Serum CT Research Articles

Study on effect of psoralidin on anti-experimental postmenopausal osteoporosis and its mechanism

To observe the effect of psoralidine in rats with ovariectomy, and preliminarily study its mechanism. Sixty female Sprague-Dawley rats were divided into 5 groups: the sham operation group, the model group, the psoralidine low-dose group (4 mg x kg(-1)), the psoralidine high-dose group (16 mg x kg(-1)) and the Zhuangguzhitong capsule group, with 12 rats in each group. Thirteen weeks later, their blood and bone samples were collected to detect bone density, bone biochemistry, pathomorphology, serum E2 and CT. Psoralidine could up-regulate the bone density of lumbar vertebra and thighbone of rats with ovariectomy (P < 0.05), the maximum bending strength of thighbone (P < 0.05), and serum E2 and CT (P < 0.05). Psoralidine has a good active effect on postmenopausal antiosteoporosis. Its mechanism may be related to such pathways as E2 and CT.

Systematic Review of Clinical Research on Biomarkers for Pediatric Traumatic Brain Injury

Abstract The objective was to systematically review the medical literature and comprehensively summarize clinical research performed on biomarkers for pediatric traumatic brain injury (TBI) and to summarize the studies that have assessed serum biomarkers acutely in determining intracranial lesions on CT in children with TBI. The search strategy included a literature search of PubMed,(®) MEDLINE,(®) and the Cochrane Database from 1966 to August 2011, as well as a review of reference lists of identified studies. Search terms used included pediatrics, children, traumatic brain injury, and biomarkers. Any article with biomarkers of traumatic brain injury as a primary focus and containing a pediatric population was included. The search initially identified 167 articles. Of these, 49 met inclusion and exclusion criteria and were critically reviewed. The median sample size was 58 (interquartile range 31-101). The majority of the articles exclusively studied children (36, 74%), and 13 (26%) were studies that included both children and adults in different proportions. There were 99 different biomarkers measured in these 49 studies, and the five most frequently examined biomarkers were S100B (27 studies), neuron-specific enolase (NSE) (15 studies), interleukin (IL)-6 (7 studies), myelin basic protein (MBP) (6 studies), and IL-8 (6 studies). There were six studies that assessed the relationship between serum markers and CT lesions. Two studies found that NSE levels ≥15 ng/mL within 24 h of TBI was associated with intracranial lesions. Four studies using serum S100B were conflicting: two studies found no association with intracranial lesions and two studies found a weak association. The flurry of research in the area over the last decade is encouraging but is limited by small sample sizes, variable practices in sample collection, inconsistent biomarker-related data elements, and disparate outcome measures. Future studies of biomarkers for pediatric TBI will require rigorous and more uniform research methodology, common data elements, and consistent performance measures.

Clinical analysis of neuropsychiatric systemic lupus erythematosus involving the central nervous system

Background Neuropsychiatric systemic lupus erythematosus (NP-SLE) presents with a wide variety of clinical manifestations, which is often difficult to diagnose with a high mortality. This study aims to investigate the clinical features of NP-SLE involving the central nervous system (CNS) and the differential diagnoses between CNS NP-SLE and intracranial infections. Methods The clinical manifestations, serum immunological features, cerebrospinal fluid (CSF) examinations (including intracranial pressure, leukocyte count, protein, glucose and chloride), CT and (or) MRI and electroencephalogram (EEG) data of 23 NP-SLE patients with CNS involved were retrospectively reviewed. Results Nine patients presented with diffuse manifestations, while 14 patients presented with focal manifestations. Serum analysis showed the positive rates of immunoglobulins anti-nuclear antibody (ANA), anti-double stranded DNA antibody (dsDNA), anti-Sm, anti-ribosmal P protein, anti-SSA and anti-SSB antibodies were 21/22, 7/22, 1/14, 2/14, 9/14 and 3/14 respectively. Patients with decreased serum C3 accounted for 14/20 while patients with decreased serum C4 accounted for 5/20. Besides, patients with increased CSF leukocyte count and microalbumin took up 5/12 and 7/12, while patients with decreased glucose and chloride levels took up 5/12 and 6/12. All 23 patients presented abnormal CT and (or) MRI and 6 patients presented abnormal EEG. Conclusion Serum immunological levels, CT and (or) MRI and EEG examinations contributed to the diagnosis of NP-SLE involving CNS. Although CSF analyses were slightly abnormal, the increase of leukocyte count and average microalbumin was not obvious, and the mean values of glucose and chloride were in the normal range, suggesting that the CSF examinations were helpful for the differential diagnoses from intracranial infections. Glucocorticoids and immunosuppressive drugs were remarkably effective for CNS NP-SLE patients.

