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lt;bgt;Introduction:lt;/bgt; Surgical site infections (SSI) involve 2-11% of all surgical procedures.lt;brgt;lt;bgt;Paper assumption:lt;/bgt; The use of 6% gel with chlorhexidine as an element of preoperative skin preparation of the operated area reduces the number of surgical site infections.lt;brgt;lt;bgt;Aim:lt;/bgt; The aim of the study was to assess the impact of body mass index (BMI), neutrophil to lymphocyte ratio (NLR), total protein, glucose, length of hospitalization before surgery, duration of surgery, length of drainage maintenance, transfusion of red blood concentrate on the number of SSI.lt;brgt;lt;bgt;Materials and methods:lt;/bgt; 248 patients were subjected to prospective analysis. Patients were operated at the Department of General and Oncological Surgery of the Provincial Specialist Hospital in Zgierz. Patients were divided into three groups depending on the microbiological degree of cleanliness of the postoperative wound: Group I - clean wounds, Group II - cleancontaminated wounds, Group III - contaminated wounds, which also included emergency surgerical procedures. In each group two subgroups were distinguished depending on the method of preoperative preparation of the surgical field: A - gel without CHG, B - 6% gel with CHG.lt;brgt;lt;bgt;Results:lt;/bgt; Surgical site infections were found in 22 patients (8.9%). The respective frequencies for groups I, II, III are: 3.0% vs 12.9% vs 12.7%. An increase in NLR by one unit resulted in a higher incidence of surgical site infections by 11%. A transfusion of RBC to the patient resulted in a 3.5-fold increase in the frequency of surgical site infections. Extending the drain maintenance time by one day increases the SSI frequency by 41%. Lowering the total protein concentration by at least 1 g/dl below normal increases the risk of surgical site infections almost three times.lt;brgt;lt;bgt;Conclusions:lt;/bgt; The use of a 6% gel preparation with chlorhexidine as an element of preoperative preparation of the surgical field reduces the risk of surgical site infections, especially in clean-contaminated and contaminated wounds.

Introduction Adrenal insufficiency is a typical complication after surgical treatment of adrenal tumors, especially after the removal of both adrenal glands. Human beings are not able to survive without adrenal glands and without proper hormonal substitution. Autotransplantation of a fragment of the adrenal gland may prevent this complication. This can be done by transplanting the entire adrenal glands or its fragment, such as the adrenal cortex cells. In the case of adrenal tumors, the entire adrenal gland can not be transplanted. However, it is possible to transplant cells from the tumor-free part. Succesful adrenal autografts may result in a new treatment of adrenal insufficiency. Materials and Methods: Autograft transplantation was performed on 3 groups of Sprague Dawley rats. In the first group, physiological corticosterone concentrations were determined. These animals were not operated. In the second group, both adrenal glands were removed. Corticosterone concentrations were determined after bilateral adrenalectomy. The third group was divided into two parts. In the first subgroup, bilateral adrenalectomy was performed simultaneosly with adrenal transplant into the omentum. In the second subgroup, right adrenalectomy was performed simultaneosly with and adrenal transplant into the omentum followed a month later by left adrenalectomy. During the experiment, corticosterone concentrations were measured at 4 time points. Results. The statistical difference between corticosterone concentrations in rats after two timed adrenalectomies and rats after bilateral adrenalectomy was statistically different, but these results were far from physiological concentrations.

Sentence recommending the content of work: Due to the health and economic consequences of postoperative hypocalcemia, it is necessary to disseminate knowledge about non-invasive methods of limiting it that can be used in everyday clinical practice such as routine perioperative calcium and vitamin D supplementation. Abstract Introduction: Postoperative hypocalcemia is a narrow but significant problem for patients undergoing thyroid and parathyroid surgery. It is the most common complication after thyroidectomy. It is associated with transient or permanent hypoparathyroidism. It could potentially be life-threatening for patients and increases the costs of hospitalization. The aim of the study was to evaluate the results of studies that routinely administrated calcium and/ or vitamin D during the postoperative period. Materials and Methods: In this article, a literature review – 15 studies that used routine perioperative calcium (7 studies), vitamin D (2 studies) and calcium with vitamin D (11 studies) supplementation was performed. Supplementation effectiveness in prevention of postoperative hypocalcemia was compared to no prophylaxis in 10 studies. Five studies compared the effect of combined administration (calcium and vitamin D) to calcium alone. The number of works dealing with this problem is not particularly large. Results: Supplementation significantly decreased the rate of laboratory and symptomatic hypocalcemia. It was also effective in reducing the severity of symptoms. The combination calcium with vitamin D was the most effective strategy. No hypercalcemia or parathyroid hormone inhibition was observed in the supplemented groups. Routine supplementation was less expensive than performing laboratory tests in the course of treatment of hypocalcemia. Conclusions: The results of analyzed studies showed the clinical and economic advantage of routine perioperative prophylactic supplementation of vitamin D and/ or calcium as compared to no prophylaxis. However, the majority of studies showed a significant range of variability in patients’ characteristics. Numerous studies did not evaluated the preoperative 25-hydroxycholecalciferol level - a risk factor for postoperative hypocalcemia. Discussion: The use of routine prophylactic supplementation of calcium and vitamin D in the perioperative period can be useful in everyday clinical practice. Further research is needed to draw clear guidelines regarding prophylactic calcium and vitamin D therapy for patients after thyroidectomy.

