Occurrence Of Nodules Research Articles

A Resistivity Survey of Phosphate Nodules in Oshoshun, Southwestern Nigeria

Abstract This geophysical study was carried out to determine the occurrence of phosphate nodules in the Oshoshun Formation of the Dahomey Basin, Southwestern Nigeria. The electrical resistivity method, comprising 1D vertical electrical sounding (VES; using Schlumberger array) and 2D geoelectrical imaging (using Wenner array), was used to determine the nature and depth of occurrence of the phosphate nodules. Six profile lines were established within the study area, and inverted sections were generated from the apparent resistivity data using DIPRO inversion algorithm. Five VES points were also acquired in the study area, and Win- Resist programme was used to process and interpret the field resistivity data. Four pits were dug along the profiles to verify the interpreted results. The results obtained by both techniques reveal similar geoelectric units: the top soil, clay, clayey sand and clay at different depths. These layers host pockets of phosphate nodules (78-≥651 Ωm) with varying thicknesses. The strong correlation between the lithology profiles obtained from the pits and the interpreted results of the inverted apparent resistivity sections demonstrates the efficacy of the electrical resistivity method in characterising phosphate occurrence within the formation.

Effect of LysM+ macrophage depletion on lung pathology in mice with chronic bronchitis.

Macrophages (MΦ) are key sentinels of respiratory exposure to inhaled environmental stimuli. In normal “healthy” tissues, MΦ are believed to be a dormant cell type that, upon exposure to stress‐causing stimuli, may get activated to exhibit pro‐ or anti‐inflammatory roles. To test whether stress present in chronic bronchitic (CB) airways triggers MΦ to manifest protective or detrimental responses, the DTA+ (LysM‐regulated Diphtheria Toxin A expressing) strain with partial MΦ‐deficiency was crossed with the Scnn1b‐Tg mouse model of CB and the progenies were studied at 4–5 weeks of age. Compared with DTA− littermates, the DTA+ mice had ~50% reduction in bronchoalveolar lavage (BAL) MΦ, and the recovered MΦ were immature, phenotypically distinct, and functionally defective. DTA+/Scnn1b‐Tg mice exhibited a similar depletion of LysM+ MΦ offset by a significant increase in LysM‐ MΦ in the BAL. In DTA+/Scnn1b‐Tg mice, lung disease was more severe than in DTA−/Scnn1b‐Tg littermates, as indicated by an increased incidence of mucus plugging, mucous cells, airway inflammation, higher levels of cytokines/chemokines (KC, TNF‐α, MIP‐2, M‐CSF, IL‐5, and IL‐17), and worsened alveolar airspace enlargement. DTA+/Scnn1b‐Tg mice exhibited increased occurrence of lymphoid nodules, which was concomitant with elevated levels of immunoglobulins in BAL. Collectively, these data indicate that numerical deficiency of MΦ in stressed airspaces is responded via compensatory increase in the recruitment of immature MΦ and altered non‐MΦ effector cell‐centered responses, for example, mucus production and adaptive immune defense. Overall, these data identify dynamic roles of MΦ in moderating, rather than exacerbating, the severity of lung disease in a model of CB.

Investigating the risk factors of hepatocellular carcinoma and survival analysis for cirrhosis after transjugular intrahepatic portosystemic shunt in treating portal hypertension