Calcitonin estimation in patients with nodular goiter and its significance for early detection of MTC: european comments to the guidelines of the American Thyroid Association

One of the most discussed and controversial issue in the management of thyroid nodules is the need to perform a routine measurement of serum Calcitonin (Ct) in all cases. The American Thyroid Association guidelines do not recommend in favor or against this procedure since they retain that there are not enough evidences that it can determine an advantage to the health outcomes of these patients. This is not the view of many European experts who met in Lisbon in 2009 at the European Thyroid Association-Cancer Research Network meeting to discuss all the still open controversial issues on the management of medullary thyroid cancer patients.This paper is focused on the routine measurement of serum Ct in all patients with thyroid nodule(s): the evidences, the rational and the benefits of this procedure are deeply analysed following the discussion that was done in Lisbon. The conclusions reached at that time are reported in detail.

Serum calcitonin estimation in medullary thyroid cancer: basal or stimulated levels?

Calcitonin (Ct) is a tumour marker essential for the diagnosis and follow-up of medullary thyroid cancer (MTC). Accurate and consistent measurements of serum Ct are of critical importance. Ct measurements by different methods can differ, leading to difficulties in the interpretation of results. Second generation assays for Ct have been developed and are now available in clinical laboratories. However, the lack of standardization for Ct assays remains a common problem with Ct assays. The reference interval and reliability should be carefully defined.The role of stimulated Ct for the diagnosis and follow-up of MTC should also be pointed out as the pentagastrin test is no more available in all countries. However, the stimulated test remains very useful to exclude MTC if the basal Ct serum level is in the grey zone (15-20 ng/L), after surgery to confirm the complete cure. A residual response after surgery could indicate a need for aggressive surgery or - in case of metastatic disease - could suggest the prognosis.High-dose Ca test (2.5mg/kg) seems to be a reliable and effective test for the diagnosis and follow-up of MTC. It seems more potent than pentagastrin with fewer side effects. The threshold able to discriminate healthy subjects from C-cell hyperplasia (CCH) cases for the stimulated Ct concentration is 184 ng/L for women and 1620 ng/L for men.As stimulated Ca test will eventually replace the pentagastrin test, there is a need to confirm or to modify the threshold identified for each assay individually.

High incidence of pseudotumour formation after large-diameter metal-on-metal total hip replacement

Peri-articular soft-tissue masses or ‘pseudotumours’ can occur after large-diameter metal-on-metal (MoM) resurfacing of the hip and conventional total hip replacement (THR). Our aim was to assess the incidence of pseudotumour formation and to identify risk factors for their formation in a prospective cohort study. A total of 119 patients who underwent 120 MoM THRs with large-diameter femoral heads between January 2005 and November 2007 were included in the study. Outcome scores, serum metal ion levels, radiographs and CT scans were obtained. Patients with symptoms or an identified pseudotumour were offered MRI and an ultrasound-guided biopsy. There were 108 patients (109 hips) eligible for evaluation by CT scan at a mean follow-up of 3.6 years (2.5 to 4.5); 42 patients (39%) were diagnosed with a pseudotumour. The hips of 13 patients (12%) were revised to a polyethylene acetabular component with small-diameter metal head. Patients with elevated serum metal ion levels had a four times increased risk of developing a pseudotumour. This study shows a substantially higher incidence of pseudotumour formation and subsequent revisions in patients with MoM THRs than previously reported. Because most revision cases were identified only after an intensive screening protocol, we recommend close monitoring of patients with MoM THR.

