Changes in quality of life after thyroidectomy in subjects with thyroid cancer in relation to the dose of levothyroxine.

PURPOSE: Previous studies demonstrated decreased quality of life (QoL) in differentiated thyroid cancer (DTC) survivors and suggested QoL variability related to time from thyroidectomy and levothyroxine dosage. The aims of this study were to evaluate QoL in thyroidectomized subjects in different levothyroxine states and to evaluate the association between TSH and thyroid hormones and QoL. METHODS: Prospective 5-year study enrolling 208 patients thyroidectomized for DTC, studied in one to four times according to levothyroxine dosage: withdrawal (WITHD), complete (C-SUPP) and mild TSH-suppression (M-SUPP), replacement (REPL). Each patient was allowed to participate into the study more than one time. A total of 300 evaluations were collected, consisting of detailed thyroid hormone profile and QoL assessment through the ThyPRO questionnaire. RESULTS: Comparing the four groups, significant differences were found for anxiety, impaired social and daily life and item 12 (overall impact of thyroid disease) domains (p < 0.05). Interestingly, C-SUPP subjects reported the best scores in almost all ThyPRO scales. Significant correlations were found between QoL and pituitary-thyroid axis function, as well as between QoL and gender, being females more affected. At multiple regression analyses fT3 demonstrated to be the best explanatory factor for overall impact of thyroid disease on the patient's life, followed by gender. CONCLUSIONS: TSH-suppressive doses of levothyroxine are more effective in improving QoL in DTC patients after thyroidectomy. These results confirm the urgent need of further studies aimed to define the best treatment of hypothyroidism, effective on well-being and harmless for patients.

Effect of Lactobacillus reuteri LRE02-Lactobacillus rhamnosus LR04 combination and gastrointestinal functional disorders in an Emergency Department pediatric population.

OBJECTIVE: Probiotics are living microorganisms that, when administered per os in adequate amounts, may confer a health benefit on the host by the regularization of an unbalanced gastroenteric microbiota. The objective of this study was to evaluate treatment effectiveness, safety, and palatability of a probiotic's combination (Lactobacillus reuteri LRE02-DSM 23878 and Lactobacillus rhamnosus LR04-DSM 16605) in a pediatric Emergency Department setting with functional gastrointestinal disorders. PATIENTS AND METHODS: Three groups were enrolled: children with functional abdominal pain; children with gastroenteritis; children with gas colic. Self-reporting sheets were delivered to each patient/parent after probiotics treatment. The primary outcome was to evaluate the evolution of clinical conditions in enrolled children. RESULTS: The outcomes showed a statistical difference among children treated with probiotics and those who did not. In the functional abdominal pain group, 58.2% of patients had a moderate symptoms improvement and 33.5% had a complete disappearance of symptoms, while in the gas colic group, 68.2% of the infants had a moderate improvement and 23.2% had a complete resolution. In the gastroenteritis group, stool consistency and number of evacuations improved in children who took probiotic administration as well. CONCLUSIONS: Probiotics therapy, at the recommended dosage of five drops per day for 15 days, is associated with symptoms improvement. Moreover, the use of probiotics led to a stool consistency's normalization in a shorter time, evaluated with BSS. A randomized trial is needed to confirm these results.

[Malignant fibrous histiocytoma of the penis]. / Malignes fibröses Histiozytom des Penis.

According to the most recent World Health Organization (WHO) guidelines a diagnosis of malignant fibrous histiocytoma (MFH) should be made only for lesions composed of tumor cells without evidence of a specific line of differentiation. This is therefore a diagnosis by exclusion which is why the name of undifferentiated high-grade pleomorphic sarcoma (UPS) should be preferred. Soft tissue sarcomas currently have an incidence in all body regions of approximately 20 cases per 1 million inhabitants per year. Soft tissue tumors of the penis represent approximately 5 % of all penile tumors and the incidence of penile sarcomas is estimated to be approximately 0.6-1 case per 100,000 patients. Only seven cases have so far been reported in the literature. This article describes the case of a 61-year-old Caucasian male who presented with a painless mass sited in the upper part of the corpus cavernosa. An incisional biopsy with a subsequent investigation using an extensive immunohistochemical panel were performed and a high-grade undifferentiated pleomorphic sarcoma or pleomorphic storiform MFH was diagnosed. In addition to the case report a literature review is presented to elaborate the discussion on the differential diagnoses of these kinds of lesions.

