[Efficacy of surgical treatment of medullary thyroid carcinoma in patients with regional and distant metastases].

Results of surgical treatment of 93 primary patients with medullary thyroid carcinoma within 1995-2009 years, including 26 (28%) - with hereditary disease (MEN2 syndrome) were analyzed. The best long-term results were observed in group of noninvasive tumor without metastases at the time of operation (39% - clinical and biochemical recovery, 32% - clinical remission). No one patient with extrathyroid tumor invasion and regional/distant metastases has completely recovered. Hereditary forms of disease are more aggressiveness in comparison with sporadic carcinomas with higher rate of distant metastases (31 and 21%) and worse survival. In sporadic group 3 (6%) patients and in hereditary group - 4 (12%) died from progression of distant metastases within 8-15 years after primary operation. Complete recovery was seen only after radical primary operations. Repeated surgery was palliative. Implementation of calcitonine screening and genetic testing for Ret-protooncogene mutation is an important task for Ukraine medicine to improve results of medullary carcinoma treatment.

["Incidental" thyroid carcinoma among patients in surgical treatment for nontumors thyroid desease].

Incidence of unexpected diagnosis of thyroid carcinoma among operations on benign thyroid surgical diseases (nodular goiter and Graves' disease) was studied in 608 patients within 2008-2009 years in specialized clinic of endocrine surgery. In 56 (9.2%) patients the "incidental" thyroid carcinoma including 43 (77%) - papillary microcarcinoma were diagnosed in histological investigations. In 10 (18%) patients which were performed within the first postoperative week. Repeated surgery demonstrates increased risk of complication (damage of parathyroid glands, recurrent laryngeal nerves and other anatomic structures of neck) considering less favoring conditions for secondary operations, it is worth to implement wider indications to frozen section, radical primary operation (total thyroidectomy at multi-nodular bilateral goiter and Graves' disease), and also maximal complete examination prior to surgery.

[Minimally invasive and endoscopic methods in surgical treatment of patients with primary hyperparathyroidism: advantages and limitations].

Results of surgical treatment of 212 patients with primary hyperparathyroidism (PHPT) within 2007-2009 years were analyzed. In 183 patients have been performed the conventional approach with revision of all 4 parathyroid glands, in 29- using minimally invasive methods (in 18 - endoscopic operations, in 11 - targeted operations through mini incision). Multi-glandular disease was observed in 5.2 % of all cases. Comparison of conventional and minimally invasive surgery demonstrates advantages of the endoscopic and targeted operations in cosmetic results and recovery time having the same rate of complications. The obligatory conditions for effective minimally invasive operations in patients with PHPT include undoubtful localisation of adenoma, diameter of tumor no more 3 cm, absence of thyroiditis, low risk of multiglandular disease, availability of quick parathyroid hormon assay (at least--one day result).

Assessment of left ventricular ejection fraction and regional wall motion with 64-slice multidetector CT: a comparison with two-dimensional transthoracic echocardiography.

The aim of this study was to compare the measurement of left ventricular ejection fraction (LVEF) and regional wall motion using 64-slice multidetector CT (MDCT) with that using two-dimensional transthoracic echocardiography (2D-TTE) in a heterogeneous patient population. In 126 patients with angina pectoris, acute myocardial infarction, chronic myocardial infarction, atypical chest pain without coronary artery disease or valvular heart disease, 64-slice MDCT was performed using retrospective electrocardiography gating without dose modulation. 20 phases of the cardiac cycle were analysed to identify the end-diastolic and end-systolic phases and to assess regional LV wall motion. For these measurements, 2D-TTE served as the reference standard. MDCT and 2D-TTE were performed within 10 days of each other. An excellent correlation between MDCT and 2D-TTE was shown for the evaluation of LVEF (59.2+/-11% vs 57.9+/-10%, respectively; r = 0.87). LVEF was slightly overestimated by MDCT, when compared with 2D-TTE, by an average of 1.4+/-5.6%. Good agreement was obtained between the use of the two techniques, with 94% of the segments scored identically on both modalities (kappa = 0.70). MDCT had a sensitivity of 97% and a specificity of 82% when compared with 2D-TTE as the reference standard. In conclusion, the use of 64-slice MDCT can provide comparable results to those using 2D-TTE for LVEF and regional wall motion assessment in a heterogeneous population.