When (and how) to surgically treat asymptomatic renal stones

Asymptomatic renal stones are identified in 8-10% of screened populations. With the increasing utilization of CT, the number of patients seeking urologic care for incidentally diagnosed renal calculi is likely to increase. Such patients present an important management dilemma: differentiating those to treat surgically from those who can be safely observed. Observational studies have revealed that approximately 50% of asymptomatic stones will progress, but most will not require surgery. Stones >15 mm in diamater and located in the renal pelvis are at highest risk of progression. Although no guidelines exist for the optimal monitoring regimen for asymptomatic stones, follow-up studies may include serum creatinine, plain radiography, ultrasonography, and CT. Shock wave lithotripsy (SWL) does not seem to offer significant benefit over observation for asymptomatic calyceal stones. Percutaneous nephrolithotomy does improve stone-free rates compared to SWL or observation. Additional research is needed to characterize the role of ureteroscopic management of asymptomatic renal stones.

The Relation Between Serum CEA Response and the CTscan Finding After Neoadjuvant Therapy in Rectal Cancer Patients

Serum Carcinoembryonic Antigen (CEA) levels are the most widely used tumor marker for colorectal cancer. Elevated serum CEA has been reported to be associated with an increased risk of relapse and poor patient outcome. Whether this marker would be altered with preoperative adjuvant treatment of rectal cancer prior to resection and can this alteration reflect any changes in the tumor have not been yet investigated. If so, this might guide us to predict curative from palliative resection and to correlate between the marker level and future tumor response to the adjuvant therapy. Aim: This review was undertaken to assess the effect of preoperative neoadjuvant therapy on serum CEA level and the re- lationship between these effect on CEA and changes of the tumor in CT scan in advanced rectal cancer patient before de- finitive surgery. Methods: Between January 2002 and October 2007, a retrospective review using the colorectal database for all rectal can- cer patients treated in King Faisal Specialist Hospital and Research Center was performed. All patients received preopera- tive long course radiotherapy alone, or combined with 5- fluorouracil. Serum CEA and CT scan was done for the patients before starting the neoadjuvant therapy, and repeated again prior to surgery. Surgical resection was planned 6 - 8 weeks following the completion of treatment. We determined the criteria of the tumor response in the CT scan findings and compared the results with the CEA level after the neoadjuvant therapy. Results: Out-off the 77 patients, 38 received radiotherapy alone, while 39 patients received chemoradiotherapy, CT scan was done for all patients in both groups (pre and post neoajuvent therapy). Patients divided into 2 groups based on the CT scan findings to: CT responder and CT non-responder patients. In the radiation only group, 21 (55 %) patients had raised CEA levels before the treatment, 18 (86%) of them showed a decrease in CEA with CT response, while 3(14%) patients' demonstrated further increase and CT non-response. 17(45%) patients with normal CEA. 15 (89%) of them showed normal CEA post treatment 12 (80%) of them showed CT response and 3 of them shows CT non-response. 2/17 (11%) patients showed further increase in CEA level and CT non-response as well. In the chemoradiotherapy group, 17 (43%) patients had high CEA level before the treatment. 16 (95%) of them showed a decrease in CEA and CT response while 1(5%) patient showed increase in CEA level and CT non-response post treat- ment. 22/39(57%) showed normal CEA where all of them remained in normal level post treatment and only 1 patient (5%) showed CT non-response. All patients with CEA and CT scan response are operable patients and we can consider them for curative resection, while all patients with CEA and CT scan non response are non operable or can get a palliative treatment due to ( metastasis or carcinomatosis). 4 patients of normal CEA post treatment CT scan shows ( increase in thickening and single new lesion in the liver with suspicious of metastasis ) but still operable patients with intension to cure. Conclusions: There is an obvious relation between serum CEA level and CT scan findings during neoadjuvant therapy. CEA level post neoadjuvent therapy can differentiate between operable and non operable patients. CT scan can be used for patients with increase CEA level as further investigation before surgery and can be eliminated for those with CEA normal or dropped level. Further studies are needed to correlate this finding with post operative histopathological finding and patient outcome