Cytomegalovirus and gastric cancer after renal transplantation: a possible interplay.

We herein have described a case of de novo gastric cancer in a renal transplant recipient with a concomitant diagnosis of gastrointestinal cytomegalovirus (CMV) disease. We hypothesize that CMV, through causing an imbalance between cell proliferation and cell death, functions as the causative agent for the progression of the gastric tumor in this case after gastric colonization. To the best of our knowledge, this is the second such case ever reported of such kind and may represent a platform for investigations aimed at understanding the possible interplay between CMV and gastric cancer.

Uterine tumors resembling ovarian sex cord tumors. A case report.

Uterine tumors resembling ovarian sex cord tumors (UTROSCT) are rare, usually benign, polypoid or nodular neoplasms which generally arise in the fourth to sixth decade of life. We report a case of a 74-year-old woman who presented with vaginal bleeding and remarkable uterine enlargement. Abdominal hysterectomy with bilateral salpingo-oophorectomy was performed and a diagnosis of UTROSCT was made. Immunohistochemistry is mandatory for a correct diagnosis and a panel of at least two markers of sex cord differentiation is recommended. Differential diagnoses include leiomyosarcoma, UTROSCT and ESTSCLE, mixed müllerian tumor and metastatic ovarian sex cord tumor.

A rare case of colic thrombotic microangiopathy in renal transplantation.

INTRODUCTION: We report a case of thrombotic microangiopathy (TM) in patient with UC and kidney transplantation. CASE REPORT: A 59-year-old Caucasian may with a renal transplant, with atrial fibrillation and ulcerative colitis (UC), was referred for asthenia, fever (38 degrees C), anemia, colicky pain, and bloody diarrhea. The maintenance therapy consisted of CSA, sodium mycophenolate, steroids, ticlopidine, and mesalazine. Laboratory data, colonscopy, and colic mucosal biopsy revealed de novo colic TM. We administered antibiotics and antishock therapy, reducing CSA, withdrawing ticlopedine and maintaining mesalazine with the resolution of the problem. CONCLUSION: Posttransplantation TM is an uncommon but severe complication of kidney transplantation associated with reduced graft survival and a high risk for death. Only an early, accurate diagnosis with optimal treatment permits resolution of the problem.

Determination of sugar compounds in olive plant extracts by anion-exchange chromatography with pulsed amperometric detection.

We describe a chromatographic method that uses isocratic elution and pulsed amperometric detection to determine soluble carbohydrates in plant tissues. Such a method provides a rapid and convenient means to obtain a complete profile of the sugar components of leaves and roots from olive (Olea europaea L. cv. Coratina) plants. A simple purification of plant extracts using pure water was developed, which is far less time-consuming and retains a high level of accuracy. Excellent separation of myo-inositol, galactinol, mannitol, galactose, glucose, fructose, sucrose, raffinose, and stachyose was achieved with an anion-exchange column and 12 mM NaOH spiked with 1 mM barium acetate as an eluent. At a flow rate of 1.0 mL/min, the time of analysis was less than 25 min, and repeatability of the method on the order of 2.2% as RSD or better for retention times and lower than 5.2% for peak areas. Recoveries approximated 100% (range 97.2-104.5%), and the method provided good precision with a coefficient of variation which ranged between 0.9 and 3.3%. Among identified carbohydrates extracted from leaves and roots of olive plants, glucose and mannitol were major compounds. Their molar ratio was estimated to be 1.2+/-0.1 and 2.2+/-0.3 for olive leaves and roots, respectively. The occurrence of soluble galactinol in plant tissues was also validated.

Separation and Pulsed Amperometric Detection of Alditols and Carbohydrates by Anion-Exchange Chromatography Using Alkaline Mobile Phases Modified with Ba(II), Sr(II), and Ca(II) Ions.

