Comparison of platelet rich plasma versus fibrin glue on colonic anastomoses in rats.

PURPOSE: To compare platelet rich plasma (PRP) and fibrin glue about the effect of anastomotic healing. METHODS: Thirty six Wistar-Albino male rats diveded into 3 groups according to control(Group1), PRP (Group 2) and fibrin glue(Tisseel VH) (Group 3). The colon was transected with scissor and subsequently an end to end anastomosis was performed using continuous one layer 6/0 vicryl sutures. Postoperative 7th day effect of anastomotic healing measuring with tissue hydroxyproline(TH) level and anastomotic bursting pressure(ABP); moreover comparison of cytokine (IL-6 and IL-10) and procalcitonin levels on 1st,3rd and 7th days. RESULTS: There was no statistically significant difference of the ABP and hydroxyproline levels between PRP and fibrin glue on the 7th day. There was no statistically significant difference between levels of proinflammatory cytokine (IL-6) (P=0.41), anti-inflammatory cytokine (IL-10) (P=0.35), and procalcitonin levels (P=0.63) on 1, 3 and 7 days. CONCLUSION: Fibrin glue and platelet rich plasma are shown to be effective in healing intestinal anastomoses without superior to each other.

Comparison of platelet rich plasma versus fibrin glue on colonic anastomoses in rats

Abstract Purpose: To compare platelet rich plasma (PRP) and fibrin glue about the effect of anastomotic healing. Methods: Thirty six Wistar-Albino male rats diveded into 3 groups according to control(Group1), PRP (Group 2) and fibrin glue(Tisseel VH) (Group 3). The colon was transected with scissor and subsequently an end to end anastomosis was performed using continuous one layer 6/0 vicryl sutures. Postoperative 7th day effect of anastomotic healing measuring with tissue hydroxyproline(TH) level and anastomotic bursting pressure(ABP); moreover comparison of cytokine (IL-6 and IL-10) and procalcitonin levels on 1st,3rd and 7th days. Results: There was no statistically significant difference of the ABP and hydroxyproline levels between PRP and fibrin glue on the 7th day. There was no statistically significant difference between levels of proinflammatory cytokine (IL-6) (P=0.41), anti-inflammatory cytokine (IL-10) (P=0.35), and procalcitonin levels (P=0.63) on 1, 3 and 7 days. Conclusion: Fibrin glue and platelet rich plasma are shown to be effective in healing intestinal anastomoses without superior to each other.

Do we need new trials of procalcitonin-guided antibiotic therapy?

Using biomarkers as a guide to tailor the duration of antibiotic treatment in respiratory infections is an attractive hypothesis assessed in several studies. Recent work aiming to summarize the evidence assessed the effect of a procalcitonin (PCT)-guided antibiotic treatment on outcomes in acute lower respiratory tract infections (LRTI), suggesting that significant reductions in antibiotic duration occur when using a PCT-guided algorithm. However, controversial evidence also suggested PCT-guided algorithms were associated with increased antibiotic duration and increased incidence of Clostridium difficile, without any impact on mortality, in real-world settings. So, although using PCT-guided antibiotic stewardship is promising, after more than a decade of randomized controlled trials on this topic the evidence in its favor is still less than compelling due to limitations in trial design, not taking into consideration fundamental aspects of PCT biology, and the absence of evidence-based antimicrobial duration in intervention and control groups. In this commentary we highlight some questions and limitations of primary PCT study data that might impact interpretation and clinical use of PCT at the bedside.

