Impairment of body mass reduction-associated activation of brown/beige adipose tissue in patients with type 2 diabetes mellitus.

Backgrounds/Objectives:The activity of brown/beige adipose tissue (B/BAT) is inversely proportional to body adiposity. Studies have shown that obese subjects submitted to distinct approaches aimed at reducing body mass present an increase of B/BAT activation. However, it is unknown if this beneficial effect of body mass reduction applies to patients with type 2 diabetes mellitus. In this study, we evaluated the impact of massive body mass reduction obtained as a consequence of bariatric surgery in the cold-induced activation of B/BAT in obese non-diabetic (OND) and obese diabetic (OD) subjects. SUBJECTS/METHODS: This is an observational study. Fourteen OND, 14 OD and 11 subjects were included in the study. All obese subjects were submitted to Roux-in-Y gastric bypass and measurements were performed before and 8 months after surgery. B/BAT was evaluated by (18F)-FDG-PET/CT scan and determination of signature transcript expression in specimens obtained in biopsies. RESULTS: Before surgery, mean B/BAT activity and the expression of signature transcripts were similar between OND and OD groups. Eight months after surgery, body mass reduction was similar between the obese groups. Nevertheless, the activity of B/BAT was increased in OND and unchanged in OD subjects. This effect was correlated with a more pronounced improvement of insulin resistance, as evaluated by the hyperinsulinemic, euglycemic clamp, in OND subjects as compared with OD subjects. CONCLUSIONS: Body mass reduction has a more efficient effect to induce the activation of B/BAT in non-diabetic than in diabetic subjects. This effect is accompanied by more pronounced insulin sensitivity and serine 473 phosphorylation of Akt in B/BAT of non-diabetic than in diabetic subjects.

Investigation on the association between thyroid tumorigeneses and herpesviruses.

Herpesviruses have been associated with various human malignancies and with thyroid autoimmunity. Aiming to investigate the presence of these viruses in thyroid nodules, we analyzed serum and thyroid tissue from 183 patients (83 benign and 100 malignant thyroid nodules). We also obtained 104 normal thyroid tissues extracted from the contralateral lobe of these patients. We used ELISA to screen the serology of all patients and a real-time quantitative PCR to analyze thyroid tissue viral load in antibody-positive patients. In addition, the presence of herpesviruses was tested by histological analysis in 20 EBV-positive tissues using the expression of LMP-1 by immunohistochemistry (IHC) and EBER by in situ hybridization (ISH). There was no evidence of HSV-2 or CMV DNA, but we found EBV DNA sequences in 29 (16%) thyroid tissue samples. We also found 7 positive EBV cases out of 104 normal tissues. Viral load was higher in tumors than in their respective normal tissues (p = 0.0002). ISH analysis revealed EBER expression in 11 out of 20 (52%) EBV-positive tissues, mostly in malignant cases (8/11, 73%). The presence of high EBV copy numbers in thyroid tumors and the expression of EBER only in malignant cases suggest an association between EBV and thyroid malignancies. However, we did not find any association between the presence of EBV and/or its viral load and any clinical or pathological tumor feature. Further studies aiming to clarify the mechanisms of EBV infection in thyroid cells are necessary to support a possible role in the development of thyroid cancer.

Distinct regulation of hypothalamic and brown/beige adipose tissue activities in human obesity.