Significant advances have been made in thyroid can-cer research in recent years, therefore relevant clinical guidelines need to be updated. The current Polish guidelines "Diagnostics and Treatment of Thyroid Carcinoma" have been formulated at the "Thyroid Cancer and Other Malignancies of Endocrine Glands" conference held in Wisła in November 2015 [1].

Background Cells adapt to hypoxia by transcriptional induction of genes that participate in regulation of angiogenesis, glucose metabolism and cell proliferation. The primary factors mediating cell response to low oxygen tension are hypoxia inducible factors (HIFs), oxygen-dependent transcription activators. The stability and activity of the α subunits of HIFs are controlled by hydroxylation reactions that require ascorbate as a cofactor. Therefore, deficiency of intracellular vitamin C could contribute to HIFs overactivation. In this study, we investigated whether vitamin C content of human thyroid lesions is associated with HIF-1α and HIF-2α protein levels. Methods Expression of HIF-1α and HIF-2α as well as vitamin C content was analyzed in thyroid lesions and cultured thyroid carcinoma cell lines (FTC-133 and 8305c) treated with hypoxia-mimetic agent (cobalt chloride) and ascorbic acid. The expression of HIFs and hypoxia–induced glucose transporters were determined by Western blots while quantitative real-time PCR (qRT-PCR) was performed to detect HIFs mRNA levels. Ascorbate and dehydroascorbate levels were measured by HPLC method. Results We found an inverse correlation between vitamin C level and HIF-1α but not HIF-2α expression in thyroid lesions. These results agree with our in vitro study showing that vitamin C induced a dose - dependent decrease of HIF-1α but not HIF-2α protein level in thyroid cancer cells FTC-133 and 8305C. The decreased HIF-1α expression was correlated with reduced expression of hypoxia-related glucose transporter 1 (GLUT1) in thyroid cancer cells. Conclusion The results demonstrate that HIF-1α activation is associated with vitamin C content in thyroid lesions. Our study suggests that high tumor tissue ascorbate level could limit the expression of HIF-1α and its targets in thyroid lesions.

This study aims to present results regarding the presence and identification of bacterial strains found in bile and gallstones located in the gallbladder and bile ducts in patients operated on due to cholelithiasis. Materials and Methods. Bacterial culture was evaluated in 92 patients. There were 54 women (59%) and 38 men (41%) who underwent surgery on account of cholelithiasis and /or gallstones in bile ducts between 2013 and 2014. Bile and gallstone samples were cultured intraoperatively for bacteria; bacterial strains were identified, and their sensitivity to antibiotics was determined. Molecular methods (NGS and Sanger method) were used to separate bacterial strains in one of the gallbladder stones and the results were compared with bacterial strains grown from the bile. Results. Bile cultures were positive in 46 patients that is, 50% of the study group. The following bacteria strains were grown: Enterococcus spp. (44%), Escherichia coli (37%) and Klebsiella spp. (35%). Candidiasis accompanied by bacterial infection was detected in 7 patients (15%). Molecular testing of gallstones revealed DNA of Enterococcus spp., Escherichia spp., Streptococcus spp. and Clostridium spp. In the bile culture of the same patient Enterococcus spp. (avium and faecalis) was detected. Conclusion 1. More than one pathogen was grown on samples obtained from 31 patients (70%) with bile infection. 2. The most common pathogens include Enterococcus spp., Escherichia coli and Klebsiella spp. 3. Bacterial infections are often accompanied by a fungal infection (Candida albicans) 4. Bacterial strains grown from a gallstone sample partially corresponded with strains identified in the bile of the same patient.

