MIDDLE TERM IMPACT OF SLEEVE GASTRECTOMY ON MAJOR CARDIOVASCULAR RISK FACTORS IN A GROUP OF ROMANIAN OBESE PATIENTS.

BACKGROUND AND AIM: The goals of bariatric surgery are to improve the quality of life by lowering body mass index (BMI) but also to treat obesity comorbidities. The aim of our study was to evaluate the impact of laparoscopic sleeve gastrectomy (LSG) on metabolic parameters. METHODS: 85 obese patients treated by bariatric surgery LSG procedure were included in the study. Basal, 6 and 12 months after surgery serum glucose levels and lipid fractions were measured. Metabolic syndrome criteria according to IDF 2006 were evaluated at baseline and after bariatric surgery. RESULTS: Our group included 61.2 % female patients, the mean age was 40.2 ±10.2 years and the metabolic syndrome criteria at baseline were confirmed in 69.4% of the study group. At twelve months after the intervention, the mean excess weight loss (%EWL) was 72%, with age and BMI subgroups variations. We found significant improvements of serum concentrations for triglycerides (P-value = 0.001, decreased by 30%), HDL-cholesterol (P-value = 0.017, increased by 26%), total cholesterol (P-value = 0.043, decreased by 12%) and glucose (P-value = 0.007, decreased by 12%). CONCLUSIONS: The positive effect of bariatric surgery was confirmed for lipid fractions and fasting glucose levels, also the metabolic syndrome prevalence was significantly reduced, all these changes contribute to lower cardiovascular risk together with significant weight loss.

[Thyroxine therapy in benign thyroid nodules]. / Tratamentul cu tiroxina al nodulilor tiroidieni benigni.

Levothyroxine (LT4) treatment in benign thyroid nodules is a controversial management. The favorable response varies between 10-60%, being, in some studies, comparable between treated and untreated groups. The aim of this study was to evaluate the response of uninodular goiter at the LT4 treatment, in comparison with untreated patients. The study group (S) included 53 patients diagnosed with nodular goiter, treated with LT4 for 1 year. 26 patients with nodular goiter, age and sex-matched, untreated, constituted the control group (C). All patients were from a minor iodine deficient area. The including criteria were euthyroidism, single nodule, solid (ultrasonography), cold (Scintigraphy), and benign (FNAB). After 1 year mean nodular volume had a significant decrement in both groups, higher in group S (35%: from 7.8 to 5.2 mL, p = 0.0098) than in group C (25%: from 8.4 to 5.9 mL, p = 0.026). Linear regression showed a slight correlation between the nodular decrement and the initial volume (r = 0.23): the responders percentage was higher in nodules with a volume < 5 ml than in those with volume > 5 ml (51.5% vs o 19.6%, p < 0.0001). The evolution of treated nodules seamed to be better than of the untreated ones, but the differences were only slightly significant. We believe that the evolution of thyroid nodules under LT4 treatment can be influenced by the iodine supply, since in most of the studies from minor iodine deficiency regions (Europe, South America) the response is better than in regions with sufficient iodine supply (North America). Knowing the potential side effects of LT4 therapy, this kind of management of benign thyroid nodules should be reserved to selected cases.

[The use of echography in the diagnosis of autoimmune thyropathies]. / Utilitatea ecografiei în diagnosticul tireopatiilor autoimune.

Ultrasonography is a first line method in thyroid imaging. The aim of this study was to evaluate the usefulness of thyroid ultrasonography in the diagnosis of thyroid autoimmune diseases (TAD): Graves' disease (GD) and autoimmune thyroiditis (AT)--Hashimoto's and atrophic thyroiditis. Ultrasonography was performed with a 7.5 MHz transducer in 1033 consecutive patients. The excluding criteria was nodular goiter, irrespective of its function. Thyroid volume was calculated using the formula of a rotating ellipsoid. Hypoechogenicity was appreciated using a qualitative scale: 1 = absent, 2 = mild, 3 = moderate, 4 = marked. In patients with TAD thyroid hypoechogenicity was significantly higher than in normal subjects (2.5 +/- 1 in GD and 2.7 +/- 1 in AT, vs. 1.2 +/- 0.6 in normal subjects, p < 0.0001). The specificity of the test in identifying TAD was 91.4%, the sensitivity was 68.6% for GD and 80.8% for AT, positive predictive value was 91.5%, and negative predictive value 91.5%. Ultrasonography is useful in identifying patients with probable autoimmune thyroid diseases, being useful in epidemiological studies and having an important contribution in confirmation of the diagnosis.

[Fine needle puncture--method of treatment in nodular pathology of the thyroid]. / La ponction à aiguille fine--méthode de traitement dans la pathologie nodulaire de la thyroïde.

