Thyroid surgery during the COVID-19 pandemic: results from a systematic review.

PURPOSE: During the COVID-19 pandemic, elective thyroid surgery is experiencing delays. The problem is that the COVID-19 pandemic is ongoing. The research purposes were to systematically collect the literature data on the characteristics of those thyroid operations performed and to assess the safety/risks associated with thyroid surgery during the COVID-19 pandemic. METHODS: We used all the procedures consistent with the PRISMA guidelines. A comprehensive literature in MEDLINE (PubMed) and Scopus was made using ''Thyroid'' and "coronavirus" as search terms. RESULTS: Of a total of 293 articles identified, 9 studies met the inclusion criteria. The total number of patients undergoing thyroid surgery was 2217. The indication for surgery was malignancy in 1347 cases (60.8%). Screening protocols varied depending on hospital protocol and maximum levels of personal protection equipment were adopted. The hospital length of stay was 2-3 days. Total thyroidectomy was chosen for 1557 patients (1557/1868, 83.4%), of which 596 procedures (596/1558, 38.3%) were combined with lymph node dissections. Cross-infections were registered in 14 cases (14/721, 1.9%), of which three (3/721, 0.4%) with severe pulmonary complications of COVID-19. 377 patients (377/1868, 20.2%) had complications after surgery, of which 285 (285/377, 75.6%) hypoparathyroidism and 71 (71/377, 18.8%) recurrent laryngeal nerve injury. CONCLUSION: The risk of SARS-CoV-2 transmission after thyroid surgery is relatively low. Our study could promote the restart of planned thyroid surgery due to COVID-19. Future studies are warranted to obtain more solid data about the risk of complications after thyroid surgery during the COVID-19 era.

Social inequalities in the metropolitan area of Rome. A multidisciplinary analysis of the urban segregation of the "formerly-Bastogi" compound.

BACKGROUND: This study tries to evaluate, through a multidisciplinary approach, the relationship between urban structure, isolation and distribution of social determinants of health, in the so-called "formerly-Bastogi, a compound, with more than 1,500 inhabitants, located in north-western Rome, Italy. METHODS: The architectural-urban analysis, conducted through site visits and evaluations of urban situation, showed how strongly the compound is isolated from the neighbourhoods, and structurally degraded. The socio-demographic analysis, based on the National Census data, showed significant differences in the distribution of the social determinants of health between "formerly-Bastogi" and the surrounding areas. RESULTS: The area under study appears to be isolated from the surrounding urban space, both because of social and architectural factors. This situation could have some association with inhabitants' health. CONCLUSIONS: If our preliminary investigation was useful for a diagnosis of the situation, a more complete - qualitative and quantitative - investigation of the context will be needed to plan appropriate multidisciplinary health-promoting interventions.

Growth and development of children living in incarceration environments of the province of Buenos Aires, Argentina.

OBJECTIVES: The objective of this study was to examine nutritional status, psychomotor and socioemotional development of children living with mothers in prison in the province of Buenos Aires, Argentina. MATERIALS AND METHODS: Sex, age, weight and height were measured in children (37) residents with their mothers (28) in the Criminal Unit No. 33 of the SPB. Nutritional indicators were calculated and analyzed according to the WHO international reference (2006). National Research Test (PRUNAPE) and the parental questionnaire Ages and Stages Questionnaires: SocioEmotional®, Second Edition (ASQ:SE-2) were applied to evaluate development. RESULTS: Anthropometric evaluation showed that 7% of children under 2 years presented low weight, 3% alert of low weight, 28% high weight and 14% low height. Children over 2 years of age showed 37.5% of high weight and 25% of risk of overweight. There were no children with short stature. PRUNAPE and ASQ:SE-2 tests: in the 30 cases that completed both tests more than half (53.3%) obtained scores within the expected. In the group of children with both tests who did not pass the PRUNAPE (n= 9), the result found in the ASQ-SE 2 was diverse: 66.6% is within the expectations and 33.3% at risk. Neither of children with both tests that did not pass the ASQ:SE-2, passed the PRUNAPE. CONCLUSION: There were high prevalences of excess weight and high percentages of risk in psychomotor development, considerably higher than in the general population. There is a need to carry out actions to reduce the harmful effect of childhood confinement.