Medullary Thyroid Nodules by Measurement of Calcitonin (Ct) in Aspiration Needle Washout in Patients with Multinodular Goiter and Moderately Elevated Serum Ct

The accuracy of fine needle aspiration cytology (FNAC) is low in medullary thyroid carcinomas (MTC). Recently, a few papers analyzed the measurement of calcitonin (Ct) in washout of the needle after aspiration (WO-Ct) suggesting that this approach may be useful in patients with high serum Ct. Here we reported, for the first time in our best knowledge, 3 patients with multinodular goiter, moderately elevated serum Ct, high value of WO-Ct, and medullary outcome. These findings suggest that in presence of high serum Ct, FNAC should be performed in all nodules, and it should be combined with WO-Ct in all cases.

Medullary Thyroid Carcinoma Surgical Cytoreduction Induces an Increase in Serum Calcitonin and Carcinoembryonic Antigen Doubling Times

Serum calcitonin (Ct) and carcinoembryonic antigen (CEA) doubling times (DT) are considered to be strong prognostic markers in patients with medullary thyroid carcinoma (MTC). The Objective of this work is to study the effect of MTC debulking on Ct and CEA DTs. 4 patients with MTC are presented who after an initial neck operation had residual disease were followed-up with serial measurements of serum Ct and CEA for several years before and after a secondary incomplete removal of involved cervical lymph nodes. The patients received no other treatment for MTC. Ct and CEA DTs were determined after fitting the Ct or CEA values to an exponential growth equation. In patient A, Ct DT increased from 1.45 years (1.17-1.89, 95% CI) preoperatively, to 5.72 (3.22-25.77) postoperatively. In patient B, Ct DT was 1.63 years (1.36-2.02) preoperatively, and very long (serum Ct practically ceased increasing) postoperatively. In patient C, Ct DT was 4.03 years (2.22-21.58) before, and very long after the operation. In patient D, Ct DT from 1.16 years (0.82-1.99) before, increased to 4.21 years (3.04-6.86) after the operation. The changes in CEA DTs were similar to those of Ct DTs in 2 patients in whom the tumor was apparently producing the protein. In conclusion, surgical MTC cytoreduction in 4 patients caused an increase in the Ct and CEA DTs, and the patients could be reclassified in new Ct DT-based strata with better prognosis than before the operation. We hypothesize that such tumor burden reduction may slow the growth of any residual MTC and we discuss mechanisms that could be responsible for this phenomenon.

A Randomized Study of Aspiration and Sclerotherapy Versus Laparoscopic Deroofing in Management of Symptomatic Simple Renal Cysts

To perform a prospective randomized study to evaluate aspiration and sclerotherapy vs. laparoscopic deroofing in the management of symptomatic simple renal cysts. Forty patients with symptomatic simple renal cysts were randomized to treatment either by ultrasonography-guided aspiration and sclerotherapy (group A-20 patients) or by laparoscopic deroofing (group B-20 patients). Two patients in group A and one patient in group B had a parapelvic cyst. Patients were evaluated by urine analysis, serum creatinine level, coagulation profile, ultrasonography, and CT urography. In group A patients, after aspiration, 1% polidocanol in a volume equivalent to 10% of cyst volume was instilled. In group B patients, laparoscopic deroofing was performed. All patients were followed up by ultrasonography up to 1 year after treatment. In group A, aspiration and sclerotherapy was performed on an outpatient basis, and none of the patients needed postoperative analgesia. Eighteen of 20 patients had complete regression; two of these had parapelvic cyst. Partial regression with relief of pain was noted in one patient, whereas treatment failed in one patient. None of the patients had any significant complication and none required analgesia. All the patients were discharged two hours after the procedure. In group B, laparoscopic deroofing was successfully performed in 19 of 20 patients. Laparoscopic deroofing could not be performed in one patient with parapelvic cyst because of failure of access. The mean analgesic requirement was 285 ± 57.98 (200-400) mg tramadol, and average hospital stay was 2.1 ± 0.32 (2-3) days. Percutaneous aspiration and sclerotherapy with polidocanol is an effective, safe, and minimally invasive therapeutic option for symptomatic simple renal cysts, with equal efficacy and lower morbidity and hospital stay in comparison with laparoscopic deroofing.

