Pheochromocytomas and paragangliomas (PPGLs) are rare neuroendocrine tumors that arise from chromaffin cells of the adrenal medulla and the sympathetic/parasympathetic neural ganglia, respectively. ...The heterogeneity in its etiology makes PPGL diagnosis and treatment very complex. The aim of this article was to provide practical clinical guidelines for the diagnosis and treatment of PPGLs from a multidisciplinary perspective, with the involvement of the Spanish Societies of Endocrinology and Nutrition (SEEN), Medical Oncology (SEOM), Medical Radiology (SERAM), Nuclear Medicine and Molecular Imaging (SEMNIM), Otorhinolaryngology (SEORL), Pathology (SEAP), Radiation Oncology (SEOR), Surgery (AEC) and the Spanish National Cancer Research Center (CNIO). We will review the following topics: epidemiology; anatomy, pathology and molecular pathways; clinical presentation; hereditary predisposition syndromes and genetic counseling and testing; diagnostic procedures, including biochemical testing and imaging studies; treatment including catecholamine blockade, surgery, radiotherapy and radiometabolic therapy, systemic therapy, local ablative therapy and supportive care. Finally, we will provide follow-up recommendations.
Background
Familial papillary thyroid microcarcinoma (FPTMC) appears to be more aggressive than sporadic papillary thyroid microcarcinoma (SPTMC). However, there are authors who indicate that ...unicentric FPTMC has a similar prognosis to SPTMC. The objective is to analyze whether unicentric FPTMC has a better prognosis than multicentric FPTMC.
Design and methods
Type of study: National multicenter longitudinal analytical observational study. Study population: Patients with FPTMC. Study groups: Two groups were compared: Group A (unicentric FPTMC) vs. Group B (multicentric FPTMC). Study variables: It is analyzed whether between the groups there are: a) differentiating characteristics; and b) prognostic differences. Statistical analysis: Cox regression analysis and survival analysis.
Results
Ninety-four patients were included, 44% (
n
= 41) with unicentric FPTMC and 56% (
n
= 53) with multicentric FPTMC. No differences were observed between the groups according to socio-familial, clinical or histological variables. In the group B a more aggressive treatment was performed, with higher frequency of total thyroidectomy (99 vs. 78%;
p
= 0.003), lymph node dissection (41 vs. 15%;
p
= 0.005) and therapy with radioactive iodine (96 vs. 73%;
p
= 0.002). Tumor stage was similar in both groups (
p
= 0.237), with a higher number of T3 cases in the group B (24 vs. 5%;
p
= 0.009). After a mean follow-up of 90 ± 68.95 months, the oncological results were similar, with a similar disease persistence rate (9 vs. 5%;
p
= 0.337), disease recurrence rate (21 vs. 8%;
p
= 0.159) and disease-free survival (
p
= 0.075).
Conclusions
Unicentric FPTMC should not be considered as a SPTMC due to its prognosis is similar to multicentric FPTMC.
Graphical Abstract
Introduction
Currently, there is no consensus on the indication of prophylactic surgery of the nodal compartments in the treatment of medullary thyroid carcinoma (MTC). The aim of our study was to ...perform a correlation study between preoperative calcitonin (basalCT) values and lymph node involvement to establish a criterion on which to base prophylactic surgery in these patients.
Material and Methods
We conducted an observational, retrospective and multicentre study with 29 hospitals. Patients over 18 years of age with a diagnosis of MTC with a pre-surgical calcitonin registry were included. The minimum surgery in all patients had to have been total thyroidectomy (TT) with central compartment lymph node dissection (CCLND). Receiver operating characteristic (ROC) curve analysis was used to establish basalCT cut-off values as predictors of postoperative lymph node involvement.
Results
A total of 244 patients were included. Baseline calcitonin (basalCT) was a good predictor of nodal involvement (AUC 0.718 and 95%CI 0.66–0.978). Heritability was identified as a preoperative factor correlated with baseline tumour CT values (
p
= 0.000). With a probability of lymph node involvement below 10%, new cut-off points were established. A prophylactic bilateral lateral lymph node dissection in sporadic tumours should be performed at a basalCT > 600 pg/mL; in the case of RET-mutated tumours this value would be 200 pg/mL.
