Papillary carcinoma of the thyroid in patients with primary hyperparathyroidism: Is there a link?

Primary hyperparathyroidism (PHPT) is present in up to 0.1% of the general population. The incidence is higher in women and increases with age. The majority of the cases is asymptomatic and up to 85% are due to single gland adenoma. Parathyroidectomy is the treatment of choice after localization of the hyperactive gland. Papillary Thyroid Carcinoma (PTC) is the most common cancer of the thyroid and constitutes more than 70% of thyroid malignancies. PTC can present as a single nodule or can be Multifocal. The incidence is higher in women. Early treatment favors a good prognosis. PTC with PHPT has been reported in 2.3-4.3% of patients undergoing surgery for PHPT. The coexistence of parathyroid adenoma and incidental PTC is thought to be rare. The mechanisms underlying the relationship between PHPT and PTC have not been established. We suggest a possible hypothesis for the relationship based on shared embryological origin and genes, high parathyroid hormone (PTH), low 1,25 hydroxy vitamin D, hypercalcemia resulting in high levels of angiogenic growth factors. This promotes the formation of parathyroid adenomas and papillary thyroid carcinoma. Presence of these two diseases can complicate patient management due to untreated hypercalcemia, unrecognized thyroid cancer and need for second surgery if not screened for both diseases carefully.

A complex endocrine conundrum.

We describe a case of recurrent primary hyperparathyroidism, manifested as 3 metachronous parathyroid adenomata, in a 50 year-old woman who also had Hashimoto hypothyroidism, gastric gastrointestinal stromal tumour (GIST), cysts in liver and kidneys, 5 intestinal polyps (one of these a villous adenoma), diverticulitis and telangiectasia of lips. She did not have medullary thyroid carcinoma (MTC). Genetic analysis of the CDC73 gene [for Hyperparathyroidism-jaw tumor (HPT-JT)], MEN1 for Multiple Endocrine Neoplasia Type1, CDKN1B for MEN4, SDHB and SDHD for Paraganglioma/Pheochromocytoma susceptibility, VHL for von Hippel-Lindau Syndrome, BMPR1A and SMAD4 for Juvenile Polyposis Syndrome (JPS) (sequencing and MLPA), karyotype and array CGH (44 K) were all normal. She was found to be homozygous for a synonomous germline variant in exon 14 (p. Ser836Ser) of the RET oncogene. This RET variant is of unclear clinical significance, and has been previously reported both in normal individuals and in individuals with MTC. It is unlikely that homozygosity for the RET variant has been casual in the multiple pathologies that our patient has developed.

The clearance kinetics of autologous RhD-positive erythrocytes coated ex vivo with novel recombinant and monoclonal anti-D antibodies.

Anti-D is given routinely to pregnant RhD-negative women to prevent haemolytic disease of the fetus and newborn. To overcome the potential drawbacks associated with plasma-derived products, monoclonal and recombinant forms of anti-D have been developed. The ability of two such antibodies, BRAD-3/5 monoclonal anti-D IgG (MAD) and rBRAD-3/5 recombinant anti-D IgG (RAD), to clear RhD-positive erythrocytes from the circulation was compared using a dual radiolabelling technique. Six RhD-positive males received autologous erythrocytes radiolabelled with (99m)Tc and (51)Cr and coated ex vivo with MAD and RAD. Blood samples were collected up to 1 h following intravenous injection, and percentage dose of radioactivity in the samples determined. Three different levels of coating were used on three separate occasions. No significant differences between MAD and RAD were observed in the initial clearance rate constant at any dose level. The log[activity]-time clearance plots were curved, showing a reduction in the clearance rate constant with time. This reduction was more marked for RAD than for MAD. The results support a dynamic model for the clearance of antibody-coated erythrocytes that may have wider relevance for the therapeutic use of antibodies.

Determining the proximal extent of ulcerative colitis: white cell scan correlates well with histological assessment.

BACKGROUND: Assessing the extent of ulcerative colitis determines therapeutic strategies and provides prognostic information. Colonoscopy with mucosal biopsy is considered unsafe in patients with severe disease. AIM: To assess the correlation between proximal extent of ulcerative colitis as determined by Technitium-99-m hexamethylpropylene amine oxime labelled leucocyte scan (white cell scan) with that determined by histological assessment. METHODS: One hundred and thirty-five patients, with histologically-confirmed ulcerative colitis, who had a white cell scan and histological assessment of colonic inflammation within 6 months of each other, during the years 1991-2004, were included. Overall agreement, quadratic-weighted kappa (kappa) and polychoric correlations (rho) were calculated to estimate the inter-rater reliability. RESULTS: The correlation between white cell scan and histological extent was excellent (kappa = 0.7 rho = 0.8). Macroscopic appearance on colonoscopy did not correlate as well with histological extent (kappa = 0.62 and rho = 0.67). White cell scans correlated significantly better in patients with extensive disease (P = 0.02). Colonoscopy predicted disease extent more accurately in patients with limited colitis (P = 0.002). CONCLUSIONS: Proximal extent of ulcerative colitis determined by white cell scans correlates well with histological assessment especially in patients with more extensive disease. White cell scans offer a reasonable alternative to colonoscopy with mucosal biopsies in determining the proximal extent of colitis.

Demographic and clinical features of adolescent parasuicides.