Crecimiento y desarrollo de niñas y niños que viven en entornos carcelarios de la provincia de Buenos Aires, Argentina / Growth and development of children living in prison environments of the province of Buenos Aires, Argentina

Objetivos: Examinar el estado nutricional, el desarrollo psicomotor y socioemocional de niñas y niños (a partir de ahora niños) que viven con sus madres en la Unidad Penal N° 33 de la provincia de Buenos Aires, Argentina. Materiales y métodos: Se registraron el sexo, la edad, el peso y la estatura de los niños (37) residentes con sus madres (28) en la Unidad Criminal No. 33 del SPB. Se calcularon los indicadores nutricionales y se analizaron según la referencia internacional de la Organización Mundial de la Salud (WHO/OMS) de 2006. Se evaluó el desarrollo infantil con la Prueba Nacional de Pesquisa (PRUNAPE) y el cuestionario socioemocional Ages and Stages Questionnaires: Socio-Emotional(R), Second Edition (ASQ:SE-2). Resultados: En la evaluación antropométrica se identificó: en menores de dos años, el 7% con bajo peso, el 3% con alerta de bajo peso, el 28% con alto peso y el 14% con baja talla. En mayores de dos años, el 37,5% tienen alto peso; y el 25%, riesgo de sobrepeso. No se encontró baja talla. En las pruebas PRUNAPE y ASQ:SE-2, de los 30 casos que completaron ambas pruebas, el 53,3% obtuvo puntuaciones dentro de lo esperado. En el grupo con ambas pruebas que no pasaron la PRUNAPE (n=9), el resultado encontrado en el ASQ:SE-2 fue que el 66,6% se hallaba dentro de las expectativas, y el 33,3%, en riesgo. En el grupo de niños con ambas pruebas que no pasaron el ASQ:SE-2, ninguno resolvió la PRUNAPE. Conclusión: Se registraron prevalencias elevadas de exceso de peso y altos porcentajes de riesgo en el desarrollo psicomotor, considerablemente superiores que en la población general. Se plantea la necesidad de acciones que disminuyan el efecto nocivo del internamiento en la infancia

Objective: The objective of this study was to examine the nutritional status, psychomotor and socioemotional development of children living with their mothers in prison in the province of Buenos Aires, Argentina. Material and method: Sex, age, weight and height were measured in children (37) residing with their mothers (28) in Prison No.33 of the SPB. Nutritional indicators were calculated and analyzed according to the WHO international reference (2006). National Research Test (PRUNAPE) and the parental questionnaire Ages and Stages Questionnaires: Socio-Emotional(R), Second Edition (ASQ:SE-2) were applied to evaluate development. Results: Anthropometric evaluation showed that 7% of children under 2 years presented low weight, 3% alert of low weight, 28% high weight and 14% low height. Children over 2 years of age showed 37.5% of high weight and 25% of risk of overweight. There were no children with short stature. PRUNAPE and ASQ:SE-2 tests: in the 30 cases that completed both tests more than half (53.3%) obtained scores within the expected range. In the group of children with both tests who did not pass the PRUNAPE (n = 9), the result found in the ASQ-SE 2 was diverse: 66.6% within expectations and 33.3% at risk. Neither of children with both tests who did not pass the ASQ:SE-2 passed the PRUNAPE. Conclussion: There were high prevalences of excess weight and high percentages of risk in psychomotor development, considerably higher than in the general population. There is a need to take action to reduce the harmful effect of childhood confinement

Seasonal variations of plasma gonadotropin, prolactin, and testosterone levels in primary and secondary hypogonadism: evidence for an independent testicular role.

BACKGROUND: Seasonal hormonal rhythmicity of the hypothalamic-pituitary-gonadal axis may influence reproductive and sexual activity in mammals. AIM: To investigate whether pituitary-gonadal axis secretion seasonality occurs in men with primary and secondary hypogonadism and whether a hierarchical machinery regulates these variations. SUBJECTS AND METHODS: Six adult males with Klinefelter's syndrome (KS), eight with idiopathic normosmic hypogonadotropic hypogonadism (HH) and ten sex- and age-matched healthy controls were studied longitudinally for one year. Every three months, three plasma samples for assay of testosterone, LH, FSH, and prolactin were drawn and the mean value was used for statistical analysis. RESULTS: Healthy males showed a significant seasonality in LH (zenith in spring) and testosterone (zenith in autumn) but not in FSH and prolactin concentrations. Patients with KS and those with HH showed a seasonal rhythmicity only of testosterone values, even if with small amplitude, with the zenith in spring and summer respectively. CONCLUSION: The lack of dependence of testosterone on gonadotropin variations in normal men and the persistence of seasonal testosterone but not gonadotropin variations both in primary and secondary hypogonadism seem to indicate a possible independent testicular regulation of this seasonality. The shift of testosterone peak in hypogonadal men with respect to controls suggests that LH variations could play a synchronizing, rather than pace-making, role in seasonal testosterone variations. Since hormonal seasonality may also influence gonadal activity in humans, replacement therapy in hypogonadism should be aimed also at restoring a normal seasonal rhythmicity of pituitary-gonadal hormone concentrations.

Uric acid does not affect the prevalence and extent of coronary artery disease. Results from a prospective study.

