Ectopic thyroid carcinoma. Case report

INTRODUCTION

Ectopic thyroid tissue can be found in many sites, including the tongue, thyroglossal duct, mediastinum, trachea, lung, aorta and abdomen. Ectopic thyroid tissue may also be involved in the same processes as normal, orthotopic thyroid gland. These processes include tumors, inflammation and hyperplasia. The appearance of such tissue in rare locations may lead to diagnostic and therapeutic dilemmas.

CASE REPORT

We report a rare case of ectopic thyroglossal thyroid carcinoma in a 63-year-old Caucasian male with a normal orthotopic thyroid gland.

CONCLUSION

Although 99% of thyroid cancers develop within the thyroid itself, in rare cases a carcinoma can arise in ectopic thyroid tissue located in the neck or in other areas of the body. Though rare, the possibility of an ectopic thyroid carcinoma must always be considered by the surgeon in cases of a pathological mass in the neck.

Appendiceal diverticulitis in a femoral hernia causing necrotizing fasciitis of the right inguinal region: report of a unique case

De Garengeot's hernia--a rare finding occurring mostly in women--is defined by the presence of the vermiform appendix within the sac of a femoral hernia. The incidence of appendicitis is rarer still, with less than a 100 cases reported to date. We present a unique case of an 84-year-old male patient with perforated appendiceal diverticulitis within a De Garengeot's hernia causing abscess and necrotizing infection of the overlying soft tissues.

Analytical evaluation of the PapilloCheck test, a new commercial DNA chip for detection and genotyping of human papillomavirus

Recently, a commercially available HPV DNA chip, the PapilloCheck test, developed by Greiner Bio-One, has become available for human papillomavirus (HPV) genotyping. The PapilloCheck test is a PCR-based test using a new consensus primer set targeting the E1 HPV gene. HPV oligoprobes immobilized on a DNA chip allow for the identification of 24 HPV types from the amplified product. In the present study, the analytical performance of the PapilloCheck test is compared to the Linear Array HPV genotyping test (Roche Diagnostics). Cervical specimens collected in PreservCyt (Cytyc) solution and obtained from women who presented abnormal cytological findings were tested primarily by the Hybrid Capture 2 High-Risk assay (HC2-HR, QIAGEN). A total of 144 samples were selected according to the signal intensity obtained with the HC2-HR test, expressed as RLU/CO value, and divided into 4 groups as follows: [0-1] RLU/CO (negative HC2-HR result, 34 samples); [1-5] RLU/CO (positive HC2-HR result, 30 samples); [5-40] RLU/CO (positive HC2-HR result, 40 samples); >40 RLU/CO (positive HC2-HR result, 40 samples). The concordance levels between the HC2-HR test and each of the genotyping assays was similar (88.8%) and the crude agreement between these assays was considered as "good". The detailed analysis of the discrepant results confirmed a possibly high rate of false positive results of HC2-HR test in the 1-5 RLU/CO grey zone. Genotype-specific comparison analysis was limited to the 23 HPV types detected by both genotyping assays (HPV types 6, 11, 16, 18, 31, 33, 35, 39, 40, 42, 45, 51, 52, 53, 55, 56, 58, 59, 66, 68, 70, 73 and 82). Of the 135 samples available for comparison, 91 (67.4%) showed absolute agreement between the assays (concordant genotype-specific results), 34 (25.1%) showed correspondence for some but not all genotypes detected by both assays (compatible genotype-specific results), and the remaining 10 (7.4%) samples did not show any similarity between the tests (discordant results). The majority of discordances were found in samples containing multiple HPV types and in samples harboring low amounts of HPV. For some HPV genotypes, there were slight differences in the detection rate between the two genotyping methods. The Linear Array test seemed to be more sensitive to detect HPV type 53 whereas PapilloCheck test seemed to be more sensitive to detect HPV type 56. For the other genotypes, including HPV types 16 and 18, the results obtained by the two methods did not differ significantly. In conclusion, this study shows that the PapilloCheck test and the Linear Array test give comparable results for detecting HPV in cervical specimens. However, these results also suggest that there is a need to standardize the type-specific sensitivity of genotyping methods and to evaluate their accuracy to detect multiple HPV infections. This would be a prerequisite for the use of genotyping assays in cervical cancer screening algorithms.

