4+ percentages (p < 0.006 < p < 0.022 respectively) in comparison to baseline levels, but their levels remained significantly (p < 0.00001) lower than the controls. The CD4/CD8 ratio was also elevated after the therapy (p < 0.048) but remained below the normal value as well. The absolute number of CD3+ and CD4+ T cells were normalized after treatment, while the CD8+ cells were still higher (p < 0.044) than controls. The increase of LPR has been registered after treatment, but it failed to reach the control values. We could not find any correlation between the number of immunoregulatory T cells and induced LPR (r = 0.07, for CD4+; r = 0.09 for CD8+ cells). CONCLUSIONS: These data indicate some profound lymphoid cell defect in CLL patients affecting CD8+ proliferation as well as LPR.

Percutaneous transluminal renal angioplasty (PTRA) as a method of therapy for renovascular hypertension in children.

The results of PTRA in treatment of renovascular hypertension in four children aged 5, 7, 13 and 15 are presented. All patients suffered from severe hypertension. Tests showed all of them to have fibromuscular dysplasia stenosis of the main renal artery and significant lateralization of renin levels. One suffered from associated polycystosis of kidneys and in another the renal artery stenosis was bilateral. In all patients successful patency was achieved. In one patient, the arterial pressure after PTRA was normalized, while in the others it was considerably improved. Two patients, tested 8 and 12 months after PTRA, were lost to further follow-up. In one of the remaining two, stenosis and hypertension reappeared 5 years after PTRA. After autotransplantation the patient was normotensive. In the other, also 5 years later, recurrent hypertension appeared related to the associated polycystosis.

Determination of impurities in high-purity gold, with a gas-stabilized low-temperature arc.

A gas-stabilized arc with aerosol supply has been used for emission spectrometric determination of Al, B, Be, Co, Cr, Fe, Ga, In, Mg, Mn, Ni, Pd, Rh and Zn, as impurities in high-purity gold. Two analytical procedures were compared: (a) direct aspiration of dissolved samples containing 2% of gold and 0.25M KCl as buffer, and (b) separation of impurities by ether extraction of gold from 1M HCl followed by impurity determination with a stabilized arc. Limits of detection, precision and recovery of the extraction procedure are given.

Non-IPSID small intestinal lymphoma: evidence for disseminated disease at presentation.

During the period 1984-1989 the authors have observed 20 patients with non-IPSID small intestinal lymphomas, 11 males and 9 females. In 11 patients the first symptoms were abdominal cramps requiring laparotomy, in 4 ileus, and in 5 perforation with peritonitis. Resection of the involved part of the intestine was performed in 17 patients. Lymphoma tissue was present in 4 of 5 retrogradely examined resection lines on macroscopically normal small intestine. According to Working Formulation, 3 patients had low grade, 3 intermediate grade and 14 high grade histology. Affection of extra intestinal/mesenteric structures was found in 18 of 20 patients, with a total of 36 other lymphoma localizations. 8 of 20 had affection of the nasopharynx and/or Waldeyer's ring. According to the Crowther's classification 55% of patients were in Stage IV, 35% in Stage III and 10% in Stage Ib. All patients were treated with chemotherapy, 13 with ProMACE regimen and 7 with CHOP-type regimens. Ten of twenty patients are alive and in complete remission for over 5 years (7 of 11 of Stage IV and 3 of 9 of Stage Ib/III; 8 of 14 with high grade and 2 of 6 with intermediate/low grade histology). Our results point to the fact that in non-IPSID lymphoma of the small intestine, lymphoma involvement of the intestinal wall might be present beyond obvious lymphoma lesions. Most patients with apparently primary small intestinal lymphoma have a widespread disease. Thus, local forms of treatment such as surgery, and/or radiotherapy can not be expected to be curative in the majority of patients. Data from this study suggest that following initial surgery the chemotherapy is the treatment of choice for these patients.

Richter syndrome with emphasis on large-cell non-Hodgkin lymphoma in previously unrecognized subclinical chronic lymphocytic leukemia.

The authors report seven cases of Richter's syndrome, i.e. of large-cell non-Hodgkin's lymphoma (NHL) arising in association with chronic lymphocytic leukemia (CLL). Six patients had the recently recognized variant of this syndrome, occurring in patients with previously undiagnosed subclinical CLL. All patients were treated with aggressive chemotherapy and a complete response of large cell NHL was achieved in 4/7. A complete response of NHL was observed in 3 out of 6, and a partial response in 2/6 patients with simultaneous occurrence of subclinical CLL and large cell NHL (response rate 5/6). Our findings might suggest that patients with Richter syndrome occurring in previously undiagnosed subclinical CLL could represent a better prognostic group in the overall population of patients with large cell NHL transformation of CLL.

