CK19 IS A USEFUL MARKER IN DISTINGUISHING FOLLICULAR VARIANT OF PAPILLARY THYROID CARCINOMA FROM BENIGN THYROID LESIONS WITH FOLLICULAR GROWTH PATTERN.

CONTEXT: Thyroid cancer is the most common endocrine malignancy. Within various subtypes of thyroid neoplasms, those with follicular growth pattern usually make diagnostic problems. OBJECTIVE: To examine ck19 expression as a diagnostic marker in thyroid neoplasms with follicular growth pattern. DESIGN: In this cross sectional study, 86 patients were enrolled. SUBJECTS AND METHODS: Totally 22 follicular adenoma (FA), 18 well differentiated tumors with undetermined malignant potential (WT-UMP) and 46 follicular variants of papillary thyroid carcinoma (FV-PTC) were enrolled and examined for Ck19 expression by immunohistochemistry staining. Membranous/cytoplasmic staining patterns were considered as positive. Specimens without staining were considered as 0, < 5% positively stained cells as 1+, 5%-25% as 2+, 25%-75% as 3+ and >75% as 4+. RESULT: CK19 was negative in most cases of FA while positive in most WDT-UMP and FV-PTCs, p<0.001. Additionally, most cases with 2+ and 3+ staining patterns were FV-PTC (75% and 81%, respectively, p<0.001) and none of FAs showed 3+ positivity (p<0.001). Additionally, most of strongly positive results in patients > 45 y/o were PTC (p<0.001). CONCLUSION: Ck19 is a useful marker in differentiating FA from FV-PTC. We found diffuse and strong (3+) staining pattern in FV-PTC but none of FAs were so. We concluded that diffuse and strong staining for ck19 in a thyroid lesion with follicular pattern of growth, especially in a patient older than 45 y/o should raise the possibility of malignancy.

Immunomodulatory effects of hydroxychloroquine on Th1/Th2 balance in women with repeated implantation failure.

BACKGROUND: Cellular immune abnormalities such as the imbalance between T-helper (Th) 1 and Th2 cytokines have been implicated as potentially modifiable causes of idiopathic repeated implantation failures (RIF). The purpose of this study was to investigate the effects of hydroxychloroquine on IL-10 and TNF-α secretion, expression of T-bet and GATA-3 transcription factors and cellular localization of TNF-α, IFN-γ, IL-10 and IL-4 in endometrial cells in women with RIF. MATERIALS AND METHODS: A total of 17 women with a history of RIF and elevated TNFα/IL-10 ratio (TNFα/IL-10> = 30.6) were included in the study. The serum levels of TNFα and IL-10, the expression of transcription factors related to Th1 and Th2 cells and the immune-reactivity of TNFα, IFN-γ as Th1 related cytokines and IL-10, IL-4 as Th2 related cytokines in endometrial tissues were evaluated by ELISA, real-time PCR, and fluorescent immunohistochemistry respectively. All, evaluations were done both before and after treatment with hydroxychloroquine (400 mg/orally per day). RESULTS: Hydroxychloroquine treatment significantly decreased (p < 0.0001) serum level of TNF-α and significantly increased serum level of IL-10 (p < 0.0001). T-bet, the Th1 transcription factor, expression was down-regulated and GATA-3, the Th2 transcription factor, expression was up-regulated. IL-10 and IL-4 fluorescent immunoreactivities significantly increased (p < 0.05 and p < 0.001 respectively) and TNFα and IFN-γ fluorescent immunoreactivities significantly decreased (p < 0.05) in endometrial tissue in women with RIF after treatment in comparison with before treatment. CONCLUSION: Hydroxychloroquine administration in women with RIF With a high TNF-α/IL-10 ratio during the implantation window can decrease this ratio and seems to be an effective therapeutic strategy in RIF caused by cellular immune abnormalities through a shift in Th2 responses.

Seroprevalence of human herpes virus-8 in renal transplant recipients: a single center study from Iran.

