Abnormalities of the thyroid in survivors of childhood Hodgkin's disease

AIM

The progress made in the treatment of Hodgkin's disease (HD) has resulted in long-term survival rates >90%, therefore late sequelae of treatment, especially endocrine diseases, have become more important. Hypothyroidism is the most frequent thyroid disease but hyperthyroidism, thyroid nodules and cancer are also frequent. Thyroid cancer begins to appear 5-10 years after neck irradiation and risk persists for decades. Therefore it is important a careful and long-term follow-up of these patients.

METHODS

This report analyzed the thyroid function of thirteen patients successfully treated for childhood HD according to three different protocols of therapy. Treatment modalities were correlated to the occurrence of thyroid dysfunction.

RESULTS

After a median follow-up of 8.3 years, nine out of thirteen patients were found to have thyroid abnormalities. Six patients developed hypothyroidism, one patient developed hyperthyroidism, two patients showed only ultrasound abnormalities.

CONCLUSIONS

The patients treated with lower radiotherapy (RT) doses and restricted RT extension showed a lower incidence of thyroid abnormalities compared to patients treated with higher RT dose and extended RT field. This study, even though performed in a small cohort of patients, confirms the high incidence of thyroid abnormalities in patients treated for HD and strengthens the importance of a long-term follow-up.

Chemical immobilisation of free-ranging Pampas foxes (Pseudalopex gymnocercus): Assessment of ketamine-xylazine and tiletamine-zolazepam combinations

Two protocols to immobilise free-ranging Pampas foxes for ear-tagging or radio-collaring were evaluated. One hundred fifteen foxes were injected with ketamine-xylazine (K-X) and thirteen with tiletamine-zolazepam (T-Z). The use of both T-Z and K-X combinations typically resulted in a smooth induction and recovery. In 86% of the cases K-X protocol was judged effective (mean±SD, K: 10.7±3.3mg/kg, X: 1.0±1.0mg/kg) while T-Z protocol was judged effective in 92% of the cases (T: 3.6±1.05mg/kg, Z: 3.6±1.05mg/kg). The primary differences between the two drug combinations were that the time necessary for the complete recovery was longer with T-Z, and thermic problems were found more frequently with K-X. Additionally, our results suggest that thermic stress may be a relatively frequent complication for Pampas foxes. This study provides baseline data on some physiologic variables in Pampas foxes captured with different methods and drugs in field conditions.

Spatial organization of Molina’s hog-nosed skunk (Conepatus chinga) in two landscapes of the Pampas grassland of Argentina

We radio-tracked 16 individuals (6 males, 10 females) of the little known Molina’s hog-nosed skunk ( Conepatus chinga (Molina, 1782)) and compared home-range dynamics, movement rates, and densities between a protected area and a landscape fragmented by agriculture. The mean home-range size (95% fixed kernel) was 166.7 ha (SD = 107.5 ha), without significant differences between areas. Home-range size varied significantly between males (mean = 243.7 ha, SD = 76.5 ha) and females (mean = 120.4 ha, SD =77.6 ha). Overlap between home range and core area was extensive between and within sexes in the protected area and more limited in the cropland area. Mean distance traveled between two consecutive resting sites was 269.5 m (SD = 365 m) and did not differ between areas, although movements were greater for males than females. Distance moved was influenced by seasons, being greater during the cold period. Finally, density estimates were consistently greater at the protected area. We argue that home-range size in Molina’s hog-nosed skunks is an inherent species property, whereas population density and territoriality are more flexible parameters that could reflect how the ecosystem state was affected. In our study, the greater dispersion of food patches in the cropland area than in the protected area may be the major factor influencing these parameters.

[A modified technique of gallbladder dissection from the liver during laparoscopic cholecystectomy. Personal technique]

BACKGROUND

Gallbladder injures during cholecystectomy happens more frequently when surgical operation is conduced under laparoscopic (16%) rather than laparotomic (8%) access. A modification of the technique of dissection of the gallbladder from the liver is presented, suggesting a progression from the medium to the lateral side. This technique should facilitate the division of the organs and, above all, limit the gallbladder iatrogenic injures.