This study aimed to explore the risk factors of hepatocellular carcinoma (HCC) and survival analysis for cirrhosis after transjugular intrahepatic portosystemic shunt (TIPS) in treating portal hypertension. A retrospective database review was performed, including 106 patients (33 females and 73 males; aged 26-68 years with mean age of 55.3 ± 9.1 years) who received TIPS for treating recurrent gastroesophageal variceal bleeding or refractory ascites with portal hypertension. All the patients were recruited from the Interventional Oncology Department at Beijing Ditan Hospital between October 2008 and December 2011. The TIPS was successfully performed on all involved patients by puncturing at the right branch of portal vein via right hepatic vein. After TIPS, the patients were consecutively followed up at the outpatient clinic. The patients were examined by contrast-enhanced computed tomography (CT) or magnetic resonance imaging (MRI) of the abdomen every 3 months for 3 years, for detecting the occurrence of malignant nodules and early HCC. The post-TIPS medical database was reviewed with univariate and multivariate analysis to identify the risk factors for new nodules retrospectively. The overall incidence of HCC was 38.7% (41/106). The multivariate analysis showed that an increased odds ratios (OR) of HCC was observed in the complication of portal hypertension (OR, 0.396; 95% confidence interval [CI], 0.171-0.918; P = 0.031) and preoperative cirrhosis classification (OR, 0.060; 95% CI, 0.021-0.175; P = 0.000). P < 0.05was considered statistically significant. After TIPS, the cumulative probabilities of survival time for patients with cirrhosis at 1, 2, and 3 years were 100%, 68%, and 61%, respectively (log rank test, P = 0.18). The cumulative incidence of new nodules was significantly lower among patients with refractory ascites than those with upper gastrointestinal hemorrhage. Specifically, the survival rates of patients with upper gastrointestinal hemorrhage at years 1, 2, and 3 were 100%, 65%, and 51%, respectively, compared to 100%, 88%, and 85% corresponding to patients with refractory ascites (P = 0.009). The cumulative incidence of HCC was significantly lower in cirrhosis patients with CT identified grade III than those with grade IV. At years 1, 2, and 3, the survival rates of cirrhosis patients with CT identified grade IV were 96%, 22%, and 20%, respectively, compared to 100%, 98%, and 90% in controls (P = 0.012). The identification of clinical variables associated with increased risks of HCC may be useful for selecting appropriate candidates for TIPS. Results suggested that the patients with cirrhosis of CT identified grade IV and with upper gastrointestinal hemorrhage might be relevant to increased odds of HCC after TIPS.

ES 02.02 The Fleischner Guideline / Lung-RADs

ES 02.02 The Fleischner Guideline / Lung-RADs

Activation of pluripotent genes in hepatic progenitor cells in the transition of nonalcoholic steatohepatitis to pre-malignant lesions

Nonalcoholic steatohepatitis is considered as a precancerous condition. However, hepatic carcinogenesis from NASH is poorly understood. This study aims to investigate the activation of pluripotent genes (c-Myc, Oct-4, KLF-4, and Nanog) and morphogenic gene (Gli-1) in hepatic progenitor cells from patient specimens and in an animal model to determine the possibility of normal stem/progenitor cells becoming the origin of NASH-HCC. In this study, expression of pluripotent and morphogenic genes in human NASH-HCC tissues was significantly upregulated compared to adjacent non-tumor liver tissues. After feeding high-fat/calorie diet plus high fructose/glucose in drinking water (HFC diet plus HF/G) for up to 12 months, mice developed obesity, insulin resistance, and steatohepatitis with significant necroptotic inflammation and fibrotic progression, as well as occurrence of hyperplastic nodules with dysplasia; and this model represents pathohistologically as a transition from NASH to NASH-HCC in a pre-carcinomatous stage. High expression of pluripotent and morphogenic genes was immunohistochemically visualized in the dysplasia areas of mouse liver, where there were many OV-6-positive cells, indicating proliferation of HOCs in NASH with fibrotic progression. Moreover, oncogenic transcription factors (c-Myc, KLF-4, and Nanog) were co-localized in these hepatic progenitor cells. In conclusion, pluripotent and morphogenic genes may contribute to the reprogramming of hepatic progenitor cells in driving these cells to be the origin of NASH-HCC in a steatotic and inflamed microenvironment.

Immature Ovarian Teratoma with Gliomatosis Peritonei- an unusual finding

Immature ovarian teratoma is a rarely seen germ cell tumor and Gliomatosis peritonei (GP) is a rare condition that occurs almost exclusively in the setting of ovarian immature teratoma. It is characterisized by the occurrence of nodules of mature glial tissues in the peritoneum, omentum and bowel wall. The glial tissue in such cases is usually low grade although there have been cases of malignant evolution described. In general, the prognosis for GP is good. It depends chiefly on the degree of maturity of the implants. In mature GP, usually no additional chemotherapy is necessary. In immature GP, chemotherapy can induce maturation of the implants. We present a case of immature ovarian teratoma associated with low grade GP.J Dhaka Medical College, Vol. 26, No.1, April, 2017, Page 79-82

Relationship between age and outcome in thyroid surgery: a prospective observational study.