BACKGROUND: Hyperuricemia may be involved in the atherosclerotic process due to endothelial dysfunction and facilitation of smooth muscle cell proliferation. However, debates still exist on the independent role of hyperuricemia, due to its association with several cardiovascular risk factors, such as hypertension, hyperlipidemia, obesity and insulin resistance. Thus, the aim of the current study was to investigate in a consecutive cohort of patients undergoing coronary angiography whether hyperuricemia is associated with the extent of coronary artery disease. METHODS AND RESULTS: Our population is represented by a total of 1901 consecutive patients undergoing coronary angiography between May 2007 and January 2010 at the Azienda Ospedaliera "Maggiore della Carità", Novara, Italy. We additionally evaluated platelet aggregation by PFA-100 (Collagen/Epinefrine) and Multiplate. Quantitative coronary angiography and analysis of IMT were performed by experienced cardiologists who had no knowledge of the patients' clinical information. Higher uric acid was associated with advanced age, larger prevalence of male gender, diabetes, renal insufficiency, hypertension, previous CABG and MI, but with a lower prevalence of family history of CAD. Patients with high uric acid were more often on calcium antagonists, ace-inhibitors, angiotensin receptor antagonists, and, as expected, on diuretics. A significant relationship was observed between uric acid and the prevalence (OR [95% CI] = 1.18 [1.04-1.32], p = 0.01) and severity of CAD (OR [95% CI] = 1.17 [1.03-1.33], p = 0.014). However, the relationship disappeared after correction for baseline confounding factors for both prevalence (OR [95% CI] = 1.06 [0.93-1.21], p = 0.35) and extent of CAD (OR [95% CI] = 1.0 [0.87-1.15], p = 0.96). No relationship was observed between acid uric and IMT (p = 0.73) analyzed in 359 consecutive patients. Finally, there was no relationship between uric acid and platelet aggregation in patients with or without aspirin therapy, as measured by PFA-100 and Multiplate. CONCLUSIONS: Our study showed that uric acid is not associated with platelet aggregation, the extent of coronary artery disease and IMT. Thus, waiting for the results of additional large studies, uric acid may not be considered as a risk factor for coronary artery disease, and its reduction by specific therapies may not be recommended to prevent coronary artery disease and atherosclerosis.

Genotoxic effects of the fungicide thiophanate-methyl on Podarcis sicula assessed by micronucleus test, comet assay and chromosome analysis.

The increasing use of pesticides in modern agriculture has raised the need to evaluate their potential threat to animal and human health. In the present study, the genotoxic effects of environmentally relevant exposure to the fungicide thiophanate-methyl (TM) were assessed in the lizard Podarcis sicula (Reptilia, Lacertidae) using micronucleus test, chromosome aberration analysis and single-cell gel electrophoresis (comet) assay. The number of micronuclei increased significantly with exposure time in lizard specimens exposed to 1.5% TM for 30-40 days. In situ hybridization with the specific HindIII centromeric satellite was positive in 18.7% of the micronuclei observed, suggesting an aneugenic effect of TM during mitosis. DNA damage, evaluated by the comet assay, documented a significant gain in comet length in relation to exposure time that was paralleled by a reduction in head size. Finally, cytogenetic analysis showed a significant increase in chromosome aberrations in exposed animals compared with controls. Our data suggest that long-term TM exposure induces a genomic damage that is positively correlated to exposure time. If such genotoxic effects arise so clearly in an ectothermal vertebrate, such as P. sicula, prolonged exposure TM must be considered as a cytogenetic hazard.

Is there a role for endocannabinoids in sperm-oviduct interaction?

The endocannabinoid system (ECS) has been found in reproductive cells and tissues in several mammals. Spermatozoa are able to respond to anandamide, and the oviduct is able to synthesize and modulate the concentration of this endocannabinoid along the isthmic and ampullary regions. The main aim of this study was to understand whether the ECS has a role during sperm storage and release within the oviduct in cattle. Data showed that 1) the endocannabinoid receptors 1 and 2 (CB1 and CB2) are present in bovine spermatozoa both in the initial ejaculate and in spermatozoa bound to the oviduct in vitro; 2) CB1 receptor is still detectable in spermatozoa released from the oviduct through penicillamine but not in those released through heparin; 3) arachidonylethanolamide (AEA) does not affect sperm viability, whereas it depresses sperm progressive motility and kinetic values; 4) sperm-oviduct binding and release in vitro are not influenced by AEA; 5) AEA depresses sperm-zona pellucida (ZP) binding; 6) binding of heparin-capacitated spermatozoa to the ZP is not affected by AEA; 7) N-acylphosphatidylethanolamine-selective phospholipase D, the main enzyme involved in anandamide synthesis, is expressed in oviductal epithelial cells. In conclusion, secretion of AEA from epithelial cells might contribute to the oviduct sperm-reservoir function, prolonging the sperm fertile life through the depression of motility and capacitation. Capacitation signals, such as heparin, that promote sperm release, might remodel the sperm surface and cause a loss of the sperm sensitivity to AEA.

