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1.
Mol Cell Biochem ; 478(10): 2351-2359, 2023 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-36703095

RESUMO

Primary hyperparathyroidism is a common endocrine disorder. Interestingly, the majority (75%) of parathyroid tumors are localized to the inferior parathyroid glands. To date, the reason for this natural bias has not been investigated. We assessed the global gene expression profile of superior and inferior glands obtained from forensic autopsies. The genes with significant differential expression between superior and inferior parathyroids were further assessed by RT-PCR in 19 pairs. As an iterative approach, additional genes with an established role in parathyroid disorders, i.e., CASR, MAFB, PAX9, TBCE, TBX1, VDR, MEN1, CCND1, and CDC73 were also evaluated by RT-PCR in all 19 pairs of superior and inferior parathyroid glands. Seven homeobox genes, namely HOXA4, HOXA5, HOXBAS3, HOXB4, HOXB6, HOXB9, IRX1, and one encoding for ALDH1A2 showed a lower expression in the inferior parathyroid glands than in the superior. Conversely, SLC6A1 showed a higher expression in the inferior glands. Of the nine genes with significant differential mRNA expression among superior and inferior glands HOXB9, HOXB4 and IRX1 could be detected by western blotting/mass spectrometry. The study is the first to show the differential expression of nine genes HOXA4, HOXA5, HOXBAS3, HOXB4, HOXB6, HOXB9, IRX1, ALDH1A2, and SLC6A1 in inferior versus the superior parathyroid glands. This could have potential implications for the preferential localization of parathyroid tumors to the inferior parathyroid glands as observed in patients with primary hyperparathyroidism.


Assuntos
Hiperparatireoidismo Primário , Neoplasias das Paratireoides , Humanos , Glândulas Paratireoides/química , Glândulas Paratireoides/metabolismo , Glândulas Paratireoides/patologia , Neoplasias das Paratireoides/genética , Neoplasias das Paratireoides/metabolismo , Neoplasias das Paratireoides/patologia , Hiperparatireoidismo Primário/metabolismo , Hiperparatireoidismo Primário/patologia , Western Blotting , Proteínas de Homeodomínio/genética , Proteínas de Homeodomínio/metabolismo
2.
J Minim Access Surg ; 17(3): 337-341, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-32964885

RESUMO

INTRODUCTION: Endoscopic thyroidectomy is an advanced procedure and has a long learning curve. Most commonly employed approach is combined axillary-breast approach (ABA). Recently, transoral endoscopic thyroidectomy vestibular approach (TOETVA) is being popularised as a scarless procedure. However, it is not established whether TOETVA or ABA approach is better to begin with. PURPOSE: The purpose of the study was to compare the initial experience of TOETVA and ABA with respect to difficulties and outcomes. METHODOLOGY: A prospective non-randomised interventional study was conducted including the initial ten patients in each group who underwent hemithyroidectomy for benign solitary thyroid nodule. Sigma plot version 12.3 was used for the statistical analysis. RESULTS: All the patients were female and comparable with respect to age (33.2 vs. 28.2 years) and size of nodule (2.7 vs. 3 cm) (TOETVA vs. ABA). The operative time (121 vs. 138.5 min, P = 0.34) and blood loss (50 vs. 60 ml, P = 0.9) were similar in both the groups. Even though the flap raising time was significantly less with TOETVA group (29.3 vs. 47.2 min, P < 0.001), it was associated with more difficulty in approaching upper pole (P = 0.02) and lower pole (P < 0.001), more intra-operative events (30% vs. 10%, P = 0.58) and conversions to open (20% vs. 10%, P = 1). Similarly, post-operative pain scoring was more with TOETVA (3 vs. 2, P = 0.04). Hospital stay was similar in both the groups (2.5 vs. 3 days, P = 1). Patients in both the groups had both overall and cosmetic satisfaction. CONCLUSIONS: Axillary-breast approach should be preferred to start learning the endoscopic thyroidectomy, as it is easier and safer than transoral endoscopic vestibular approach.