Background:The occurrence of thyroid nodules and goiter increases with age. In general, surgery age is a predictor of perioperative morbidity. In thyroid surgery, there are different data on the role of age on morbidity. We investigated the influence of age on the outcome in thyroid surgery in a prospective single cohort study with a follow-up after 1 year.Methods:Total thyroidectomy or hemithyroidectomy was performed in euthyroid benign thyroid goiters (n=152). The primary endpoint was surgery duration. The secondary endpoints were weight of resected tissue, body mass index (BMI), amount and type of perioperative and long-term complications, and quality of life (QoL) preoperatively and 1 year postoperatively.Results:A significant three-way interactive relationship between age, surgery duration, and amount of resected tissue was found. An increase in any of these variables results in an increase in both other variables. The amount of perioperative complications was associated with resected tissue size. The QoL increases significantly after surgery by up to 10% and decreases significantly with age (mean QoL after surgery=84.9 of 100 for the youngest group and 75.7 of 100 for the oldest group). No long-term complications were recorded.Conclusion:The number of thyroid operations, especially of benign thyroid goiters, decreases annually in Germany. This can be explained by the fact that, on the one hand, the surgical indications are made more restrictive as conspicuous nodes are better clarified by improved technical aids. On the other hand, conservative measures (i.e. L-thyroxine and iodide administration) are used to achieve a size regimen of the goiter. Our results show that perioperative complications increase with patients’ age and surgery duration. However, the more restrictive surgical decision also entails the risk that patients will have to be operated at an older age and possibly with a bigger goiter, which is associated with higher operative morbidity. Therefore, in addition to the possibility of conservative therapy of the symptomatic goiter, the affected patients should also be thoroughly informed about the option to perform elective early thyroid surgery with regard to improved postoperative QoL and to keep the overall stress at a minimum for elderly patients.

English

English

Technetium scintigraphy as a predictive tool of thyroid malignancy

&lt;p class="abstract" style="display: inline !important;"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Thyromegaly is a common cause of physician consultation. Solitary thyroid nodules are conventionally viewed with suspicion. Clinical examination cannot reliably distinguish between a solitary thyroid nodule and a dominant nodule in multinodular goiter. Ultrasonographical examination has its own pitfalls. Technetium 99 is a commonly used modality for the functional assessment of solitary thyroid nodule detection. It has the advantage of low cost with lower radiation dose to the exposed patients. On literature search, studies on technetium 99 scintigraphy for thyroid in context to the Indian scenario do not yield much information and very few studies are notable. This study was conducted to correlate and qualify thyroid cold nodule as detected by Technetium 99 pertechnetate thyroid scan. &lt;span lang="EN-IN"&gt;This study was conducted to correlate, qualify and compare the predictive value of Technetium 99 pertechnetate scintigraphy on solitary thyroid nodule via fine needle aspiration cytology and to countercheck with histopathological examination. &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;A prospective cohort study in a NABH, NAAC and JCI accredited tertiary care teaching university hospital was conducted over a period of 36 months. All the subjects underwent clinical assessment of the neck included standard examination techniques to segregate solitary thyroid nodules. They were then subjected to Technetium 99 pertechnate scintigraphy using the standard protocol. All the patients with solitary cold nodule underwent FNAC followed by nodule excision or hemi-thyroidectomy under general anaesthesia. All the specimens underwent histo-pathological examination by an experienced histopathologist. The results were statistically analysed using pearson chi-square test. &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;Cold nodules as detected by Technetium 99 pertechnetate thyroid scan is a reasonable indicator of probable malignancy via fine needle aspiration cytology. Occurrence of cold nodules is highest in 3&lt;sup&gt;rd&lt;/sup&gt; to 5&lt;sup&gt;th&lt;/sup&gt; decade of life (21-50 year age group). Occurrence of cold nodules is higher in females (83%) whereas occurrence of malignancy in cold nodules is higher in males (85%). Occurrence of malignancy in cold nodules is higher in subjects less than 21 and above 50 years. &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;Technetium 99m pertechnetate thyroid scintigraphy is an important preoperative tool in management of thyroid nodules and its routine use in all such patients is recommended especially to rule out cold nodules.&lt;/span&gt;&lt;/p&gt;