Differential DMRT1 expression in the gonads of Podarcis sicula (Reptilia: Lacertidae).

DMRT genes encode a large family of transcription factors which share an unusual cysteine-rich DNA-binding motif, the DM domain. DM family members have been studied in the context of sexual development; in particular, the DMRT1 gene appeared to be the one most directly involved in sex determination, but its activity is largely unexplored and possible downstream targets of this factor have yet to be identified. DMRT1 of the lacertid lizard Podarcis sicula (PsDMRT1) was isolated as a model to study differential gene expression during the seasonal reproductive cycle of an ectothermal species. The adult testis of P. sicula exhibits full activity in spring, complete regression in summer and a slow autumnal recrudescence without spermiation. We cloned a 591-bp partial ORF of the PsDMRT1 fragment, whose putative amino acid sequence contains the conserved DM domain. Northern blot analysis of mRNA from different tissues of P. sicula individuals captured in spring demonstrated DMRT1 transcripts only in testis. Semi-quantitative RT-PCR and in situ hybridization experiments showed peak PsDMRT1 expression in spring, lower expression in autumn and no expression during the period of gonad regression. A possible correlation between androgen level variations and PsDMRT1 transcripts is hypothesized and discussed. Finally, data showed that PsDMRT1 is expressed only in spermatogenic cells, before the second meiotic division, suggesting that its role is confined to the proliferation and maintenance of spermatogonia and spermatocytes.

Serum thyrotropin receptor antibodies concentrations in patients with Graves' disease before, at the end of methimazole treatment, and after drug withdrawal: evidence that the activity of thyrotropin receptor antibody and/or thyroid response modify during the observation period.

AIM AND METHODS: We performed a quantitative retrospective analysis of serum thyrotropin receptor antibody (TRAb) concentrations measured by a second-generation radioreceptor assay in 58 patients with Graves' disease (GD) at the onset of the disease, at the end of 18 month methimazole (MMI) treatment, and after MMI withdrawal in order to evaluate the correlation between the presence of these antibodies and the relapse of hyperthyroidism. Sixty healthy subjects were enrolled as a control group. RESULTS: Before MMI treatment the best cutoff TRAb value for identifying patients with GD was 1.45 UI/L (specificity, 100%; sensitivity, 98.3%). At the end of MMI treatment, serum TRAb concentrations were significantly lower (p < 0.001) than those measured at baseline, but they were still significantly higher (p < 0.001) than those found in the control subjects. At the end of MMI treatment, 44 patients (75.9%) had positive TRAb values (>1.45 UI/L). After MMI withdrawal (median, 15 months), 34 patients (58.6%) became hyperthyroid, 4 patients (6.9%) became hypothyroid, and 20 patients (34.5%) remained euthyroid. There was a significant correlation between serum TRAb concentrations at the end of MMI treatment and the percentage of patients who became hyperthyroid (r: 0.56; p < 0.001) and the time of appearance of hyperthyroidism (r: -0.38; p = 0.03). All 4 patients with TRAb values below 0.9 UI/L at the end of MMI treatment remained euthyroid throughout the follow-up period. Among the 27 patients who had serum TRAb values higher than 4.4 UI/L, 23 developed hyperthyroidism and 4 hypothyroidism. The TRAb values between 0.9 and 4.4 UI/L did not discriminate between the 27 patients (46.6%) who remained euthyroid from those who had relapse of hyperthyroidism. Thus a different TRAb end of treatment cutoff was calculated to identify patients who became again hyperthyroid. This TRAb cutoff value was 3.85 UI/L (sensitivity, 85.3%; specificity, 96.5%). All but 1 patient who had serum TRAb values above 3.85 UI/L became hyperthyroid after MMI was withdrawn (positive predictive value, 96.7%). In these patients, relapse of hyperthyroidism was independent of the changes in serum TRAb concentrations (r: 0.27; p = 0.15) and occurred after a median period of 8 weeks (range, 4-48). Hyperthyroidism also developed in 5 of 24 patients who had serum TRAb concentrations lower than 3.85 UI/L at the end of MMI treatment. In these 5 patients the relapse of hyperthyroidism occurred after a median period of 56 weeks (range, 24-120) and was always accompanied by an increase in serum TRAb concentrations. CONCLUSIONS: TRAb persist in the blood of most patients with GD after 18 months of MMI treatment. Both the frequency and the time of appearance of hyperthyroidism are closely correlated with serum TRAb concentrations at the end of MMI treatment. Our data would suggest that TRAb maintain stimulating activity after a full course of MMI treatment in the large majority of patients with GD. However, it is likely that the potency of these antibodies and/or the thyroid response to them change during treatment, as suggested by the different values measured in euthyroid control subjects and in euthyroid patients after MMI treatment.

