Predictors of incomplete response to therapy among Filipino patients with papillary thyroid cancer in a tertiary hospital.

BACKGROUND: Although survival rate in papillary thyroid cancer (PTC) is high, the risk of persistence and recurrence together with the dramatic rise in its incidence cannot be overemphasized. Filipinos are considered to be at greater risk for negative outcomes. A paradigm shift in the management of PTC introduces re-stratification based on response to therapy which was reported to have better correlation with long-term outcome. The study aimed to identify predictors of incomplete response after thyroidectomy and radioiodine therapy among patients with PTC. The results of the study may have important implications in our understanding of the disease process allowing more aggressive treatment and monitoring of certain subgroups of patients. METHODOLOGY: Retrospective review of 225 patients with PTC (59% ATA low risk, 30 % ATA intermediate risk and 11% ATA high risk) who underwent thyroidectomy and radioiodine therapy was performed. Thirteen variables were considered (age, gender, histopathological variant, stage, extent of disease, MACIS score, AMES score, primary tumour size, lymph node, lymphovascular invasion, bilaterality, multifocality and preoperative TSH level). Logistic regression analysis using Backward Wald algorithm was used to identify independent predictors of incomplete response to therapy after 24 months. RESULTS: Of the 225 patients, 69 (31%) had incomplete response. Biochemical and structural (predominantly thyroid bed, lung and bone) incomplete response was observed in 6 and 63 patients, respectively. Incomplete response was documented in 8, 54 and 92% of low-, intermediate- and high-risk patients based on ATA recommendation. Incomplete response was significantly dependent on gender, lymph node involvement and location, extent of malignancy and multifocality taking into account the size of concurrent tumours (p < 0.05). The model was found to have high sensitivity (71%) and specificity (96%). CONCLUSION: A significant fraction of PTC patients experienced incomplete response to therapy. Our data suggest that male gender, lateral or mediastinal lymph node involvement, class III extent of disease by De Groot and multifocality with concurrent tumour or tumours more than 1 cm are major predictors of incomplete response. Not all predictors of recurrence and mortality are consistent predictors of treatment response which may be equally important in a disease with low mortality but significant morbidity like PTC.

Serologic survey in animals of 'Q' fever in Nuevo Leon.

The serological prevalence of Q fever in Mexico is unknown. A serological survey for Coxiella burnetii was undertaken on a randomly selected population of dairy cattle, beef cattle, goats and sheep flocks. Serological examination of animal sera for antibodies against Coxiella burnetii was carried out by the ELISA technique. The 28% of the dairy cattle and 10% of beef cattle examinated were antibody positive. Sera from goats and sheep also had antibodies against this rickettsia, 35% and 40% respectively.

Serological survey of canine borreliosis.

Lyme disease or Borreliosis, a tick-borne disease caused by Borrelia burgdorferi, has been described recently in dogs. A total of 850 blood samples were obtained from dogs in the metropolitan area of Monterrey, Mexico. An indirect immunofluorescent assay (IFA) was used to detect antibodies against Borrelia burgdorferi, the etiologic agent of Lyme disease in human beings. The 16% (136) of these dogs had positive results. These findings suggest that exposition to this microorganism is common in dogs in this area and that this disease is of importance to veterinarians.

Effects of exercise mode and intensity on postprandial thermogenesis in lean and obese men.

To characterize further the impact of exercise before a meal on thermogenesis, the effects of exercise intensity and mode and the duration of the effect of exercise on the thermic effect (TEF) of a 720-kcal mixed meal were compared in 10 lean and 10 obese men (16 +/- 1 vs. 34 +/- 2% fat). In study A, TEF (kcal/3 h) was significantly greater for the lean than the obese men during rest and immediately after 1 h of cycling at 50 and 100 W. TEF was significantly greater after both exercise intensities than during rest for the obese men, but exercise had no effect on TEF in the lean men. In study B, TEF was significantly greater for the lean than the obese men during rest and immediately after 1 h of leg cycling at an O2 consumption of 1.09 l/min but only marginally different after 1 h of arm exercise at the same O2 consumption (P = 0.15). For the obese men, TEF was greater after arm than leg cycling and greater after leg cycling than at rest (P less than 0.01), but TEF was not different among the three conditions for the lean men. In study C, TEF was compared at rest and immediately and 24 h after 1 h of cycling at 100 W. TEF was greater for the lean than the obese men under all conditions (P less than 0.05). For the obese but not the lean men, TEF was greater both immediately after and on the day after exercise than at rest (P less than 0.01). Thus, acute exercise improves but does not normalize the blunted TEF in obesity; a minimally intense bout of exercise is needed to improve TEF; exercise mode alters thermogenesis in the obese men, even at a fixed intensity; and TEF in the obese men is enhanced for as long as 24 h after exercise.

