Case presentation of the smallest non-functional parathyroid carcinoma and review of the literature.

INTRODUCTION: Non functional parathyroid carcinoma (PC) is one of the rarest malignant neoplasms. Due to the lack of symptoms and laboratory findings, it is mostly diagnosed in late AQ2 stages, when local invasion and dissemination are already present. However, our case is an exception, because it was detected in early stage, with no local invasion present. We present a case of the smallest non-functional PC yet reported and review of the literature. CASE PRESENTATION: A 47-year-old woman was admitted to outpatient Clinic where fine-needle aspiration biopsy (FNAB) of bilateral thyroid nodules (slide 1) and central neck mass (slide 2), which was suspected to be an enlarged lymphatic nodule or parathyroid gland was performed. Results came back as Bethesda I-colloid (slide 1), and Bethesda IV (slide 2), stating that it is hard to distinguish thyroid gland oxyphil lesions from parathyroid cells. Total thyroidectomy was performed as well as excision of the left central neck mass, without any involvement of surrounding structures. Pathological examination revealed bilateral thyroid follicular nodular disease, papillary microcarcinoma, and parathyroid carcinoma with vascular and capsular invasion, measuring 10 × 8 × 7 mm. The immunohistochemical profile included positive PTH, Chromogranin A, and negative TTF1. CONCLUSION: Non-functional PC is usually diagnosed in advanced stages, already involving adjacent structures; however, this case presents a rare example. It is important not to exclude PC as a differential diagnosis in the absence of elevated Ca and PTH serum levels. Follow-up will be difficult, since there are no prognostic parameters to rely on.

Remediation of Toxic Metal Contaminated Sediment Using Three Types of nZVI Supported Materials.

Due to nZVI effectiveness in the removal of toxic metals as well as low-cost regarding its production, kaolinite, bentonite and carboxymethyl cellulose supported nZVI were chosen for in-situ remediation of river sediment. Small-scale laboratory studies have shown that the percentage of removed metal (Ni, Zn and Pb) ranged up to 80% depending on the nanomaterial used. The metal mobility in sediments was investigated using single extraction, which is proved to be better for quick estimation of metal mobility, and for highly contaminated sites both single and sequential extraction needs to be used. Risk assessment code indicated medium risk for Ni and high risk for Pb and Zn in untreated sediment. In-situ treatment in laboratory proved to be very effective, providing the choice of optimal doses of three different nanomaterials used towards the concentration of toxic metals in the sediment.

Recycling of polluted dredged sediment - Building new materials for plant growing.

The worldwide concern is caused by a large quantity of dredged sediment. The issue becomes more severe when contaminated sediment has to be landfilled. Therefore, researchers involved in the dredged sediment management are increasingly motivated to improve circularity in sediment management processes. Prior to the dredged sediment usage in agriculture, its necessary to confirm conclusively its safety in the context of trace elements (TEs) levels. This study reports the use of different solidification/stabilization (S/S) sediment amendments (cement, clay, fly ash and green synthetized nano-zerovalent iron-nZVI) to remediate dredged sediment. The aim was to identify the effects of applied sediment S/S treatments on the growth and development of Brassica napus. The results showed that in all S/S mixtures TEs levels in the highly labile and bioavailable fraction were significantly decreased (less than 10%, while untreated sediment contained up to 36% of TEs). Simultaneously, the highest share of metals (69-92%) was in the residual fraction, which is considered as chemically stable and biologically inert fraction. Nevertheless, it was noticed that different S/S treatments trigger plants' functional traits indicating that plants' establishment in S/S treated sediment can be limited to certain extent. Besides, based on primary and secondary metabolites (elevated specific leaf area along with declined malondialdehyde content) it was concluded that Brassica plants employ a conservative resource use strategy aiming to buffer phenotypes against stress condition. Lastly, it was inferred that among all analyzed S/S treatments, green synthetized nZVI from oak leaves can effectively promote TEs stabilization in dredged sediment, concurrently enabling plant's establishment and fitness.

Prevalence and risk factors for thyroid cancer in patients with multinodular goitre.

BACKGROUND: Rates of thyroid cancer in patients with multinodular goitre (MNG) vary widely, from 3 per cent in older studies to 35 per cent in more recent studies. The purpose of the present study was to evaluate the prevalence of thyroid cancer in patients operated on for MNG, and to determine risk factors for incidental thyroid malignancy. METHODS: A prospectively developed database of all patients who underwent thyroidectomy for a benign MNG at the high-volume endocrine surgery unit of a tertiary referral university hospital was interrogated. RESULTS: A total of 3233 patients were analysed, separated into three groups according to their functional thyroid status (hypothyroid, hyperthyroid or euthyroid). There were 2788 women (86.2 per cent); the mean patient age was 56.4 years and mean preoperative disease duration was 106.2 months. Incidental thyroid cancer was identified in 1026 patients (31.7 per cent), of which 917 (89.4 per cent) were papillary cancers. Multivariable regression analysis identified functional thyroid status, younger age, male sex, smaller adenoma size, smaller thyroid glands, Hashimoto's thyroiditis and chronic non-specific thyroiditis as independent risk factors for thyroid cancer. CONCLUSION: MNG was associated with a considerable rate of incidental thyroid cancer, which has been underestimated. A variety of factors should be taken into account when considering the malignant potential of a presumed benign MNG.