Serum antibodies to collagen XIII: a further good marker of active Graves' ophthalmopathy.

OBJECTIVE: In Graves' ophthalmopathy (GO) intercellular adhesion molecule-1 (ICAM-1) is thought to play a key role in lymphocyte infiltration into the orbit, and serum levels of its soluble form are positively correlated to clinical activity score (CAS). Serum antibodies against collagen XIII (CollXIIIAb), a plasma membrane protein expressed at a low level in almost all connective tissue-producing cells, have been detected in GO, but their significance is unclear. The aim of this study was to search for CollXIIIAb in Graves' patients with and without ophthalmopathy and to correlate their levels with CAS and with serum soluble ICAM-1 (sICAM-1) values. PATIENTS: We studied 66 patients with Graves' disease whose sera had been previously tested for sICAM-1 levels, grouped as follows: 28 with moderate and active ophthalmopathy (group 1), 12 of them hyperthyroid (group 1a) and 16 euthyroid (group 1b); 13 with mild and inactive ophthalmopathy and normal thyroid function (group 2); 25 without ophthalmopathy (group 3), 11 of them hyperthyroid (group 3a) and 14 euthyroid (group 3b). Finally, 26 sera of normal controls were studied. MEASUREMENTS: CollXIIIAb were evaluated by an enzyme-linked immunosorbent assay (ELISA) method. RESULTS: In group 1 patients, CollXIIIAb were detected at high levels in 8/12 (66.6%) in group 1a [optical density (OD) ranging from 0.529 to 0.894] and in 10/16 (62.5%) in group 1b (OD 0.560-0.855). In group 2 patients, CollXIIIAb were detected but at low levels (OD 0.205-0.260) in 4/13 patients (30.7%). In group 3 patients, CollXIIIAb were present at low levels in 6/11 (54.5%) of group 3a and in 5/14 (35.7%) of group 3b (OD 0.215-0.290 and 0.144-0.245, respectively). CollXIIIAb were detected in only 4/26 normal controls (15%) but at low levels (OD 0.150-0.185). CollXIIIAb values in both groups 1a and 1b were significantly higher than those of the remaining groups. A positive correlation between CollXIIIAb levels and CAS but not thyroid hormone levels was found in groups 1a, 1b and 2. Moreover, a positive correlation between CollXIIIAb levels and sICAM-1-values was also evidenced in all three groups. CONCLUSIONS: Our results suggest that CollXIIIAb could be considered as a further good marker of active inflammatory processes involving the adipose connective tissue in GO. In particular, the high levels of CollXIIIAb in sera of Graves' patients with active ophthalmopathy could reflect an increased expression of type XIII collagen on the membrane of activated fibroblasts in these patients. Thus, the evaluation of these antibodies could be added to other known markers as a useful and inexpensive tool in monitoring Graves' patients and in modulating the treatment of GO.

High serum osteoprotegerin levels in patients with hyperthyroidism: effect of medical treatment.

This study was aimed at evaluating serum osteoprotegerin (OPG) concentrations in a cohort of patients with hyperthyroidism before and after methimazole (MMI) treatment. One hundred fourteen hyperthyroid patients [93 with Graves disease (GD) and 21 with toxic nodular goitre (TNG)] and 68 matched for sex and age healthy subjects were evaluated for serum free-thyroxine (FT4), free-triiodiothyronine (FT3), thyrotropin (TSH), TSH receptor antibodies (TRAb), bone alkaline phosphatase (BALP), C-telopeptides of type-1 collagen (CrossLaps), OPG levels, and bone mineral density (BMD). In hyperthyroid patients, the biochemical evaluations were performed before and after 6 and 12 months of MMI treatment, whereas BMD was measured at baseline and after 12 months of treatment. Hyperthyroidism was more severe in GD than TNG patients. Serum OPG levels were found to be significantly higher in hyperthyroid patients than in the healthy subjects (4.3 pmol/l, range: 1.6-12.0, vs. 2.2 pmol/l, range: 1.4-6.0; P < 0.001), the values being higher in GD patients than TNG. A significant correlation between serum OPG levels and age was found in the healthy subjects (r: 0.48; P < 0.001) but not in hyperthyroid patients (r: -0.03; P = 0.8). In the healthy subjects, serum OPG levels were also positively correlated with both serum FT4 (r: 0.23; P = 0.03) and FT3 (r: 0.24; P = 0.04) levels. In hyperthyroid patients, however, serum OPG was still correlated with FT3 levels (r: 0.38; P < 0.001), whereas the correlation with serum FT4 was lost (r: 0.19; P = 0.06). In hyperthyroid patients, but not in the healthy subjects, serum OPG levels were correlated positively with CrossLaps (r: 0.20; P = 0.03) and negatively with BALP (r: -0.24; P = 0.01) and BMD (r: -0.33; P = 0.01). After 6 months of MMI treatment, serum OPG concentrations decreased significantly in TNG patients (from 3.5 pmol/l, range: 1.6-8.0, to 2.3 pmol/l, range: 1.0-4.3; P < 0.001), whereas a not significant change in OPG levels occurred in GD patients (from 4.8 pmol/l, range: 1.8-12.0, to 4.2 pmol/l, range: 1.0-14.0; P = 0.7). At Month 12 of treatment, serum OPG concentrations were significantly lower than those measured at baseline in both TNG (2.5 pmol/l, range: 1.0-3.1, vs. 3.5 pmol/l, range: 1.6-8.0; P < 0.001) and GD (2.1 pmol/l, range: 1.0-8.6, vs. 4.8 pmol/l, range: 1.8-12.0; P < 0.001). At this time, no significant differences in serum OPG, CrossLaps, and BALP values were found between patients and control subjects. At the end of follow-up, BMD was higher than those measured at baseline but still significantly lower than those measured in the control subjects. This study shows that hyperthyroid patients have serum OPG concentrations significantly higher in comparison with euthyroid subjects, in relation to thyroid hormone excess and high bone turnover. Medical treatment of hyperthyroidism normalizes serum OPG levels in temporal relationship with the normalization of bone metabolism markers, even in presence of persistent abnormal bone structure as determined by ultrasonography.