MDCT findings of acute aortic dissection with diastolic prolapse of the intimal flap into the left ventricle.

Acute aortic regurgitation is frequently recognised in patients with Stanford Type A aortic dissection. However, diastolic prolapse of the aortic intimal flap into the left ventricle can cause aortic regurgitation in rare cases. Here is presented an image report of severe aortic regurgitation that was secondary to the back-and-forth intimal flap movement of acute Type A aortic dissection by the use of transthoracic echocardiography and multidetector row CT.

Atypical radiological manifestations of pulmonary Langerhans cell histiocytosis in a 12-year-old girl.

Pulmonary Langerhans cell histiocytosis is a rare pulmonary disease that typically affects cigarette smokers from 30-40 years of age onwards. It is very rare in children, especially for those under 15 years of age. We report an atypical radiological manifestation of isolated pulmonary Langerhans cell histiocytosis in a 12-year-old girl that showed multifocal consolidation and multiple small nodules on an initial chest radiograph, and gradual fibrotic change with multiple cysts on follow-up chest radiographs and CT scans.

[Differentiated thyroid cancer in the Ukraine: clinical experience with treatment of 2000 patients and current world-wide tendencies].

Principal moments of recent (2006) European and USA consensus for the management of patients with differentiated thyroid cancer (DTC) are described. The situation with treatment of DTC patients in the Ukrain was analyzed. It was established that preoperative cytological investigation and express-biopsy should be possible and reliable as well as adequate primary surgery. The absence of full concordance of the Ukranean and European modes of management of DTC patients was established. To improve the situation more radical primary surgery, routine use of radioiodine ablation in high and low risk groups, elimination of radiological and laboratory limitations are strongly recommended.

Differential item functioning of the Geriatric Depression Scale in an Asian population.

BACKGROUND: The Geriatric Depression Scale (GDS) is widely used for screening and assessment of major depressive disorder (MDD). Screening scales are often culture-specific and should be evaluated for item response bias (synonymously differential item functioning, DIF) before use in clinical practice and research in a different population. In this study, we examined DIF associated with age, gender, ethnicity and chronic illness in a heterogeneous Asian population in Singapore. METHODS: The GDS-15 and Structured Clinical Interview for DSM-IV diagnosis of MDD were independently administered by interviewers on 4253 non-institutionalized community living elderly subjects aged 60 years and above who were users of social service agencies. Multiple Indicator Multiple Cause latent variable modelling was used to identify DIF. RESULTS: We found evidence of significant DIF associated with age, gender, ethnicity and chronic illness for 8 items: dropped many activities and interests, afraid something bad is going to happen, prefer staying home to going out, more problems with memory than most, think it is (not) wonderful to be alive, feel pretty worthless, feel (not) full of energy, feel that situation is hopeless. LIMITATIONS: The smaller number of minority Indian and Malay subjects and the self-report of chronic medical illnesses. CONCLUSIONS: In a heterogeneous mix of respondents in Singapore, eight items of the GDS-15 showed DIF for age, gender, ethnicity and chronic illness. The awareness and identification of DIF in the GDS-15 provides a rational basis for its use in diverse population groups and guiding the derivation of abbreviated scales.

Posterior mediastinal dumbbell ganglioneuroma with fatty replacement.

We report a case of a posterior mediastinal dumbbell ganglioneuroma with fatty replacement on CT and MRI. Most dumbbell tumours are neurogenic in origin. Fatty replacement of non-lipomatous malignancies is rare. This report suggests that a ganglioneuroma with fatty replacement should be added to the differential diagnosis of fat-containing posterior mediastinal tumours.