Evolving paradigms for successful molecular imaging of medullary thyroid carcinoma

Medullary thyroid cancer (MTC) is a rare, neuroendocrine tumour (NET) of parafollicular C cells comprising 5–8% of all thyroid cancers with variable biological behaviour and prognosis [1]. Overall mean survival in MTC is 75–85% at 10 years [1–3]. Management of both hereditary (20–30%) and sporadic MTC is challenging due to early cervical lymph node metastases occurring in 50% of patients and distant metastases to the liver, lung and bones being found in 10–20% at diagnosis [1, 3]. MTC secretes several neuroendocrine peptides, of which calcitonin (Ct) and less-specific carcinoembryonic antigen (CEA) are useful tumour markers for diagnosis, surveillance and prognosis. Yet despite the high sensitivity of an elevated serum Ct value as a predictor of disease presence, MTC is an elusive and notoriously problematic tumour to image [1, 3]. Anatomy-based imaging with CT and MRI has exhibited limited sensitivity due to the frequent small size of the metastatic deposits. Although a variety of specific and nonspecific scintigraphic techniques such as Tl, Tc-sestamibi, Tc-tetrofosmin, I/I-metaiodobenzylguanidine, Tc-(V)dimercaptosuccinic acid (DMSA), and Inoctreotide have been used to image MTC, none has emerged as the imaging technique of choice [4, 5]. This raises the question as to why we have been unable to successfully image MTC. The rarity of MTC implies that no single centre can collect a sufficient number of cases, and to date there have been no large, cooperative studies to establish optimal imaging protocols. It has become apparent that MTCs are a heterogeneous group of neoplasms, and the biological behaviour of one MTC may differ significantly from that of another. Imaging approaches that have proven successful, for example using F-fluorodeoxyglucose (FDG) PET/CT in lymphoma and solid cancers and In-octreotide for somatostatin receptor scintigraphy (SRS) in carcinoids, may be too simplistic an imaging approach for MTC, which often appears intermediate in biological behaviour between more aggressive neoplasms characterized by high Ki-67 indices, and hormonally active NETs in which FDG PET has limited value. Genetic testing provides a valuable insight into the phenotypic expression of MTC. Genetic mapping has confirmed the central role of germline mutations of the rearranged during transfection (RET) protooncogene in the pathogenesis of inherited MTC and has shown that somatic RET mutations occur in 50–60% of patients with sporadic MTC, and there have been advances in our understanding of how activated RET tyrosine kinase signalling pathways affect tumour growth and angiogenesis [1, 6–8]. Insights from genetic testing allow informed management decisions. As an example, the dilemma of the timing of prophylactic thyroidectomy in multiple endocrine neoplasia type 2 (MEN2), an autosomal D. Rubello (*) :M. C. Marzola : S. Chondrogiannis Department of Nuclear Medicine, Medical Physics, Radiology, Santa Maria della Misericordia Hospital, Via Tre Martiri 140, 45100 Rovigo, Italy e-mail: domenico.rubello@libero.it

Étude prospective chez 100 patients des résultats de la technique d’anastomose urétéro-iléale en double cheminée dans la néovessie de Hautmann