The influence of parity on multinodular goiter prevalence in areas with moderate iodine deficiency.

Despite the observation that parity may increase the risk of thyroid carcinoma, very few studies have investigated the possible repercussion of parity on thyroid benign pathology. Recently, parity has been identified as one of the factors contributing to a larger thyroid size in healthy females. The aim of this work was to investigate a possible role for parity on the prevalence of multinodular goiter in iodine deficient areas. For this purpose, the reproductive histories of 2 cohorts of women, normal (Group I, 235 cases) and non-toxic multinodular goiter (NTMNG) affected (Group II, 274 cases) were compared. All subjects were euthyroid and had no previous history of thyroid function abnormalities. The number of full-term previous pregnancies (2.55+/-0.11 vs 1.77+/-0.10) and age (47.7+/-0.76 vs 42.3+/-0.83 yr) were found significantly higher (p<0.001) in multinodular goiter (MNG) patients than controls. Parity and age were found to be directly correlated (p<0.001), nevertheless the partial correlation coefficients demonstrated an independent and statistically significant difference for both variables between normal and NTMNG. Therefore, the independent effects of parity and age were further investigated. The effect of age on NTMNG prevalence seems to be weaker, in fact significant differences (p<0.001) for age between patients and controls were detected only when the effect of parity was absent (nulliparous), while with increasing gestations the effect of age disappeared. Our results indicate that age plays a minor role compared to parity which can therefore be considered as a stronger risk factor. In conclusion, the present study shows that, at least in iodine deficient regions, non-toxic multinodular goiter women show a statistically significant higher parity rate than healthy controls. Age may play a certain role but only when additional stronger risk factors are absent.

[Role of flowmetric analysis and of color-Doppler ultrasonography with contrast media in the different phases and follow-up of Graves' disease]. / Ruolo dell'analisi flussimetrica e dell'eco color-Doppler con mdc nelle differenti fasi e nel follow-up della malattia di Graves.

PURPOSE: The objectives of this study were: 1) to evaluate the role of color-Doppler ultrasonography (CDU) assessment of thyroid vascularity, measuring the peak systolic velocity (PSV) at the level of the inferior thyroid artery, and the intrathyroid vascularization in Graves' diseas; 2) to evaluate the role of contrast agent administration in predicting the relapse of hyperthyroidism or the biological activity of the disease after withdrawal of antithyroid drugs. PATIENTS AND METHOD: The study included 74 Graves' patients (59 F/ 15 M; mean age 45 years; range 23-71). Graves' disease was diagnosed according to the usual clinical and laboratory criteria. On the basis of the clinical and biochemical findings we divided Graves' patients into 4 different groups. Treatment was continued for at least 12 months, CDU examination was carried out after discontinuing therapy. Eight patients showed a relapse of hyperthyroidism within 5 months after suspension of therapy. In all cases the evaluation of intraparenchymal vascularization and PSV at the level of the inferior thyroid artery in basal conditions was followed by administration of contrast agent (Levovist, 300 mg/ml), with slow infusion (<2 ml/min) to avoid blooming artifact. Intraparenchymal vascularization was classified into 4 patterns according to Vitti et al. RESULTS: The value of the peak systolic velocity (PSV) at the level of the inferior thyroid artery was the best predictor of relapse. A value higher than 40 cm/sec was present in all the patients that showed relapse and only in two patients with stable remission. Administration of contrast agent is important to evaluate the biological activity of the disease. In the 5 patients exhibiting slightly increased vascularization after contrast agent administration we could assume the clinico-pathological recovery. CONCLUSIONS: CDU study of thyroid vascularization, based on the measurement of PSV at the level of the inferior thyroid artery and on the response to contrast agent administration is useful to distinguish three groups of patients: A) PSV >40 cm/sec with pattern III for at least 10 minutes from the beginning of the contrast agent administration (High risk of relapse); B) PSV <40 cm/sec with pattern II or III after contrast agent administration (Biological activity of the disease-Thyroiditis); C) PSV <40 cm/sec with Pattern I after contrast agent administration (Poor biological activity of the disease-recovery).