Evaluación del paciente adulto con fiebre sin foco clínico evidente en la unidad de emergencia / Evaluation adult patient with fever without source in the emergency department

La fiebre es un motivo de consulta frecuente en los servicios de urgencia (SU), concentrando el 4,4 por ciento a 7,5 por ciento de las consultas. La evaluación del paciente adulto con fiebre en el servicio de urgencias siempre es un desafío. Aunque la condición subyacente que ocasiona los síntomas puede variar considerablemente, se requiere una aproximación diagnóstica sistematizada, identificando las categorías de riesgo y diferenciando las causas infecciosas que requieren tratamiento antimicrobiano. A pesar de ser un motivo de consulta frecuente no existe un manejo médico estandarizado. El amplio espectro de presentaciones puede ir desde pacientes graves y comprometidos, a pacientes de buen aspecto general febriles, siendo estos últimos donde la estratificación de riesgo es fundamental, reconociendo las poblaciones de riesgo elevado (inmunocomprometidos, embarazadas y el adulto mayor) que pueden tener infecciones graves y complicaciones asociadas serias. En el adulto joven febril sin foco evidente y sin factores de riesgo, se mantiene la discusión si existe algún marcador que por sí solo permita estratificar el riesgo en este grupo. En este contexto, ni el hemograma ni los biomarcadores de inflamación sistémica como la proteína C reactiva y la procalcitonina sérica han demostrado claros beneficios a favor de su uso. La implementación de un protocolo estandarizado basado en la evidencia en la evaluación y tratamiento del paciente adulto febril sin foco clínico evidente nos permitiría optimizar el uso de los recursos de salud y racionalizar el uso de antimicrobianos.

Febrile illness is one of the most frequent causes of attendance at emergency departments (EDs) worldwide, accounting for 4.4 to 7.5 percent of all ED consultation. The evaluation of adult patients with fever in the emergency department is always a challenge. Although the underlying conditions causing the symptom of fever vary considerably, it requires a systematic approach regardless of the underlying condition, concentrating upon a primary division between bacterial infections and other conditions and subsequent risk stratification, often using the same parameters. Despite being a frequent complaint there is no a standard medical management. The broad spectrum of presentations can range from serious and committed patients to patients in good general appearance with fever, the latter being where risk stratification is essential, recognizing high-risk populations (immunocompromised, pregnant women and the elderly) who may have infections and more serious complications. In the young adult patient, fever without apparent focus, with no risk factors, there is still debate as to whether there is a marker that allows itself to stratify risk in this group. In this context, the blood cell count and biomarkers of systemic inflammation such as C-reactive protein and procalcitonin have not shown clear results in favor of its use. The implementation of a standardized protocol based on the evidence in the assessment and treatment of febrile adult patients without clinically apparent focus allow us to optimize the use of health resources and rational antimicrobials use.

Diagnóstico clínico e laboratorial do hiperparatiroidismo secundário / Clinical and laboratory diagnoses of secondary hyperparathyroidism

O hiperparatiroidismo secundário (HPTS), observado nos doentes urémicos, apesar de se instalar desde estadios precoces da insuficiência renal,apresenta manifestações clínicas pouco específicas e frequentemente tardias. Para além da promissora técnica de avaliação da arquitectura trabecularóssea por tomografia quantitativa microcomputorizada os métodos imagiológicos são de escassa utilidade no diagnóstico das alterações ósseasassociadas ao HPTS. Ao longo dos últimos anos foram avaliados diversos marcadores bioquímicos da remodelação óssea e a respectiva utilidade nodiagnóstico não invasivo da osteodistrofia renal. Finalmente, é ainda discutido o eventual papel de factores locais (citoquinas e factores de crescimento) na modulação da remodelação óssea.

Secondary hyperparathyroidism represents one extreme of the spectrum of the bone and endocrine changes observed in uraemic patients, and may develop since early stages of renal failure. The clinical symptoms and signs are non-specific and the contribution of image evaluation in the diagnosis of secondary hyperparathyroidism is, frequently, misleading. In this review, in addition to the classic modulators of bone remodeling, like parathyroid hormone (and PTHfragments), calcitriol and calcitonin, the role of others local factors involved in osteoblast and osteoclast activation, like cytokines and growth factors, is alsodiscussed.

Toward an operative diagnosis in sepsis: a latent class approach.