BACKGROUND/OBJECTIVES: The identification of brown/beige adipose tissue in adult humans has motivated the search for methods aimed at increasing its thermogenic activity as an approach to treat obesity. In rodents, the brown adipose tissue is under the control of sympathetic signals originating in the hypothalamus. However, the putative connection between the depots of brown/beige adipocytes and the hypothalamus in humans has never been explored. The objective of this study was to evaluate the response of the hypothalamus and brown/beige adipose tissue to cold stimulus in obese subjects undergoing body mass reduction following gastric bypass. SUBJECTS/METHODS: We evaluated twelve obese, non-diabetic subjects undergoing Roux-in-Y gastric bypass and 12 lean controls. Obese subjects were evaluated before and approximately 8 months after gastric bypass. Lean subjects were evaluated only at admission. Subjects were evaluated for hypothalamic activity in response to cold by functional magnetic resonance, whereas brown/beige adipose tissue activity was evaluated using a (F 18) fluorodeoxyglucose positron emisson tomography/computed tomography scan and real-time PCR measurement of signature genes. RESULTS: Body mass reduction resulted in a significant increase in brown/beige adipose tissue activity in response to cold; however, no change in cold-induced hypothalamic activity was observed after body mass reduction. No correlation was found between brown/beige adipose tissue activation and hypothalamus activity in obese subjects or in lean controls. CONCLUSIONS: In humans, the increase in brown/beige adipose tissue activity related to body mass reduction occurs independently of changes in hypothalamic activity as determined by functional magnetic resonance.

Lymphatic vessel density and expressions of lymphangiogenic growth factors in salivary carcinomas.

Nodal metastasis is an important prognostic indicator in head and neck cancers, including salivary carcinomas. In these, the risk for lymph node metastasis is variable and strongly associated with the tumor histologic type. The aim of the current study was to evaluate the lymphatic vessel density (LVD) and expressions of lymphangiogenic growth factors by tumor cells in different histologic types of salivary carcinomas subdivided according to the risk for nodal metastasis. In 15 high-risk (undifferentiated, high-grade mucoepidermoid and salivary duct carcinomas) and 60 low/moderate-risk tumors (adenoid cystic, low/intermediate-grade mucoepidermoid, acinic cell, myoepithelial, epithelial-myoepithelial and polymorphic low-grade carcinomas) the expressions of vascular endothelial growth factor-C (VEGF-C), hepatocyte growth factor (HGF) and D2-40 (for assessing LVD) were examined. No significant differences were encountered between high- and low/moderate/-risk carcinomas regarding LVD and VEGF-C or HGF expressions. Furthermore, the expression of these proteins did not correlate with LVD. Lymphatic vascular invasion was found mainly in high-risk carcinomas. Intratumoral LVD was significantly lower than peritumoral, regardless of the risk for metastasis and primary site of the lesion. The histologic types of salivary carcinomas which are associated with high-risk for nodal metastasis do not present increased LVD or VEGF-C and HGF expressions. The greater tendency for metastasis in these carcinomas seems to be related to their capacity to invade lymph vessels. Further studies on tumor cell interactions with lymphatic endothelial cells are needed to improve our understanding of the metastatic potential of salivary carcinomas.

Treatment of locally aggressive well-differentiated thyroid cancer.

The object of this study, conducted at Unicamp between 1988 and 1998, was to evaluate retrospectively the outcome of patients treated for locally aggressive well-differentiated thyroid carcinomas (LATC). Nineteen (42%) of 45 patients with thyroid carcinomas were considered to have LATC. The preoperative diagnosis of carcinoma was made either by fine needle aspiration biopsy (15 patients) or during surgery (4 patients). The usual prognostic factors were analyzed and classified according to risk groups. Survival was evaluated using the Kaplan-Meier method. Most of the patients were female (73%), with a mean age of 48 years. Eighteen (95%) had papillary carcinomas. Four patients were classified as high risk (21%) and the remaining 15 (79%) as intermediate risk. All patients underwent total thyroidectomy and different types of neck dissections. The structures invaded by tumors were strap muscles and trachea (four cases); recurrent nerve and larynx (three cases); manubrium, esophagus, and jugular vein (two cases); and hyoid bone and pharynx (one case). Complete tumor resection was carried out according to the extent of local invasion; no postoperative deaths resulted. Details of the procedures are provided in Table 4 and in the Discussion. Postoperative radioactive iodine treatment was used in 15 patients (79%). A mean follow-up (+/-7 years) revealed 13 (68%) patients without disease, 4 patients (21%) alive with controlled systemic disease, and 2 (11%) deaths from distant metastasis. The Kaplan-Meir survival curve was comparable with other studies in the literature. This study found that the frequency of LATC (42%) was higher than in most studies. Aggressive surgical therapy to treat these tumors is compatible with a low recurrence rate and long-term survival in a significant proportion of patients.

