ABSTRACT
BACKGROUND: Recent studies suggest that mitogen-activated protein (MAP) kinase contributes to the growth and tumorigenesis of human epithelial cancers. Furthermore, blockade of this pathway may inhibit the growth of epithelial cancers. To determine whether MAP kinase is activated in human papillary thyroid carcinomas (PTCs), we analyzed the presence of native MAP kinase (MAPK) and activated phosphorylated MAP kinase (pMAPK) in papillary thyroid cancers and thyroid carcinoma cell lines. METHODS: Protein from paired specimens of 10 patients with PTC was analyzed by immunoblot for MAPK and pMAPK. In addition, MAPK protein expression and cell growth were analyzed in 3 thyroid tumor cell lines treated with a mitogen extracellular kinase inhibitor, U0126. RESULTS: All 10 PTCs had equal expression of MAPK in the tumors and adjacent normal tissue. Six of the 10 tumors demonstrated increased expression of the pMAPK in the tumor specimen compared to the adjacent normal tissue. Interestingly, 3 of 4 patients without differential expression had multifocal PTC. The pMAPK was expressed constitutively in 3 thyroid cancer cell lines. The MAPK inhibitor treatment decreased pMAPK expression and decreased serum-induced growth in all 3 cell lines. CONCLUSIONS: MAP kinase activation is common in PTCs and may offer a potential target for growth inhibition of PTCs.
Subject(s)
Carcinoma, Papillary/enzymology , Drosophila Proteins , Mitogen-Activated Protein Kinase 1/metabolism , Mitogen-Activated Protein Kinases/metabolism , Thyroid Neoplasms/enzymology , Blotting, Western , Carcinoma, Papillary/genetics , Enzyme Activation , Genes, ras , Humans , Mitogen-Activated Protein Kinase 3 , Proto-Oncogene Proteins/genetics , Proto-Oncogene Proteins c-ret , Receptor Protein-Tyrosine Kinases/genetics , Thyroid Neoplasms/geneticsABSTRACT
BACKGROUND: Recently local/regional anesthesia has been reintroduced as an alternative to general anesthesia for thyroidectomy. This study was undertaken to analyze characteristics and outcomes of patients who had thyroid surgery performed under regional anesthesia compared with those who had thyroidectomy under general anesthesia. STUDY DESIGN: One hundred seventy-five consecutive patients who underwent thyroid surgery under regional or general anesthesia during a 3-year period were analyzed. Fifty-eight operations were performed under regional anesthesia and 116 under general anesthesia. Patient characteristics analyzed included age, gender, obesity, anesthesia class, and tumor pathology. Postoperative complications, including nausea or vomiting, were compared. Additionally, operative times and length of stay in each group were compared. RESULTS: Patient characteristics including age, gender, tumor pathology, and anesthesia class were similar in both groups. But only 2% of patients treated under regional anesthesia were obese compared with 23% under general anesthesia. Although not significant, there was a trend toward decreased incidence of nausea and vomiting in the regional group. Other complications for the regional and general anesthesia groups were equal at 3%. Two patients required conversion to general anesthesia. Complications in the general anesthesia group included one episode of transient symptomatic hypocalcemia, two patients with transient vocal cord paralysis, and one episode of hematoma. Finally, there was a statistically significant increase in total operating room time and length of stay for the general anesthesia group. CONCLUSIONS: Regional anesthesia is a safe alternative to general anesthesia for patients undergoing thyroid surgery. Patients who cannot communicate verbally with the surgical team or who are obese may not be ideal candidates for regional anesthesia. The use of regional anesthesia results in a decreased length of stay and similar operative and operating room times.