[An update of B-mode echography in the characterization of nodular thyroid diseases. An echographic study comparing 7.5 and 13 MHz probes]. / Attualità dell'ecografia nel modo B nella caratterizzazione delle malattie nodulari tiroidee. Studio ecografico di confronto con sonde da 7,5 e da 13 MHz.

PURPOSE: We investigated B-mode US capabilities in diagnosis and characterizing thyroid nodules and compared our personal findings with those of the few analytical studies in the literature. We also compared the diagnostic accuracy of conventional 7.5 MHz versus more recent 13 MHz transducers. MATERIAL AND METHODS: We examined 136 consecutive patients with a single thyroid nodule: they were 97 women and 39 men, age ranging 15-87 years (mean: 37.4). The patients were submitted to scintigraphy and laboratory tests first and then to US, fine-needle biopsy and/or histologic examination. The final diagnosis was made at cytology and/or histology: we had 98 follicular hyperplasias, 20 follicular adenomas and 18 carcinomas. We studied the presence/absence of the halo sign, cystic portions, microcalcifications; nodule margins and echogenicity relative to the thyroid gland were also studied. RESULTS: The presence of microcalcifications had the highest specificity for malignancy. The sensitivity of this parameter was higher with 13 MHz than with 7.5 MHz transducers. Relative to microcalcifications, absence of cystic portions and irregular margins, 13 MHz US had 64.7-89% accuracy. The halo sign and lesion echogenicity did not permit a reliable differential diagnosis between benign and malignant nodules with both 7.5 and 13 MHz transducers. The association of microcalcifications and irregular margins had the highest accuracy, scoring 86% at 7.5 MHz and 90.5% at 13 MHz. CONCLUSIONS: High frequency US is a sensitive tool for diagnosing thyroid nodes. Accurate analysis of the US signs can suggest the benign/malignant lesion nature, which must be integrated with color, power and pulsed Doppler findings.

A longitudinal study of vasopressin cell antibodies, posterior pituitary function, and magnetic resonance imaging evaluations in subclinical autoimmune central diabetes insipidus.

Cytoplasmic autoantibodies to vasopressin-cells (AVPcAb) have been detected not only in patients with overt central diabetes insipidus (CDI), but also in patients with endocrine autoimmune diseases without CDI. This suggests that complete CDI can be preceded by a preclinical stage. Among 878 patients with endocrine autoimmune diseases without CDI, 9 patients found to be AVPcAb positive and 139 AVPcAb-negative controls were enrolled in this open prospective study. They were evaluated for AVPcAb and posterior pituitary function at least yearly for about 4 yr (range, 37-48 months); during this span, magnetic resonance imaging (MRI) of posterior pituitary and stalk was performed only in the AVPcAb-positive patients. Five of the 9 AVPcAb-positive patients had normal posterior pituitary function at study entry. They were AVPcAb positive throughout the follow-up period. At later stages of the study, 3 of them developed partial CDI, and 1 developed complete CDI. The remaining 4 patients showed impaired response to the water deprivation test at study entry and were diagnosed as having partial CDI. Two of them agreed to receive desmopressin replacement for 1 yr. After this treatment, the patients became negative for AVPcAb and displayed normal posterior pituitary function until the end of the follow-up. Conversely, the 2 untreated patients with partial CDI remained AVPcAb positive. One of them developed overt CDI. None of the controls became AVPcAb positive or developed CDI. The normal hyperintense MRI signal of the posterior pituitary, present at study entry, persisted subsequently in all 9 AVPcAb-positive patients, including those developing overt CDI, only disappearing in the late phase of complete CDI. In asymptomatic subjects, the monitoring of AVPcAb, but not MRI, seems to be useful to predict a progression toward partial/overt CDI. Early desmopressin therapy in patients with partial CDI could interrupt or delay the autoimmune damage and the progression toward clinically overt CDI.

Endocrine secretions under abnormal light-dark cycles and in the blind.