Detection of Lung Cancer Using Digital Image Processing Techniques: A Comparative Study

This paper focuses on early stage lung cancer detection. Lung cancer is prominent cancer as it states large number of deaths of more than a million every year. It creates need of detecting the lung nodule at early stage in Computer Tomography medical images. So to detect the occurrence of cancer nodule at early stage, the requirement of methods and techniques is increasing. There are different methods and techniques existing but none of them provide a better accuracy of detection. One of the techniques is content based image retrieval Computer Aided Diagnosis System (CAD) for early detection of lung nodules from the Chest Computer Tomography (CT) images. This optimization algorithm allows physicians to identify the nodules present in the CT lung images in the early stage hence the lung cancer. The MATLAB image processing toolbox based implementation is done on the CT lung images and the classifications of these images are carried out. The performance measures like the classification rate and the false positive rates are analyzed.

Type I interferon response gene expression in established rheumatoid arthritis is not associated with clinical parameters.

BackgroundA peripheral blood interferon (IFN) signature (i.e., elevated type I interferon response gene [IRG] expression) has been described in a subset of patients with rheumatoid arthritis (RA). In the present study, we systematically assessed the association between this IRG expression and clinical parameters.MethodsExpression of 19 IRGs was determined in peripheral blood from 182 consecutive patients with RA and averaged into an IFN score per individual. Correlation and unpaired analyses were performed on the complete patient group. The analyses were internally validated by using an algorithm to randomize the patient group 1000 times into two equally sized sets, and then analyses were performed on both sets.ResultsAssociations were assessed between IFN score and disease duration, 28-joint Disease Activity Score and its components, the occurrence of erosions and nodules, autoantibody positivity, and immunosuppressive treatment. This analysis revealed lower IFN scores in patients using hydroxychloroquine, prednisone, and/or sulfasalazine, but it did not show significant associations between the other parameters and the IFN score. Selecting patients who were not treated with hydroxychloroquine, prednisone, and/or sulfasalazine (n = 95) did not reveal any significant associations either.ConclusionsIRG expression in RA is affected by immunosuppressive treatment with prednisone, hydroxychloroquine, and/or sulfasalazine, but it is not evidently associated with other clinical parameters. Hence, the IFN signature appears to describe a subgroup of patients with RA but does not seem to reflect disease activity.Electronic supplementary materialThe online version of this article (doi:10.1186/s13075-016-1191-y) contains supplementary material, which is available to authorized users.

Comparison of Fine Needle Aspiration Cytology (FNAC) and thyroid ultrasonography in the diagnosis of thyroid nodules

Introduction: Occurrence of thyroid nodules is a common clinical problem in Sri Lanka. Clinical assessment, biochemical investigations, ultrasonography, fine needle aspiration cytology (FNAC) and histology are used in the diagnosis. Objectives: To determine the value of FNAC and ultrasonography (USS) to distinguish neoplastic nodules from non-neoplastic nodules of the thyroid. Method: A retrospective cross sectional study involving 73 patients from Base Hospital Embilipitiya, during the period 2009 January to 2013 December was carried out. Results: Study population was female predominant 70(95.9%) with the age ranging from 17-70 (mean 42.7). Sensitivity, specificity, positive predictive value, negative predictive values and accuracy for FNAC were 94.1%, 87.2%, 86.5%, 94.4%, and 90.4% respectively. The corresponding values for ultrasonography were 64.7%, 69.2%, 64.7%, 69.2% and 67.1% respectively. Conclusion: The findings of this study are in keeping with the other studies in Sri Lanka and the region. In addition, FNAC has a higher validity than USS in detection of thyroid neoplasms.