Evaluation of the COBAS AmpliPrep-total nucleic acid isolation-COBAS TaqMan hepatitis B virus (HBV) quantitative test and comparison to the VERSANT HBV DNA 3.0 assay

Quantitative detection of hepatitis B virus (HBV) in serum or plasma has become the most direct and reliable method for monitoring chronic hepatitis B. Here, we report the performance characteristics of a real-time PCR hepatitis B DNA quantitative assay, the COBAS TaqMan (CTM) HBV test (Roche Diagnostics, Meylan, France), in combination with an automated DNA extraction on the COBAS AmpliPrep (CAP) instrument using the total nucleic acid isolation kit (TNAI kit), a generic reagent for nucleic acid isolation (both from Roche Diagnostics). The linearity, accuracy, and specificity of the CAP-TNAI-CTM HBV test were evaluated using various reference panels and standards (HBV panel 2004 from Quality Control for Molecular Diagnostics, OptiQuant HBV panel from AcroMetrix, WHO International Standard for HBV, and Teragenix hepatitis B genotype panel). Quantitative results show that the CAP-TNAI-CTM HBV test performed well with respect to linearity, accuracy, and reproducibility from at least 100 to 500,000 HBV DNA IU/ml. Based on the log(10) IU of HBV DNA/ml measured, the intra-assay variation ranged from 2.49% to 8.46% and the interassay variation ranged from 1.88% to 7.83%. The test was extremely sensitive and could detect samples containing HBV DNA below the reported quantification threshold (<30 IU/ml). All HBV genotypes were correctly amplified, and no cross-contamination occurred during the automated sample preparation. In addition, 402 human serum samples were tested comparatively to the VERSANT HBV DNA 3.0 assay (bDNA; Bayer Diagnostics, Puteaux, France). The viral load results of the CAP-TNAI-CTM test and bDNA were significantly correlated, but the agreement between the two tests was poor, with large differences between results for individual samples. The hands-on time was estimated to be reduced from 2.30 h with bDNA to 45 min with the CAP-TNAI-CTM test, and up to 84 samples were completely processed within a working day. Overall, the performance characteristics of the CAP-TNAI-CTM test demonstrated that it provides a high-throughput sensitive and reliable method for quantitation of HBV DNA levels in the routine molecular laboratory.

Assessment of local stage in rectal cancer using endorectal ultrasonography (EUS)

BACKGROUND

Preoperative staging of rectal cancer is essential for the selection of the optimal treatment. This study aims to evaluate the accuracy of endorectal ultrasonography (EUS) in local staging of rectal cancer.

PATIENTS AND METHODS

During a 4-year period, 33 patients with biopsy-proven rectal cancer underwent evaluation of the invasion of the rectal wall, the mesorectal lymph nodes status and the pelvic organs using EUS. We compared the EUS findings (uTN) to the histopathology examination of the resected specimens (pTN) according to TNM classification.

RESULTS

Most patients had T3 tumours. Overall accuracy in assessing the depth of rectal wall invasion (T) and the lymph node status was 79% and 59% respectively. Two patients previously treated by preoperative chemoradiation were correctly staged only for N stage.

CONCLUSIONS

EUS is a valuable diagnostic tool in local staging of rectal cancer. Progressively increasing experience will overcome the obstacles in accurate interpretation of ultrasound images.

[Evaluation of the effect of professional dental cleaning and education in dental hygiene in type 1 diabetic patients]

In the setting of a prospective, randomized trial the impact of professional oral hygiene and of intensive patient education in oral hygiene was investigated. It was studied, whether in young to middle-aged type 1 diabetic patients the risk or the progression of periodontal disease can be influenced during one year. Primary endpoint was bleeding at probing, secondary indices, the plaque index and probing pocket depth. 83 patients were enrolled, 70 completed the study according to the protocol. Oral cleansing was dramatically improved by education in the short term, however, the effect was much weaker after 6 and 12 months, respectively, although there remained some improvement compared to the basic level. Bleeding at probing increased in both groups, without reaching the level of statistical significance. Probing pocket depth increased in the intervention group weakly but significantly and remained unchanged in the control group. The tested intervention (professional oral hygiene, patient education in oral hygiene) could not improve the periodontal status in our type 1 patients.