3.
Breast J ; 26(7): 1316-1320, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32172534

RESUMO

Axillary lymph node dissection (ALND) is an important step in the management of node-positive operable breast cancer. It is associated with large amount of axillary drainage and increased risk of wound-related infection. Tranexamic acid (TA) has antifibrinolytic property and is being extensively used in controlling blood loss. However, its role in reducing axillary drainage after ALND is still not well-established. The aim of this study is to evaluate the effectiveness of TA in reducing the axillary drainage, early removal of the drain, and decreasing the wound-related infection in breast cancer patients undergoing ALND. This is a prospective nonrandomized double-armed cohort study. Total of 47 patients were included in the TA group and 46 in the nontranexamic (NTA) group. All the patients in TA group received a single dose of intravenous (IV) TA at the time of induction followed by oral TA for five days after surgery. Both TA and NTA groups had similar proportions of locally advanced breast cancers (57.4% vs 56.5%, P = .90). Majority of them underwent modified radical mastectomy (MRM) (70.2% vs 67.4%, P = .76). Patients in TA group had significantly lower axillary drainage (440 ml vs 715.5 ml, P = .003) with earlier removal of the drain (8 vs 11 days, P = .046). Seroma formation (19.1% vs 32.6%, P = .13) and wound-related infection (4.3% vs 8.7%, P = .43) were nonsignificantly lower in the TA group. Tranexamic acid reduces axillary drainage and facilitates early removal of the drain after axillary lymph node dissection.


Assuntos
Neoplasias da Mama , Ácido Tranexâmico , Axila , Neoplasias da Mama/cirurgia , Estudos de Coortes , Feminino , Humanos , Excisão de Linfonodo/efeitos adversos , Mastectomia , Estudos Prospectivos
4.
World J Surg ; 40(3): 562-9, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-26757717

RESUMO

BACKGROUND: A large proportion of follicular thyroid carcinoma (FTC) patients in developing countries present with overt skeletal metastases (SM). These patients often require surgical interventions for prevention of morbidity, palliation of symptoms, and facilitation of radioiodine therapy (RAIT). Scarce literature is available about the long-term outcome of such patients. The aim of this study was to evaluate the long-term outcome of FTC patients undergoing surgical intervention for SM. METHODS: We retrospectively reviewed the data of FTC patients with SM (January 1990-December 2011). Out of 91 patients with SM, 32 had surgical interventions for SM. All had total thyroidectomy performed. RESULTS: The mean age of the patients was 48.5 years (M:F = 1:2). Majority (93.7%) had synchronous metastases and 22% had multiple SM. The surgical interventions for SM included: laminectomy (50%), resection of skull metastases (18.8%), resection of manubrium sterni (18.8%), partial clavicle excision (9.4%), and hemimandibulectomy (3.1%). The main intents were palliation (50%) and facilitation of RAIT (37.5%). 84% patients received RAIT. Median follow-up was 52 months (mean = 50 ± 37). Five- (56 vs 63%) and 10-year (28 vs 23%) overall survival (OS) did not differ significantly (p = 0.968) from those not having interventions for SM. On univariate analysis tumor invasion (p = 0.006) and synchronous presentation of SM (p = 0.043) were significant risk factors for OS, whereas on multivariate analysis tumor invasion (p = 0.006) was significant. CONCLUSIONS: Surgical interventions directed at SM in FTC patients with overt multiple SM might not result in improve OS. However, considering reasonable long-term survival, interventions should be considered for desired palliation and preservation of body function.


Assuntos
Adenocarcinoma Folicular/cirurgia , Neoplasias Ósseas/secundário , Tireoidectomia , Adenocarcinoma Folicular/mortalidade , Adenocarcinoma Folicular/secundário , Adulto , Neoplasias Ósseas/epidemiologia , Feminino , Seguimentos , Humanos , Índia/epidemiologia , Masculino , Pessoa de Meia-Idade , Morbidade/tendências , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida/tendências , Fatores de Tempo
6.
Sci Rep ; 14(1): 18679, 2024 08 12.
Artigo em Inglês | MEDLINE | ID: mdl-39134585

RESUMO

Breast cancer (BC) has emerged as the most common malignancy among females. The genomic profile of BC is diverse in nature and complex due to heterogeneity among various geographically different ethnic groups. The primary objective of this study was to carry out a comprehensive mutational analysis of Indian BC cases by performing whole exome sequencing. The cohort included patients with a median age of 48 years. TTN, TP53, MUC16, SYNE1, and OBSCN were the frequently altered genes found in our cohort. The PIK3CA and KLC3 genes are driver genes implicated in various cellular functions and cargo transportation through microtubules, respectively. Except for CCDC168 and PIK3CA, several gene pairings were found to be significantly linked with co-occurrence. Irrespective of their hormonal receptor status, RTK/RAS was observed with frequently altered signaling pathways. Further analysis of the mutational signature revealed that SBS13, SBS6, and SBS29 were mainly observed in our cohort. This study supplements the discovery of diagnostic biomarkers and provides new therapeutic options for the improved management of BC.