METHODS

During 1995-2000 we have employed our technique in 637 patients, 89 (14%) affected by acute cholecystytis, subjected to laparoscopic cholecystectomy.

RESULTS

Gallbladder injures occurred in 38 cases (6%), with stones liberation 12 (1,9%): 11 had been submitted to surgery in emergency. All patients have been subjected to follow-up from 12 to 30 months. No intraperitoneal abscess was observed, while suppuration of the umbilical port occurred in 12 patients (1,9%): 6 were affected by systemic illnesses.

CONCLUSIONS

Our technique can limit the incidence of iatrogenic gallbladder injuries during laparoscopic cholecystectomies, reducing surgical times, antibiotics administration, incidence of perioperative complications. Besides, this technique may facilitate the gallbladder dissection from the liver in case of infundibular stones.

Intracholecystic hemorrhage: an atypical complication after liver needle biopsy

The authors report an unusual case of intracholecystic hemorrhage related to liver biopsy in a 23-year-old man. Echography and computed tomography evidenced changes in density within the gallbladder which were probably caused by hemorrhagic discharge. Although the mechanism by which liver biopsy induced intracholecystic hemorrhage is unclear, the authors believe that this iatrogenic complication was probably the result of microlesions of the gallbladder wall caused by needle puncture: the lesions extended into the submucosa and provoked slow hematic leakage. The pain syndrome began 48 hours after biopsy. The peculiarity of this case report was confirmed by the fact that no bile was aspirated, no choleperitoneum was found, and no gallbladder tissue was detected in the sample. The authors conclude by recommending clinical and echographic control following liver biopsy.

In vitro protection of acetylcholinesterase and butyrylcholinesterase by tetrahydroaminoacridine. Comparison with physostigmine

The protective action of 1,2,3,4-tetrahydro-9-aminoacridine (THA) against the long-lasting inactivation of acetylcholinesterase (AChE) and butyrylcholinesterase (BuChE) brought about by diisopropylfluorophosphate (DFP) and physostigmine, as well as by neostigmine in the case of AChE only, was evaluated by a dilution technique using Electrophorus electricus AChE and horse serum BuChE as target enzymes. In parallel experiments, the ability of physostigmine itself to protect these enzymes from DFP was evaluated and compared with that of THA. THA pretreatment was seen to prevent in a dose-dependent manner the inhibition of both AChE and BuChE. However, it was appreciably more potent towards AChE than towards BuChE. THA mean EC50 values for protecting AChE against 10, 40 and 100 microM DFP were 0.04, 0.16 and 0.45 microM, respectively; against 1 microM physostigmine the value was 1.8 microM and against 1.2 microM neostigmine it was 3.0 microM. The THA mean EC50 value for protecting BuChE against 3 microM physostigmine was 0.55 microM and the values for protecting against 3, 10 and 40 microM DFP were 1.5, 3 and greater than 10 microM, respectively. The protective action of THA was time independent: recovery of the maximal enzymic activity was immediate upon dilution. Unlike THA, the protective action of physostigmine developed progressively after dilution and was maximal within 3-4 (AChE) or 6-8 hr (BuChE). Under our experimental conditions, 0.3 microM physostigmine protected approximately 70% of AChE from 40 microM DFP and 5 microM physostigmine protected 9 and 47% of BuChE from 40 and 3 microM DFP, respectively. The results of this work suggest that THA exerts its protective action by shielding the active site of AChE and BuChE from the attack of the inactivating agents on account of its higher enzymic affinity, whereas the protective action of physostigmine against DFP takes advantage also of the carbamylation of the enzyme. These results are in line with the hypothesis that protection of AChE is the primary mechanism responsible for the antidotal action of THA against organophosphorus poisoning.