BACKGROUND: Recent data have suggested that 18 million of new sepsis cases occur each year worldwide, with a mortality rate of almost 30%. There is not consensus on the clinical definition of sepsis and, because of lack of training or simply unawareness, clinicians often miss or delay this diagnosis. This is especially worrying; since there is strong evidence supporting that early treatment is associated with greater clinical success. There are some difficulties for sepsis diagnosis such as the lack of an appropriate gold standard to identify this clinical condition. This situation has hampered the assessment of the accuracy of clinical signs and biomarkers to diagnose sepsis. METHODS/DESIGN: Cross-sectional study to determine the operative characteristics of three biological markers of inflammation and coagulation (D-dimer, C-reactive protein and Procalcitonin) as diagnostic tests for sepsis, in patients admitted to hospital care with a presumptive infection as main diagnosis. DISCUSSION: There are alternative techniques that have been used to assess the accuracy of tests without gold standards, and they have been widely used in clinical disciplines such as psychiatry, even though they have not been tested in sepsis diagnosis. Considering the main importance of diagnosis as early as possible, we propose a latent class analysis to evaluate the accuracy of three biomarkers to diagnose sepsis.

[Mucoepidermoid carcinoma of the thyroid: a case report and literature review]. / Carcinoma mucoepidermóide de tireóide: relato de caso e revisão da literatura.

The mucoepidermoid carcinoma is a neoplasia that usually occurs at salivary glands, breast, pancreas and gastrointestinal tract. The primary occurrence on thyroid gland is rare and only 33 cases were previously published. Although the majority of cases of mucoepidermoid carcinoma of the thyroid (MECT) show a benign evolution, this paper describes a patient with an aggressive tumor. A literature review over clinical, histopathological, immunohistochemical features and histogenetic origin was discussed.

Carcinoma mucoepidermóide de tireóide: relato de caso e revisão da literatura / Mucoepidermoid carcinoma of the thyroid: a case report and literature review / Mucoepidermoid carcinoma of the thyroid: a case report and literature review

O carcinoma mucoepidermóide é um tipo de neoplasia encontrada geralmente nas glândulas salivares, mamas, pâncreas e trato digestivo. O acometimento primário da glândula tireóide é muito raro, apenas 33 casos na literatura. Embora a maioria dos casos de carcinoma mucoepidermóide de tireóide (CMET) tenha evolução favorável, o caso clínico relatado descreve uma paciente com tumor agressivo e, a partir deste relato, é apresentada revisão da literatura quanto aos aspectos clínico, histopatológico, imunohistoquímico e origem histogenética dessa neoplasia.

The mucoepidermoid carcinoma is a neoplasia that usually occurs at salivary glands, breast, pancreas and gastrointestinal tract. The primary occurrence on thyroid gland is rare and only 33 cases were previously published. Although the majority of cases of mucoepidermoid carcinoma of the thyroid (MECT) show a benign evolution, this paper describes a patient with an aggressive tumor. A literature review over clinical, histopathological, imunohistochemical features and histogenetic origin was discussed.

Calcitonina pleural – Resultados preliminares e perspectivas / Pleural calcitonin - Preliminary results and future

Introdução: a calcitonina é um hormônio polipeptídico cuja secreção é originária, principalmente, das células C ou parafoliculares tiroideanas. Níveis elevados ocorrem em pacientes com doença não malígna do pulmão e nas seguintes doenças malignas: câncer de mama, carcinóide, hepatoma, hipernefroma, câncer de pulmão, gastrinoma, tumores gastrointestinais e o carcinoma medular da tireóide. O objetivo do presente estudo foi avaliar a utilidade diagnóstica da calcitonina, dosada no líquido pleural, como marcador tumoral para o diagnóstico diferencial na síndrome do derrame pleural. Pacientes e Método: três líquidos pleurais, provenientes de três pacientes, com causas de síndrome do derrame pleural confirmada. Radioimunoensaio, tendo iodo como marcador, foi utilizado para dosagem de calcitonina pleural (CALC-L). Resultados: os níveis encontrados para CALC-L em pacientes com derrame pleural parapneumônico complicado, carcinoma brônquico de células não pequenas e adenocarcinoma pleural foram 68pg/mL, 89pg/mL e 46pg/mL respectivamente. O valor normal no soro varia de 23 e 71pg/mL. Conclusão: ainda não foi possível calcular o rendimento da CALC-L para diagnóstico diferencial na síndrome do derrame pleural. O valor de referência no líquido pleural ainda não pode ser estabelecido

