A hypothesis: Role of physical factors in pathophysiology of rhinophyma - Focus on habitual mechanical trauma.

BACKGROUND: Rhinophyma is a skin disorder which causes nose enlargement and deformation due to proliferation of sebaceous glands and connective tissue. It is not only an aesthetic problem but may also lead to impaired nasal breathing and problems with liquids intake. HYPOTHESIS: Although rhinophyma is considered to be a subtype of rosacea, here we hypothesise whether it is a separate disease with mechanical trauma as a main reason of the disease progress. METHODS: 22 patients with diagnosed rhinophyma were qualified for the study. All patients were physically examined and detailed patients' medical history was obtained. Patients were asked to answer a number of questions regarding their usual skin care, purification procedure as well as handling of the nose and nasal cavity. Results were subjected to statistical analysis. RESULTS: Due to our observations there is a group of patients who have never presented any typical symptoms of rosacea while they are now suffering from rhinophymatous changes. Most of those patients confirmed longlasting mechanical nose cleaning which included any skin lesions removal by squeezing and nose picking which resulted in local skin inflammation, swelling, pain or itching. CONCLUSION: It is suspected that many different factors may induce rhinophyma development. In our opinion, mechanical repetitive trauma is one of the most important. Therefore we encourage physicians to include adequate questions while taking medical history from the patient and implement proper recommendations for nasal care as soon as possible.

[Evaluation of surgical treatment results in patients with differentiated thyroid cancer from materials in the Oncologic Institute in Gliwice]. / Ocena wyników leczenia operacyjnego chorych na zróznicowane raki tarczycy w materiale Instytutu Onkologii w Gliwicach.

The optimal surgical treatment for patients with differentiated thyroid carcinoma is still controversial and discussed. The aim of this study was to analyze the effectiveness of treatment in differentiated thyroid carcinoma, to establish the prognostic value of histopathological type, clinical advancement, the extent of surgery and to estimate the therapeutic benefit rate of the radical approach. The randomized group of 768 patients with differentiated thyroid carcinoma, aged between 16 to 40 (median age 44), treated in Oncology Center Institute in Gliwice between 1986 and 1997 were analyzed. They were operated in different surgical clinics in Poland. The primary total thyroidectomy was performed in 153 of patients (20%), the secondary radical operation in 474 (62%). 136 persons were operated by less radical approach. Cervical lymph node metastases were observed in 26% of patients. Distant metastases occurred in 8% of cases. 610 persons were treated with 131I. All patients were administered hormonal therapy to suppress TSH. Locoregional recurrence occurred in 7.5% of patients. Complete remission was observed in 71.5% of persons (548 patients). The influence of distant metastases lymph node metastases and tumor size on the long-term prognosis was analyzed in univariate statistic analysis. There were no differences in survival in patients with papillary and follicular carcinoma. The 10-year survival was statistically significantly longer in patients who underwent radical surgical treatment (92%) than after non-total thyroidectomy (80%). Despite the relatively high risk of surgical complications the benefits of the radical approach were significant.

[Evaluation of results after repeated radical surgery for differentiated thyroid cancer]. / Ocena wyników wtórnego radykalnego leczenia chirurgicznego chorych na zróznicowane raki tarczycy.

Total thyroidectomy is the treatment of choice in thyroid cancer. Unfortunately, the diagnosis is not always established before the first operation and the secondary radical surgery is necessary. The aim of this study was to analyze the effectiveness of secondary surgery in differentiated thyroid carcinoma. The randomized group of 768 patients with differentiated thyroid carcinoma, treated in Oncology Center Institute in Gilwice between 1986 and 1997 was analyzed. Among them 474 persons (56%) - 398 females and 76 males (median age 44 years) were operated more than once in different clinics in Poland. They were compared with 136 persons operated by less radical approach. Negative histobiological risk factors were noted in 4% to 33% of cases. Cervical lymph node metastases were observed in 18% of patients. Distant metastases occurred in 3% of cases. 373 persons were treated with 131(I). All patients administered hormonal therapy to suppress TSH. After secondary operation the rate of cancer foci was 28% (when radicalization was performed durning one year after primary surgery) and 56% when it was done later. This difference was statistically significant (p=0,0002). Locoregional recurrence was observed in 5% of patients. In the entire examined group the actual 5-year-survival was 98% and 10-year-survival was 92%. Complete remission was observed in 80% of patients. The incidence of multifocality in 1/3 of cases and the presence of neoplasm in the re-operated thyroid gland in 1/4 of cases have substantiated the decision for secondary surgery. The delay in radicalization surgery of more than 12 months has doubled the risk of multifocality in thyroid gland remnants. Our results have confirmed the necessity of the secondary surgery after nonradical primary thyroid resection in differentiated thyroid carcinoma.