Diagnosis of superficial esophageal cancer and dysplasia using endoscopic screening with a 2% lugol dye solution in patients with head and neck cancer.

BACKGROUND: Head and neck cancer (HNC) has a high incidence in Brazil, with cancer of the oral cavity being one of the five most common cancers among Brazilians. Alcohol and tobacco consumption may contribute to synchronous or metachronous HNC and esophageal cancer. The early detection of superficial esophageal cancer and dysplasia in asymptomatic patients with HNC, after successfully treating the primary cancer, may provide an effective cure. METHODS: A prospective study involving 60 patients with HNC was carried out at the State University of Campinas (UNICAMP) to screen for superficial esophageal cancer and dysplasia using endoscopy and a 2% lugol dye solution followed by biopsy of the suspicious areas. RESULTS: Five patients (8.3%) had superficial esophageal cancer, which was diagnosed as intraepithelial carcinoma in three of them (5.0%). In four patients, the superficial esophageal cancer was synchronous, and in one it was metachronous to HNC. Five patients (8.3%) had dysplasias in the esophageal epithelium (three were classified as mild and two as moderate). CONCLUSION: These results demonstrate the value of endoscopic screening of the esophagus using lugol dye in patients with HNC, particularly because superficial esophageal cancer is extremely difficult to detect by conventional methods in asymptomatic patients.

[Importance of upper digestive endoscopy using lugol dye solution for the diagnosis of superficial esophageal cancer and dysplasia in patients with head and neck neoplasms]. / A importância da endoscopia digestiva alta com solução de lugol no diagnóstico de câncer superficial e displasia em esôfago de doentes com neoplasias de cabeça e pescoço.

Head and neck cancer has a high incidence in Brazil, with cancer of the oral cavity being one of the five most common cancers among Brazilians. Alcohol and tobacco consumption may contribute to synchronous or metachronous head and neck cancer and esophageal cancer. A prospective study involving 60 patients with head and neck cancer was carried out at the State University of Campinas--UNICAMP, Campinas, SP, Brazil to screen for superficial esophageal cancer and dysplasia using endoscopy and a 2% lugol dye solution followed by biopsy of the suspicious areas. Five patients (8.3%) had superficial esophageal cancer, which was diagnosed as intraepithelial carcinoma in three of them (5.0%). In four patients, the superficial esophageal cancer was synchronous and in one it was metachronous to head and neck cancer. Five patients (8.3%) had dysplasias in the esophageal epithelium (three were classified as mild and two as moderate). These results demonstrate the value of endoscopic screening of the esophagus using lugol dye in patients with head and neck cancer, particularly since superficial esophageal cancer is extremely difficult to detect by conventional methods in asymptomatic patients.

Parapharyngeal space tumors: considerations in 26 cases.

CONTEXT: Parapharyngeal space tumors comprise less than 0.5% of all head and neck neoplasms. The majority of these tumors are benign, but surgery is usually required to establish the diagnosis and treat the patients. We present 26 patients treated surgically for tumors arising in the parapharyngeal space (PPS) at the State University of Campinas Hospital--UNICAMP. CASES SERIES: Of these, 17 (65.5%) had benign and 9 (34.6%) malignant neoplasms. The surgical and pathological data relevant to these cases are highlighted, observing any local recurrence, surgical complications and the five-year survival. Neurogenic tumors and soft tissue sarcomas were, respectively, the most frequent benign (35.3%) and malignant neoplasms (44.5%). Benign tumors accounted for the majority of the cases and involved minimal surgical morbidity with no recurrence during a median follow-up of five years. Malignant tumors had a high rate of recurrence and mortality. Surgery is the treatment of choice for PPS tumors. A knowledge of the anatomy of this site is essential for the safe performance of surgical procedures. Malignant neoplasms have a poor prognosis. Fine needle aspiration was helpful in diagnosis of all tumors.