Rising incidence of thyroid cancer in Serbia.

BACKGROUND: In the past decade, the incidence of thyroid cancer (TC) has shown a stable increase, for both sexes, in many parts of the world at a rate faster than for any other type of malignancy. The aim of our study was to analyze and report changes in TC incidence in Serbia, as well as to evaluate potential reasons for these changes. So far, the incidence of TC in Serbia has not been reported. MATERIAL AND METHODS: This is a retrospective descriptive epidemiological study of TC data from the Cancer Register for Serbia for a ten year period, from 1999 to 2008. Crude rates (CR), age-specific rates (ASR), age-adjusted rates (AAR), linear trends and average annual percentage changes (AAPC) were calculated and analyzed. RESULTS: TC incidence increased substantially for both genders with the highest increase in 2007 for the age group 50-59 (females 14.2, males 10.3). TC was three times more common in females (CR 4.7:1.5). The AAR for females ranged 1.9-4.8 (3.3, 95% CI 2.6-4.0), for males 1.0-2.6 (1.0, 95% CI 0.8-1.2) and for both sexes combined 1.4-3.2 (2.2, 95% CI 1.7-2.6). The incidence trend for males showed an increase (y =0.05x + 0.70, p =0.058). It was highly statistically significant for females (y =0.31x + 1.61, p <0.001) and both genders combined (y =0.18x + 1.18, p <0.001). AAPC was highest for ages 20-29 and 30-39, for females (+25.2%) and males (+17.3%), respectively. CONCLUSIONS: We found a substantial increase in TC incidence in Serbia for both genders. The highest increase in TC incidence was found in females aged 20 to 29 years while the highest incidence was found in the age group 50 to 59.

Risk factors for anaplastic thyroid cancer.

Background. Anaplastic thyroid cancer (ATC) is a form of thyroid cancer with very poor prognosis, but is fortunately quite rare. Its aetiology is unknown and not well researched. Aim. The aim of this study was to identify potential risk factors for ATC. Material and Method. Case-control study of 126 ATC patients (77 females and 49 males) and 252 controls individually matched by gender, age, and place of abode. In statistical analysis we used a Cox regression model. Results. Univariate logistic regression showed that the risk factors for ATC are low education level, type B blood group, goitre, other nonthyroid malignancies, diabetes, late menarche, and an early first pregnancy. Multivariate logistic regression analysis showed that independent risk factors for ATC are low education level (OR = 1.42, 95% CI = 1.09-1.86), type B blood group (OR = 2.41, 95% CI = 1.03-5.66), and goitre (OR = 25-33, 95% CI = 5.66-126.65). Conclusion. Independent risk factors for ATC are: low education level, type B blood group, and goitre.

[Immunoglobulins G, A, M and circulatory immune complexes in patients with laryngeal carcinoma].

INTRODUCTION: Malignant tumors of the head and neck represent 5% of all malignancies, of which the most common are tumors of the larynx and oral cavity. In the blood serum of patients with malignant tumors increased levels of immunoglobulins and circulating immune complexes have been detected, with a diverse relevance to the clinical course and prognosis of the disease. AIM: Due to contradictory findings of the correlation between the humoral immune response and the clinical course of the disease, we examined 42 male patients with laryngeal carcinoma. All patients underwent surgery, of which 15 patients were treated postoperatively with radiotherapy. The changes in the levels of immunoglobulins and circulating immune complexes in the blood serum were recorded and evaluated. RESULTS: Analysis of the results showed an immunological disorder of an abnormal level of circulating immune complexes in the blood serum that normalized after the surgical removal of the tumor. The levels of immunoglobulins G and A were abnormal during the whole postoperative period of examination. CONCLUSION: The normalizing of the levels of circulating immune complexes in the blood serum, after surgical removal of the tumor, shows a strong association between the two, and this could consequently mean that it could be used as a prognostic tool, particularly in correlation with other immunological parameters.

[Bilateral vocal paralysis phonosurgery in adults].

Ordinary clinical manifestation of the patient with bilateral vocal fold paralysis is inability of abducting the cords with a result of narrowing the glottic space, causing inspiratory stridor and mild dysphonia. Such patients can be life threatened due to narrowing airway. Some kind of surgery has to be performed on these patients in order to enlarge the airway. When we treat patients with OPG, the most reasonable way is to gradually enlarge airway at glotic level and there are several surgical methods for achieving this. The least agresive and the safest procedures are posterior transversal cordectomy (PTC) or medial arytenoidectomy (MA), after which we can perform extended versions of some of these methods or combination of both. Bilateral vocal fold paralysis has to be diagnostically different from stenosis of posterior commissure, even though the procedures such as medial arytenoidectomy, posterior transversal cordectomy and total arytenoidectomy can be performed in both cases. The patients have to be explained that the aim of the procedure is to enlarge airway to the detriment of voice quality and voice capabilities.