Conclusion
The baseline CT value is a good predictor of postoperative lymph node involvement in MTC, however, cut-off points should depent on the hereditary nature of the tumour.
Purpose
Familial papillary thyroid microcarcinoma (FPTMC) can present a more aggressive behavior than the sporadic microcarcinoma. However, few studies have analyzed this situation. The objective is ...to analyze the recurrence rate of FPTMC and the prognostic factors which determine that recurrence in Spain.
Methods
Spanish multicenter longitudinal analytical observational study was conducted. Patients with FPTMC received treatment with curative intent and presented cure criteria 6 months after treatment. Recurrence rate and disease-free survival (DFS) were analyzed. Two groups were analyzed: group A (no tumor recurrence) vs. group B (tumor recurrence).
Results
Ninety-four patients were analyzed. During a mean follow-up of 73.3 ± 59.3 months, 13 recurrences of FPTMC (13.83%) were detected and mean DFS was 207.9 ± 11.5 months. There were multifocality in 56%, bilateral thyroid involvement in 30%, and vascular invasion in 7.5%; that is to say, they are tumors with histological factors of poor prognosis in a high percentage of cases. The main risk factors for recurrence obtained in the multivariate analysis were the tumor size (OR: 2.574, 95% CI 1.210–5.473;
p
= 0.014) and the assessment of the risk of recurrence of the American Thyroid Association (ATA), both intermediate risk versus low risk (OR: 125, 95% CI 10.638–1000;
p
< 0.001) and high risk versus low risk (OR: 45.454, 95% CI 5.405–333.333;
p
< 0.001).
Conclusion
FPTMC has a recurrence rate higher than sporadic cases. Poor prognosis is mainly associated with the tumor size and the risk of recurrence of the ATA.
Graphical abstract
•Estradiol down-regulates the neutrophil influx to the vaginal lumen.•Etradiol down-regulates the gradients of CXCL1.•Estradiol receptor-alpha (ESR1) is essential in the CXCL1 down regulation.
Female ...reproductive mucosa must allow allogenic sperm survival whereas at the same time, avoid pathogen infection. To preserve sperm from neutrophil attack, neutrophils disappear from the vagina during the ovulatory phase (high estradiol); although the mechanisms that regulate neutrophil influx to the vagina during insemination remain controversial.
We investigated the sex hormone regulation of the neutrophil migration through the cervix during insemination and revealed that ovulatory estradiol dose fades the CXCL1 epithelial expression in the ectocervix and fornix; hence, retarding neutrophil migration and retaining them in the epithelium. These mechanisms spare sperm from neutrophil attack to preserve reproduction, but might compromise immunity. However, luteal progesterone dose promotes the CXCL1 gradient expression to restore neutrophil migration, to eliminate sperm and prevent sperm associated pathogen dissemination. Surprisingly, these mechanisms are hormone dependent and independent of the insemination. Thus, sex hormones orchestrate tolerance and immunity in the vaginal lumen by regulating neutrophil transepithelial migration in the fornix and ectocervix.
Introducción El seudoaneurisma aórtico con infección de prótesis en aorta ascendente (PIPAA) tras cirugía cardíaca es una entidad infrecuente (0,9-2%) pero grave (mortalidad intrahospitalaria > 40%). ...El tratamiento más extendido es la cirugía con recambio protésico y terapia antibiótica adecuada a antibiograma; pero el recambio protésico en ocasiones es técnicamente inviable e incluso puede aumentar la mortalidad perioperatoria. Existen casos en los que se ha preservado la prótesis infectada con éxito terapéutico, realizándose limpieza/reparación quirúrgica local apoyada con omentoplastia. No existe consenso en la duración de la terapia médica, y el tratamiento «supresor a largo plazo» en ocasiones se complica por efectos adversos de los antibióticos. Objetivos Aportar dos nuevos casos y evaluar el tratamiento realizado tras un seguimiento a largo plazo. Método Análisis descriptivo de aspectos microbiológicos, farmacológicos y resultados de la terapia realizada, en dos casos de PIPAA de pacientes intervenidos por disección de aorta (prótesis de dacrón en posición supracoronariana) y por insuficiencia y anuloectasia aórtica (tubo valvulado). Se realiza tratamiento quirúrgico conservador de la prótesis aórtica (limpieza quirúrgica, reparación del seudoaneurisma y omentoplastia), asociándose terapia antibiótica prolongada ajustada a antibiograma. Conclusión Ambos casos presentan, tras más de 1 año de seguimiento, según criterios clínicos, microbiológicos y pruebas de imagen, ausencia de signos de recidiva infecciosa, resultando la terapia adecuada. Aun sin poder establecer tiempo óptimo de tratamiento, serían razonables 6 semanas de tratamiento endovenoso seguidas de 24 semanas de terapia supresora, a ser posible oral, y valorar su retirada siempre que no existan signos de recidiva.
