Relationship between endothelial function of micro- and macrocirculation in patients with peripheral arterial disease.

BACKGROUND: In the pathogenesis of peripheral arterial occlusive disease (PAD), different risk factors of atherosclerosis are involved which stimulate the development of the functional and morphological deterioration of vessel walls in macro- and microcirculation. The endothelial dysfunction (ED) of macrovessels has been proven, however, data on ED in microcirculation are sparse. Therefore, we have studied the relationship between micro- and macrocirculation in PAD patients. PATIENTS AND METHODS: The study included 85 participants: 30 patients had PAD without diabetes mellitus, 30 patients had PAD and diabetes mellitus type 2, and 25 were healthy controls. Flow-mediated dilation (FMD) and endothelium-independent dilation (NMD) were studied as markers of macrocirculation, while ED of microcirculation was determined by peripheral arterial tonometry, which enabled calculation of the reactive hyperemia index (RHI). Simultaneously, the augmentation index (AI) as a measure of arterial stiffness was calculated. RESULTS: In comparison to healthy subjects, PAD patients had reduced FMD (5.7 ± 1.3 % vs. 10.0 ± 2.4 %, p < 0.001) and significantly decreased NMD (11.0 ± 2.9 % vs 23.0 ± 9.0 %, p < 0.001). Low-flow-mediated constriction was not significantly different between the groups. In both groups of patients, RHI was significantly lower than in the controls (1.75 ± 0.45 vs. 2.05 ± 0.54, p = 0.033). Furthermore, AI as an indicator of arterial stiffness was significantly higher in patient groups than in controls. However, there were no significant differences between the groups of PAD patients with and without diabetes mellitus in indicators of the functional capability of micro- and macrocirculation. An interrelationship was shown between risk factors and both FMD and NMD. Significant correlation was also found between FMD and RHI, as was a borderline correlation between FMD and AI. CONCLUSIONS: In PAD patients with and without diabetes, the functional capability of the entire arterial system is deteriorated. These patients have ED in micro- and macrocirculation, as well as increased arterial stiffness.
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Recurrence rate in regional lymph nodes in 737 patients with follicular or Hürthle cell neoplasms.

BACKGROUND: Preoperative ultrasound (US) evaluation of central and lateral neck compartments is recommended for all patients undergoing a thyroidectomy for malignant or suspicious for malignancy cytologic or molecular findings. Our aim was to find out how frequent was recurrence in regional lymph nodes in patients with follicular or Hürthle cell neoplasm and usefulness of preoperative neck US investigation in patients with neoplasm. PATIENTS AND METHODS: Altogether 737 patients were surgically treated because of follicular or Hürthle cell neoplasms from 1995 to 2014 at our cancer comprehensive center, among them 207 patients (163 females, 44 males; mean age 52 years) had thyroid carcinoma. RESULTS: Carcinoma was diagnosed in follicular and Hürthle cell neoplasm in 143/428 and 64/309 of cases, respectively. A recurrence in regional lymph nodes occurred in 12/207 patients (6%) during a median follow-up of 55 months. Among patients with carcinoma a recurrence in regional lymph nodes was diagnosed in follicular and Hürthle cell neoplasms in 2% and 14%, respectively (p = 0.002). Recurrence in regional lymph nodes was diagnosed in 3/428 of all patients with follicular neoplasm and 9/309 of all patients with Hürthle cell neoplasm. CONCLUSIONS: Recurrence in lymph nodes was diagnosed in 0.7% of patients with a preoperative diagnosis of follicular neoplasm and 3% of patients with a Hürthle cell neoplasm. A recurrence in regional lymph nodes is rare in patients with carcinoma and preoperative diagnosis of follicular neoplasm. Preoperative neck ultrasound examination in patients with a follicular neoplasm is probably not useful, but in patients with Hurtle cell neoplasm it may be useful.

Surgical treatment of breast cancer in patients aged 80 years or older--how much is enough?

BACKGROUND: The population of elderly people is increasing and so is the population of breast cancer patients aged ≥80 years. The aim of our retrospective study was to identify independent prognostic factors for the duration of breast cancer-specific survival of surgically treated patients aged ≥80 years. The secondary aim was to determine the appropriate surgical treatment of breast cancer in patients aged ≥80 years. METHODS: We reviewed the medical records of 154 patients aged ≥80 years with early-stage breast cancer (mean age 83 years) who underwent surgery at the tertiary cancer center in the period from 2000 to 2008. Tumor stage was pT1/pT2 and pT3/pT4 in 75% and 25%, respectively. Surgical treatment comprised: quadrantectomy (in 27%), mastectomy (in 73%), axillary dissection (in 57%), and sentinel lymph node biopsy (in 18%), while 25% of patients had no axillary surgery. RESULTS: During a median follow-up of 5.3 years, 31% of patients died of breast cancer, while 28% of patients died of other causes. Half of our patients with poorly differentiated breast cancer or estrogen receptor-negative tumor died of breast cancer. Multivariate statistical analysis showed that the pathological T-stage, pathological N-stage and estrogen receptors were independent prognostic factors for the duration of breast cancer-specific survival of patients. CONCLUSION: Short breast cancer-specific survival indicates that, in patients aged ≥80 years, breast cancer with metastases in axillary lymph nodes can be an aggressive disease.