We attempted to determine the results of the ureterointestinal anastomosis in the Hautmann orthotopic ileal neobladder. This study was conducted prospectively and focused on ureteral stricture, which occurs mainly during the 2 years after surgery. Between January1999 and June 2009, a total of 100 consecutive patients (five women and 95 men) with bladder cancer underwent cystectomy followed by construction of a Hautmann neobladder. The median age of the patients was 62 (36-78) years. The mean follow-up was 63 (±28) months and included physical examination, serum creatinine values, urine cytology, CT scans and renal ultrasonography. A total of 197 renal units (RU) were included. In eleven RU, hydronephrosis was present preoperatively and improved postoperatively. In ten others RU, hydronephrosis persisted postoperatively without symptoms. The anastomotic stricture rate was 4%, concerning eight RU by seven patients. Five inflammatory strictures (2.5%) occurred early on the 5th, 6th, 8th and 13th postoperative weeks and were revealed by pyelonephritis. Three strictures were tumors in nature and were revealed by urine cytology and radiology on the 6th, 7th and the 14th month respectively. The five inflammatory strictures were treated with percutaneous nephrostomy, balloon dilatation and ureteral stenting. For three of these four patients, surgical reimplantation was necessary on the 4th, 5th and 7th months, like in the case of the three tumoral strictures. With a minimal 2 years follow-up, ureterointestinal anastomosis with double chimney had, in this study, a 4% rate of anastomotic stenosis. The surgical modification avoiding tension seemed to preserve ureteral vascularization.

Hyperinsulinemia during oral glucose tolerance test and high normal serum cortisol are associated with increased secretion of calcitonin in normal subjects

Previous studies showed that insulin stimulated directly calcitonin (Ct) secretion in the pig thyroid, while dexamethasone stimulated the production of Ct and Ct mRNA in medullary thyroid carcinoma (MTC) cell lines. The objective of this study was to investigate if hyperinsulinemia during the oral glucose tolerance test (GTT) stimulates Ct secretion in normal subjects as well as to examine the relationship between serum cortisol and Ct. In 26 normal subjects (9 men and 17 women) with detectable basal serum Ct, aged 22-70 yr [51.5±14.6 (mean±SD), median 55.5], we measured serum or plasma Ct, cortisol, ACTH, insulin, and blood glucose before (0 min) and at 30, 60, 90, and 120 min after ingestion of 75 g glucose. During GTT mean serum cortisol increased slightly by 9.3% at 30 min, whereas mean serum insulin increased 9.4-fold, reaching a peak value at 60 min. Median serum Ct increased by 51% (p<0.001) in normal subjects (by 27% in men, p=0.004, and by 44% in women, p<0.001) at 30 min and remained significantly higher thereafter (up to 120 min) when compared to median baseline level. Regression analysis showed that basal serum cortisol, but not basal serum insulin, was correlated with basal serum Ct (p=0.01). Peak concentrations of Ct were also correlated with peak concentrations of cortisol at 30 min (p<0.001) but not at later time points. Serum insulin was correlated with serum Ct at the serum insulin peak level (60 min), and at later time points (90 and 120 min) (p=0.001). Multiple and simple regression analysis showed that calcitonin-AUC (Area Under Curve) values correlated with insulin-AUC (p=0.003), and also with cortisol-AUC (p=0.02) values, the standardized effect of insulin-AUC on Calcitonin-AUC being greater than that of cortisol-AUC. These findings suggest that acute hyperinsulinemia during GTT is very likely associated with increased Ct secretion in normal subjects. Serum cortisol within the physiological range was also correlated with serum Ct under basal conditions, as well as during GTT.

Screening for Medullary Thyroid Carcinoma with Serum Calcitonin Measurements in Patients with Thyroid Nodules in the United States and Canada

Medullary thyroid carcinoma (MTC) is a rare thyroid malignancy with the potential for aggressive behavior. Measurement of serum calcitonin (Ct) in the thyroid nodule population is the most sensitive way to detect occult MTC. An important and controversial question is whether all patients with thyroid nodules should undergo Ct measurements to detect occult MTC. The prevalence of MTC detected by performing surgery on unselected individuals with thyroid nodules with elevated serum Ct is 0.4%. The central role of pentagastrin (PG) stimulation for triaging patients with minimally elevated serum Ct to prevent unnecessary surgery is reviewed. Data concerning a large reservoir of medullary thyroid microcarcinomas are discussed. Given the unavailability of PG in the United States and Canada, the available data argue against routine Ct measurements in all individuals with thyroid nodules in these countries because of the potential for unnecessary surgery and the uncertain benefit in diagnosing medullary microcarcinoma.