The standardization of secondary electrolytic conductivity cells requires the use of a certified reference material. The accepted certification method involves electrochemical impedance spectroscopy ...(EIS) to estimate the material’s solution resistance. This method normally assumes that the impedance’s imaginary component can be neglected; and hence, the measured impedance approximates the real impedance. Thus, a linear extrapolation of the impedance versus the period (inverse frequency) yields solution resistance. However, experimental impedance data usually do not exhibit a linear behavior over the spectra of frequency, which strongly suggest that the ideal capacitive assumption may not strictly apply. To account for the observed nonlinear behavior, we have proposed to introduce the concept of a constant phase element (CPE) to the analysis of impedance. This approach leads to the development of a relationship that improves the fitting of experimental data and improves the accuracy of the estimation, by establishing a critical frequency where extrapolation should be done. Finally, we are presenting simulated results to demonstrate how sizeable capacitive effects can influence the determination of solution resistance, and a final analysis to estimate the impact on constant cell or electrolytic conductivity values.
Purpose
To study the utility of positron emission tomography with computerized tomography (PET/CT) in patients with a stage I–III melanoma.
Patients and methods
PET/CT findings from all patients with ...a stage I–III melanoma attended at our hospital from September 2011 to November 2015 were reviewed.
Results
Data from 83 patients with a stage I–III melanoma, 39 patients with a positive sentinel lymph node biopsy (SLNB) and 35 patients with locoregional recurrences were analyzed. Sensitivity of PET/CT in clinical stage I–III patients was 5%, with a 14% of false positives. In patients with a positive SLNB, PET/CT previous to complete lymph node dissection had a 23% of false negatives. In patients with clinical locoregional recurrences, PET/CT findings revealed asymptomatic visceral distant metastasis in 25.7%.
Conclusions
PET/CT has a significant rate of false positive and negative results in patients with a stage I–III melanoma. Utility in patients with nodal locoregional recurrences seems higher than in patients with skin metastases.
Este trabajo es una propuesta para establecer las competencias y las habilidades que debe poseer o adquirir el personal que participa en el proceso de certificación de materiales de referencia para ...obtener información confiable en los procesos bioquímicos de medición. La Guía ISO 34:2000 General requirements for the competence of reference materials producers (ISO, 2000), es la plataforma internacional para este proceso, la cual, se subdivide en seis bloques principales: planificación, preparación del material, caracterización, asignación del valor de la propiedad e incertidumbre, manejo y almacenamiento y servicio posventa. Adicionalmente, existe un juego de guías internacionales relacionadas con este tema (Guías ISO Serie 30), que auxilian en la determinación de las competencias apropiadas para el personal. La propuesta también considera los resultados obtenidos en los ejercicios de comparación organizados por la Oficina Internacional de Pesas y Medidas (BIPM) y el Comité Consultivo para Cantidad de Sustancia (CCQM).
Este trabajo es una propuesta para establecer las competencias y las habilidades que debe poseer o adquirir el personal que participa en el proceso de certificación de materiales de referencia para ...obtener información confiable en los procesos bioquímicos de medición. La Guía ISO 34:2000 General requirements for the competence of reference materials producers (ISO, 2000), es la plataforma internacional para este proceso, la cual, se subdivide en seis bloques principales: planificación, preparación del material, caracterización, asignación del valor de la propiedad e incertidumbre, manejo y almacenamiento y servicio posventa. Adicionalmente, existe un juego de guías internacionales relacionadas con este tema (Guías ISO Serie 30), que auxilian en la determinación de las competencias apropiadas para el personal. La propuesta también considera los resultados obtenidos en los ejercicios de comparación organizados por la Oficina Internacional de Pesas y Medidas (BIPM) y el Comité Consultivo para Cantidad de Sustancia (CCQM).
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