Prognostic factors in differentiated thyroid carcinoma: a multivariate analysis of 234 consecutive patients

BACKGROUND AND OBJECTIVES

The clinical characteristics and patient outcome of a group of patients treated for differentiated thyroid carcinoma (DTC) were analyzed in order to assess the relative influence of different prognostic factors.

MATERIALS AND METHODS

We retrospectively reviewed data about sex, age, size and histologic behavior of the tumor, extrathyroid extension of the tumor, lymph node status, distant metastasis at diagnosis, surgical procedures, and overall survival from 234 patients treated for DTC. Data were submitted to a statistical analysis.

RESULTS

Using a univariate analysis, we found that survival rates were significantly influenced by age (P = 0.0001), size (P = 0.018), extrathyroidal extension (P = 0.000001), lymph node involvement (P = 0.03), and distant metastases (P = 0.049). Age and size were independent prognostic factors at multivariate analysis (t = 2.694 and t = 2.443, respectively).

CONCLUSIONS

On the basis of our results and of a review of the literature, we conclude that total thyroidectomy is the treatment of choice in DTC, except for small (<1 cm) papillary carcinoma, that could be treated by lobectomy plus isthmectomy, while lymphadenectomy is indicated only in case of macroscopic involvement.

[Varicocele in young recruits]

The authors, after an examination of the literature on the subject, present the results of a retrospective study in which the incidence of varicocele among selected young soldiers population called up at SARVAM (Viterbo) from May 1993 until October 1995 is evaluated.

Increased transforming growth factor-beta1 plasma concentration is associated with high plasma 3,3',5'-tri-iodothyronine in elderly patients with nonthyroidal illnesses

OBJECTIVE

To study transforming growth factor-beta1 (TGF-beta1) plasma concentrations in elderly patients with nonthyroidal illnesses (NTI).

DESIGN

Case-control study.

METHODS

We measured plasma concentrations of tri-iodothyronine (T3), reverse T3 (rT3), thyroxine (T4), free T3 (fT3) and free T4 (fT4) estimates, TSH, and TGF-beta1 in 48 elderly NTI patients consecutively admitted in our Division of Internal Medicine and Metabolic Diseases, and in 11 healthy age- and sex-matched controls.

RESULTS

The data on thyroid hormones enabled us to identify three groups: Group A, subjects (8 patients) with T3 and fT3 levels comparable to those in controls: Group B, subjects (30 patients) with T3 and fT3 levels lower than controls but rT3 levels comparable to those of controls; Group C, subjects (10 patients) with T3 and fT3 levels lower than those of controls and higher rT3 levels. The patients of Group C showed higher plasma levels of TGF-beta1 compared with controls. Moreover, we found a positive correlation between TGF-beta1 and rT3 (rs = 0.38, P < 0.01) in the whole group of NTI patients.

CONCLUSIONS

Our data seem to confirm the hypothesis that TGF-beta1 could play a role in the pathogenesis of some modifications of thyroid function observed in patients with nonthyroidal illnesses.

Reduced plasma concentrations of transforming growth factor β1 (TGF-β1) in obese women

OBJECTIVE

To evaluate Transforming Growth Factor beta1, (TGF-beta1) plasma concentrations and the possible relationship between this growth factor and various hormones in obese women.

DESIGN

Case-control study.

SETTING

Outpatient's Service for the Prevention and Treatment of Obesity at the University Hospital.

SUBJECTS

Twenty-five women with mild to moderate obesity, and 15 non-obese healthy women were used as controls.

MEASUREMENTS

Evaluation of TGF-beta1, insulin, prolactin, sex-hormone binding globulin, androstenedione, free triiodothyronine, free tetraiodothyronine, thyroid-stimulating hormone, dehydroepiandrosterone-sulfate, testosterone, insulin-like growth factor 1, cortisol and adrenocorticotropic hormone plasma concentrations in obese women. Blood samples were taken from fasting subjects for the determination of the above parameters.

RESULTS

In obese women plasma TGF-beta1 concentrations were lower than in controls. The obese subjects also had lower GH, IGF-1 and SHBG plasma concentrations and increased insulinaemia. A positive correlation was found between TGF-beta1 and both IGF-1 (r = 0.52; P < 0.01) and DHEA-S (r = 0.43; P < 0.05), while a negative correlation was found between TGF-beta1 and SHBG (r = -0.49; P < 0.05).