Multidetector-row CT coronary angiographic finding of myocardial bridging.

Myocardial bridging is caused by muscles overlying the intramyocardial course of an epicardial coronary artery. It is a congenital anomaly characterized by systolic compression of the tunnelled segment, commonly affecting the mid-portion of the left anterior descending coronary artery. The authors report two cases of myocardial bridging using electrocardiogram-gated multidetector-row CT coronary angiography as a reliable and non-invasive imaging technique.

Spontaneous rupture of the left common iliac vein associated with May Thurner syndrome: successful management with surgery and placement of an endovascular stent.

We report a case of spontaneous rupture of the left common iliac vein diagnosed pre-operatively with CT and successfully treated with surgery and placement of a stent. A 60-year-old woman was referred to our emergency room because of a sudden left lower abdominal pain and swelling of the left lower extremity. CT revealed a huge retroperitoneal haematoma and extrinsic compression of the left common iliac vein with acute thrombosis of deep veins of the left lower extremity. Venous patch angioplasty was performed at the site of spontaneous rupture. After thrombectomy with use of a Forgaty catheter, a stent was placed at the occluded segment of the left common iliac vein under the C-arm fluroscopic guidance. Follow-up CT 10 days and 8 months after initial examination demonstrated a venous stent with preserved luminal patency and striking resolution of deep vein thrombosis of the left lower extremity.

Calcified endobronchial leiomyoma.

We report a case of calcified endobronchial leiomyoma in the left main bronchus. Leiomyoma of the airways is a rare benign tumour, usually described as a solitary lesion and located in the membranous portion of the lower third of the trachea and rarely in the bronchi. Chest CT showed a well-defined, calcified, polypoid endobronchial mass with a broad stalk in the left main bronchus.

[Potentialities of laparoscopic adrenalectomy in treatment of patients with adrenal tumors].

Experiences with laparoscopic adrenalectomies in the clinic were analyzed. The laparoscopic method was used in 47 out of 252 adrenalectomies followed by only 1 mild complication and 3 conversions. A comparison of open and laparoscopic adrenalectomies has revealed advantages of the endoscopic method with respect of tolerance of the procedure, its safety and duration of the rehabilitation period. The technique and indications to adranalectomy were analyzed. The authors emphasize the advantages of the transperitoneal approach and good perspectives of laparoscopic adrenalectomy in almost all cases of benign and non-invasive adrenal tumors.

Myocardial enhancement pattern in patients with acute myocardial infarction on two-phase contrast-enhanced ECG-gated multidetector-row computed tomography.

AIM: To evaluate the myocardial enhancement pattern of the left ventricle on two-phase contrast-enhanced electrocardiogram (ECG)-gated multidetector computed tomography (MDCT) images in patients with acute myocardial infarction (AMI). METHODS: Two-phase contrast-enhanced ECG-gated MDCT examinations were performed in 16 patients with AMI. The presence, location and pattern of myocardial enhancement were evaluated. MDCT findings were compared with the catheter angiographic results. RESULTS: Subendocardial (n = 9) or transmural (n = 6) area of early perfusion defects of the myocardium was detected in 15 of 16 patients (94%) on early-phase CT images. Variable delayed myocardial enhancement patterns on late-phase CT images were observed in 12 patients (75%): (1) subendocardial residual perfusion defect and subepicardial late enhancement (n = 6); (2) transmural late enhancement (n = 1); (3) isolated subendocardial late enhancement (n=1); and (4) isolated subendocardial residual perfusion defect (n = 2). On catheter angiography, 14 of 15 corresponding coronary arteries showed significant stenosis. CONCLUSION: Variable abnormal myocardial enhancement pattern was seen on two-phase, contrast-enhanced ECG-gated MDCT in patients with AMI. Assessment of myocardial attenuation on CT angiography gives additional information of the location and extent of infarction.