Fine needle biopsy (FNB) has been used as a therapeutic method in different nodular lesions of the thyroid. Between 1989-1995, 295 subjects with thyroid cysts, 235 women and 60 men have been treated by FNB. The treatment of cysts was performed by: one or multiple aspirations in 207 cases, sclerosis by injection with tetracycline in 77 cases and by ethanol washing in 11 cases. 263 (89.11%) cases have been cured and we have lost track of 32 cases in the survey. Of the 207 cases treated by aspiration, 177 (86.5%) have been cured after one or more aspirations. Of the 77 cases treated by injections with tetracycline, 75 (97.26%) displayed sclerosis after one or more injections. All 11 cases treated by ethanol washing method displayed sclerosis. Between 1993-1995 we used percutaneous ethanol injection (PE1) in 6 cases, as an alternative to the classic treatment, in order to induce necrosis of toxic adenoma. After 1 to 9 injections all cases were cured, with the appearance of the entire image of the gland on the scintigram. In 4 cases of cold nodules with benign cytology PEI, induced a significant decrease of volume appreciated by sonography.

[Thyroid actinomycosis (actinobacteriosis)]. / Actinomicoza (actinobacterioza) tiroidiana.

An extremely rare case (the 15th case reported in the literature, according to our knowledge) of the infection with Actinomyces Israeli localized at the level of thyroid gland is presented. Although the clinical and imaging data, the fine needle aspiration biopsy, and the intraoperative aspect clearly suggested the diagnosis of thyroid cancer, the microscopic examination surprisingly identified "sulfur granules", specific to actinomycosis, so that treatment and prognosis were reconsidered.

[The hyperfunctional thyroid nodule]. / Nodulul tiroidian hiperfunctional.

Authors report their experience of 22 years regarding 284 patients with hyperfunctional thyroidal nodules (279 operated), representing 12.4% of the 2,289 cases of thyroidal (875 hyperthyroid) diseases treated during this period. The diagnosis was established on the basis of the confrontation of the anamnestic symptomatology and of that found at the clinical examination--which confirmed the pure character of thyrotoxicosis by showing the presence of a thyroidal nodule--with the study of the global glandular function and the scintigram, completed with dynamic tests. Among the typical clinical and scintigraphic, usually severe, forms (with cardiothyreosis) may be distinguished asymptomatic or atypical forms (with dissociated or intermittent manifestations). The treatment of the toxic thyroidal adenoma is surgical, except some contraindications of a general order. The surgical treatment is aimed at achieving the permanent cure of the disease, without sequelae or functional and/or morphological relapses. The subtotal lobectomy (210 cases) is preferred as an exeresis procedure to the enucleoresection (45 cases). In most operated cases (93%) the immediate clinical and biological results were favourable.

[Hyperthyroidism in the elderly. The clinical forms. The incidence of signs and symptoms. The evolutionary features]. / L'hyperthyroïdie chez les vieillards. Formes cliniques. Fréquence des signes et des symptómes. Particularités évolutives.

The last 15 years, 1939 patients suffering from different clinical forms of hyperthyroidism were hospitalised in the Clinic of Endocrinology of Iasi. The frequency of the disease increases with age, especially for the toxic nodular goitre. In older patients we have noted a non-typical clinical course of the disease, with prevailing cardiovascular signs and weight loss. The clinical course is also particular especially because of the associated pathology. We have made some theoretical considerations concerning the possible explanations of these phenomena.

[The "cold" thyroid nodule]. / Nodului tiroidian "rece".

The main problem posed by an (apparent) solitary thyroid nodule is cancer identification, present in about 10% of the nodules excised surgically. This percent might increase to 25-30% in the cold scintigraphic nodules. Therefore, a combination of all the methods for nodule assessment is necessary: anamnesis, physical examination, functional tests, therapeutic test with tyrosine and thyroid imaging, but mainly the intensive active exploration including puncture-biopsy with a fine needle and exeresis with extemporaneous and paraffin morphological checking. Starting from a two decades' experience of a group of endocrinologists, surgeons, anatomo-pathologists and specialists in nuclear medicine, in 2,289 thyropathies operated--of whom 1691 (poly)nodular goitres and 1,190 non-capturing nodules--the authors suggest an investigation algorithm for achieving a differentiated surgery in terms of the pre- and intraoperative morphological findings. This attitude permitted both the improvement of the surgeries of thyroid cancers and the exeresis of benign nodules under low-risk surgical conditions or avoidance of a "non-necessary" surgery.

[Cases of thyroid cancer irradiated at the Iasi Radiology-Oncology Clinic (1984-1988)]. / Comentariu la cazuistica de cancer tiroidian iradiat în Clinica radiologie-oncologie Iasi (1984-1988).

The study is based on 35 cases of thyroid cancer treated by external radiotherapy. The analysis of these cases and especially their grouping on clinical stages according to the recent TNM classification reveal the prognostic importance of such factors as the patients' age, histopathological form and the loco-regional and at distance spread.

[The incidence of conjugal sterility of endocrine origin]. / La fréquence de la stérilité conjugale d'origine endocrinienne.

During a 14-year interval, 27,000 patients were admitted to the Endocrinological Clinic of Iasi, of whom 337 (207 women and 130 men) for sterility. The endocrine disturbances that may induce sterility are reviewed.