Pró-calcitonina e proteína C reativa em processos infecciosos graves / Procalcitonin and C-reactive protein in septic patients

Marcadores bioquímicos da resposta inflamatória são necessários para a obtenção de evidências objetivas da existência de processos infecciosos. A proteína C reativa (PCR) tem sido utilizada para essa finalidade, com baixa especificidade. A pró-calcitonina (PCT) foi proposta como marcador mais específico, mas seu valor prognóstico ainda não está bem estabelecido. Avaliamos qual desses marcadores teria maior poder em prever a evolução clínica de pacientes com sepse. Dosamos PCT e PCR no soro de 19 pacientes internados na unidade de tratamento intensivo do Hospital São Paulo, na Escola Paulista de Medicina (EPM), a pró-calcitonina por ensaio imunoluminométrico (LUMItest PCT, Brahms Diagnostica GmbH, Berlin, Germany) e a proteína C reativa por imunonefelometria (High Sensitivity CRP, Dade Behring, Marburg, Germany). As concentrações de PCT foram significativamente mais elevadas no grupo de pacientes que faleceram do que no grupo dos que tiveram alta hospitalar (p < 0,002), o mesmo não acontecendo com as concentrações de PCR. Não observamos correlação entre as concentrações de PCT e PCR tanto no grupo dos pacientes que faleceram quanto no grupo dos que se recuperaram (RS = 0,205, valor crítico 0,553 e RS = 0,029, valor crítico 0,811, respectivamente). Concluímos que ambos são marcadores sensíveis de processo séptico e que a concentração de pró-calcitonina mais elevada parece estar associada a pior prognóstico.

[Study of RET protooncogene in multiple endocrine neoplasm 2A and in familial medullary thyroid carcinoma. Clinical pathological findings in asymptomatic carriers]. / Estudio del protooncogen RET en neoplasia endocrina multiple 2A y en carcinoma medular de tiroides familiar. Hallazgos clínico-patológicos en portadores asintomáticos.

Twenty five percent of the medullary thyroid carcinoma (MTC) is hereditary and 5% is familiar (FMTC), or considered as multiple endocrine neoplasia (MEN) type 2A (17%) or 2B (3%). These diseases are the result of the autosomic dominant inheritance of a mutation in the RET protooncogene, in one out of 12 different known codons. We analyzed 7 families (2 MEN 2A and 5 FMTC). Six mutations were detected in the most frequent codon, 634 (2 MEN 2A y 4 FMTC) and one family with FMTC presented a novel mutation: a transition T > C at codon 630, resulting a C630A change. Among 57 individuals studied, 25 (43.85%) presented the mutation. Seven (28%) were asymptomatic carriers, including 5 children aged 11 +/- 3.2 years. The children underwent total thyroidectomy. The histopathologic examination showed C cells hyperplasia and microcarcinoma focus in both lobes, even in the presence of normal, basal or pentagastrine stimulated, calcitonine levels. In conclusion, we describe a germine novel mutation in the RET protooncogene: C630A; and the corresponding findings of C-cell disease in gene mutated carriers that emphasize the importance of prophylactic thyroidectomy as soon as the molecular diagnosis is confirmed.