The effect of some divalent nonelectroactive cations (DNCs) in the anion-exchange chromatographic separations with alkaline mobile phases of carbohydrates and alditols was investigated; the ions examined at a typical concentration of 1 mM were Ca(II), Ba(II), and Sr(II). The use of these cations in the eluent as their corresponding acetates or nitrates has been found to yield at least a two-fold effect. First, the peak symmetry and concurrently the column efficiency is greatly improved. Second, the presence of Ba(II) or Sr(II) significantly enhances the response of all analytes investigated in pulsed amperometry at a gold working electrode. The action of the DNCs on the separation seems to be related to a very effective removal of carbonate ion from the alkaline eluent and, especially, their ability to complex cyclic and acyclic polyhydroxy compounds. Efficiency estimated from data calculated at 10% of peak height can increase by as much as 25% with a comparably lower RSD (15%, n = 9). From the viewpoint of the separation efficiency and reproducibility of chromatographic data, all divalent inorganic ions employed were well-behaved. However, only the use of Ba(II) or Sr(II) is recommended since alkaline mobile phases containing Ca(II) ion negatively affect the gold electrode response of some analytes.

Steroid receptors in CNS: estradiol(ER) and progesterone(PR) receptors in human spinal cord tumors.

To investigate the role of steroid hormones in the occurrence and growth of human spinal cord tumors and to study the biochemical basis of the sex related difference in the incidence of the various spinal oncotypes, ER and PR have been measured in 24 human spinal cord tumors (12 neurinomas, 6 meningiomas, 5 ependymomas and 1 astrocytoma) by means of sodium thiocyanate exchange assay at low temperature and with dextran-coated charcoal method and R5020 for PR. Cytoplasmic and nuclear receptors have been evaluated. Neurinomas are the oncotypes which contained both ER (usually in the nuclear fraction) adn PR: estradiol binding has been found only in one meningioma; ependymomas contained cytoplasmic ER and the astrocytoma had nuclear ER and cytoplasmic PR. The dissociation constant is in favour of a high affinity binding (Kd = 0.15 X 10(-9)M for ERc; Kd = 3.85 X 10(-9)M for ERn; Kd = 8.07 X 10(-9)M for PRc). The overall incidence of steroid receptors in the spinal oncotypes studied is higher in male than in female patients (63.64 vs 46.15% for ER and 100 vs 71.43% for PR). Further studies on a greater number of patients will help to define the correlation between different spinal oncotypes and steroid receptors as well as the possibility of an endocrine therapy as adjuvant treatment for selected patients.

Steroid receptors in the pathogenesis of chronic subdural hematoma.

Chronic subdural hematoma (CSDH), located between the dura mater and the arachnoid and usually characterized by a well-vascularized external capsule (HEM), has a higher incidence in male patients with elevated urinary estrogens than in female patients. In an attempt to increase our understanding of the physiopathogenesis of CSDH, total estrogen receptor (ER) was measured in HEM specimens from four male patients by a sodium thiocyanate exchange assay and cytosol progesterone receptor (PRc) in three specimens by a dextran-coated charcoal adsorption assay. Although no nuclear ER could be detected, ERc and PRc were found in all three specimens examined. The presence of ER in a mesenchymal tissue like HEM could suggest that, in addition to inducing vascular changes, estrogens might act directly on HEM through a receptor-mediated mechanism more pronounced in men than in women, whose vascular network is adapted to high estrogen values.

[Chromosome abnormalities in bone marrow cells and peripheral lymphocytes in a patient with Fanconi's anemia]. / Anormalità cromosomiche in cellule di midollo osseo e in linfociti periferici di una paziente con anemia di Fanconi.

In direct preparations of bone marrow cells from an 18 years old patient with Fanconi's anaemia (FA) a low frequency of structural chromosome aberrations was observed (4% excluding gaps), while in cultured bone marrow cells (48 hours) and in cultured peripheral lymphocytes such aberrations were found to be about 3 times as many. The increase of chromosome abnormalities "in vitro" is discussed and the most recent observations on possible factors determining susceptibility to chromosome breakage in cases with FA are taken into account.

Sister chromatid exchange distribution in bone marrow cell chromosomes from patients with refractory anemia.

Statistical analysis (chi2 test) of the interchromosomal distribution of sister chromatid exchanges in bone marrow cells from 3 patients with refractory anemia showed significant differences concerning chromosome 1. Analysis of intrachromosomal sister chromatid exchange distribution concerning chromosome 1 showed that a considerable number of sister chromatid exchanges is localized in the terminal segments of both chromosome arms.