The demographic, ethnic and clinical characteristics of 102 adolescents admitted to the Port-of Spain General Hospital over a 10-month period because of parasuicide were studied. The estimated rate of attempted suicide among adolescents was 94 per 100,000 of the hospital catchment population. Ninety per cent of the sample were females. Fifteen per cent had previously attempted suicide. Twenty-five per cent were clinically depressed, 22% had adjustment reactions, and in 49% no mental illness was detected. In 50% of cases, no further treatment was necessary after the first psychiatric interview. Intra-family conflicts were the most frequent reasons given for the attempted suicides. Girls of East Indian origin attempted suicide more frequently than those of African origin. Adolescents of mixed racial backgrounds attempted suicide less frequently than those of either African or East Indian origins. The findings of the study suggest a need for the adolescent psychiatric services to be upgraded, and for a review of the hospital policy of admitting all parasuicides of whatever degree as this is resulting in unnecessary and costly utilization of hospital beds.

Demographic and clinical features of adolescent parasuicides

The demographic, ethnic and clinical characteristics of 102 adolescents admitted to the Port-of-Spain General Hospital over a 10-month period because of parasuicide were studied. The estimated rate of attempted suicide among adolescents was 94 per 100,000 of the hospital catchment population. Ninety per cent of the sample were females. Fifteen per cent had previously attempted suicide. Twenty-five per cent were clinically depressed, 22 per cent had adjustment reactions, and in 49 per cent no mental illness was detected. In 50 per cent of cases, no further treatment was necessary after the first psychiatric interview. Intra-family conflicts were the most frequent reasons given for the attempted suicides. Girls of East Indian origin attempted suicide more frequently than those of African origin. Adolescents of mixed racial backgrounds attempted suicide less frequently than those of either African or East Indian origins. The findings of the study suggest a need for the adolescent psychiatric services to be upgraded, and for a review of the hospital policy of admitting all parasuicides of whatever degree as this is resulting in unnecessary and costly utilization of hospital beds

Demographic and clinical features of adolescent parasuicides

The demographic, ethnic and clinical characteristics of 102 adolescents admitted to the Port-of-Spain General Hospital over a 10-month period because of parasuicide were studied. The estimated rate of attempted suicide among adolescents was 94 per 100,000 of the hospital catchment population. Ninety per cent of the sample were females. Fifteen per cent had previously attempted suicide. Twenty-five per cent were clinically depressed, 22 percent had adjustment reactions, and in 49 percent no mental illness was detected. In 50 percent of cases, no further treatment was necessary after the first psychiatric interview. Intra-family conflicts were the most frequent reasons given for the attempted suicides. Girls of East Indian origin attempted suicide more frequently than those of African origin. Adolescents of mixed racial backgrounds attempted suicide less frequently than those of either African or East Indian origins. The findings of the study suggest a need for the adolescent psychiatric services to be upgraded, and for a review of the hospital policy of admitting all parasuicides of whatever degree as this is resulting in unnecessary and costly utilization of hospital beds (AU)

The pattern of in-patient psychiatric referrals in a general hospital.

All patients referred for a psychiatric consultation from the adult wards of a General Hospital over a 10-month period were examined. The referral rate was 1.4%. Twice as many female patients were referred as male patients. Parasuicide accounted for 68% of referrals. The most common psychiatric diagnoses were adjustment reaction (41%), depression (23%), alcohol dependence (5%) and schizophrenia (5%). In 30% of referrals, no psychiatric treatment was necessary; 26% were transferred to the psychiatric unit and 17% were discharged to the out-patients' psychiatric clinic. Explanations are offered for the "hidden" psychiatric morbidity in General Hospitals and the high percentage of referrals who did not need psychiatric follow-up. Suggestions are made for a better liaison between physicians and psychiatrists.

The pattern of in-patient psychiatric referrals in a general hospital

All patients referred for a psychiatric consultation from the adult wards of a General Hospital over a 10-month period were examined. The referral rate was 1.4 percent. Twice as many female patients were referred as male pateints. Parasuicide accounted for 68 percent of referrals. The most common psychiatric diagnoses were adjustment reaction (41 percent), depression (23 percent), alcohol dependence (5 percent). In 30 percent of referrals, no psychiatric treatment was necessary; 26 percent were transferred to the psychiatric unit and 17 percent were discharged to the out-patients' psychiatric clinic. Explanations are offered for the "hidden" psychiatric morbidity in General Hospitals and the high percentage of referrals who did not need psychiatric follow-up. Suggestions are made for a better liaison between physicians and psychiatrists (AU)

The pattern of in-patient psychiatric referrals in a general hospital

All patients referred for a psychiatric consultation from the adult wards of a General Hospital over a 10-month period were examined. The referral rate was 1.4 per cent . Twice as many female patients were referred as male pateints. Parasuicide accounted for 68 per cent of referrals. The most common psychiatric diagnoses were adjustment reaction (41 per cent ), depression (23 per cent ), alcohol dependence (5 per cent ). In 30 per cent of referrals, no psychiatric treatment was necessary; 26 per cent were transferred to the psychiatric unit and 17 per cent were discharged to the out-patients' psychiatric clinic. Explanations are offered for the "hidden" psychiatric morbidity in General Hospitals and the high percentage of referrals who did not need psychiatric follow-up. Suggestions are made for a better liaison between physicians and psychiatrists.