Pneumocyte Biomarkers KL-6 and Surfactant Protein D Reflect the Distinct Findings of High-Resolution Computed Tomography in Nonspecific Interstitial Pneumonia

Background: Serum levels of pneumocyte biomarkers KL-6 and surfactant protein D (SP-D) are useful diagnostic markers for interstitial lung diseases. However, associations of serum KL-6 and SP-D with radiologic findings in nonspecific interstitial pneumonia (NSIP) remain unclear. Objectives: To determine whether serum levels of KL-6 and SP-D reflect fibrotic and/or inflammatory processes in NSIP, we investigated the correlation between high-resolution computed tomography (HRCT) findings and serum KL-6 and SP-D levels. Methods: Serum levels of KL-6 and SP-D were measured in 21 patients with biopsy-confirmed NSIP. The radiographic extent of 6 HRCT patterns and total HRCT score, defined as the scored fibrotic index, were assessed. Changes in the levels of serum markers and CT findings during follow-up were also monitored. Results: Serum levels of KL-6 in NSIP positively correlated with the total HRCT score and overall extent of interstitial disease. Serum levels of SP-D in NSIP showed a positive correlation with the area of ground-glass attenuation without traction bronchiectasis and the inflammatory CT pattern, but the levels were inversely correlated with the area of ground-glass attenuation with traction bronchiectasis and the fibrotic CT pattern. The follow-up CT and serum marker changes after treatment showed that percent change of disease extent was reflected in both markers, especially KL-6. Further, the decreased fibrotic pattern correlated with both biomarkers. Conclusions: The results indicate that serum levels of KL-6 in NSIP reflect the overall extent of interstitial lesions, which include both inflammatory and fibrotic lesions, while the levels of SP-D mainly reflect the extent of inflammatory lesions.

The Use of Preoperative Routine Measurement of Basal Serum Thyrocalcitonin in Candidates for Thyroidectomy due to Nodular Thyroid Disorders: Results from 2733 Consecutive Patients

The preoperative routine measurement of basal serum thyrocalcitonin (CT) in candidates for thyroidectomy due to thyroid nodules is currently a subject of debate. The objective of this study was to evaluate the role of systematic basal serum CT measurement in improving the diagnosis and surgical treatment of medullary thyroid carcinoma (MTC) in patients undergoing thyroidectomy for nodular thyroid disorders, regardless of preoperative CT levels. We determined basal serum CT levels in 2733 consecutive patients before thyroid surgery and performed a pentagastrin test in patients with hypercalcitoninemia. We correlated basal and stimulated CT levels with intraoperative and definitive histopathological findings, and we analyzed the impact of these results on surgical procedures. Twelve MTCs were found among the 43 patients with basal serum CT level of 10 pg/ml or greater. Two MTCs were present among the 2690 patients with normal CT levels. MTC was always present in patients with a basal CT of 60 pg/ml or greater. For CT levels ranging from 10 to 59 pg/ml, MTC was diagnosed in 11% of patients. When preoperative hypercalcitoninemia was present, total thyroidectomy associated with comprehensive intraoperative histopathological analysis allowed the intraoperative diagnosis of five latent, subclinical MTCs. The pentagastrin test gave no additional diagnostic information for the management of patients with elevated preoperative basal serum CT level. Routine measurement of CT in the preoperative work-up of nodular thyroid disorders is useful. This procedure improves intraoperative diagnosis of MTC and enables adapted initial surgery, the most determinant factor of treatment success.