Assuntos
Neoplasias da Mama , Sequenciamento do Exoma , Mutação , Humanos , Feminino , Neoplasias da Mama/genética , Pessoa de Meia-Idade , Adulto , Índia/epidemiologia , Biomarcadores Tumorais/genética , Idoso , Análise Mutacional de DNA
7.
Trop Doct ; 53(3): 396-397, 2023 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-37113077

RESUMO

Fibrocystic disease of breast is characterized by lumpiness and discomfort. Our 48-year-old perimenopausal patient had a painless progressively enlarging non-tender lump in her right breast since 1 year. On physical examination a 10 × 8 cm firm non-tender lump was observed occupying almost the whole breast, whose surface was nodular though not fixed. The operative specimen appeared like a honeycomb with multiple cavities filled with yellowish firm material typical of tuberculosis. Surprisingly, histology found neither this nor malignancy. Radical breast excision is never warranted except if the latter is confirmed.


Assuntos
Doença da Mama Fibrocística , Tuberculose , Feminino , Humanos , Pessoa de Meia-Idade , Doença da Mama Fibrocística/diagnóstico , Doença da Mama Fibrocística/cirurgia , Doença da Mama Fibrocística/patologia
8.
Indian J Nucl Med ; 38(3): 218-223, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-38046977

RESUMO

Introduction: Recurrent/persistent primary hyperparathyroidism in patients who have undergone previous parathyroidectomy is a challenging condition. Imaging is important for localizing the parathyroid adenoma for re-exploration and 18F-Fluorocholine (18F-FCH) positron emission tomography/computed tomography (PET/CT) seems ideal for this purpose. Aim: This prospective study attempted to ascertain the utility of 18F-FCH PET/CT as an investigation in preoperative localization of abnormal parathyroid tissue in recurrent/persistent primary hyperparathyroidism while comparing it with 99mTc-Sestamibi dual-phase scintigraphy with early single-photon emission CT (SPECT)/CT and neck ultrasonography (USG). Methods: Twenty patients with biochemical features of recurrent/persistent primary hyperparathyroidism were enrolled into this study. They underwent neck USG, 99mTc-Sestamibi dual-phase scintigraphy with early SPECT/CT and 18F-FCH PET/CT for localization of parathyroid lesions. Six patients underwent surgical resection of the detected lesions, 3 were awaiting surgery, and 11 were managed conservatively. One patient died due to COVID. Results: The calculated positive predictive values on a per-lesion basis of neck USG, 99mTc-sestamibi scintigraphy and early SPECT/CT and 18F-FCH PET/CT in the cohort of the 5 operated patients were 75% (3/4), 71.4% (5/7), and 71.4% (5/7), respectively. On a per-patient basis, the lesion detection rate was 100% for 99mTc-sestamibi scan and FCH PET (5/5) and 80% on neck USG (4/5). Conclusion: 18F-FCH PET/CT is a highly accurate imaging modality for the detection of parathyroid lesions in patients with recurrent/persistent primary hyperparathyroidism.

9.
IFAC Pap OnLine ; 55(10): 1307-1312, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-38620785

RESUMO

The COVID-19 pandemic has shown that stock outs of essential items like hand sanitizers, tissue papers and other items of hygiene and daily use have been characteristic of a supply chain, especially immediately following a pandemic wave. Consequently, retailers have to indulge in substantial supplier management efforts to ensure product availability during a pandemic wave. Using a piecewise deterministic differential game, we model a scenario where, while anticipating a pandemic wave, a supplier decides on product availability efforts to ensure product availability under the impending threat of stock outs. A market leader coordinating retailer, on the other hand, decides on the proportion of the costs of the efforts to be shared with the supplier.