Papillary carcinoma in a thyroglossal duct: case report.

CONTEXT: Thyroglossal duct cysts are the most common congenital cervical abnormality in childhood. Malignant lesions are rare in thyroglossal duct cysts (about 1%). OBJECTIVE: To report a case of papillary carcinoma in thyroglossal duct cysts. DESIGN: Case report. CASE REPORT: The patient was a 21-year-old female with a four-month history of an anterior midline neck mass but without other symptoms. The physical examination revealed a 4.0 cm diameter, smooth, painless, cystic nodule at the level of the hyoid bone. The thyroid gland was normal by palpation and no neck lymph nodes were found. Indirect laryngoscopy, fine-needle biopsy aspiration and cervical ultrasound were normal and compatible with the physical findings of a thyroglossal duct cyst. The patient underwent surgery with this diagnosis, under general anesthesia, and the mass was resected by the usual Sistrunk procedure. There were no local signs of invasion of the tissue surrounding the cyst or duct at surgery. The patient was discharged within 24 hours. Histopathological examination of the specimen showed a 3.5 x 3.0 x 3.0 cm thyroglossal cyst, partially filled by a solid 1.0 x 0.5 cm brownish tissue. Histological sections showed a papillary carcinoma in the thyroid tissue of a thyroglossal cyst, with normal thyroid tissue at the boundary of the carcinoma. There was no capsule invasion and the margins were negative. The follow-up of the patient consisted of head and neck examinations, ultrasonography of the surgical region and thyroid, and total body scintigraphy. The patient has been followed up for two years with no further evidence of disease.

Melanoma ganglionic metastasis 30 years after treatment of the primary tumor--a case report.

The recurrence of melanoma in patients is well-documented, and is dependent on a number of factors. We report a case in which a patient had a case of ganglionar metastasis in the neck after a 30-year disease-free interval following primary treatment.

Uma nova ambulância para transporte de doentes e acidentados / A new ambulance for transportation of patients and accident victims

Apresenta-se um novo veículo para transporte de pacientes acidentados, com aumento de 30% da área interna útil e teto elevado, que possibilita massagem cardíaca externa e maior facilidade para manutençäo de via venosa. As condiçöes de segurança para os socorristas, durante o transporte, foram aumentadas pela utilizaçäo de assentos escamoteáveis dotados de cintos de segurança. Foi acrescida uma maca destinada especialmente ao transporte de suspeitos de fraturas. Os testes, realizados com pessoal treinado, confirmaram a possibilidade de realizaçäo contínua e efetiva das medidas de reanimaçäo durante o transporte. A possibilidade de execuçäo de massagem cardíaca externa e demais medidas de reanimaçäo cardiopulmonar, pela reduçäo da necessidade de desenvolver grandes velocidades, aumentou significativamente a segurança dos socorristas e dos pacientes

[Benign tumors of the bile ducts]. / Tumores benignos das vias biliares.

Benign neoplasms are rare events in the extrahepatic biliary ducts, and scanty literary references on the subject are available. Four cases of obstructive jaundice caused by benign tumours of the extrahepatic biliary ducts have been reviewed. Two of them have also displayed lithiasis of the gallbladder and common bile duct. In three cases histopathologic confirmation was obtained, in contrast to the remaining case in which only a gross pathologic presumptive diagnosis was possible. Three patients underwent surgical resection, and in one of them hepatojejunostomy was performed. The patient with a presumptive diagnosis of "inflammatory polyp" was not submitted to surgery, due to the special circumstances of the case. The undisturbed follow-up of the four cases attested to the worthiness of the surgical procedures.

