Advances in the management of differentiated thyroid cancer with follicular cell strain.

The management of nodules and thyroid cancer is evolving. The aim is to individualize the treatment, decreasing aggression in the forms low risk and instead seeking new therapeutic options in advanced disease. This update shows the main recent advances in this field.

Relationship of plasma leptin and adiponectin concentrations with menopausal status in Tunisian women.

To evaluate the effect of menopausal status and body mass index (BMI) on circulating leptin and adiponectin concentrations and investigate whether there is an influence of menopausal transition on the relationships of these adipokines and leptin to adiponectin (L/A) ratio with lipid profile and insulin resistance in a sample of Tunisian women. One hundred ninety-six premenopausal (mean age 35.3±7.6 years) and 180 postmenopausal women (mean age 53.4±6.2 years) were included in the study. Participants were stratified into obese and normal weight groups based upon their baseline BMI. Fasting glucose, HDL-cholesterol (HDL-C), triglycerides (TG), total cholesterol (TC), insulin, leptin, and adiponectin concentrations were measured. Homeostasis model assessment of insulin resistance (HOMA-IR) was calculated. Premenopausal women had significantly higher leptin and L/A ratio and lower adiponectin levels than postmenopausal women. Menopause had no effect on the mean values of BMI, insulin or HOMA-IR, HDL-C, and TG. Using a multiple linear regression model, menopausal status was identified, as significant independent predictor for leptin and adiponectin levels. Irrespective of the menopausal status, obese women exhibited higher leptin and L/A ratio and lower adiponectin levels compared to those with normal weight. Comparison between the two menopausal stages in obese and normal weight groups showed that leptin and L/A ratio decreased, while adiponectin increased from pre- to postmenopausal stage only in obese group. The L/A ratio correlated better with lipid profile and HOMA-IR in postmenopausal stage. The present study showed a significant interaction between menopause and BMI on leptin and adiponectin secretion. Menopausal transition affects the relationships of these adipokines with lipids and insulin resistance.

[Predictive elements of malignancy of isolated thyroid nodules]. / Elements predictifs de malignite d'un nodule isole de la thyroïde.

The clinically revealed thyroid nodules are very frequent (3 to 5% of the general population), among them, fewer than 10% are malignant. The objective of this retrospective study type witness-case is to determinate the malignity predictive clinical and paraclinical elements for 45 patients presenting a thyroid malignant nodule and 45 others matched by age and sex presenting a thyroid isolated nodule. These patients were treated at the ORL ward of Charles Nicolle Hospital over a period of 10 years from 1989 to 1999. The average age of advent of malignant nodule is 43.2 + 14.4 years old with a clear female predominance (sex ratio = 4). The elements clearly linked to the hazard of thyroid cancer are loss of weight (p = 0.05; OR = 8.11), hard consistency of nodule (p = 0.002), the presence of cervical adenopathies (p = 0.05; OR = 4.22), vocal cords paralysis (p = 0.04), the presence of anemia (p = 0.01; OR = 5.7), a solid structure at sonography (p = 0.05) and the presence of a flux at doppler-sonography (p = 0.02). Personal antecedents of non malignant thyroid pathology, the nodule location and size and hypoechogenic features have not been clearly associated with the hazards of thyroid cancer.

[Value of ambulatory blood pressure monitoring in blood pressure profile determination in type 2 diabetes]. / Apport de la MAPA dans l'étude du profil tensionnel du diabétique type 2.

Risk assessment in the type 2 diabetic patients must take into account the major risk factors, particularly arterial hypertension which is commonly associated, increasing the risk for macrovascular and microvascular complications. The aim of this study is to determine whether ambulatory blood pressure monitoring provides additional information to clinical (office) blood pressure measurement for the detection and control of hypertension in type 2 diabetic patients. Ambulatory blood pressure monitoring is more helpful than office blood pressure measurement for the evaluation of blood pressure levels. It is very valuable in type 2 diabetic patients for detecting autonomic dysfunction and elevated blood pressure load, which are associated with cardiovascular complications.

Adiponectin and metabolic syndrome in a Tunisian population.

The aim of this study was to investigate the relationship between the adiponectin levels and various characteristics of the metabolic syndrome (MS) in a sample of the Tunisian population. Three hundred and fifty-four individuals were included in this study. Body mass index, blood pressure, HDL-cholesterol, triglycerides, glucose, insulin, and adiponectin concentrations were measured. Insulin resistance was assessed by homeostasis model assessment of insulin resistance (HOMA-IR). MS was identified with the NCEP-ATP III criteria. Subjects with MS showed significantly lower adiponectin levels compared to those without MS. For both genders, the prevalence and the number of MS components increased significantly as the adiponectin concentrations decreased. Subjects with the lowest adiponectin quartile had an increased risk of MS adjusted for age, gender, and HOMA-IR. Our findings suggest that hypoadiponectinemia is strongly associated with the risk of MS independent of insulin resistance.

LEPR p.Q223R Polymorphism influences plasma leptin levels and body mass index in Tunisian obese patients.

BACKGROUND AND AIMS: The leptin receptor (LEPR) plays a crucial role in the regulation of body weight. Several common polymorphisms have been described in the human LEPR gene including the p.Q223R polymorphism (rs1137101). The association of this polymorphism with obesity or related metabolic phenotypes has been controversial. The aim of this study was to investigate the impact of the LEPR p.Q223R polymorphism on body mass index (BMI), plasma leptin and lipid parameters in a sample of the Tunisian population. METHODS: The study included 391 obese patients and 302 normal weight subjects. LEPR p.Q223R genotypes were identified by the PCR-RFLP analysis. RESULTS: Obese patients homozygous for RR genotype showed lower leptin levels than those with other genotypes (p = 0.005) adjusted for age, BMI and gender. Stratified analysis by gender revealed that obese male patients carrying the R allele showed significantly lower BMI (p = 0.007) and leptin levels (p = 0.037) than subjects homozygous for the Q allele. In obese women, the LEPR p.Q223R polymorphism was found associated with lower leptin concentrations (p = 0.05). After adjustment for age and BMI, the association between the LEPR variant and plasma leptin remained significant only within female patients (p = 0.027). A general linear model including leptin as dependant variable and age, BMI, menopausal status and genotype as covariates revealed that the LEPR p.Q223R polymorphism is independently associated with leptin levels in obese women (p = 0.026). CONCLUSIONS: Our findings suggest that the LEPR p.Q223R polymorphism influences plasma leptin levels and BMI in obese patients.