A cutoff thyroglobulin value suggestive of distant metastases in differentiated thyroid cancer patients.

Serum thyroglobulin is used as part of the early postoperative assessment of differentiated thyroid cancer (DTC) since there is a clear relationship between an increased risk of recurrence and persistent disease after initial treatment and high postoperative stimulated thyroglobulin (ps-Tg) values. Thus, although ps-Tg above 10-30 ng/mL is considered an independent predictor of worse prognosis, the value that is associated with distant metastases is not defined. Thus, this was our objective. We selected 655 DTC patients from a nuclear medicine department database (Irmandade Santa Casa de Misericórdia de São Paulo, Brazil). All patients had received total thyroidectomy and radioactive iodine (RAI) therapy and had ps-Tg values higher than 10 ng/mL with negative anti-thyroglobulin antibodies. Then, we selected patients who presented post-therapy whole-body scan with pulmonary and/or bone uptake but with no mediastinum or cervical uptake. Patients with negative findings on functional imaging or any doubt on lung/bone uptake were submitted to additional exams to exclude another non-thyroid tumor. Of the 655 patients, 14.3% had pulmonary and 4.4% bone metastases. There was a significant difference in ps-Tg levels between patients with and without metastases (P<0.001). The cutoff value of ps-Tg was 117.5 ng/mL (sensitivity: 70.2%; specificity: 71.7%) for those with lung metastasis, and 150.5 ng/mL (sensitivity: 79.3%; specificity: 85%) for those with bone metastasis. The cutoff value for patients with eitherpulmonary or bone metastasis was 117.5 ng/mL (sensitivity: 70.2%; specificity: 83.7%). Our findings demonstrated that ps-Tg could predict distant metastasis in DTC patients. We identified a cutoff of 117.5 ng/mL with a high negative predictive value of 93.7%.

A cutoff thyroglobulin value suggestive of distant metastases in differentiated thyroid cancer patients

Serum thyroglobulin is used as part of the early postoperative assessment of differentiated thyroid cancer (DTC) since there is a clear relationship between an increased risk of recurrence and persistent disease after initial treatment and high postoperative stimulated thyroglobulin (ps-Tg) values. Thus, although ps-Tg above 10-30 ng/mL is considered an independent predictor of worse prognosis, the value that is associated with distant metastases is not defined. Thus, this was our objective. We selected 655 DTC patients from a nuclear medicine department database (Irmandade Santa Casa de Misericórdia de São Paulo, Brazil). All patients had received total thyroidectomy and radioactive iodine (RAI) therapy and had ps-Tg values higher than 10 ng/mL with negative anti-thyroglobulin antibodies. Then, we selected patients who presented post-therapy whole-body scan with pulmonary and/or bone uptake but with no mediastinum or cervical uptake. Patients with negative findings on functional imaging or any doubt on lung/bone uptake were submitted to additional exams to exclude another non-thyroid tumor. Of the 655 patients, 14.3% had pulmonary and 4.4% bone metastases. There was a significant difference in ps-Tg levels between patients with and without metastases (P<0.001). The cutoff value of ps-Tg was 117.5 ng/mL (sensitivity: 70.2%; specificity: 71.7%) for those with lung metastasis, and 150.5 ng/mL (sensitivity: 79.3%; specificity: 85%) for those with bone metastasis. The cutoff value for patients with eitherpulmonary or bone metastasis was 117.5 ng/mL (sensitivity: 70.2%; specificity: 83.7%). Our findings demonstrated that ps-Tg could predict distant metastasis in DTC patients. We identified a cutoff of 117.5 ng/mL with a high negative predictive value of 93.7%.

[Basedow-Graves' disease: analysis of various parameters in the prognosis of remission after clinical treatment]. / Doença de Basedow-Graves: análise de diferentes parâmetros na previsão de remissão após tratamento clínico.

Fifty patients with Graves' disease were evaluated in relation to their outcome following medical treatment: goiter size, T3/T4 ratio, TSH and TSAb plasma levels were studied. Patients were followed for 8-20 months of medical treatment with PTU and 24-36 months thereafter. Thirty patients were eliminated for abandoning treatment (50%) or due to PTU side-effects (10%). The 20 patients remaining presented similar remission/relapse rates regardless of their T3/T4 ratio, greater than 20 (21% vs. 79%) or less than 20 (16% vs. 84%). Patients with TSH levels greater than 0.10 uU/ml immediately after PTU withdrawal presented a slight increase of remission rate (30% vs. 10%). Patients with goiter size greater than 60 cm3 at the beginning of medical treatment presented a remission rate of 8%, while those with goiters less than or equal to 60 cm3 showed a remission rate of 50%. Finally, normalization of TSAb levels (less than 15%) occurred at a remission rate of 100%, while all patients who did not achieve this goal relapsed shortly after PTU withdrawal. Based on these results, the authors conclude that the determination of TSAb levels is a reliable parameter of predict remission of Graves' disease following medical treatment.