The long-term risk of malignancy among renal transplant patients is approximately 100 times that of the general population. Unlike North America and many European countries, Kaposi's sarcoma is the most common cancer after renal transplantation in most series reported from the Middle East. Human herpes virus-8 (HHV-8) has a major role in the pathogenesis of Kaposi's sarcoma. The risk of posttransplantation Kaposi's sarcoma is 23% to 28% among seropositive patients compared with 0.7% among seronegative patients. This study was conducted to investigate the seroprevalence of HHV-8 among our transplant recipients. The sera from 100 renal transplant recipients were examined by indirect immunofluorescence against latent nuclear antigen. Sixty of 100 patients were males. The overall mean age was 41.1 years (range, 17-74 years) with 17 patients older than 55 years. The mean transplantation duration was 41.6 months. Twenty-five percent of patients were seropositive for HHV-8. There was statistically significant seropositivity for HHV-8 among recipients older than 55 years (P=.02). Eight of 17 patients older than 55 years were seropositive (47%), whereas 17/83 patients younger than 55 years were seropositive (20%). There were no significant differences for HHV-8 seropositivity regarding sex, transplantation duration, and immunosuppressive regimen, including dose of immunosuppressive drugs and cyclosporine blood levels. In this study, we showed seropositivity for HHV-8 among a significant percentage of our renal transplant recipients, a finding which may render them at risk to develop Kaposi's sarcoma. Seropositive and seronegative patients were followed for 16 months. One HHV-8 seropositive patient (1/25) developed Kaposi's sarcoma.

Effect of vitamin E on diabetes-induced changes in small intestine and plasma antioxidant capacity in rat.

The present study was designed to evaluate the effect of Vitamin E (Vit. E) on diabetes-induced changes in small intestine, lipid peroxidation and plasma antioxidant capacity in rats. Twenty-four rats were divided into three groups (n=8), namely control, non-treated diabetic (NTD) and Vit. E-treated diabetic (VETD) groups. The VETD group received 300 mg of Vit. E daily in drinking water. After 6 weeks, the length and weight of small intestine, villus height, crypt depth and muscular layer thickness showed a significant increase in the NTD group compared to the control group. In the VETD group, these parameters did not show any significant difference compared to the control group. The level of malondialdehyde (MDA) in the red blood cells showed a significant increase in the NTD group, but not in the VETD group, compared to the control group. The plasma antioxidant capacity showed a significant increase in VETD compared to the NTD group. These findings indicate that Vit. E significantly improved small intestinal changes in diabetic rats and that these effects could be mediated at least in part by enhanced plasma antioxidant capacity and reduced lipid peroxidation.

Spot urine 5-hydroxy indole acetic acid and acute appendicitis.

BACKGROUND/AIMS: Appendectomy for suspected appendicitis cases is a common procedure. Its clinical diagnosis needs to be supported by accurate confirmatory tests. No single paraclinical test with a high degree of sensitivity and specificity is available for its diagnosis. The appendix contains numerous serotonin-producing cells (enterochromaffin cells). In the inflammatory process and subsequent cell injury, serotonin is released and converted to 5-HIAA (5-hydroxy indole acetic acid). We studied the elevation of 5-HIAA in the spot urine of acute appendicitis patients. METHODOLOGY: 5-HIAA was measured by high-performance liquid chromatography in the spot urine samples of 40 healthy individuals and 166 patients who presented to emergency units of the university hospitals with acute abdominal pain. The results of the urine concentrations were compared to the histopathology reports of the removed appendices and the final diagnosis of other diseases. RESULTS: From 80 cases with a presumptive diagnosis of appendicitis, 73 were operated on and seven cases discharged after a few hours observation. Sixty-five out of 66 documented appendicitis patients showed a striking increase of urinary spot 5-HIAA with significant differences vs. all cases of healthy control individuals (P < 0.001). The 5-HIAA values of all of the negative appendectomy cases (n = 7) and all of the discharged cases after the observation period (n = 7) were within healthy control ranges. The mean value of the appendicitis group (42.76 +/- 2.26 mumol/L) was also significantly higher vs. all other acute abdomens which could mimic acute appendicitis (P < 0.05) excepting gastroenteritis patients. Considering 20 mumol/L as the cutoff value sensitivity, specificity, positive and negative predictive values of this test for discriminating appendicitis in clinically suspected patients were 98%, 100%, 100% and 93%, respectively and in all acute abdomens were 98%, 71%, 69% and 98.6%, respectively. The patients with gastroenteritis also showed elevation of 5-HIAA (43.05 +/- 2.7 mumol/L) vs. other nonappendicitis groups (P < 0.05). CONCLUSIONS: We have concluded that measurement of 5-HIAA in spot urine is a highly reliable test supporting the clinical diagnosis of appendicitis and if it does not show an increase, appendicitis can be ruled out with a very high degree of confidence which helps to reduce unnecessary appendectomies. In clinically suspected appendicitis patients with diarrhea, an increase of 5-HIAA may not confirm the diagnosis.