"Incidentally discovered medullary thyroid carcinoma in the post-operative Graves' patient - A case report".

OBJECTIVE: To report a very rare case of incidentally discovered Medullary Thyroid Carcinoma after total thyroidectomy in a patient with Graves' disease, review available literature, and present readers with management information. RESULTS: Medullary Thyroid Carcinoma in the setting of Graves' disease is a rare scenario. Only fifteen total cases besides ours has been described in literature, and only six other cases were incidentally discovered. CONCLUSIONS: When Medullary Thyroid Carcinoma is incidentally discovered in the setting of Graves' disease, retroactive workup should begin with postoperative calcitonin, CEA level, testing for RET mutation, and a comprehensive neck ultrasound as soon as the diagnosis is made.

Hypercalcemic Crisis Secondary to a Superior Mediastinal Parathyroid Adenoma: A Case Report.

Hypercalcemic crisis is a rare endocrine emergency that occurs in a small percentage of patients with primary hyperparathyroidism. Although modern diagnostic capabilities allow timely diagnosis and intervention, hypercalcemic crisis still has a high potential for morbidity and mortality. We report an adult patient with a history of kidney stones who presented with heart palpitations, shortness of breath, fatigue, nausea, and 20-pound weight loss over 2 months. Workup revealed hypercalcemia, elevated parathyroid hormone (PTH), and a mediastinal mass on computed tomography angiography. This patient's hypercalcemic crisis was treated with intravenous hydration using normal saline, zoledronate, and furosemide. After medical optimization, the patient underwent definitive treatment with surgical parathyroidectomy via a transcervical approach. At operation, a large parathyroid adenoma was removed from a posterior-superior mediastinal location dorsal to the recurrent laryngeal nerve with subsequent normalization of calcium and PTH. We discuss the timing of parathyroidectomy in cases of hypercalcemic crisis and the surgical approach to ectopic parathyroid glands in the mediastinum.

Cadmium and Lead Decrease Cell-Cell Aggregation and Increase Migration and Invasion in Renca Mouse Renal Cell Carcinoma Cells.

Metastatic renal cell carcinoma (RCC) remains an important clinical issue; the 5-year survival rate of patients with metastasis is approximately 12%, while it is 93% in those with localized disease. There is evidence that blood cadmium and lead levels are elevated in RCC. The current studies were designed to assess the impact of cadmium and lead on the progression of RCC. The disruption of homotypic cell-cell adhesion is an essential step in epithelial-to-mesenchymal transition and tumor metastasis. Therefore, we examined the impact of cadmium and lead on the cadherin/catenin complex in Renca cells-a mouse RCC cell line. Lead, but not cadmium, induced a concentration-dependent loss of E-cadherin, while cadmium, but not lead, increased p120-catenin expression, specifically isoform 1 expression. Lead also induced a substantial increase in matrix metalloproteinase-9 levels. Both cadmium and lead significantly decreased the number of Renca cell aggregates, consistent with the disruption of the cadherin/catenin complex. Both metals enhanced wound healing in a scratch assay, and increased cell migration and invasion. These data suggest that cadmium and lead promote RCC progression.

Minimally invasive method for determining the effective lymphatic pumping pressure in rats using near-infrared imaging.

The ability to quantify collecting vessel function in a minimally invasive fashion is crucial to the study of lymphatic physiology and the role of lymphatic pump function in disease progression. Therefore, we developed a highly sensitive, minimally invasive research platform for quantifying the pumping capacity of collecting lymphatic vessels in the rodent tail and forelimb. To achieve this, we have integrated a near-infrared lymphatic imaging system with a feedback-controlled pressure cuff to modulate lymph flow. After occluding lymphatic flow by inflating a pressure cuff on the limb or tail, we gradually deflate the cuff while imaging flow restoration proximal to the cuff. Using prescribed pressure applications and automated image processing of fluorescence intensity levels in the vessels, we were able to noninvasively quantify the effective pumping pressure (P(eff), pressure at which flow is restored after occlusion) and vessel emptying rate (rate of fluorescence clearance during flow occlusion) of lymphatics in the rat. To demonstrate the sensitivity of this system to changes in lymphatic function, a nitric oxide (NO) donor cream, glyceryl trinitrate ointment (GTNO), was applied to the tails. GTNO decreased P(eff) of the vessels by nearly 50% and the average emptying rate by more than 60%. We also demonstrate the suitability of this approach for acquiring measurements on the rat forelimb. Thus, this novel research platform provides the first minimally invasive measurements of P(eff) and emptying rate in rodents. This experimental platform holds strong potential for future in vivo studies that seek to evaluate changes in lymphatic health and disease.