Efeito da calcitonina de salmäo sobre a cicatrizaçäo de defeitos ósseos: estudo radiográfico e histológico em coelhos / Effect of calcitonin on bone healing process of cincumscribed bone defects: histological and radiographic analysis

O objetivo deste estudo foi avaliar, histológica e radiograficamente, a açäo da calcitonina de salmäo sobre a cicatrizaçäo de defeitos ósseos circunscritos, criados cirurgicamente em fêmur de coelhos saudáveis. Esses foram divididos aleatoriamente em dois grupos: controle (n = 12) e tratado (n = 12). O grupo controle näo recebeu qualquer substância durante o experimento, enquanto no grupo tratado foi aplicada dose diária de 2 Ul/kg de calcitonina por via intramuscular. Os animais foram sacrificados nos períodos de 7, 14, 21 ou 28 dias após a criaçäo dos defeitos ósseos. As áreas radiolúcidas desses foram medidas em mm2, por meio de um programa de computador denominado Auto-CAD, demonstrando que essas, em média, foram menores no grupo tratado, mas estatisticamente significantes apenas nos períodos intermediários de 14 e 21 dias. Histologicamente, aos 7 dias, os defeitos do grupo tratado apresentaram uma maior neoformaçäo óssea. Aos 28 dias, houve a formaçäo de um osso menos compacto no grupo controle. No entanto, aos 14 e 21 dias, os resultados foram semelhantes entre os dois grupos. Os resultados obtidos neste trabalho possibilitaram inferir que a calcitonina de salmäo demonstrou resultados positivos quanto à cicatrizaçäo óssea em defeitos circunscritos, baseados nas análises radiográficas e histológicas realizadas

Amphicrine medullary carcinoma of the thyroid with luminal differentiation: report of an immunohistochemical and ultrastructural study.

A case of amphicrine medullary carcinoma of the thyroid is presented. The patient was an 18-year-old female with nonhereditary MEN IIb, submucosal neuromas in the oral cavity, and a thyroid tumor that metastasized to regional lymph nodes. Histologically the thyroid tumor was composed of polygonal cells arranged in a solid/trabecular pattern admixed with mucus-producing goblet cells and displaying focal cytoplasmic lumen formation. Immunohistochemical stains were positive for calcitonin, carcinoembryonic antigen, and chromogranin. Electron microscopy demonstrated C-cells containing neurosecretory granules as well as intestinal-type microlumina. The presence of goblet cells and intestinal-type microlumina in medullary carcinoma of the thyroid is reminiscent of amphicrine tumors of the gastrointestinal tract and supports the hypothesis that the parafollicular C-cells of the thyroid may be of endodermal derivation.

Cancer da glandula tireóide / Thyroid cancer

O conhecimento do cancer da tireoide continua a se desenvolver. Em geral, apresenta evolucao favoravel, apos tratamento adequado. O entendimento das caracteristicas peculiares a esses tumores fundamenta os principios do tratamento. Essas caracteristicas sao analisadas juntamente com dados recentes com o objetivo de delinear aspectos diagnosticos e terapeuticos

[Medullary cancer of the thyroid. Experience at the Hospital de Valdivia]. / Cáncer medular de tiroides. Experiencia del Hospital de Valdivia.

BACKGROUND: Medullary carcinoma of the thyroid is an infrequent type of thyroid tumor. AIM: To retrospectively study all cases of medullary carcinoma of the thyroid diagnosed at a regional hospital. PATIENTS AND METHODS: The charts and pathological studies of eight patients with medullary carcinoma of the thyroid, among 75 with thyroidal cancer, were reviewed. RESULTS: Solitary nodules were the presenting sign in seven patients and cachexia in one. Five patients were subjected to total thyroidectomy, five to cervical lymph node dissection and four to complementary radiotherapy. Pathological diagnosis was made with the surgical piece in seven patients and by aspiration cytology in one. Five of the eight patients are alive after 50 months of follow up as a mean, one patient with bone metastasis. CONCLUSIONS: The small sample size precludes conclusions on the prognosis and treatment of the disease.

