Retinol Binding Protein-4 and Adiponectin Levels in Thyroid Overt and Subclinical Dysfunction

Thyroid dysfunction is accompanied by numerous changes in intermediary metabolism. Retinol binding protein-4 (RBP-4) and adiponectin are 2 adipocytokines that have multiple metabolic functions. The aim of our study was to examine serum RBP4 and adiponectin levels in clinical (before and after therapy) and subclinical hyperthyroid and hypothyroid subjects as compared to controls.150 patients with thyroid dysfunction were recruited (65 hyperthyroid and 85 hypothyroid) while 28 euthyroid subjects served as a control group. We measured anthropometric, biochemical and hormonal (free T4, free T3, TSH, insulin) parameters in all participants. RBP-4 and adiponectin were measured using commercial ELISA kits.Mean baseline levels of RBP-4 were higher in patients with clinical hypothyroidism (29.0±10.2 ng/ml, 25.1±12.6 ng/ml, 38.8±16.5 ng/ml, 31.9±13.2 ng/ml, 20.4±8.2 ng/ml in patients with hyperthyroidism, subclinical hyperthryrodism, hypothyroidism, subclinical hypothyroidism and controls respectively, F=4.86, P<0.001) and decreased significantly in patients with clinical hyperthyroidism and hypothyroidism after normalization of thyroid hormones' levels (from 29.0±10.2 to 24.9±8.4 ng/ml, p=0.003 and from 38.8±16.5 to 29.0±10.8 ng/ml, p=0.001 respectively). We did not observe analogous changes in adiponectin levels in any of the studied groups.RBP-4 levels are higher in patients with clinical hypothyroidism and exhibit a marked decrease after normalization of thyroid function in both hyper and hypothyroid patients. We suggest that RBP-4 may play a role in the metabolic disturbances which accompany thyroid dysfunction.

Contribution of (99m)Tc-depreotide (Neospect) scintigraphy in lung cancer staging

PURPOSE

The aim of this study was to evaluate the usefulness of scintigraphy with (99m)Tc-depreotide in the staging of lung cancer, especially in cases where CT findings are doubtful.

METHODS

53 patients with suspected lung cancer were investigated with whole body planar acquisition and single photon emission computed tomography (SPECT) of the thorax after i.v. injection of 740 MBq (99m)Tc-depreotide (Neospect). The results were compared with CT and correlated with histological findings.

RESULTS

In 50 of 53 patients the biopsy was positive for bronchogenic carcinoma (31 patients with non small cell lung cancer [NSCLC], 18 with small cell lung cancer (SCLC), and 1 patient with neuroendocrine cancer). In the remaining 3, biopsy revealed no bronchogenic carcinoma (3 patients with inflammation). In 2/31 patients with NSCLC and doubtful CT findings, uptake of (99m)Tc-depreotide was the only non invasive reliable staging method.

CONCLUSION

It seems that scintigraphy with (99m)Tc-depreotide in patients with SCLC does not change the tumor stage, whereas in NSCLC the contribution of Neospect in lung cancer staging may be a helpful tool, especially in cases where CT alone is unable to distinguish between IIIA and IIIB stages (operable from non operable status).

Long acting octreotide in the treatment of advanced hepatocellular cancer and overexpression of somatostatin receptors: randomized placebo-controlled trial

AIM

To estimate if and to what extent long acting octreotide (LAR) improves survival and quality of life in patients with advanced hepatocellular carcinoma (HCC).

METHODS

A total of 127 cirrhotics, stages A-B, due to chronic viral infections and with advanced HCC, were enrolled in the study. Scintigraphy with 111Indium labeled octreotide was performed in all cases. The patients with increased accumulation of radionuclear compound were randomized to receive either oral placebo only or octreotide/octreotide LAR only as follows: octreotide 0.5 mg s.c. every 8 h for 6 wk, at the end of wk 4-8 octreotide LAR 20 mg i.m. and at the end of wk 12 and every 4 wk octreotide LAR 30 mg i.m.. Follow-up was worked out monthly as well as the estimation of quality of life (QLQ-C30 questionnaire). Patients with negative somatostatin receptors (SSTR) detection were followed up in the same manner.

RESULTS

Scintigraphy demonstrated SSTR in 61 patients. Thirty were randomized to receive only placebo and 31 only octreotide. A significantly higher survival time was observed for the octreotide group (49+/-6 wk) as compared to the control group (28+/-1 wk) and to the SSTR negative group (28+/-2 wk), LR=20.39, df=2, P<0.01. The octreotide group presented 68.5% lower hazard ratio [95% CI (47.4%-81.2%)]. During the first year, a 22%, 39% and 43% decrease in the QLQ-C30 score was observed in each group, respectively.

CONCLUSION

The proposed therapeutic approach has shown to improve the survival and quality of life in SSTR positive patients with advanced HCC.

Long acting octreotide in the treatment of advanced hepatocellular cancer and overexpression of somatostatin receptors: Randomized placebo-controlled trial

AIM: To estimate if and to what extent long acting octreotide (LAR) improves survival and quality of life in patients with advanced hepatocellular carcinoma (HCC).

METHODS: A total of 127 cirrhotics, stages A-B, due to chronic viral infections and with advanced HCC, were enrolled in the study. Scintigraphy with ¹¹¹Indium labeled octreotide was performed in all cases. The patients with increased accumulation of radionuclear compound were randomized to receive either oral placebo only or octreotide/octreotide LAR only as follows: octreotide 0.5mg s.c. every 8 h for 6 wk, at the end of wk 4-8 octreotide LAR 20 mg i.m. and at the end of wk 12 and every 4 wk octreotide LAR 30mg i.m.. Follow-up was worked out monthly as well as the estimation of quality of life (QLQ-C30 questionnaire). Patients with negative somatostatin receptors (SSTR) detection were followed up in the same manner.

RESULTS: Scintigraphy demonstrated SSTR in 61 patients. Thirty were randomized to receive only placebo and 31 only octreotide. A significantly higher survival time was observed for the octreotide group (49 ± 6 wk) as compared to the control group (28 ± 1 wk) and to the SSTR negative group (28 ± 2 wk), LR = 20.39, df = 2, P < 0.01. The octreotide group presented 68.5% lower hazard ratio [95% CI (47.4%-81.2%)]. During the first year, a 22%, 39% and 43% decrease in the QLQ-C30 score was observed in each group respectively.

CONCLUSION: The proposed therapeutic approach has shown to improve the survival and quality of life in SSTR positive patients with advanced HCC.

Induced in vivo targeted transarterial and transvenous immunostimulation in patients with unresectable pancreatic carcinoma

On the basis of the preliminary results of this study, in vivo dual immunostimulation in patients with advanced pancreatic cancer appears to be a promising therapeutic alternative. A surgical technique is presented in which the spleen of the patient is used as the target organ for in vivo lymphokine activated killer cell generation. Additionally, applying locoregional transvenous administration of gamma-INF and IL2 in the area of the tumor, tumor infiltrating lymphocytes (TIL) area activated, thus completing the system of dual in vivo immunostimulation.