Occurrence and lung cancer probability of new solid nodules at incidence screening with low-dose CT: analysis of data from the randomised, controlled NELSON trial

US guidelines now recommend lung cancer screening with low-dose CT for high-risk individuals. Reports of new nodules after baseline screening have been scarce and are inconsistent because of differences in definitions used. We aimed to identify the occurrence of new solid nodules and their probability of being lung cancer at incidence screening rounds in the Dutch-Belgian Randomized Lung Cancer Screening Trial (NELSON). In the ongoing, multicentre, randomised controlled NELSON trial, between Dec 23, 2003, and July 6, 2006, 15 822 participants who had smoked at least 15 cigarettes a day for more than 25 years or ten cigarettes a day for more than 30 years and were current smokers, or had quit smoking less than 10 years ago, were enrolled and randomly assigned to receive either screening with low-dose CT (n=7915) or no screening (n=7907). From Jan 28, 2004, to Dec 18, 2006, 7557 individuals underwent baseline screening with low-dose CT; 7295 participants underwent second and third screening rounds. We included all participants with solid non-calcified nodules, registered by the NELSON radiologists as new or smaller than 15 mm(3) (study detection limit) at previous screens. Nodule volume was generated semiautomatically by software. We calculated the maximum volume doubling time for nodules with an estimated percentage volume change of 25% or more, representing the minimum growth rate for the time since the previous scan. Lung cancer diagnosis was based on histology, and benignity was based on histology or stable size for at least 2 years. The NELSON trial is registered at trialregister.nl, number ISRCTN63545820. We analysed data for participants with at least one solid non-calcified nodule at the second or third screening round. In the two incidence screening rounds, the NELSON radiologists registered 1222 new solid nodules in 787 (11%) participants. A new solid nodule was lung cancer in 49 (6%) participants with new solid nodules and, in total, 50 lung cancers were found, representing 4% of all new solid nodules. 34 (68%) lung cancers were diagnosed at stage I. Nodule volume had a high discriminatory power (area under the receiver operating curve 0·795 [95% CI 0·728-0·862]; p<0·0001). Nodules smaller than 27 mm(3) had a low probability of lung cancer (two [0·5%] of 417 nodules; lung cancer probability 0·5% [95% CI 0·0-1·9]), nodules with a volume of 27 mm(3) up to 206 mm(3) had an intermediate probability (17 [3·1%] of 542 nodules; lung cancer probability 3·1% [1·9-5·0]), and nodules of 206 mm(3) or greater had a high probability (29 [16·9%] of 172 nodules; lung cancer probability 16·9% [12·0-23·2]). A volume cutoff value of 27 mm(3) or greater had more than 95% sensitivity for lung cancer. Our study shows that new solid nodules are detected at each screening round in 5-7% of individuals who undergo screening for lung cancer with low-dose CT. These new nodules have a high probability of malignancy even at a small size. These findings should be considered in future screening guidelines, and new solid nodules should be followed up more aggressively than nodules detected at baseline screening. Zorgonderzoek Nederland Medische Wetenschappen and Koningin Wilhelmina Fonds Kankerbestrijding.

Sulfur isotope patterns of iron sulfide and barite nodules in the Upper Cretaceous Chalk of England and their regional significance in the origin of coloured chalks