The aim was to assess the usefulness of strain elastography (SEG) in the diagnostics of two groups of thyroid nodules (TNs): follicular lesions (FL) with low malignancy risk (20.0%) and low percentage of papillary carcinomas (PTCs) among cancers as well as TNs with unequivocal cytology (UC) and high percentage of PTCs among cancers.168 TNs were analysed and eventually surgically treated: 100 UC (50 benign and 50 malignant - 90.0% PTCs) and 68 FL (60 benign, 8 malignant - 50.0% PTCs). Elasticity score (ES) and strain ratio (SR) were evaluated, and their effectiveness was compared with the evaluation of the number of ultrasound malignancy risk features (NoUMRFs).In the UC group the evaluation of mean values of SR and ES in both sections (meanSR, meanES) was more efficient than NoUMRFs analysis (AUC: 0.903 and 0.869 vs. 0.754, p0.05). The following thresholds: meanSR ≥ 2.01, meanES ≥ 2.5, NoUMRFs ≥ 2, were related to the increased malignancy risk in nodules (OR: 45.0; 23.2; 5.4, respectively), but only meanSR ≥ 2.01 was an independent risk factor (OR: 20.3; SEN: 86.0%, SPC: 88.0%). In the FL group, only the evaluation of tSR (SR assessed in transverse section) had the value of AUC0.7, and only the set of features: tSR ≥ 1.7 and NoUMRFs ≥ 1 increased the malignancy risk in nodules (OR: 12.0; SEN: 75.0%, SPC: 75.0%).SEG is more reliable than conventional US in the diagnostics of TNs. The efficacy of SEG decreases with lowering percentage of PTCs among cancers. But in FL nodules SEG may support the selection of nodules for surgical treatment.

Objectives: The aim of this study was to assess the exposure of patients to organic substances produced and identified in surgical smoke formed in the abdominal cavity during laparoscopic cholecystectomy. Material and Methods: Identification of these substances in surgical smoke was performed by the use of gas chromatography-mass spectrometry (GC-MS) with selective ion monitoring (SIM). The selected biomarkers of exposure to surgical smoke included benzene, toluene, ethylbenzene and xylene. Their concentrations in the urine samples collected from each patient before and after the surgery were determined by SPME-GC/MS. Results: Qualitative analysis of the smoke produced during laparoscopic procedures revealed the presence of a wide variety of potentially toxic chemicals such as benzene, toluene, xylene, dioxins and other substances. The average concentrations of benzene and toluene in the urine of the patients who underwent laparoscopic cholecystectomy, in contrast to the other determined compounds, were significantly higher after the surgery than before it, which indicates that they were absorbed. Conclusions: The source of the compounds produced in the abdominal cavity during the surgery is tissue pyrolysis in the presence of carbon dioxide atmosphere. All patients undergoing laparoscopic procedures are at risk of absorbing and excreting smoke by-products. Exposure of the patient to emerging chemical compounds is usually a one-time and short-term incident, yet concentrations of benzene and toluene found in the urine were significantly higher after the surgery than before it.

Thyroid surgery is the most commonly performed procedure in the field of endocrine surgery. Studies are still ongoing on the development of a single algorithm for diagnosis and care of patients at risk of postoperative hypoparathyroidism. The aim of the study was to determine the biochemical marker that would allow the most accurate diagnosis of patient groups at risk of developing hypoparathyroidism and to identify risk factors for this disorder.The prospective study included 142 consecutive patients undergoing total thyroidectomy for benign goiter from January 1st 2014 to December 31st 2015. Serum intact parathyroid hormone (iPTH), total calcium (Ca), phosphate (P), and magnesium (Mg) levels have been measured preoperatively and at 1, 6, 24, and 48 h postoperatively.Clinical symptoms of hypoparathyroidism developed in 25 (17.6%) of 142 patients. The best diagnostic accuracy for hypoparathyroidism based on ROC curves was obtained for iPTH at 6h (AUC 0.942; 95% CI: 0.866-1.000, p0.001) and its percentage change from baseline ΔiPTH at 6h (AUC 0.930; 95% CI: 0.858-1.000, p0.001). In an multivariate analysis, the preoperative Ca level higher by 0.1 mmol/l, and iPTH level higher by 0.1 pmol/l were associated with a lower risk of hypoparathyroidism, by 68% (p=0.012) and 61% (p=0.007), respectively. A 1% decline in iPTH from baseline increased the risk of hypoparathyroidism by 15% (p0.001).The most reliable markers indicating a high risk of postoperative hypoparathyroidism are the decline in ΔiPTH at 6h by65% or iPTH level at 6h1.57 pmol /l. A postoperative decline in iPTH levels is an independent risk factor for the development of hypoparathyroidism. Preoperative higher concentrations of Ca and iPTH are protective factors for the development of this disorder.