CONCLUSIONS

The reduction in TGF-beta1, an antilipogenic factor, may play a role in the pathogenesis of obesity and could be involved in the development of some obesity-related endocrine alterations.

Bile ductopenia following therapy with sulpiride

We report a case of ductopenia associated with cholestatic hepatitis in a 59-year-old woman treated for 41 years for temporal epilepsy. The patient developed jaundice, without any clinical or biochemical features of hypersensitivity, 10 months after the beginning of treatment with sulpiride. Liver biopsy showed ballooning and acidophilic degeneration of the hepatocytes, macrophages packed with lipofuscin, biliary pigment in Kupffer cells, some biliary plugs, confluent necrosis and absence of biliary ducts in all the portal tracts. These features and the presence of foci of cholangiolitis suggest a destructive cholangitis as the pathogenetic mechanism causing ductopenia. Other causes of ductopenia were excluded. Sulpiride is known to produce severe cholestatic jaundice, which we believe is due to ductopenia. The absence of hypersensitivity and the 10-month latency suggest that sulpiride may cause liver damage through a toxic mechanism in genetically susceptible subjects.

[Incidental discovery of adrenal neoplasms: our experience]

Incidental radiologic diagnosis of clinically silent adrenal masses is reported with increasing rates. Between 1981 and 1994 we observed 30 patients with "incidentaloma": for each of them a careful hormonal and instrumental evaluation was obtained. 24 patients were surgically treated. No significant biochemical alterations were observed; ETG, TC and RMN had a sensitivity of 86%, 93% and 83%, respectively. At seleno-cholesterol scintigraphy 5 incidentalomas (all adenomas) had a concordant pattern and 5 (none of these adenoma) had a discordant pattern. MIBG scintigraphy showed an uptaking ganglioneuroma. The observed histotypes were: 10 adenomas, 3 cysts, 1 hematoma, 1 myelolipoma, 1 angiomyolipoma, 1 ganglioneuroma, 1 ganglioneurofibroma, 1 paraganglioma, 1 aspecific granulomatous necrosis, 4 cortical carcinoma and 3 metastatic lesions. We did not observe any postoperative acute adrenal failure. The main problem raised by incidentalomas is to define their nature; hence the need of a careful hormonometabolic, morpho-functional and instrumental evaluation. The available diagnostic procedures, even when combined, cannot always define if an incidentaloma is a benign or a malignant lesion: in the current clinical practice, the size of the mass is still the most important criterion to define a therapeutic approach. Surgical excision is mandatory in presence of an hormonal production, even subclinic, and/or a large size of the mass (over 5 cm). If the tumor size is less than 5 cm, an aggressive strategy may be chosen in selected low-risk patients, because of the low morbidity of adrenalectomy. In our experience, the transperitoneal subcostal approach has been adopted routinely with good results.

[Adenomatoid tumor of the epididymis]

Adenomatoid tumor of the epididymis is an uncommon lesion accounting for approximately 30% of all the paratesticular neoplasms. One case observed in this Urological Department is reported and a review of our series of paratesticular neoplasms treated in the last 10 years has been considered.

Epidermoid Cysts of the Testis: Report of a Case and Rationale for Management

Epidermoid cysts are about 1 % of all testicular tumours. The Authors report a case observed at their Urological Department and justify the choice of radical surgical treatment due to the possible malignancy of the lesion, which could not be ascertained through the diagnostic means available; overall the Authors analyse critically the rationale for conservative surgical management.

Preparation of lyso-GM1 (II3Neu5AcGgOse4-long chain bases) by a one-pot reaction

A simple procedure is described for preparing lyso-GM1, a GM1 derivative that lacks the fatty acid moiety, starting from GM1 ganglioside using a one-pot reaction. Ganglioside deacylation was carried out in KOH/propan-1-ol in the absence of oxygen. The yield of lyso-GM1 under optimal conditions (6 h, 90 degrees C, 0.2 N KOH, 1 mM GM1) was 54%. The chemical structure of lyso-GM1 was determined by 1H-NMR and FAB-MS analyses, thus proving that the acetamide groups of galactosamine and sialic acid units were not affected during the deacylation reaction.