Enalapril versus captopril: a double-blind multicentre comparison in essential hypertension.

A collective, multicentre (Ljubljana, Split, Zagreb) comparison of the antihypertensive effects between two angiotensin converting enzyme inhibitors (ACEI) captopril and enalapril was made in 69 hypertensives of both sexes, having a diastolic blood pressure (DBP), following two weeks on a placebo, of between 110 and 130 mm Hg (14.7 and 17.3 kPa). There were 35 patients on enalapril (20-40 mg), and 34 on captopril (50-100 mg). Both drugs under study decreased significantly the mean DBP already after the first week of ACEI treatment (p less than 0.001). By the end of the trial (9th week) captopril had decreased the DBP in the supine position from the initial 180.3 +/- 15.3/117.7 +/- 6.4 mm Hg to 151.6 +/- 11.1/96.8 +/- 7.2 mm Hg. Enalapril had lowered the DBP more efficiently: from 182.7 +/- 16.7/118.7 +/- 7.7 to 145.6 +/- 12.8/92.2 +/- 6.4 mm Hg (p less than 0.05). The average reduction in mean DBP was 16.9% on captopril, and 20.9% on enalapril. Low dose ACEI monotherapy (i.e. 50 mg and 20 mg) achieved DBP normalization in 11.8% on captopril and in 26.4% on enalapril (p less than 0.01). There were no significant heart rate changes. The laboratory results did not change appreciably and there were no relevant side-effects, although particular attention was paid to the expected adverse reactions, such as cough, ageusia or proteinuria. It is concluded that the ACEIs under study showed comparable effectiveness within the used dose range, enalapril being more potent, longer acting, and possibly safer.

Controlled multicentre comparison of captopril versus lisinopril in the treatment of mild-to-moderate arterial hypertension.

The antihypertensive efficacy and safety of lisinopril (L), a novel ACE inhibitor, were compared to those of captopril (C), the familiar drug of the same class, in a multicentre controlled trial. The study included 91 mild-to-moderate, middle-aged hypertensives of both genders, 46 of which were randomized to C and 45 to L. After a two-week placebo period the examinees were receiving either L o.d. in increasing dosage of 10, 20, or 40 mg per day (amount necessary to achieve normotension), or C b.i.d. in a corresponding daily dose of 25, 50, or 100 mg. During the eight-week formal part of the trial, L decreased the systolic blood pressure from the initial values by an average of 14.9%, and the diastolic pressure by some 15.2%. The same parameters were lowered on C by 11.2%, and 11.7%, respectively. The mean arterial pressure from an initial average of 125.5 mmHg was lowered to 110.9 mmHg on C (11.6% reduction, p < 0.01), and from 125.3 mmHg to 108.2 mmHg on L (13.6% reduction, p < 0.01). Although the L effects were more pronounced, the observed between-group differences did not reach the level of statistical significance, except for the achievement of normotension, which disclosed the superiority of L (p < 0.05). The tolerability of both drugs was good and only one examinee had to be excluded because of side-effects (proteinuria). It is concluded that both ACEIs under study showed comparable efficacy and safety, L being marginally more potent and longer acting.

Nicardipine versus nifedipine: multicentre controlled trial in essential hypertension.

