Consenso intersocietario* sobre tratamiento y seguimiento de pacientes con cáncer diferenciado de tiroides / Inter Society Consensus for the Management of Patients with Differentiated Thyroid Cancer

La incidencia del cáncer diferenciado de tiroides se incrementó exponencialmente en todo el mundo. Aunque estos tumores presentan un pronóstico excelente, se produjeron múltiples cambios en el enfoque terapéutico y de seguimiento en los últimos años. Esta situación, vinculada principalmente con la estadificación por riesgos de recurrencia de la enfermedad, determinó la necesidad de generar un consenso entre representantes de las 3 sociedades argentinas que habitualmente se encuentran involucradas en el manejo de estos pacientes, (Sociedad Argentina de Endocrinología y Metabolismo, Asociación Argentina de Cirugía de Cabeza y Cuello y Asociación Argentina de Biología y Medicina Nuclear). Las recomendaciones se realizaron de acuerdo a la experiencia de los participantes y a la revisión de la literatura. Rev Argent Endocrinol Metab 52:85-118, 2014 Conflictos de interés: Pitoia F: Consultoría, Advisory Board, Speaker Genzyme-Sanofi; Consultoría, Advi­sory Board, Speaker, Steering Committee Bayer; Consultoría, Advisory Board, Speaker Astra Zeneca. Califano I: Speaker Genzyme-Sanofi; Consultoría, Advisory Board, Speaker AstraZeneca. Faure E: Consultoría, Advisory Board, Speaker Genzyme-Sanofi; Consultoría, Advisory Board, Speaker AstraZeneca. Gauna A: Advisory Board Genzyme-Sanofi.; Advisory Board Bayer. Mollerach A: Advisory Board Genzyme-Sanofi. Orlandi A: Advisory Board, Speaker Genzyme-Sanofi. El resto de los autores no declaran conflictos de intereses.

The incidence of differentiated thyroid cancer increased exponentially worldwide. Although these tumors usually have an excellent prognosis, multiple changes occurred in the therapeutic approach and follow-up in recent years. This situation, mainly related to the stratification by the risk of recurrence of the disease, made it necessary to build a consensus among representative members from the three Argentinean societies that are usually involved in the management of these patients, (Argentinean Society of Endocrinology and Metabo lism, Argentinean Association of Head and Neck Surgery and Argentinean Association of Biology and Nuclear Medicine). The recommendations were done according to personal experiences and review of bibliography. Rev Argent Endocrinol Metab 52:85-118, 2014 Conflicts of interest: Pitoia F: Consultancy, Advisory Board, Speaker Genzyme-Sanofi; Consultancy, Advisory Board, Speaker, Steering Committee Bayer; Consultancy, Advisory Board, Speaker AstraZeneca. Califano I: Speaker Genzyme-Sanofi; Consultancy, Advisory Board, Speaker AstraZeneca. Faure E: Consultancy, Advisory Board, Speaker Genzyme-Sanofi; Consultancy, Advisory Board, Speaker AstraZeneca. Gauna A: Advisory Board Genzyme-Sanofi.; Advisory Board Bayer. Mollerach A: Advisory Board Genzyme-Sanofi.Orlandi A: Advisory Board, Speaker Genzyme-Sanofi. No other financial conflicts of interest exist.

Parthenogenesis in non-rodent species: developmental competence and differentiation plasticity.

An oocyte can activate its developmental process without the intervention of the male counterpart. This form of reproduction, known as parthenogenesis, occurs spontaneously in a variety of lower organisms, but not in mammals. However, it must be noted that mammalian oocytes can be activated in vitro, mimicking the intracellular calcium wave induced by the spermatozoon at fertilization, which triggers cleavage divisions and embryonic development. The resultant parthenotes are not capable of developing to term and arrest their growth at different stages, depending on the species. It is believed that this arrest is due to genomic imprinting, which causes the repression of genes normally expressed by the paternal allele. Human parthenogenetic embryos have recently been proposed as an alternative, less controversial source of embryonic stem cell lines, based on their inherent inability to form a new individual. However many aspects related to the biology of parthenogenetic embryos and parthenogenetically derived cell lines still need to be elucidated. Limited information is available in particular on the consequences of the lack of centrioles and on the parthenote's ability to assemble a new embryonic centrosome in the absence of the sperm centriole. Indeed, in lower species, successful parthenogenesis largely depends upon the oocyte's ability to regenerate complete and functional centrosomes in the absence of the material supplied by a male gamete, while the control of this event appears to be less stringent in mammalian cells. In an attempt to better elucidate some of these aspects, parthenogenetic cell lines, recently derived in our laboratory, have been characterized for their pluripotency. In vitro and in vivo differentiation plasticity have been assessed, demonstrating the ability of these cells to differentiate into cell types derived from the three germ layers. These results confirmed common features between uni- and bi-parental embryonic stem cells. However data obtained with parthenogenetic cells indicate the presence of an intrinsic deregulation of the mechanisms controlling proliferation vs. differentiation and suggest their uni-parental origin as a possible cause.