10.
Pediatr Endocrinol Diabetes Metab ; 28(3): 178-187, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35942826

RESUMO

INTRODUCTION: Primary hyperparathyroidism (PHPT) is a rare disease in children and adolescents. Early recognition of this disease is important to prevent significant morbidity and mortality. MATERIAL AND METHODS: We included 10 consecutive patients with PHPT aged 14 to 19 years of age and followed-up prospectively upto one year after parathyroidectomy. RESULTS: Our cohort included 6 females and 4 males. The mean age of the patients was 16.7 ±1.8 years. The symptoms at presentation were musculoskeletal pain (90%), bone deformity (50%), fracture (30%), proximal myopathy (40%), renal stones (50%), reflux symptoms (40%), and pancreatitis (30%). The mean serum calcium was 3.1 ±0.5 mmol/l, mean serum inorganic phosphorus was 0.9 ±0.3 mmol/l and median serum alkaline phosphatase (ALP) was 1911.5 IU/l (IQR: 522.7-5702.3). The median serum intact parathyroid hormone was 133.5 pmol/l (IQR: 69.5 -178.7) while serum 25(OH)D was 47.7 nmol/l (IQR: 23.7-72.7). Hypercalciuria was observed in 7 patients. Hungry bone syndrome was observed in 4 (40%) patients after surgery. Typical parathyroid adenoma was found in 9 (90%) patients while one patient had atypical adenoma with high mitotic index. After one year of surgery, all patients had significant improvement in clinical and biochemical parameters with persistence of residual bone deformities. CONCLUSIONS: Our study showed the spectrum of manifestations of PHPT in children and adolescents and outcomes of parathyroidectomy till one year. Long-term follow-up studies with bigger cohorts are required to understand the true nature of the disease in children and adolescents.


Assuntos
Hiperparatireoidismo Primário , Adolescente , Fosfatase Alcalina , Doenças Ósseas/etiologia , Cálcio/urina , Criança , Feminino , Humanos , Hiperparatireoidismo Primário/complicações , Hiperparatireoidismo Primário/cirurgia , Masculino , Hormônio Paratireóideo , Fósforo , Adulto Jovem
11.
Indian J Otolaryngol Head Neck Surg ; 73(1): 72-77, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33078125

RESUMO

This study endeavours to comprehensively the study the spectrum of ENT manifestations in mild and asymptomatic COVID-19 and observe the natural course of anosmia and dysgeusia consequent to SARS-Cov-2 infection. A prospective cohort study was undertaken at a tertiary care centre in India on admitted patients with RT-PCR proven COVID-19. Patients were included provided the baseline National Early Warning Score (NEWS) was less than 4. Patients were screened for ENT manifestations using a questionnaire at baseline, 7 days, 14 days and 28 days. 225 patients were included in the study. Of these complete data at 4 weeks was available for 210. Out of 145 patients with mild COVID-19 (asymptomatic = 80), ENT manifestations accounted for 66.2% of all symptoms. Smell and taste disturbance had an overall incidence of 20% and 45% of ENT manifestations. Temporal trends of the recovery rate of anosmia and dysgeusia were 53.6% and 66.7% at 2 weeks, respectively. Corresponding rates at 3 weeks were 89.29% and 86.7%, respectively. By the end of 4 weeks 96% of the patients had recovered completely. The incidence of anosmia and dysgeusia in this study parallels the rates reported from other Asian countries, albeit, lower than the rates quoted from the Western Hemisphere. We recommend structured reporting of all ENT manifestations especially smell and taste disturbances to accurately identify individuals infected with SARS-Cov-2.

13.
Pathol Res Pract ; 216(4): 152830, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31982181

RESUMO

BACKGROUND: Biallelic loss of SMARCB1/INI1 is associated with highly aggressive malignancies, namely renal and extra-renal malignant rhabdoid tumors, and atypical teratoid/ rhabdoid tumor. Increasing availability of molecular testing and immunohistochemical stains acting as surrogate tools to genetic analysis has led to an increasing recognition of SMARCB1 loss in a variety of neoplasms. Interestingly, many of these lack the typical rhabdoid features ascribed to this group of tumors, making their identification difficult. CASE PRESENTATION: We describe the cytological, histological, immunohistochemical and molecular features of the first case of primary SMARCB1 (INI1)-deficient carcinoma of the thyroid gland in literature. The tumor was unique in various aspects; apart from never having been documented at this location, it showed extensive glandular differentiation, mimicking metastatic adenocarcinoma. CONCLUSION: Awareness of this novel entity is essential to avoid misdiagnosis, and for appropriate management, especially in an era of increased feasibility of targeted therapy.


Assuntos
Biomarcadores Tumorais/análise , Carcinoma/patologia , Proteína SMARCB1/deficiência , Neoplasias da Glândula Tireoide/patologia , Adulto , Evolução Fatal , Humanos , Masculino
16.
BMJ Case Rep ; 20182018 Aug 27.
Artigo em Inglês | MEDLINE | ID: mdl-30150330

RESUMO

Carcinoma breast presenting with paraneoplastic cerebellar degeneration is a rare scenario. We report a case of a 52-year-old woman, which is a follow-up case of completely treated carcinoma breast presenting with paraneoplastic cerebellar degeneration which, on investigation, revealed metastatic disease with recurrence at previous scar site and metastasis to contralateral axilla. The patient was given pulse methyl prednisolone therapy and underwent wide local excision of nodule and right axillary lymph node dissection with 14 cycles of trastuzumab and paclitaxel as adjuvant therapy. However, there was no detectable change in neurological symptoms at 6-month follow-up postoperatively. This case report highlights the need for clinicians to be aware of all possible presentations of carcinoma breast and its recurrence, including rare manifestations as in this case.