BLOOD PRESSURE REDUCTION FOLLOWING ADRENALECTOMY IN PRIMARY ALDOSTERONISM: A RETROSPECTIVE FOLLOW-UP STUDY: PP.18.174

Objective: To determine which patient characteristics can predict blood pressure (BP) outcome following adrenalectomy for primary aldosteronism (PA). Design and Methods: We analysed the records of 130 patients who had undergone adrenalectomy for unilateral PA between 2001 and 2009 in whom postoperative follow-up was available. Lateralisation of PA was ascertained by adrenal venous sampling except in patients less than 55 years old with a typical Conn adenoma on CT scan. The primary outcome was the decrease of systolic BP (SBP) after surgery. Linear regression was used to look for associations with predictive variables. The change in antihypertensive medication was considered as a potential confounding factor. Results: Patients characteristics were the following (median or percentage): 46 years old; male 57%; duration of hypertension 5 years; office BP 150/92 mmHg on two different drug classes; serum potassium <3.7 mmol/l in 85%; typical adenoma on CT scan in 60%. After surgery, office BP decreased by 21/7 mmHg and the number of drug classes by 1. BP levels before surgery and the change in the number of drug classes following surgery were the only factors significantly associated with BP outcome in univariate and multivariate analyses. The figure shows the observed change in SBP following surgery (adjusted for medication change) according to SBP before surgery. BP outcome of surgery was predicted by the following linear equation (R2 = 50%): change in office SBP (mmHg) ∼ 93 – 0.77 x office SBP before surgery – 2.7 x change in the number of drug classes.Conclusions: The change in medication is a confounding factor that must be considered when assessing BP outcome following surgery. When this change is taken into account, SBP before surgery is the only factor predicting the decrease in SBP following surgery. The expected outcome of adrenalectomy is independent from of all other patient characteristics such as age, gender, family history of hypertension, duration of hypertension, serum potassium level and CT scan features.

Breath gas aldehydes as biomarkers of lung cancer

There is experimental evidence that volatile substances in human breath can reflect presence of neoplasma. Volatile aldehydes were determined in exhaled breath of 12 lung cancer patients, 12 smokers and 12 healthy volunteers. Alveolar breath samples were collected under control of expired CO(2). Reactive aldehydes were transformed into stable oximes by means of on-fiber-derivatization (SPME-OFD). Aldehyde concentrations in the ppt and ppb level were determined by means of gas chromatography-mass spectrometry (GC-MS). Exhaled concentrations were corrected for inspired values. Exhaled C(1)-C(10) aldehydes could be detected in all healthy volunteers, smokers and lung cancer patients. Concentrations ranged from 7 pmol/l (161 pptV) for butanal to 71 nmol/l (1,582 ppbV) for formaldehyde. Highest inspired concentrations were found for formaldehyde and acetaldehyde (0-55 nmol/l and 0-13 nmol/l, respectively). Acetaldehyde, propanal, butanal, heptanal and decanal concentrations showed no significant differences for cancer patients, smokers and healthy volunteers. Exhaled pentanal, hexanal, octanal and nonanal concentrations were significantly higher in lung cancer patients than in smokers and healthy controls (p(pentanal) = 0.001; p(hexanal) = 0.006; p(octanal) = 0.014; p(nonanal) = 0.025). Sensitivity and specificity of this method were comparable to the diagnostic certitude of conventional serum markers and CT imaging. Lung cancer patients could be identified by means of exhaled pentanal, hexanal, octanal and nonanal concentrations. Exhaled aldehydes reflect aspects of oxidative stress and tumor-specific tissue composition and metabolism. Noninvasive recognition of lung malignancies may be realized if analytical skills, biochemical knowledge and medical expertise are combined into a joint effort.

Atorvastatin-induced pancreatitis

Drugs account for 1–2% of all cases of pancreatitis. A 58-year-old man was prescribed atorvastatin 10 mg for 6 months for hyperlipidemia. He developed acute abdominal pain and vomiting with epigastric tenderness. Serum lipase and CT scan of the patient suggested the presence of acute pancreatitis. The patient was hospitalized; atorvastatin was stopped and treated symptomatically. He recovered completely within 10 days of drug withdrawal. The causality of the adverse drug reaction according to Naranjo and WHO-UMC Scale was probable. The exact mechanism of pancreatitis due to atorvastatin is not known. It may be a class effect of HMG CoA reductase inhibitors as it had been reported with other statins too. The definite causal relationship is difficult to establish, as rechallenge with the suspected drug was not done due to ethical consideration.