AbstractThe relationship between the development of iron sulfide and barite nodules in the Cenomanian Chalk of England and the presence of a red hematitic pigment has been investigated using sulfur isotopes. In southern England where red and pink chalks are absent, iron sulfide nodules are widespread. Two typical large iron sulfide nodules exhibit δ34S ranging from −48.6‰ at their core to −32.6‰ at their outer margins. In eastern England, where red and pink chalks occur in three main bands, there is an antipathetic relationship between the coloured chalks and the occurrence of iron sulfide or barite nodules. Here iron sulfide, or its oxidised remnants, are restricted to two situations: (1) in association with hard grounds that developed originally in chalks that contained the hematite pigment or its postulated precursor FeOH3, or (2) in regional sulfidization zones that cut across the stratigraphy. In the Cenomanian Chalk exposed in the cliffs at Speeton, Yorkshire, pyrite and marcasite (both iron sulfide) nodules range in δ34S from −34.7‰ to +40.0‰. In the lower part of the section δ34S vary from −34.8‰ to +7.8‰, a single barite nodule has δ34S between +26.9‰ and +29.9‰. In the middle part of the section δ34S ranges from +23.8‰ to +40.0‰. In the sulfidization zones that cut across the Cenomanian Chalk of Lincolnshire the iron sulfide nodules are typically heavily weathered but these may contain patches of unoxidised pyrite. In these zones, δ34S ranges from −32.9‰ to +7.9‰. The cross-cutting zones of sulfidization in eastern England are linked to three basement faults – the Flamborough Head Fault Zone, the Caistor Fault and the postulated Wash Line of Jeans (1980) – that have affected the deposition of the Chalk. It is argued that these faults have been both the conduits by which allochthonous fluids – rich in hydrogen sulfide/sulfate, hydrocarbons and possibly charged with sulfate-reducing bacteria – have penetrated the Cenomanian Chalk as the result of movement during the Late Cretaceous or Cenozoic. These invasive fluids are associated with (1) the reduction of the red hematite pigment or its praecursor, (2) the subsequent development of both iron sulfides and barite, and (3) the loss of overpressure in the Cenomanian Chalk and its late diagenetic hardening by anoxic cementation. Evidence is reviewed for the origin of the red hematite pigment of the coloured chalks and for the iron involved in the development of iron sulfides, a hydrothermal or volcanogenic origin is favoured.

Thyroid lobectomy is an effective option for unilateral benign nodular disease.

The use of thyroid lobectomy in the treatment of unilateral, benign nodules is limited by the potential of nodular recurrence in the remaining lobe. This study aimed to assess the rate and clinical impact of nodular recurrence in the contralateral lobe after thyroid lobectomy and to identify predictive factors of recurrence. Single-centre retrospective study. Records of patients that underwent lobectomy for unilateral thyroid nodules between 1991 and 2010 were reviewed and 270 patients were included. Exclusion criteria were: presence of contralateral nodule(s) ≥5mm on preoperative ultrasound, diagnosis of cancer necessitating completion thyroidectomy or pseudonodules. Recurrence was defined as the occurrence of nodule(s) ≥5mm in the remaining lobe on at least one postoperative ultrasound. A set of clinical, imaging, histological and biochemical parameters was tested as predictors of recurrence using logistic regression. After a median follow-up of 78months (range, 12-277months), the global recurrence rate was 42% and recurrence of nodules of a size ≥1cm occurred in 19%. Reoperation rate was 1·1%. 90% of patients were treated postoperatively by levothyroxine. Median time to nodular recurrence was 4years. Preoperative contralateral lobe volume and resected thyroid weight were identified as significant predictors of recurrence (P=0·045 and P=0·03 respectively). Thyroid lobectomy is an effective therapeutic strategy for unilateral, benign nodules, resulting in a low rate of clinically relevant nodular relapse in a mildly iodine-deficient area. Patients with uninodular disease and a contralateral lobe of normal size are particularly good candidates for lobectomy.

Artesunate obliterates experimental hepatocellular carcinoma in rats through suppression of IL-6-JAK-STAT signalling.

Activation of the IL-6 mediated JAK-STAT (Janus associated kinase-signal transducer and activator of transcription) oncogenic signalling plays a major role in hepatocellular carcinoma pathogenesis. The aim of this study is to assess the anti-tumour, anti-proliferative and apoptotic potential of artesunate and its capacity to modulate JAK-STAT pathway in a nitrosodiethylamine mediated experimental hepatocellular carcinoma model. Administration of nitrosodiethylamine (200mg/kg body weight by i.p. Injections) to rats resulted in alterations of liver pathophysiological parameters such as increased relative liver weight, and increased tumour nodule occurrence. It also increased the levels of serum marker enzymes (AST, ALT, ALP, LDH, and γGT) and tumour biomarker (AFP) levels suggestive of its capacity to cause liver tumourigenesis. Additionally, the immunohistochemistry of liver sections pertaining to nitrosodiethylamine administered animals showed increased detection of AgNOR, PCNA, and GST-Pi positive cells suggestive of its capacity to promote liver proliferation associated tumourigenesis. On the contrary, artesunate (25mg/kg bodyweight) supplementation to nitrosodiethylamine administered animals decreased all the above mentioned pathophysiological, biochemical, and immunohistochemistry parameters suggesting its anti-tumour and anti-proliferative potential. Furthermore, immunoblot analysis showed significant up-regulation of IL-6, GP130, JAK-2, STAT-3 (pY705), Bcl-xL, Bcl-2 and simultaneous down-regulation of Caspase-3, PARP and SOCS-3 in nitrosodiethylamine administered animals. Nevertheless, the immunoblot analysis revealed vice-versa on artesunate supplementation to nitrosodiethylamine administered animals, indicating promotion of the feedback loop inhibition mechanism through SOCS3 up-regulation thereby leading to suppression of JAK-STAT signalling. Overall all these findings substantiate that artesunate promotes anti-tumour, anti-proliferation and apoptosis against nitrosodiethylamine mediated hepatocellular carcinoma.