Tumores benignos das vias biliares. / Benign tumors of the bile ducts

Os tumores benignos das vias biliares sao raros e poucas referencias sao encontradas. Sao apresentados quatro casos de tumores benignos com quadro clinico de ictericia obstrutiva, sendo que dois apresentavam litiase da vesicula e coledoco e dois nao a apresentavam. Em tres houve confirmacao anatomopatologica e em um, o diagnostico foi presuntivo. O tratamento foi cirurgico e consistiu na ressecao do tumor em tres, sendo que em um deles realizou-se derivacao biliar interna. Um caso com diagnostico presuntivo de polipo inflamatorio nao foi ressecado em virtude das implicacoes cirurgicas. A boa evolucao ate o momento atesta a validade dos procedimentos cirurgicos

O uso da via aerea esofageana. / The use of esophageal obturator airway

A via aerea com obturador esofageano (VAOE) e um dispositivo que facilita a intubacao e obliteracao do esofago e atraves de uma mascara facial, permite a insuflacao de ar ou oxigenio que ventila os pulmoes. O dispositivo evita a regurgitacao de conteudo gastrico e a insuflacao de ar indevida ao estomago.O metodo descrito pode ser usado por pessoal medico ou paramedico nao treinado em intubacao traqueal sendo de facil manipulacao e apredizado.As complicacoes sao raras e evitaveis, principalmente se a tecnica e aplicada adequadamente. O tubo nao deve ser retirado sem o devido esvaziamento do balonete esofagico e, cuidados devem ser tomados para evitar intubacao traqueal inadvertida. Nao ha experiencia sobre sua aplicacao em criancas, nao sendo recomendavel o seu uso em pacientes abaixo de 16 anos. Os autores utilizaram o dispositivo em 10 pacientes adultos, observando o tempo para sua instalacao e a eficacia da ventilacao boca-tubo e concluiram que o metodo permite efetiva ventilacao pulmonar em 5 a 10 segundos

Alternativas técnicas para a massagem cardíaca externa clássica / Technical alternative for classical external cardiac massage

Os autores apresentam uma comparacao entre massagens cardiacas externas efetuadas com o calcanhar, com o cotovelo e pela maneira classica em um manequim registrador, utilizando 30 voluntarios. As duas alternativas (calcanhar e cotovelo) mostraram-se eficientes quando aplicadas por reanimadores com baixo peso (calcanhar) em ambulancias com teto baixo (cotovelo)

Analgesia pos-operatoria com morfina peridural. / Post-operative analgesia with morphine epidural

Os autores apresentam o estudo feito em 29 pacientes submetidos a puncao peridural lombar com insercao de cateter que foi mantido durante 3 dias, para a avaliacao da analgesia produzida pela morfina. Com a dose de 5 mg de morfina a latencia variou de 15 a 60 minutos, com media de 20 minutos, e a duracao do efeito variou de 18 a 24 horas, com media de 20 horas. Houve varias intercorrencias: retencao urinaria (65%), prurido (20%), nauseas e vomitos (27%). A retencao urinaria foi contornada com cateterizacao vesical, enquanto que as demais intercorrencias nao foram tratadas, e assim mesmo bem toleradas pelos pacientes. Nao se encontrou nenhum caso em que a analgesia nao fosse considerada boa, sendo que a maioria dos pacientes obtiveram alta hospitalar sem tomar nenhum outro analgesico. Fato interessante foi a observacao da deambulacao precoce dos pacientes, mesmo aqueles submetidos a cirurgias do andar superior do abdomen. A casuistica e pequena, de modo que nao permitiu verificar se o tempo de internacao e ou nao menor do que com o tratamento convencional. E necessario um estudo mais prolongado para se concluir sobre a validade do metodo para uso rotineiro no combate a dor pos-operatoria