Preoperative serum thyroglobulin concentration as a predictive factor of malignancy in small follicular and Hürthle cell neoplasms of the thyroid gland.

BACKGROUND: Cytologic examination of a fine-needle aspiration biopsy specimen cannot distinguish between benign and malignant follicular or Hürthle cell neoplasms. Serum thyroglobulin (Tg) concentrations are higher in follicular and Hürthle cell carcinomas than in benign follicular or Hürthle cell tumors, but preoperative measurement of Tg is not recommended for initial evaluation of thyroid nodules. The aim of this study was to find out whether preoperative serum Tg concentration is a predictive factor of malignant disease in patients with a follicular or Hürthle cell neoplasm with a diameter of 2 cm or less. METHODS: From 1988 to 2013, a total of 244 patients (214 female, 30 male, age range 9 to 82 years, median age 52 years) had a surgical procedure at our institute because of follicular or Hürthle cell neoplasms with a tumor diameter of 2 cm or less. In these patients a preoperative concentration of Tg was determined and Tg-autoantibodies were negative. The risk factors for malignancy were identified by a chi-square test and multivariate logistic regression. RESULTS: The histopathologic diagnoses were carcinoma, adenoma, and benign goiter in 62 (25.5%), 115 (47%), and 67 (27.5%) patients, respectively. The median preoperative Tg concentration in benign tumors, papillary carcinomas, follicular carcinomas, and Hürthle cell carcinomas was 41, 87, 72, and 106 ng/ml (P = 0.05), respectively. The predictive factors for carcinoma shown by the chi-square test were: sex, thyroid volume, and preoperative Tg concentration. The independent predictors of malignancy as shown by multivariate logistic regression were: male sex (odds ratio, 2.57; P = 0.02), and a Tg concentration of more than 80 ng/ml (odds ratio, 2.35; P = 0.005). CONCLUSION: The independent predictors of malignancy in follicular or Hürthle cell neoplasms are sex and preoperative Tg concentration.

Neonatal Toxic Shock Syndrome-like Exanthematous Disease: A Report of Two Cases.

Neonatal toxic shock syndrome (TSS)-like exanthematous disease is characterized by exanthema, thrombocytopenia and fever in neonates infected with TSS toxin-1 producing Staphylococcus aureus . Although the disease is rare, it should be known to neonatologists as it represents a differential diagnosis in neonates with exanthema and thrombocytopenia. Two presented neonates with Neonatal TSS-like exanthematous disease are rare European cases of this specific neonatal disease.

Deterioration of endothelial function of micro- and macrocirculation in patients with diabetes type 1 and 2.

BACKGROUND: Vascular complications are an important cause of morbidity in patients with diabetes mellitus (DM). Endothelial dysfunction is an early marker of atherosclerosis and has already been shown in macrocirculation of diabetic patients; however, data on endothelial function of microcirculation is scarce. Our aim was to evaluate endothelial function in macro- and microcirculation and their interrelationship in patients with type 1 and 2 DM. METHODS: The study included 30 patients with type 1 DM, 30 patients with type 2 DM and 25 healthy controls. The endothelial function of large arteries was studied measuring flow-mediated dilation (FMD). Peripheral arterial tonometry was used for investigation of the endothelial function of microcirculation, measuring Reactive Hyperemia Index (RHI) and Augmentation Index (AI). RESULTS: In comparison to controls, both DM groups had decreased FMD: type 1 (4.0±5.0% vs. 10.0±7.8%, P=0.005) and type 2 (5.0±0.6% vs. 10.0±7.8%, P=0.007). However, only type 2 DM group had a lower RHI (1.71±0.44 vs. 2.05±0.54, P=0.017) in comparison to controls. CONCLUSIONS: Patients with type 1 and 2 DM had deteriorated functional capability of macrocirculation. However, endothelial dysfunction of microcirculation was present only in type 2 DM patients. Type 2 DM patients were also at higher risk for atherosclerosis because of the more frequent presence of risk factors.