Ninety-five hypertensive outpatients of both sexes, aged 23 to 65 years with diastolic blood pressures above 105 but below 120 mmHg (greater than 14.0 but less than 16.0 kPa), after one week on a placebo were randomly assigned either to nicardipine plus a placebo (40 mg/day - 48 patients) or nifedipine sustained-release plus a placebo (20 mg/day - 47 patients) for an additional six weeks. The study groups were homogeneous and comparable. After the run-in period the average blood pressure was 181 +/- 17/116 +/- 9 mmHg (24.1 +/- 2.3/15.5 +/- 1.2 kPa) in the nicardipine and 177 +/- 22/116 +/- 9 mmHg (23.6 +/- 2.9/15.5 +/- 1.2 kPa) in the nifedipine group (p greater than 0.10). In the acute oral test (nicardipine 40 mg to all the subjects; blood pressure measured at 30 min intervals during two hours) almost identical hypotensive effects within and between groups were observed (mean arterial pressure decrease of 11%, after 120 min; p less than 0.05). At the end of this trial blood pressure decreased further to 152 +/- 12/94 +/- 11 mgHg (20.3 +/- 1.6/12.5 +/- 1.5 kPa) (mean decrease of 20%; p less than 0.01) on nicardipine and to 145 +/- 12/94 +/- 11 mmHg (19.3 +/- 1.6/12.5 +/- 1.5 kPa) (mean decrease of 20%; p less than 0.01) on nifedipine. There were no significant changes in pulse rate. The observed between-group differences were trivial (p greater than 0.10). The laboratory data did not alter appreciably during this study. Three patients on nicardipine and four on nifedipine reported headache, palpitations and flushing: one patient on nicardipine and two on nifedipine were as a result excluded from the trial. It was concluded that nicardipine and nifedipine sustained-release were comparably effective and well-tolerated drugs suitable as the first-line agents for the management of mild to moderate hypertension.

[Eye complaints indicative of a tumor elsewhere in the body]. / Oogklachten wijzend op een tumor elders in het lichaam.

A variety of clinical presentations of malignant tumour metastases outside of the eye and orbit, were seen in four patients: a 52-year-old man who was scheduled to have a surgical removal of an oesophageal carcinoma and who presented with retinal detachment, a 58-year-old woman in whom retinopathy was the first sign of a cervical carcinoma (cancer-associated retinopathy), a 71-year-old man who had been treated for colon carcinoma and who presented with an orbital mass, and finally a 67-year-old woman with an orbital mass as the first sign of a Grawitz tumour. Metastasis should be considered in patients with a history of malignancy, who present with ophthalmologic complaints. Further it should be borne in mind that eye problems can be the first sign of oncological disease outside the eye.

[Hyperuricemia and plasma renin activity in essential arterial hypertension]. / Hiperuricemija i reninska aktivnost plazme u esencijalnoj arterijskoj hipertenziji.

The frequency of hyperuricemia in 253 patients with essential hypertension (EH) was studied. The level of uric acid in serum and frequency of hyperuricemia were determined in patients divided according to sex and renin plasma activity (RPA). High values of uric acid in serum were found in a total of 69 patients (27.3%), of which there were 40 males (30.1%) and 29 females (24.2%). The highest values of uric acid were found in those with high RPA, but the difference was significant only in males (p < 0.05). No correlation was observed between the values of the uric acid in serum and RPA in none of the renin subgroups. On the basis of our study, it was not possible to explain the high values of uric acid in serum in patients with EH, especially in those with high plasma renin activity, as well as the role of renin-angiotensin-aldosterone system in the pathogenesis of hyperuricemia.

The changes of serum immunoglobulins in patients treated by a combination of anti-CD20 monoclonal antibody rituximab plus chlorambucil for low-grade non- Hodgkin's lymphoma.

PURPOSE: To assess whether the therapeutic application of monoclonal anti-CD20 antibody (rituximab) may affect normal B lymphocyte function, since CD20 is involved in their activation, proliferation and differentiation. PATIENTS AND METHODS: Serum immunoglobulins (Igs) concentrations and their possible relation to pretreatment levels of Igs and B-cells ratio as well as the T/B cell ratio were investigated in 9 patients with low-grade non Hodgkin's lymphoma (NHL) during the administration of rituximab (Mabthera(R)) and chlorambucil combination therapy. Serum Igs concentrations were determined by the radial immunodiffusion (RID) method and the number of B and T lymphocytes by flow cytometry analysis. RESULTS: The altered values of Igs concentration and B cell number were registered in each patient before therapy. Generally, the therapy did not normalize the pretreatment alterations of these parameters, though it depleted malignant clones from peripheral blood. Nevertheless, IgM and IgA concentrations have been considerably changed from baseline level (35-74%) in 5 patients. The concentration of IgA and IgM raised in 4, while the IgM declined from baseline values in 1 patient, irrespective of their therapeutic response. Four of these patients had a normal concentration of these Igs classes, and a profound B cell number alteration before therapy. CONCLUSION: The changes of IgM and IgA concentrations in relation to pretreatment B cell number, although found in a small number of patients, might deserve further investigation with an aim to study any interference of the anti-CD20-based therapy with lymphocytes function.