Both endogenous and exogenous factors are involved in regulation of endocrine secretions. Among the exogenous ones, light plays an important role both in animals and in humans. Pineal gland mediates light action on the endocrine system, by means of variations of melatonin (MT) secretion. Here we discuss about the influence of abnormal light-dark cycles and in particular of blindness on pineal and pituitary secretions and on those of correlated glands. MT secretion is usually inhibited by light: thus it reaches the highest levels at night. Exposure to short or long photoperiod causes variations in circadian or infradian MT rhythmicity. Blind patients can show higher daytime levels with a phase-advanced or phase-delayed circadian rhythm. Lack of light stimulus affects cortisol rhythm shifting the zenith of secretion and inducing a free-running rhythm. Blindness can abolish nocturnal growth hormone (GH) peak and impair the GH response to some stimuli; moreover it impairs the growth of affected patients. Light stimulus influences favorably gonadal function both in animals and in man. In animals, sexual activity and gonadal function decline during the seasons with reduced luminosity. A similar finding has been described in women living in a region with a strong seasonal contrast in luminosity. Blindness can impair luteinizing hormone, follicle-stimulating hormone, prolactin and testosterone secretion in prepubertal boys causing pubertal delay or more severe hypogonadism; it can affect pubertal development and fertility in women. Light can influence thyroid function in animals. Lack of light stimulus in blind man seems to cause different effects on thyroid function before and after puberty. Increase of free thyroid hormone levels has been found in prepubertal but not in adult blind patients, probably due to a resetting of the threshold for thyrotropin feedback suppression after puberty in these patients.

Pobreza, desarrollo psicológico y escolaridad en niños que padecieron desnutrición temprana / Poverty, psychological developmental and school education in children that malnutrition early suffered

Este estudio, realizado entre 1994-95 en la Unidad de Rehabilitación Nutricional del Hospital de Niños de La Plata, se basa en los resultados encontrados en la última etapa de un grupo de 100 niños de nivel socioeconómico bajo provenientes del Gran La Plata, que presentaron desnutrición temprana de causa primaria de grado leve o moderado. Se analizan las condiciones de vida actuales de las familias, el coeficiente de desarrollo psicológico de los niños y su vinculación con la situación eduacional de los mismos. El grupo inicial, pudieron ser evaluados 44 niños sanos y eutrópicos, teniendo una edad promedio de 9 años 6 meses. Se aplicó el Test de Terman-Merrill (LM) para evaluar el coeficiente intelectual de los mismos. Mediante encuestas ad-hoc, se relevaron las caracteristicas sociodemográficas, ocupacionales y de vivienda de las familias a fin de compararlas con los valores locales que asumen los indicadores de necesidades básicas insatisfechas (NBI), utilizados por el Instituto Nacional de Estadísticas y Censos para medir pobreza estructural, para lo cual se aplicó el test de proporciones. Las familias presentan, en términos comparativos con los NBI locales, peores condiciones de vida, dada la insatisfacción en los parámetros considerados. El puntaje promedio del cociente intelectual de los niños es de 76,05 ubicándose en las categorías de retraso: 18,2 por ciento, riesgo: 72,7 por ciento y normal: 9,1 por ciento. En relación a los valores esperados para la población general, las categorías de retraso y riesgo se hallan incrementadas seis y cinco veces y la categoría de normalidad se encuentra representada nueve veces menos. El 60 por ciento son ... (AU)

Pobreza, desarrollo psicológico y escolaridad en niños que padecieron desnutrición temprana / Poverty, psychological developmental and school education in children that malnutrition early suffered

Este estudio, realizado entre 1994-95 en la Unidad de Rehabilitación Nutricional del Hospital de Niños de La Plata, se basa en los resultados encontrados en la última etapa de un grupo de 100 niños de nivel socioeconómico bajo provenientes del Gran La Plata, que presentaron desnutrición temprana de causa primaria de grado leve o moderado. Se analizan las condiciones de vida actuales de las familias, el coeficiente de desarrollo psicológico de los niños y su vinculación con la situación eduacional de los mismos. El grupo inicial, pudieron ser evaluados 44 niños sanos y eutrópicos, teniendo una edad promedio de 9 años 6 meses. Se aplicó el Test de Terman-Merrill (LM) para evaluar el coeficiente intelectual de los mismos. Mediante encuestas ad-hoc, se relevaron las caracteristicas sociodemográficas, ocupacionales y de vivienda de las familias a fin de compararlas con los valores locales que asumen los indicadores de necesidades básicas insatisfechas (NBI), utilizados por el Instituto Nacional de Estadísticas y Censos para medir pobreza estructural, para lo cual se aplicó el test de proporciones. Las familias presentan, en términos comparativos con los NBI locales, peores condiciones de vida, dada la insatisfacción en los parámetros considerados. El puntaje promedio del cociente intelectual de los niños es de 76,05 ubicándose en las categorías de retraso: 18,2 por ciento, riesgo: 72,7 por ciento y normal: 9,1 por ciento. En relación a los valores esperados para la población general, las categorías de retraso y riesgo se hallan incrementadas seis y cinco veces y la categoría de normalidad se encuentra representada nueve veces menos. El 60 por ciento son ...