[Early evaluation of treatment effectiveness using 131I iodine radiotherapy in patients with differentiated thyroid cancer]. / Ocena wczesnej skutecznosci leczenia uzupelniajacego jodem promieniotwórczym 131I chorych na zróznicowane raki tarczycy.

UNLABELLED: This paper presents the preliminary results of a prospective randomized trial on early effectiveness of 30 mCi versus 60 mCi for ablation of thyroid remnants in patients with WDTC after total thyroidectomy. Since April 1998 to January 2000, 220 patients with papillary thyroid cancer in stage T1b-3, N0-x, M0 had entered the study. 106 patients received 60 mCi and 114 received 30 mCi as the first ablation dose. The subject for the analysis was the uptake over the neck, post-therapeutic whole body scintigraphy and Tg level 6 months after ablation. The early effectiveness of ablation was estimated using a 5-degree scale: 0--very good effect, 1--good effect, 2--dubious effect-required repetition of WBS and Tg assessment in 6-12 months, 3--insufficient ablation--required repetition of radioiodine treatment, 4--for evident dissemination or local recurrence. RESULTS: Grades 0 were obtained in 29 (53%) after 30 mCi (group I) and in 38 patients (86%) after 60 mCi (group II). Grades 1 were obtained in group I in 15 patients (28%) and in 4 patients (9%) of group II. Grades 2 were obtained in group I in 9 patients (17%) and in group II in 1 (2.3%). Grade 3 was obtained only in 1 (2%) patient after 30 mCi. Grade 4 was obtained in one patient after 60 mCi (2.3%). The difference in uptake over the neck in the two groups was statistically significant (p < 0.05), although the differences in early effectiveness between the both groups according to the 5-degree scale were on the borderline of significance (p = 0.075). There was a correlation between uptake before and after ablation in 30 mCi group, which was not seen present in 60 mCi group. CONCLUSION: For the ablation of thyroid remnants 60 mCi should be considered as a standard dose.

[Use of recombinant human TSH for stimulation of iodine radioisotope uptake in metastases of thyroid cancer during therapy with 131I]. / Zastosowanie rekombinowanego ludzkiego TSH do stymulacji jodochwytnosci przerzutów raka tarczycy w czasie terapii jodem promieniotwórczym 131I.

The diagnostics with the use of recombinant human TSH for the follow-up of differentiated thyroid carcinoma (DTC) has been already approved. In more than 400 diagnostic scans, rhTSH proved to be effective in promoting 131I uptake in thyroid remnants and DTC metastases in patients receiving suppressive doses of thyroxine. However, information about its application in radioiodine treatment of DTC are scarce, especially with respect to patients with metastatic disease. In this review we have described our own results obtained during rhTSH aided radioiodine treatment of 42 patients with advanced DTC with reference to current literature data about diagnostic and therapeutic application of rhTSH.

[Use of 13-cis retinoic acid for treatment of advanced differentiated thyroid cancer]. / Zastosowanie kwasu 13-cis-retinowego w leczeniu zaawansowanego zróznicowanego raka tarczycy.

UNLABELLED: Retinoids, a large group of compounds structurally related to vitamin A, are able to induce redifferentiation of thyroid cancer cells. The aim of the study is to present our early results of retinoids redifferentiation therapy of thyroid cancer patients. In 15 patients with advanced thyroid cancer, whose cancer foci did not concentrate radioiodine, 13-cis retinoic acid (Roaccutan) was given for 6 weeks before radioiodine treatment. Radioiodine therapy was performed under exogenous TSH stimulation (Thyrogen). Three patients were treated twice. The planned retinoid dose was delivered to 11 patients. In the other four patients the reduction of retinoids dose was necessary due to severe side effects. In post-therapeutic scintigraphy radioiodine uptake was visible in two out of seven patients (29%) with lung metastases, in 5 out of 9 (56%) with locoregional disease and in two with bone metastases. On the whole, in 50% of patients reinduction of radioiodine uptake was visible, however, in most patients only a very discrete one. Thyroglobulin concentration before and after retinoids therapy did not differ significantly. CONCLUSIONS: In a subgroup of patients 13-cis retinoic acid can induce radioiodine uptake, however, prospective studies in larger groups of patients are necessary to prove its clinical application.