[Surgical treatment of sporadic and radiation-induced thyroid cancer in young patients]. / Khirurgicheskoe lechenie sporadicheskogo i radioindutsirovannogo raka shchitovidnoi zhelezy u liudei molodogo vozrasta.

An analysis of results of treatment of sporadic thyroid cancer in 68 children and juveniles and in 119 adult patients with radio-induced carcinomas irradiated in childhood after the Chernobyl APS accident in 1986 has revealed that the sporadic thyroid cancer in children and adults with radio-induced carcinomas are highly aggressive. For all this, radio-induced carcinomas are known to have aggressive local growth that in most cases required extended operations. The surgical treatment of carcinomas allows to get survival of the absolute majority of the patients.

[Analysis of efficacy of complex treatment of patients with differentiated forms of the thyroid gland cancer using distant radiation therapy]. / Analiz éffektivnosti kompleksnogo lecheniia bol'nykh s differentsirovannymi formami raka shchitovidnoi zhelezy s ispol'zovaniem distantsionnoi luchevoi terapii.

Retrospective analysis of efficacy of complex treatment, including surgical intervention, radioiodine therapy (RITH), suppressive hormonotherapy of differentiated forms of the thyroid gland cancer (DFTHGC) was done in 281 patients with positive effect of postoperative distant radiation therapy (PDRTH) application as a component of the treatment. Positive effect of therapy was estimated basing on the dynamic scintigraphy data with 131I and determination of thyroglobulin level in blood serum. The PDRTH conduction does not improve prognosis of the disease, does not lower the tumor metastasizing frequency to regional lymph nodes and remote organs and does not replace RITH. To achieve positive result in 12.8% of patients with PDRTH more than two courses of RITH were performed, enhancing so the total radiation dosage on the organism. To provide protracted nonrecurrent survival of patients with DFTHGC the radical approach is necessary, envisaging performance of thyroidectomy, the timely conduction of RITH with subsequent suppressive therapy using L-thyroxin.

[Surgical treatment of multinodular goiter in iodine deficiency states]. / Khirurgichne likuvannia bagatovuzlovykh form zoba pry iodoefitsytnomu stani.

Data are submitted from the analysis of factors of the pathogenesis of multinodular non-toxic goiter in 380 persons. Of these, 256 underwent surgery. An apparent iodine deficiency in the body (in two thirds of patients) has been found out to be an important cause of development, progression and recurrence of goiter. Only 5 to 14 percent of patients, predominantly those presenting with recurrent goiter, demonstrated an elevated level of thyrotrophin. More commonly seen in these patients is inherited predisposition to goiter. The authors attach much value to urine iodine levels, and consider it mandatory that a correction of iodine deficiency be carried off with available drugs both during the conservative treatment and in recurrences.

Cloning of the Aspergillus niger pmrA gene, a homologue of yeast PMR1, and characterization of a pmrA null mutant.

The pmrA gene, a yeast PMR1 homologue, was isolated from Aspergillus niger. Sequence analysis of the pmrA cDNA and the genomic DNA revealed that two introns exist in the coding region, and that an open reading frame in the cDNA encodes a polypeptide of 1056 amino acids containing all the conserved regions present in P-type Ca2+-ATPases. The predicted pmrA protein exhibited a high degree of sequence similarity to the Pmr1 proteins from yeasts and mammalians (50-59% identity). The expression of the pmrA cDNA partially restored the growth defect of Yarrowia lipolytica pmr1 null mutant on EGTA-containing medium. This indicates that the A. niger pmrA gene encodes a functional homologue of the yeast P-type Ca2+-ATPase involved in the secretory pathway. An A. niger pmrA null mutant exhibited growth retardation on EGTA-containing medium and the growth defect was overcome by adding Ca2+ or Mn2+ into the medium. This suggests an involvement of the pmrA protein in Ca2+ and Mn2+ homeostasis in A. niger.