Insulinoma: consideracoes sobre os aspectos clinicos e cirurgicos. / Insulinoma: considerations on clinical and surgical aspects

E apresentado um caso de insulinoma em doente idosa, com historia de dez anos de evolucao. O diagnostico clinico foi confirmado pela determinacao da relacao insulina/glicemia de jejum, ultrasonografia e tomografia computadorizada. O tumor era grande, localizado na regiao cefalica do pancreas, tendo sido enucleado. Sao discutidos os diferentes aspectos clinicos e cirurgicos dos tumores pancreaticos produtores de insulina

Conversao de tiroxina (T4) em 3,5,3'triiodotironina (T3) e 3,3',5-triiodotironina (reverso T3) em suspensoes de leucocitos humanos. Estudo nos estados de hiper e hipotiroidismo. / Thyroxine (T4) to 3,5,3'-triiodothyronine (T3) and 3,3',5-triiodothyronine (reserve T3) conversion in human leukocyte suspensions. Study in hyper and hypothyroidism states

O metabilismo periferico dos hormonios tiroidianos foi estudado em suspensoes de leucocitos humanos, determinando-se, por radioimunoensaio, agestao in vitro de T3 e rT3 a partir de T4 nao radioativo. Pode-se evidenciar, nas suspensoes de leucocitos provenientes de pacientes portadores de hipertiroidismo, maior geracao in vitro de T3 e rT3, enquanto que diminuicao significativa foi observada nos pacientes com hipotiroidismo. Essas alteracoes sao aparentemente devidas ao excesso e a falta de hormonios tiroidianos, respectivamente, ja que em ambos os casos elas puderam ser revertidas pelo tratamento clinico adequado

Resseccao de 80 porcento de jejuno-ileo e sua repercussao na histometria das celulas parietais do estomago e na secrecao do muco gastrico. / Resection of 80 percent of the jejuno-ileum and its repercussion in the histometry of stomach parietal cells and gastric juice secretion

Apos reseccoes intestinais extensas, tem sido descrito aumento da secrecao acida do estomago. Neste trabalho foi estudado a histometria das celulas parietais do estomago e o muco gastrico apos resseccao de 80% de jejuno-ileo, em ratos. Com 60 e 90 dias de operados, os animais apresentaram aumento significativo do numero medio de celulas parietais, nao havendo, no entanto alteracao significativa do muco gastrico

Resseccoes intestinais extensas e nutricao parenteral / Extensive intestinal resections and parenteral nutrition

A nutricao parenteral total modificou o prognostico e a avolucao de doentes submetidos a extensas resseccoes intestinais.Neste trabalho de 31 grandes enterectomizados, 18 necessitaram do emprego da nutricao endovenosa, hospitalar, domiciliar ou temporaria, por periodo prolongado. A alta mortalidade (77,4% ) destaca a gravidade do sindrome do intestino curto. Sao discutidos as indicacoes e o importante papel da nutricao parenteral na recuperacao destes doentes

Aspectos nutricionais do politraumatizado. / Nutritional aspects of the multiple trauma patient

No atendimento do doente traumatizado, uma vez superada a fase inicial e estabilizadas as condicoes cardio-circulatorias e hemodinamicas, os cuidados de ordem nutricional devem receber atencao especial. A deficiencia proteico-calorica pode surgir ou ser agravada na evolucao do politraumatizado e esta intimamente relacionada ao prognostico. Neste artigo sao discutidos diferentes aspectos nutricionais do trauma, as opcoes terapeuticas e suas indicacoes

Sobrevivencia prolongada apos resseccao intestinal extensa e nutricao parenteral domiciliar. / Prolonged survival after extensive intestinal resection and parenteral feeding at home

A nutricao parenteral domiciliar ou ambulatorial representa um grande avanco nas tecnicas de nutricao parenteral endovenosa. Ela tem permitido uma nutricao adequada a um limitado numero de doentes, provisoria ou definitivamente incapacitados de utilizarem a via digestiva normal. Os autores relatam um doente portador de sindrome do intestino curto e que se tem beneficiado desta terapeutica. Analisam aspectos relacionados a esta forma de suporte nutricional