Large animal models for cardiac stem cell therapies.

Cardiovascular disease is the leading cause of death in developed countries and is one of the leading causes of disease burden in developing countries. Therapies have markedly increased survival in several categories of patients, nonetheless mortality still remains high. For this reason high hopes are associated with recent developments in stem cell biology and regenerative medicine that promise to replace damaged or lost cardiac muscle with healthy tissue, and thus to dramatically improve the quality of life and survival in patients with various cardiomyopathies. Much of our insight into the molecular and cellular basis of cardiovascular biology comes from small animal models, particularly mice. However, significant differences exist with regard to several cardiac characteristics when mice are compared with humans. For this reason, large animal models like dog, sheep and pig have a well established role in cardiac research. A distinct characteristic of cardiac stem cells is that they can either be endogenous or derive from outside the heart itself; they can originate as the natural course of their differentiation programme (e.g., embryonic stem cells) or can be the result of specific inductive conditions (e.g., mesenchymal stem cells). In this review we will summarize the current knowledge on the kind of heart-related stem cells currently available in large animal species and their relevance to human studies as pre-clinical models.

Double pelvic osteotomy for the treatment of hip dysplasia in young dogs.

UNLABELLED: The aim of this study was to evaluate the feasibility of the double pelvic osteotomy (DPO) (osteotomy of the ilium and pubis) to treat clinical cases of hip dyplasia in young dogs instead of performing a triple pelvic osteotomy (TPO) (osteotomy of the ilium, pubis, and ischium). Candidates for DPO were 4.5- to nine-month-old dogs with coxofemoral joint subluxation and laxity, indicative of susceptibility to future development of severe hip dysplasia. The angle of reduction (AR) and angle of subluxation (AS) with Ortolani's sign, Norberg angle (NA), percentage of femoral head (PC) covered by the acetabulum, and the pelvic diameters and their relationships were measured clinically and radiographically before and after surgery. The surgical technique was similar to the TPO technique, but excluded ischiatic osteotomy. A DPO was carried out in 53 joints of 34 dogs; AR and AS values immediately postoperatively and at the one- and two-month follow-up examinations were significantly lower than the preoperative values (p <0.01). The complications encountered were mainly represented by implant failure (3.5%), partial plate pull-out (9.4%), and incomplete fracture of the ischial table (7.5%). Changes in PC and NA values obtained immediately after surgery and at the first and second follow-up examinations were significantly greater (p <0.01 both) than values obtained before surgery. Sufficient acetabular ventroversion was achieved to counteract joint subluxation and the modifications of AR and AS. The NA and PC direct postoperative values reflected a significant improvement in the dorsal acetabular coverage. CLINICAL RELEVANCE: Restoration of normal joint congruity (PC from 50 to 72%) and maintenance of the pelvic geometry without pelvic narrowing were the most intriguing features of DPO. The complications observed were greatly reduced when using dedicated DPO plates. Based on our experience, the morbidity after unilateral and bilateral DPO was lower than after TPO because elimination of the ischiatic osteotomy allowed for increased stability of the pelvis. The surgical technique of DPO was a little more demanding than TPO because of the difficulty in handling and rotating the acetabular iliac segment, but this difficulty was offset by elimination of ischial osteotomy.

Proximal tibial epiphysiodesis to reduce tibial plateau slope in young dogs with cranial cruciate ligament deficient stifle.

The purpose of this study was to evaluate the ability of proximal tibial epiphysiodesis to reduce the tibial plateau slope in young dogs with cranial cruciate ligament (CCL) deficient stifles. Of the 14 treated dogs, eight had a bilateral injury, for a total of 22 joints. After physical and radiographical examination and measurement of tibial plateau slope, all of the dogs underwent surgery. Insertion of the screw was placed in the most proximal part of the tibial plateau, in its medio-lateral centre, aiming to the tibial shaft and using a K wire predriven as a guide; correct position of the screw was confirmed with intraoperative fluoroscopy or radiography. In all of the dogs the tibial slope was decreased at the time of physis fusion and the degree of change depended on the age and the breed of the dog at the time of surgery. The minimum change was 4 degrees and the maximum was 24 degrees. There was a statistically significant difference between tibial slope measured before surgery compared to tibial slope measured at the last follow-up visit after surgery. This study shows that the partial proximal tibial fusion in dogs with ACL injuries was effective in reducing the tibial slope during the residual growing time to such an extent to stabilize the joint, provided that the surgery had been carried out when there was still residual growing potential. The technique appeared to be mini-invasive and malalignment complications could be avoided by correct and precise insertion of the screw.