Transit time flow measurement in off-pump surgery: is it a functional index of the biological graft integrity?

OBJECTIVE: Transit-time flow measurement (TTFM) represents a valid tool in the assessment of the quality of the anastomosis during coronary artery bypass graft (CABG). Nevertheless, a high variability limits its standardized use, lacking univocally accepted cut-off flow values. Our study analyzes TTFM data collected from a study population that underwent off-pump CABG (OP-CABG), with the aim to differentiate into subgroups according to the presence of diabetes mellitus. PATIENTS AND METHODS: Patients referred to the Cardiovascular Unit of S. Michele Hospital (Caserta, Italy) for coronary artery disease (CAD) and underwent OP-CABG between January 2015 and December 2019 were enrolled, and intraoperative TTFMs data were recruited and evaluated. Mean graft flow (MGF) and pulsatility index (PI) values were collected and analyzed. RESULTS: The study population was composed of 342 patients who underwent OP-CABG with TTFM data regarding 824 grafts. Diabetic patients shared a higher cardiovascular risk profile. The TTFM assessment showed better results for the use of the arterial grafts in diabetic patients, especially for those insulin-dependent; conversely, venous grafts showed worse data with lower MGF and higher PI values. In particular, the anastomoses of the saphenous vein graft with marginal obtuse (MO) coronary artery showed worse MGF results in the insulin-dependent rather than normoglycemic subgroup (28.66 vs. 38.44, p=0.003). CONCLUSIONS: Diabetic patients, especially in the insulin-dependent subgroups, have demonstrated lower MGF and higher PI values collected from venous anastomoses with, conversely, inverse results from the arterial one. These results might be correlated to an altered biological adaptability caused by the effects of the diabetic endocrine disorder.

Effects of alendronate on bone loss in pre- and postmenopausal hyperthyroid women treated with methimazole.

High levels of thyroid hormones accelerate bone turnover. The aim of the present study was to evaluate the effects of treatment with alendronate in patients affected by hyperthyroidism and osteoporosis. We studied 40 hyperthyroid patients with bone loss, divided into two groups according to menopausal state. Before treatment and after 6 and 12 months, serum thyroid hormones levels, serum osteocalcin level and bone mineral density were evaluated. In all patients we observed an increase in bone mineral density after treatment with alendronate, and a corresponding decrease in serum osteocalcin level.

Treatment of advanced medullary thyroid carcinoma with a combination of recombinant interferon alpha-2b and octreotide.

BACKGROUND: The medical treatment of advanced medullary thyroid carcinoma (MTC) is still questionable. Results of chemotherapy are disappointing with almost no curative responses, few partial responses, and many side-effects. A recent report has suggested the activity of combination recombinant interferon alpha-2b (rIFN-alpha-2b) and octreotide, a somatostatin analogue, in the treatment of a metastatic carcinoid tumor. This new therapeutic schedule may be used in other neuroendocrine tumors. In this study we evaluated the therapeutic effectiveness of octreotide and rIFN-alpha-2b in patients with advanced MTC. METHODS: Eight patients affected by advanced MTC received octreotide at a daily dose of 150 micrograms for 6 months and subsequently at a daily dose of 300 micrograms for another 6 months, subcutaneously, and rIFN-alpha-2b at a daily dose of 5.000.000 IU intramuscularly 3 times a week for 12 months. Plasma calcitonin, carcinoembryonic antigenic levels, and morphologic staging were evaluated at 0, 1, 3, 6, and 12 months. RESULTS: The therapy was stopped in two patients because of diarrhea and toxicity of drugs used. Pre-existing diarrhea in four patients and flushing in one significantly improved during treatment. A maximum decrease of calcitonin was reached after 1 month in 2 patients and after 3 months in 4. In all of the patients carcinoembryonic antigen levels decreased during treatment. No significant changes of size of metastases were observed. CONCLUSIONS: The combination of octreotide and interferon is well tolerated and can be recommended for the treatment of advanced MTC.

[Risk factors and prevention of thyroid carcinoma]. / Fattori di rischio e prevenzione del carcinoma della tiroide.

Thyroid carcinoma represents the most frequent endocrine tumor. Recent reports have documented an increase in the incidence of thyroid cancer. Its incidence varies geographically around the world from 0.9/ 100,000 men and 2.4/100,000 women in Great Britain to 8.8/100,000 men and 18.2/ 100,000 women in Hawaii. Radiation exposure has been strongly implicated as an aetiological factor. The greatest risk occurs with acute exposure to X and/or gamma rays, with a linear dose response curve, while the risk is inversely related to age at exposure with a latent period of 5-20 years. Together with irradiation, other factors (iodine, alcohol and calcium diet intake, hyperthyroidism, Hashi-moto's thyroiditis, Gardner syndrome, Cowden syndrome, pharmaceutical agents, hormonal factors, occupational exposure, activation of cellular oncogenes) have been associated with the risk of thyroid cancer. In prevention a policy should include regulations and methods for avoiding radiation exposure of the thyroid and for preventing nutritional deficiency and excess of iodine. Besides, early and continuous suppressive therapy of all patients affected by non-toxic goiter or treated previously with thyroidectomy, and a screening of medullary thyroid carcinoma (MTC) using pentagastrin stimulation test and restriction fragment length polymorphism analysis, in subjects with a familial history of MTC, are of paramount importance to prevent thyroid cancer.