Organ preserving surgery for renal cell cancer: Our experience

During the last 10 years, 18 patients affected by kidney neoplasia have been operated on conservatively (2 patients with bilateral carcinoma, 1 patient with damaged controlateral kidney, and 15 patients with controlateral healthy kidney). All the tumors were smaller than 5 cm. In 14 cases the histological examination showed the tumor as being renal cell carcinoma, in 3 cases oncocytoma and in 1 case angiomyolipoma. All the patients had a normal post operative course and are alive with a mean follow up of 21.1 months.

Changes of the human liver GM3 ganglioside molecular species during aging

Sialosyl-lactosylceramide, GM3, is the major ganglioside of human liver, where it constitutes more than 90% of the total lipid-bound sialic acid. When analyzed by thin-layer chromatography, human liver GM3 migrates as two main spots. They are representative of ganglioside molecular species which differ in the acyl moiety. The faster running spot is mainly composed of molecular species with non-hydroxylated C22-C24 acyl chains; the other contains mainly molecular species bearing non-hydroxylated C16-C18 and alpha-hydroxylated C16-C24 acyl chains. In this study the content of the two GM3 molecular species groups was investigated in 31 subjects ranging from 19 to 85 years of age. By thin-layer chromatography we observed that the group of molecular species containing non-hydroxylated C22-C24 acyl chains, decreased linearly with subject age, while that of non-hydroxylated C16-C18 acyl chains and hydroxylated C16-C24 acyl chains increased linearly. Fast-atom-bombardment mass spectrometry performed on seven samples from subjects ranging from 21 to 78 years of age demonstrated that the age-dependent increase of the lower spot is caused by an increase in the hydroxylated fatty acid form of GM3, the content of non-hydroxylated C16-C18 fatty acid species remaining constant with age.

[Hiatal hernia in old age]

Following a review of the literature on the topic, the Authors examined all patients admitted to the Institute of Surgical Pathology 1st at the University of Pavia between 1-1-1974 and 31-12-1988 for hiatus hernia, paying special attention to those aged over 65. From an analysis of the results, it was possible to evaluate the influence of collateral pathologies and age-dependent biological changes on the basic disease and the outcome of the operation in elderly patients. In conclusion, this pathology, although not strictly confined to old age, affects a large number of elderly patients, particularly females. It rarely causes acute attacks and it is therefore possible to time the operation to coincide with the patient's best conditions. This is the reason for the excellent results achieved, whereas complications are not related to chronological age but above all to the biological age of the patient.

[Hernias of the abdominal wall in old age]

Following a review of the literature on the topic, the authors examined all patients admitted to the Institute of Surgical Pathology 1st at the University of Pavia between 1-1-1974 and 31-12-1988 affected by hernias of the abdominal wall or surgical laparoceles, paying special attention to those patients aged over 65. Attention was focused on concomitant diseases, the acuteness of the basic pathology and possible recurrence. From the results obtained it was concluded that the associated pathology and the acute state of the basic diseases condition the successful outcome of the operation more than age itself. For this reason, it is important that patients affected by these pathologies are operated as soon as possible in order to carry out an elective operation which reduces postoperative complications and reduces the risk of recurrence.

[A diagnostic protocol for gastric cancer in old age]

After examining the various diagnostic methods used for gastric cancer, the paper analyses all geriatric patients affected by this disease and hospitalised in the Institute of Pathological Surgery at the University of Pavia between 1/1/1974 and 31/12/1986. The results obtained confirmed that: the subjective symptoms of the elderly patient affected by gastric cancer differ in a large number of cases from those in adults; in some cases, in fact, the disease is silent for long periods of time, whereas it is only slight in others; tests performed revealed neoplasia and possible metastases. In conclusion, although the symptomatology in elderly patients is not clear, some symptoms (weight loss, anemia, etc.) may give the doctor cause for concern. Diagnosis may be made using a variety of tests, ranging from the more commonplace (X-ray of the digestive tract, echography, gastroscopy with biopsy, etc.) to the most recent techniques (immunoscintigraphy).

Pharmacologic probe with progabide of GABA mechanisms in essential tremor

Progabide, a gamma-aminobutyric acid agonist, was given to ten patients with essential tremor in a double-blind, placebo-controlled crossover study. The effect of progabide did not differ from that of placebo. Alterations in gamma-aminobutyric acid neurotransmission do not appear to be involved in the pathogenesis of essential tremor.