Adaptive responses of rats trained with reductions in exercise heart rate.

This study was designed to test the hypothesis that rats trained with marked reductions in exercise heart rate respond with adaptations indicative of increased intrinsic myocardial performance. Therefore, we measured changes in maximum work capacity (VO2max), biochemical-functional indexes of cardiac contractile capacity, and skeletal muscle oxidative capacity in normal-trained (NT) rats and in rats trained while receiving the selective cardiac beta 1-blocking drug atenolol (AT). Training consisted of treadmill running at approximately 80% VO2max (untrained) for 1-h duration, 6 days/wk, for a total of 8 wk. Exercise heart rate of the AT group was markedly reduced and averaged 140 beats/min below the NT group for any given session. Compared with sedentary controls, VO2max was increased by 11%, and red vastus lateralis muscle citrate synthase activity was increased by 28% in both AT and NT groups (P less than 0.05). There were no differences between trained and nontrained groups with regard to Ca2+-regulated myofibril adenosinetriphosphatase. In situ derived left ventricular pressure and the maximum rate of left ventricular pressure development were not augmented relative to sedentary control values when the trained hearts were either stimulated inotropically or maximally afterloaded . These findings suggest that maximum exercise capacity can be enhanced in rodents conditioned with and without limited elevation in exercise heart rate; however, this reduction of exercise heart rate acceleration does not provide a stimulus to enhance the intrinsic functional capacity of the rodent heart.

Transcription and translation in the autonomous parvovirus KRV.

We describe here the isolation and partial characterization of at least five viral specific RNAs synthesized in the rat nephroma (RN) cell after infection with the parvovirus KRV. The RNAs have the approximate lengths of 4.7, 3.4, 3.0, 1.25, and 0.95 kilobases (kb) and are probably the functional messages. The 4.7-kb RNA would represent a transcript of 95 to 100% of the viral genome. The most abundant message, about 3.0 kb, represents over 50% of the viral genome and probably codes in the reticulocyte transcribing system for the most abundant viral protein (MW 68,000) which is the main viral capsid protein. This abundant RNA, on the basis of R loop data, has an origin of transcription about 0.38 to 0.42 map units from the 3' end of the single-stranded KRV genome.

Biochemical properties of overloaded fast-twitch skeletal muscle.

Previous studies suggest that fast-twitch skeletal muscle overloaded by surgical removal of synergists contains a greater percent of slow-twitch fibers than normal muscle. Therefore we examined subcellular systems known to represent biochemical properties of slow-twitch skeletal muscle by measuring myosin ATPase, Ca2+ regulation of myofibril ATPase, Ca2+ uptake of sarcoplasmic reticulum (SR), and marker enzymes of glycogenolysis in normal soleus (NS) and in normal (NP) and surgically overloaded (OP) plantaris muscles of adult female rats. The OP muscles were 65% larger than NP muscles (P less than 0.001). Specific activity of myosin and myofibril ATPase was approximately 25% lower in OP compared with NP muscle (P less than 0.05). Sodium dodecyl sulfate-polyacrylamide gel electrophoresis of myosin revealed the presence of more slow and less fast myosin light-chain components in OP muscles. Although SR of NP muscle took up more Ca2+ than OP muscle during the initial for both groups. Marker regulatory enzymes of glycogenolysis collectively were reduced by 40% in OP compared with NP muscle (P less than 0.001). Collectively the data are consistent with the concept that some muscle fiber types were converted from "fast" to "slow" in the OP muscle.

Effect of functional overload on substrate oxidation capacity of skeletal muscle.