Assuntos
Axila/patologia , Neoplasias da Mama/patologia , Cicatriz/patologia , Metástase Linfática/fisiopatologia , Metilprednisolona/administração & dosagem , Fármacos Neuroprotetores/administração & dosagem , Degeneração Paraneoplásica Cerebelar/fisiopatologia , Neoplasias da Mama/complicações , Neoplasias da Mama/terapia , Terapia Combinada , Feminino , Humanos , Excisão de Linfonodo , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Degeneração Paraneoplásica Cerebelar/etiologia , Degeneração Paraneoplásica Cerebelar/terapia , Pulsoterapia , Resultado do Tratamento
17.
Indian J Surg Oncol ; 9(1): 6-10, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29563727

RESUMO

The importance of capsular invasion in follicular thyroid carcinoma (FTC) has not been extensively studied. The aim of the present study was to correlate the clinical features and outcome of FTC with histology features particularly emphasizing on the importance of the number of foci of capsular invasion. This was a retrospective study. Histology of 123 FTC patients was reviewed. Patients were divided in three groups based on the number of foci of vascular and capsular invasion noted in primary tumor: group 1-capsular invasion at <6 and vascular invasion at <4 foci, group 2-either capsular invasion ≥6 or vascular invasion at ≥4 foci, and group 3-capsular invasion ≥6 and vascular invasion at ≥4 foci. Different prognostic factors and overall survival (OS) were compared among the groups. The incidences of distant metastases (p = 0.008) and OS (p = <0.001) were significantly different among the groups. On univariate analysis, age (p = 0.001), tumor size (p = <0.0001), distant metastases (p = <0.0001), vascular invasion (p = 0.018), and capsular invasion (p = 0.003) were significantly associated with OS. On multivariate analysis, age (p = 0.020), distant metastases (p = 0.045), and foci of capsular invasion (p = 0.005) were significant. The number of foci of capsular invasion seems to have significant prognostic value in widely invasive FTC.

18.
Nucl Med Commun ; 39(12): 1190-1196, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30379751

RESUMO

OBJECTIVE: The aim of the present study was to assess the utility of early dynamic PET/computed tomography with fluorine-18-fluorocholine (F-FCH) in detecting parathyroid lesions and in differentiating parathyroid lesions from cervical lymph nodes (LNs). PATIENTS AND METHODS: A prospective study was conducted on 14 patients with clinical and biochemical evidence of primary hyperparathyroidism by having a positive Tc-sestaMIBI scan. Patients underwent early dynamic F-FCH PET/computed tomography scan, after the administration of 5-8 mCi (185-296 MBq) at 1 min per frame for 15 min. Delayed static images of 2-3 min per bed position were taken between 45 and 60 min. 3D-VOI's were plotted on parathyroid adenoma, cervical LN and thyroid. Dynamic and static images were interpreted by two expert nuclear medicine physicians independently and the following parameters were calculated for parathyroid adenoma and cervical LN: maximum standardized uptake value (SUVmax), time activity curve for SUVmax, t-peak. Adenoma to thyroid ratio (A/T) and cervical LN to thyroid ratio were calculated for each dynamic and static image. RESULTS: Fourteen (eight females and six males) patients were included in the study. All patients showed a higher SUVmax in the adenoma and the cervical LN in the early dynamic images as compared with delayed static images. A/T ratio obtained in the dynamic and static images were compared and found to have insignificant difference (P=0.2255). The difference between mean A/T and LN to thyroid ratio was found to be significant (P=0.0117) during the dynamic study. CONCLUSION: A possible explanation of higher SUVmax in the dynamic images in adenomas may be due to the increased vascularity/early F-FCH uptake. Results indicate early dynamic imaging could suffice, without the need for a delayed image after 45 min, and this technique could adequately differentiate a parathyroid adenoma from a cervical LN.


Assuntos
Colina/análogos & derivados , Hiperparatireoidismo Primário/diagnóstico por imagem , Glândulas Paratireoides/diagnóstico por imagem , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Adolescente , Adulto , Criança , Feminino , Humanos , Hiperparatireoidismo Primário/patologia , Masculino , Pessoa de Meia-Idade , Glândulas Paratireoides/patologia , Estudos Prospectivos , Fatores de Tempo , Adulto Jovem
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