Clinical and histopathological characteristics of patients with incidental and nonincidental thyroid cancer.

IntroductionThyroid nodules (TNs) are a common pathology. Their prevalence increases with age. Some of them are suspected of malignancy and qualified for surgery. Sometimes their malignant nature is detected incidentally after a surgical procedure. The aim of the study is to analyze clinical and histopathological characteristics of patients with incidental and nonincidental thyroid carcinoma (ITC vs. NITC).Material and methodsThe case records of 3,241 patients with solitary and multiple TNs who were treated consecutively between 2008 and 2014 were analyzed retrospectively. After the final selection 235 (7.25%) patients were included in the study (202 females and 33 males, mean age: 52.9 +16.5 years). Seventy-five (31.91%) cases were incidentally diagnosed and 160 (68.09%) were diagnosed before surgery.ResultsWe did not observe any differences in age, gender or stage of disease at the time of diagnosis between the patients with ITC and NITC (p = 0.366, p = 0.850, p = 0.226 respectively). The occurrence of solitary nodules in patients with NITC was significantly higher compared to patients with ITC (p < 0.0001). There were no differences in histopathological types of thyroid cancer (TC). The logistic regression analysis showed that solitary TC was an independent predictor of NITC (p < 0.0001).ConclusionsThere are no differences in gender, age or histopathological type of cancer in patients with ITC and NITC. Papillary TC is the predominant type in both groups. Incidence of TC in a solitary nodule is significantly higher in NITC than ITC. Solitary type of TC is an independent predictor of NITC. The prevalence of ITC is associated with multifocal type of TC.

Efficacy of Technetium Scintigraphy as an investigative Tool in Papillary Carcinoma of Thyroid: A Prospective Study

ABSTRACT Introduction and background Thyromegaly is a common cause of physician consultation. Solitary thyroid nodules are conventionally viewed with suspicion. Clinical examination cannot reliably distinguish between a solitary thyroid nodule and a dominant nodule in multinodular goiter. Ultrasonographical examination has its own pitfalls. Technetium 99 is a commonly used modality for the functional assessment of solitary thyroid nodule detection. It has the advantage of low cost with lower radiation dose to the exposed patients. On literature search, studies on Technetium 99 scintigraphy for thyroid in context to the Indian scenario does not yield much information, and very few studies are notable. This study was conducted to correlate and qualify thyroid cold nodule as detected by technetium 99 pertechnetate thyroid scan. Objective This study was conducted to correlate, qualify, and compare the predictive value of technetium 99 pertechnetate scintigraphy on solitary thyroid nodule vis-à-vis fine needle aspiration cytology (FNAC) and to countercheck with histopathological examination (HPE). Materials and methods A prospective cohort study in a National Accreditation Board for Hospitals &amp; Health care Providers, National Assessment and Accreditation Council, and Joint Commission International-accredited tertiary care teaching university hospital was conducted over a period of 36 months. All the subjects underwent clinical assessment of the neck that included standard examination techniques to segregate solitary thyroid nodules. They were then subjected to technetium 99 pertechnetate scintigraphy using the standard protocol. All the patients with solitary cold nodule underwent FNAC followed by nodule excision or hemi-thyroidectomy under general anesthesia. All the specimens underwent HPE by an experienced histopathologist. The results were statistically analyzed using Pearson's chi-square test. Results (1) Cold nodules as detected by technetium 99 pertechnetate thyroid scan is a reasonable indicator of probable malignancy vis-à-vis FNAC. (2) Occurrence of cold nodules is highest in third to fifth decade of life (21- to 50-year age group). (3) Occurrence of cold nodules is higher in females (83%), whereas occurrence of malignancy in cold nodules is higher in males (85%). (4) Occurrence of malignancy in cold nodules is higher in subjects less than 21 and above 50 years. (5) Technetium 99m pertechnetate thyroid scintigraphy is an important preoperative tool in management of thyroid nodules, and its routine use in all such patients is recommended, especially to rule out cold nodules. How to cite this article Mohanty S, Sreenivas C, Raj V, Efficacy of Technetium Scintigraphy as an investigative Tool in Papillary Carcinoma of Thyroid: A Prospective Study. Int J Head Neck Surg 2016;7(4):220-222.