We determined the effects of surgically induced functional overload (O) on rodent fast-twitch plantaris (P) and slow-twitch soleus (S) skeletal muscle substrate oxidative capacity. Compared with normal control muscles of weight-matched rats, bilateral overload produced 68 and 23% increases in the wet weight of OP and OS muscles, respectively (p less than 0.05). Total protein concentrations of the O muscles remained unchanged relative to controls. The enzymatic capacity to oxidize pyruvate, palmitate, and alpha-glycerophosphate was unchanged in OP muscles relative to controls. Certain ketone oxidative enzyme markers were increased in the whole as well as in the inner "red" and outer "white" regions of OP muscle. Citrate synthase activity (a marker for tricarboxylic acid cycle oxidative capacity) was decreased in the whole and in the red region but unchanged in the white region of OP muscles. In contrast, the above measurements were significantly decreased in the OS muscles compared with controls (p less than 0.05). These findings suggest that there is both an expansion and a change in composition of the mitochondrial pool of enlarged P muscle. The effects on OS muscle, however, suggest the possibility that the oxidative capacity is not altered parallel with the enlargement, although fibre-typing (fast-twitch to slow-twitch) changes and altered mitochondrial composition could also contribute in part to the change.

Visualization of the liver with 99mTc-EHDP in thalassemia major.

A case is reported in which substantial liver uptake of 99mTc-hydroxyethylidene diphosphonate (99mTC-EHDP) was seen on bone scan. The patient, a 25-year-old male with the diagnosis of thalassemia major made at the age of 3 years, had received regular blood transfusions over many years. Clinical and laboratory evidence of hemosiderosis suggests that the presence of large quantities of iron in the liver of this patient may have been responsible for the hepatic uptake of the bone scanning agent.

Visualization of a malignant pericardial effusion with Tc-99m-EHDP.

Increased accumulation of radioactivity in a pericardial effusion was observed on a routine bone scan in a patient with known primary breast and lung carcinomas. A dynamic flow study and echocardiography confirmed the presence of the effusion. Microscopic examination of the pericardial fluid revealed the presence of malignant cells.

Decreased bone uptake of technetium-99m polyphosphate in thalassemia major.

Bone scans were performed with Tc-99m stannous polyphosphate on four patients with thalassemia major. Three of the scans show generalized decrease in skeletal uptake of the radiopharmaceutical, associated with renal enlargement and markedly increased renal radioactivity. The skeletal findings are consistent with the known bone abnormalities in thalassemia major, which are secondary to the extensive marrow hyperplasia and include loss of trabeculae and cortical thinning with consequent loss of bone mass. The increased renal uptake is probably due in part to the increased renal excretion (secondary to the poor bone uptake) and in part to the tubular dilatation and renal enlargement associated with thalassemia major. In addition, the presence of excessive amounts of iron in these patients may play a role in both the skeletal and renal findings.

Adenosarcoma of uterus and ovary: a clinicopathologic study of two cases.

We report the clinical and pathologic features of two cases of adenosarcoma. Our first case occurred in the ovary of a 51-year-old woman with extensive pelvic involvement. She was treated vigorously with radiation and chemotherapy and at the present time almost 9 years later the patient is free of disease. This represents a case with one of the longest survival reported in the literature. Our second case occurred in a 37-year-old woman and was limited to the endometrium.

Metastatic calcification in lungs and stomach demonstrated on bone scan in multiple myeloma.

A case of multiple myeloma with associated intense radionuclide uptake in the lungs and stomach on bone scan is presented. There was no roentgenographic evidence of calcification, and the bone scan provided the only antemortem evidence of metastatic calcification.

Granulomatous hepatitis: spectrum of scintigraphic manifestations.

Four cases of granulomatous hepatitis are presented. Hepatocellular disease in general and the clinical, histological and scintigraphic manifestations of granulomatous hepatitis are discussed.

Demonstration of superior vena caval obstruction and "hot spot" on liver scan in a case of non-Hodgkin's lymphoma.

A case of total superior vena cava obstruction and "hot spot" in the liver demonstrated by a radiocolloid liver scan in a case of non-Hodgkin's lymphoma of the anterior mediastinum, is presented. The study showed total obstruction of the superior vena cava and the presence of collateral circulation. The patient received radiation therapy, and a subsequent radiocolloid study showed relief of the obstruction and disappearance of the "hot spot."