Thyroid carcinoma arising from a sacrococcygeal mass: a malignant teratoma?

A 59-year-old African American male with a remote history of Graves' disease presented with a 13-cm sacrococcygeal mass that was resected. Pathologic examination revealed this to be papillary thyroid carcinoma with large areas of hemorrhage and necrosis. No other teratomatous elements were identified. The patient underwent extensive evaluation of the thyroid gland with ultrasound, computed tomography (CT) scan, and laboratory studies without any evidence of thyroid mass or malignancy. In addition, further evaluations with chest/abdominal/pelvic CT as well as a bone scan failed to reveal any evidence of metastatic disease. At 1-year follow-up, the patient has remained euthyroid and without evidence of recurrence. We believe that our patient may represent the first reported case of malignant transformation of mature thyroid tissue in a sacrococcygeal teratoma. The impact of his diagnosis on the decision-making for performing a total thyroidectomy is discussed.

Novel strategies for the pharmacological management of type 2 diabetes

Type 2 diabetes is characterized by high concentrations of glucose in the blood, which is caused by decreased secretion of insulin from the pancreas and decreased insulin action. This condition is prevalent worldwide and is associated with morbidity and mortality secondary to complications such as myocardial infarction, stroke and end-stage renal disease. The importance of tight control of blood glucose in either preventing or delaying the progression of complications is recognized. Currently, there are many therapeutic options to treat hyperglycemia in type 2 diabetes. However, tight control is difficult to achieve and is often associated with side-effects. Recent advances in understanding insulin secretion, action and signaling have led to the development of new pharmacological agents. In this article, we review new molecules that are promising candidates for the future management of diabetes, focusing on their mechanism of action, efficacy, safety profile and potential benefits compared with pharmacological agents that are available currently.

Glucagon-like peptide-1 inhibits apoptosis of insulin-secreting cells via a cyclic 5'-adenosine monophosphate-dependent protein kinase A- and a phosphatidylinositol 3-kinase-dependent pathway

The activation of the glucagon-like peptide-1 (GLP-1) receptor has been shown to have an important role in the functional activity of islet beta-cells and in the expansion of the islet cell mass. Constant remodeling of islet cell mass is mediated in vivo by proliferative and apoptotic stimuli to ensure a dynamic response to a changing demand for insulin. The present study was undertaken to investigate the biological activity of GLP-1 when cells were challenged by a proapoptotic stimulus. We have shown that activation of the GLP-1 receptor inhibits H(2)O(2)-induced apoptosis in a cultured mouse insulinoma cell line, termed MIN6. GLP-1 reduced DNA fragmentation and improved cell survival. This was mediated by an increased expression of the antiapoptotic proteins Bcl-2 and Bcl-xL. GLP-1 also prevented the H(2)O(2)-dependent cleavage of poly-(ADP-ribose)-polymerase. Inhibition of the GLP-1-dependent increase of cAMP by Rp-cAMP blocked the antiapoptotic action of GLP-1, as determined by DNA fragmentation and poly-(ADP-ribose)-polymerase assays and by detection of Bcl-2 and Bcl-xL protein levels. Investigation of the role of the protein kinases, PI-3 kinase (PI3K) and MAPK, by use of the inhibitors PD098059 and LY294002 demonstrated that the activation of PI3K, but not MAPK, was required to prevent proapoptotic events in cells exposed to H(2)O(2). The present study provides evidence that GLP-1 has an antiapoptotic action mediated by a cAMP- and PI3K-dependent signaling pathway.

Distractive properties of a threaded interbody fusion device. An in vivo model

STUDY DESIGN

Twenty sheep underwent anterior lumbar interbody fusions with either a threaded titanium interbody fusion device (cage, n = 8), autogenous iliac crest dowel graft (autograft, n = 6), or interbody decortication only (sham, n = 6). Two sheep had misplaced cages and were excluded. Sheep were killed after 6 months.

OBJECTIVES

To determine whether this model is useful for examining the distractive and fixation properties of interbody fusion cages.

SUMMARY OF BACKGROUND DATA

Interbody fusion cages are used in anterior lumbar interbody fusion procedures to provide immediate intersegmental fixation and to distract and preserve interbody height. The process of physiologic anchorage by bone ingrowth into such devices is under investigation.

METHODS

Sheep were radiographed immediately after surgery and 2, 4, and 6 months after surgery. Interbody distraction and angulation were measured with a digital photo image analyzer at each time point. After the sheep were killed, stiffness to flexion, extension, and lateral bending moments were measured. Twelve untreated cadaver spines were also tested for comparison.

RESULTS

After surgery, interbody distraction successfully occurred in cage and autograft-implanted sites. Loss of interbody height ensued, however, in all groups during the first 2 months. Percentage loss of height was lowest in cage sites. By 6 months, only cage sites remained distracted beyond normal. Fusions in all groups were stiffer than untreated spines. Autograft sites were stiffer than cage sites to lateral bending. Sham sites were stiffer than cage and autograft sites to flexion, but this likely resulted from complete intervertebral collapse.

CONCLUSION

Despite early subsidence, interbody fusion cages successfully distracted and preserved interbody spaces. This model is useful for investigating methods of improving distraction and stabilization.