Parathyroid ultrasonography and bone metabolic profile of patients on dialysis with hyperparathyroidism.

To evaluate the parathyroid ultrasonography and define parameters that can predict poor response to treatment in patients with secondary hyperparathyroidism due to renal failure. This cohort study evaluated 85 patients with chronic kidney disease stage V with parathyroid hormone levels above 800 pg/mL. All patients underwent ultrasonography of the parathyroids and the following parameters were analyzed: Demographic characteristics (etiology of chronic kidney disease, gender, age, dialysis vintage, vascular access, use of vitamin D), laboratory (calcium, phosphorus, parathyroid hormone, alkaline phosphatase, bone alkaline phosphatase), and the occurrence of bone changes, cardiovascular events and death. The χ(2) test were used to compare proportions or the Fisher exact test for small sample frequencies. Student t-test was used to detect differences between the two groups regarding continuous variables. Fifty-three patients (66.4%) had parathyroid nodules with higher levels of parathyroid hormone, calcium and phosphorus. Sixteen patients underwent parathyroidectomy and had higher levels of phosphorus and calcium × phosphorus product (P = 0.03 and P = 0.006, respectively). They also had lower mortality (32% vs 68%, P = 0.01) and lower incidence of cardiovascular or cerebrovascular events (27% vs 73%, P = 0.02). Calcium × phosphorus product above 55 mg(2)/dL(2) [RR 1.48 (1.06, 2.08), P = 0.03], presence of vascular calcification [1.33 (1.01, 1.76), P = 0.015] and previous occurrence of vascular events [RR 2.25 (1.27, 3.98), P < 0.001] were risk factors for mortality in this population. There was no association between the occurrence of nodules and mortality. The identification of nodules at ultrasonography strengthens the indication for parathyroidectomy in patients with secondary hyperparathyroidism due to renal failure.

A Rare Concurrence of Leiomyomatosis Peritonealis Disseminata, Leiomyosarcoma of the Pelvis and Leiomyomatous Nodule of the Liver.

Leiomyomatosis peritonealis disseminata (LPD) is a rare entity that is characterized by the presence of multiple subperitoneal or peritoneal smooth muscle nodules throughout the peritoneal surface mimicking a malignant process. LPD follows a benign course in general, and it is often found incidentally during abdominal surgery. There have been reported cases of LPD with malignant degeneration although the association is uncertain. Concurrent finding of LPD and leiomyosarcoma of the pelvis is very rare that could be coincidental, malignant transformation of LPD to leiomyosarcoma, or progression of undetected primary leiomyosarcoma. There are only a few previously reported cases in the literature. Herein, we report a case of 56-year-old woman with a history of leiomyoma of uterus who presented with progressive abdominal swelling secondary to mass lesions in the pelvis. The patient underwent exploratory laparotomy and debulking of the tumors, and the histologic examination of the tumors revealed coexistence of LPD and leiomyosarcoma. After recovery from the operation, core needle biopsy of the superficial, residual liver mass was obtained to investigate potential liver metastasis, and the histopathologic findings are consistent with leiomyoma which represents the first simultaneous occurrence of LPD, leiomyosarcoma, and leiomyomatous nodule of the liver.