[Prospective analysis of criteria for interpreting measurements of thyroglobulin serum concentration during conditions of endogenous TSH stimulation in serum of patients with differentiated thyroid carcinoma]. / Prospektywna analiza kryteriów interpretacyjnych oznaczania stezenia tyreoglobuliny w warunkach stymulacji endogennym TSH w surowicy chorych na zróznicowane raki tarczycy.

The aim of this study was the assessment of diagnostic value of thyroglobulin serum measurement in patients with DTC during endogenous TSH stimulation. Thyroglobulin was measured by immunofluorometric method (Delfia-Wallac) in patients after combined surgery and I131 ablation. Predictive values for two threshold levels 10 and 30 ng/ml were compared. At 5 years follow up it has been demonstrated, that Tg values higher than 10 ng/ml were the true signals of DTC relapse only in 46% patients. Tg values higher than 30 ng/ml were associated with disease progression in 65% of patients. Thus, we accept Tg concentration of 30 ng/ml measured during endogenous TSH stimulation as a good cut-off limit for the detection of DTC progression. Reduction of this threshold up to 10 ng/ml is associated with the increased risk of false positive results.

[Comparison of efficacy of various methods of thyroglobulin measurements in differentiated thyroid cancer]. / Porównanie skutecznosci róznych metod oznaczania tyreoglobuliny jako markera zróznicowanego raka tarczycy.

Monitoring patients with differentiated thyroid carcinoma (DTC) by thyroglobulin (Tg) measurements requires selecting optimal methods used for detection of this marker. An increase the thyroglobulin concentration in serum is a predictor of tumor recurrence. All serum thyroglobulin assays can be falsified by presence of Tg autoantibodies, which are present in approximately 20% of DTC patients. The aim of this study was a comparison of the clinical utility of two different methods for determining serum Tg concentration in monitoring patients with DTC during thyroxine treatment. Tg concentration was measured in serum samples of 1530 patients with DTC during replacement thyroid hormone using two methods: fluoroimmunometric assay (IFMA) Wallac Delfia Thyroglobulin and immunoradiometric assay (IRMA) Brahms DYNOtest Tg-S. 1847 values of Tg concentration and recovery test detected between 1992 and 1995 years using IFMA methods and 1187 values of Tg and thyroglobulin autoantibodies concentration measured in 2000 year using IRMA methods were also included. The correlation between Tg values in all patients group wasn't good (r = 0.83; p < 0.05), but when we excluded patients with incorrect recovery test determined by IRMA, the correlation factor was higher (r = 0.94; p < 0.05). The estimation of Tg recovery test obtained in IRMA assay eliminated from monitoring only 3% patients with DTC, when IFMA assay excluded nearly 1/5 patients, whereas the estimation Tg autoantibodies 7% from all patients. The IRMA method is the most resistant to interference and allows to monitor a reliably greater group of patients with DTC during thyroxine treatment.

[Prognostic significance of selected oncogene and suppressor gene expression in follicular thyroid carcinoma]. / Prognostyczne znaczenie ekspresji wybranych onkogenów i genów supresorowych w raku pecherzykowym tarczycy.

Oncogene and suppressor gene expression (cyclin D, p21WAF1, nm23-H1, Rb1, p16INK4A, and p53) was evaluated in 23 follicular thyroid carcinomas diagnosed in 20 women and 3 men operated or reoperated in Institute of Oncology in Gliwice in years 1992-1999. Positive reaction with p16INK4A, Rb1 and cyclin D1 antibodies was observed in all tumors, with nm23-H1 in 22 cases. The presence of p21WAF1 was stated in 8 cases (34.8%) and p53 in 7 cases (30.4%). A simultaneous presence of expression of p53 and lack of expression of p21WAF1 was stated three times and in two cases were accompanied by distant metastases. This pattern of expression was only rarely observed in minimally invasive follicular cancer. The prognostic significance of simultaneous immunohistochemical analysis of p53 and p21WAF1 in follicular thyroid carcinoma is suggested and has to be proved in further studies.

Recombinant human TSH for the treatment of differentiated thyroid cancer metastatic to the spine.