[Retrospective analysis of the incidence of severe hypoglycemia in 458 type 1 diabetic patients]

During 1 year a retrospective study concerning frequency and risk markers of severe hypoglycemia was conducted in type-1 diabetic patients undergoing their annual routine check-up. The aim was to contribute to the epidemiology of severe hypoglycemia and to investigate, whether severe hypoglycemia is associated with specific features of therapy (strategy of insulin treatment, level of metabolic control expressed as mean blood glucose and glycosilated hemoglobin, insulin species, use of betablocking agents) or with patient characteristics (age, duration of diabetes, awareness of hypoglycemic symptoms, late complications of diabetes). From the cohort of 710 eligible patients 458 agreed to participate in the study, 61% had experienced severe hypoglycemia at least once, 17% during the last year. The incidence calculated for the whole diabetes duration is 21/100 patient years, and for the last year 56/100 patient years. The following were risk markers for severe hypoglycemia: older age, longer duration of diabetes, reduced awareness of hypoglycemic symptoms, decreasing frequency of symptomatic hypoglycemic episodes, and lower HbA1c. No association was found with the following variables: Serum creatinine, autonomic neuropathy, use of betablocking agents, and presence of anti-insulin antibodies. Intensive insulin therapy with individualized treatment goals in terms of blood glucose control was successful in avoiding severe hypoglycemia in patients who had already experienced them before.

[Follow-up of albumin excretion during pregnancy and post partum in type 1 diabetic patients in comparison with health pregnant probands]

32 diabetic and 31 metabolic healthy pregnant women are studied to answer the following questions: Is there a difference in the albumin-excretion rate (AER) during the pregnancy in primary normoalbuminuric type 1 diabetics and non-diabetics? Is there a difference 6 months post partum between the 2 groups? The average age of the diabetics (D) is 28, of the non-diabetics (ND) 27 years; the diabetics suffer from diabetes mellitus 12.5 years. In the 16th week of pregnancy, we find a AER (D vs. ND) of 5.0 vs. 2.37 micrograms/min (not significant [n.s.]), creatinin in serum 0.77 vs. 0.75 mg/dl (p < 0.05), creatinin clearance 92.5 vs. 103.4 ml/min (n.s.). In the 28th and in the 34th to 38th week, there is no significant elevation of the AER compared to the 16th week; but there is a significant elevation in the diabetics vs. the non-diabetics. 6 months post partum, the AER (D vs. ND) are: 6.13 vs. 5.11 micrograms/min (n.s. vs. 16th week and D vs. ND); in each group one person is found with a positive microalbuminuria (MA): 48.2 micrograms/min (D) and 27.4 mg/min (ND). Another diabetic woman shows post partum an isolated higher value of creatinin in serum: 1.5 mg/dl (without MA). This parameter is post partum significant higher (0.97 [D], 0.96 [ND] mg/dl) than in the 16th week of pregnancy (0.77 [D], 0.75 [ND] mg/dl). The creatinin clearance decreases post partum (pp): 92.2 ml/min (pp) vs. 102.0 ml/min (28th week) in the diabetics (n.s.) and 80.6 ml/min (pp) vs. 111.0 ml/min (28th week) in the non-diabetics (p < 0.05). Concerning the studied renal parameters, there is a significant difference of the albumin-excretion rates during the pregnancy between preconceptional normoalbuminuric type 1 diabetic and non-diabetic women, but 6 months post partum, there is no significant difference. The diabetics show a significant increase of the creatinin in urine and in serum and no significant change of the creatinin clearance 6 months post partum.

Detection and genotyping of herpes simplex virus types 1 and 2 by polymerase chain reaction

A simple and rapid polymerase chain reaction (PCR) procedure was developed for simultaneous detection and typing of herpes simplex virus (HSV) types 1 and 2. It was possible to detect and type HSV using two primers pairs in a simultaneous double PCR reaction, where the type of HSV present was determined on the basis of an ethidium-bromide-stained band after agarose gel electrophoresis. This PCR assay was tested on about 500 clinical specimens.

[ExacTech--a new measuring system for personal control of blood glucose]

ExacTech is a pen-sized glucose meter that uses an amperometric principle for blood glucose determination. Accuracy was assessed in 94 capillary blood samples by comparing the ExacTech values to the hexokinase method. Correlation between the methods was 0.983. 76% of ExacTech measurements were within +/- 10% of the reference method. Coefficients of variation for within run precision determined in two different blood glucose levels were 3.2% (81 mg/dl) and 4.2% (222 mg/dl) resp. 12 diabetic patients compared ExacTech to their reflectance meters. The ExacTech readings when correlated with the hexokinase method gave slightly better results than those obtained with common glucose meters. Patients acceptability of this novel measuring system was excellent.