Calcitonina: fisiologia e deficiência / Calcitonin: physiology and defficiency

O desenvolvimento e o aprimoramento das técnicas de dosagem da calcitonina sérica (CT) (radioimunoensaio e ensaios imunométricos), os avanços da biologia molecular, abriram novas e interessantes perspectivas, permitindo amplicar o conhecimento acerca da CT, este hormônio tantas vezes dito "sem funçao". Nesta revisao, sao discutidos aspectos históricos, estruturais e moleculares da CT, os métodos de dosagem, a importância e utilidade dos testes provocativos, sobretudo no diagnóstico do câncer medular da tireóide. Além disso, sao abordados os principais aspectos fisiológicos conhecidos, bem como as condiçoes caracterizadas por deficiente reserva secretóia de CT como no hipotireoidismo congênito, na tireoidite crônica autoimune, em pacientes tireoidectomizados e em mulheres no período pós-menopausa.

Immunohistochemistry of medullary thyroid carcinoma and C-cell hyperplasia by an affinity-purified anti-human calcitonin antiserum.

BACKGROUND: The diagnosis of medullary thyroid carcinoma (MTC) depends on the calcitonin immunohistochemistry. Familial MTC is associated with C-cell hyperplasia (CCH), whereas sporadic MTC is not. A specific and sensitive calcitonin immunohistochemistry is necessary for the diagnosis of MTC and CCH. METHODS: An affinity-purified anti-calcitonin antiserum (APxCT) was used for immunohistochemistry of the thyroids of 15 patients with MTC. The thyroids of five patients with familial MTC were studied in detail, with each gland sectioned in 48 areas. RESULTS: Between three and ten independent MTC were found in each thyroid, and CCH was found in all five patients (24.2%, varying from 8.4-56.3% of the 48 areas from each thyroid). MTC and CCH were localized mainly in the middle third and in the central axis of the thyroid lobes. They often were found together in the same area (in a total of 21 areas for the five thyroids sectioned in 48 areas) but ten areas with MTC did not have CCH, and 37 areas with CCH did not have MTC. In ten thyroids partially studied, CCH was indicated in three patients thought to have sporadic MTC. In two thyroids, with follicular and papillary carcinoma, a higher density of C-cells was found around the tumors, but disease was not characterized as CCH. CONCLUSIONS: APxCT antiserum increased the immunohistochemical specificity and sensitivity. The distinction of the familial from the sporadic MTC requires a careful and extensive search of CCH. C-cells in high density may be found around follicular cell carcinomas, being a potential source of diagnostic error.

Pulmonary endocrine cells of Aymara Indians from the Bolivian Andes.

INTRODUCTION: There is evidence to suggest that life at high altitude causes changes in the population of pulmonary endocrine cells, possibly because of exposure to chronic hypoxia. A study was made of the populations of pulmonary endocrine cells in three Aymara Indians and three Mestizos of La Paz (3600 m), Bolivia, which were compared with those in four white lowlanders. METHODS: Pulmonary endocrine cells were immunolabelled for neurone specific enolase and their two major secretory products, gastrin releasing peptide and calcitonin, and their numbers expressed per cm2 of tissue section. RESULTS: No differences in morphology, number, content, or distribution of immunoreactive cells were found when the native highlanders were compared with the lowlanders. CONCLUSIONS: If chronic hypoxia as such exerts an influence on human pulmonary endocrine cells it was not apparent in this morphological study. There was no increase in gastrin releasing peptide containing pulmonary endocrine cells, such as have previously been seen in patients with pulmonary hypertension characterised by plexogenic pulmonary arteriopathy. This may be due to the fact that in plexogenic pulmonary arteriopathy there is free migration of smooth muscle cells. Although three of the highlanders in this present study showed pulmonary vascular remodelling, this was in contrast only modest.