The diagnostic use of recombinant human TSH (rhTSH) in follow- up of differentiated thyroid cancer (DTC) is already approved, however its application in (131)I therapy is still to be evaluated. We report results obtained in four patients with DTC metastatic to central skeleton, in whom 5 courses of rtTSH aided 131I therapy were administered.

Volatile and semivolatile organo-halogen trace analysis in surface water by direct aqueous injection GC-ECD.

A procedure for simultaneous determination of volatile and semivolatile chloroorganic compounds (from trichloromethane to di- and trichlorobenzenes to hexachlorobutadiene) in aqueous samples was developed. The procedure is based on a DAI-GC-ECD technique widely used for trihalomethanes determination in drinking water. The DAI technique application could have been extended to semivolatile chloroorganic compounds by using a Rtx-624 (60 m x 0.32 mm I.D., df 1.8 microns (6% cyanopropyl, 94% dimethyl polysiloxane). Precision (R.S.D.) and detection limits of the DAI-GC-ECD procedure with respect to 12 volatile and semivolatile chloroorganics were determined. Relative standard deviations (R.S.D.) were lower than 22% and the detection limits (concentration equivalent to a peak height three times the baseline noise) range from 0.02 microgram L-1 for trichloroethene and tetrachloroethene to 0.25 microgram L-1 for hexachlorobutadiene to 1.6 micrograms L-1 for 1,2-dichlorobenzene. The method was successfully used to determine chloroorganic pollutants in river water.

Use of INAA to study the interaction between Se and Te in cells of Saccharomyces cerevisiae.

The differences in the effects of inorganic Se (IV and VI) compounds and seleno-cystine [(CySe)2] on the Te (as Na2TeO3) uptake by the yeast, Saccharomyces cerevisiae, has been studied. Se, Te, Ag, Zn, Fe and Co contents of the cells were measured by instrumental neutron activation analysis. For the determination of the Ag content, the monostandard method was applied as the analytical method. The contents of other elements were determined by comparison with standards having similar amounts of the determined element as the sample. Results obtained show that an antagonist interaction occurs between SeO2 and Te. There was a significant increase in the concentrations of Se and Te when the yeast was incubated in the medium containing (CySe)2 and Te. (CySe)2 markedly increased the Ag content of cells, especially within the first 8 h of incubation. The low level of SeO2 in the medium are the exterior factor which produce an observable increase of the Ag concentration in the cells. The higher level of SeO2 in the medium causes a long-term marked increase in the Ag content of the cells. The uptake yield of Ag also increased in the presence of (NH4)2SeO4 in the medium. The Te supply produced a significant enhancement in the Ag content of the cells during the initial 8 h of incubation. The presence of Se and/or Te in the medium causes change in the intracellular Zn, Fe and Co levels.

Use of INAA to study the determination of Se, Th, Zn, Co and Fe levels of yeast cells.

Differences in the effects of seleno-cystine (CySe)2, glutathione (GSH), Se(IV) [as SeO2] and Se(VI) [as (NH4)2SeO4] on Th(IV) [as Th(CO3)2] uptake by the cells, Saccharomyces cerevisiae, have been studied. The Th, Se, Zn, Co and Fe levels of the yeast cells were measured by instrumental neutron activation analysis. Results obtained show that the addition of Th alone to the culture medium resulting in the Th content of the cells and the Th level of the yeast slightly decreased during the incubation. The addition of Th in combination with GSH produced a higher decrease of the Th content in comparison with the single Th dosage. During the initial 48 h of the incubation the presence of Th and Se(VI) in the medium produced a decrease of the Th level of the cells in comparison with the addition of Th alone. (CySe)2 or SeO2 does not produce a regular change of the Th level of the cells. Th uptake by the yeast influenced the retention of Se in the cells. In fact, the Se levels of the cells were always significantly higher when the yeast was incubated in the medium containing Th and SeO2 or Se(VI). The enhance in the Se level of the cells rises with increasing concentrations of SeO2 in the culture medium. Th decreased the Se content of the yeast when the cells were incubated in the medium containing (CySe)2 and Th. GSH supply in combination with Th and SeO2 produced a very significant enhancement of the Se abundance in the cells in comparison with the single addition of SeO2. Se-compounds and/or Th dosages affected the Zn, Co and Fe contents of the cells. The Fe level of the yeast is below the quantitative detection limit of Fe when the cells were incubated in the medium containing Th.