The diagnostic category of follicular lesion of undetermined significance (FLUS) was intended to allow selection of cases with low risk of malignancy from all smears with indeterminate, suspicious cytology (ISC), which can potentially take advantage from repeat fine-needle aspiration (rFNA). Aim of the study was a comparison of the risk of malignancy related to FLUS nodules and other nodules with ISC: suspected follicular neoplasm (SFN) and suspected malignancy (SM), as well as analysis of the usefulness of assessing ultrasonographic malignancy risk features (UMRF) in nodules with ISC.We analysed UMRF, rFNA, and results of histopathological examination (H) in 441 FLUS, 135 SFN, and 72 SM nodules.The frequency of exposing cancer in H in FLUS nodules was 5.9%, and when cytological follow up was also included it was 2.9%. rFNAs made the diagnosis more precise in 72.7% of FLUS, and in 5.2% it was diagnosis/suspicion of cancer. The incidence of cancer in SFN nodules was 8.2%, in SM nodules with suspicion of papillary cancer - 61.1%, and in nodules with suspicion of other or unspecified malignancy - 53.8% (p0.0001 FLUS vs. both groups). The presence of calcifications is the only independent UMRF for nodules with ISC (OR 4.7). Features of importance are also microcalcifications (OR 3.8), especially in the SM group, and taller-than-wide-shape (OR 2.2). FLUS and SFN nodules are characterised by particularly low value of assessing suspicious margins; analysis of hypoechogenicity is of low value in SFN nodules, like suspected vascularisation in SFN and SM nodules.The risk of cancer in FLUS and SFN nodules is lower than in SM nodules. rFNAs of FLUS nodules make the diagnosis more precise in more than 70% of cases and are effective in revealing cancers. UMRFs present variable diagnostic value depending on the subcategory of ISC.

was to assess the usefulness of prognostic scales: ASA (American Society of Anesthesiologist), MPI (Meinheim Peritonitis Index), MOFS (the Multiple Organ Failure Score) and SPI (the Simple Prognostic Index) in the prognosis of the course of disease in patients operated on for peritonitis.The study was conducted in the Clinical Department of General and Oncological Surgery of the Medical University in Łódź between January 2009 to December 2010. During this period 263 patients were operated on for peritonitis. Before surgery all patients were classifed into particular groups according to the above mentioned prognostic scales according to their criteria.There were 29 (11%) deaths. ASA ≥4 (p30 (p1. ASA, MPI, MOFS and SPI scales are of high signifcance in predicting the outcome in patients operated on for peritonitis. 2. The ASA scale in spite and due to its simplicity is adequate enough to be used in everyday practice in patients operated on for peritonitis. 3. The MPI scale is most suitable in the scientifc aims and in comparing the outcomes of patients operated on for peritonitis.

The significance of lymph node metastases and the optimal extent of lymphadenectomy remain matters of controversy in papillary thyroid cancer. This study was designed to assess the feasibility and reliability of OSNA and real-time PCR for CK19 and TG mRNA in papillary thyroid cancer lymph nodes evaluation compared to standard histopathology.Each of 92 randomised lymph nodes from 32 papillary thyroid cancer patients were divided into representative parts and assessed using the three studied methods.Eighteen (19.6%) lymph nodes from ten (31.3%) patients were positive according to histopathology. When the cut-off value distinguishing metastatic from non-metastatic lymph nodes in the OSNA assay was set at 250 copies per microlitre, the results were positive in 16 (17.4%) lymph nodes from 11 (34.4%) patients. Twenty three (25%) lymph nodes were tested positive in real-time PCR for TG mRNA. Real-time PCR for CK19 mRNA was positive in 18 (19.6%) lymph nodes from 13 (40.6%) patients. No statistically significant differences were noted between the diagnostic accuracy of either molecular method compared to the histopathological examination (p = 0.81). Overall, 20 positive molecular biology results were noted in patients with negative histopathology results. Conversely, in 18 lymph nodes, despite a metastasis finding in histopathology, at least one molecular test yielded a negative result.It was revealed that OSNA is a reliable technique for the evaluation of lymph node metastases in papillary thyroid cancer. This method was shown to have equivalent accuracy to histopathology and real-time PCR.

The aim of the study was to evaluate the clinical spectrum of emergency surgery for acute abdominal disorders and their outcome.The study group comprised 1426 patients, aged between 10 and 92 years subject to emergency surgery, due to an acute abdomen during the period 2001-2004. Analysis comprised age, sex, concomitant diseases, ASA scale classification, postoperative diagnosis, type of surgery, complications, mortality and duration of hospitalization. Patients were divided into two age groups:60 and ≥60 years.Appendicitis was the most common diagnosis (52.9%) in patients under 60 years, while cholecystitis (32.5%) and ileus (30.9%) in patients over 60 years. Complications were observed in 14.8% patients, the most common being related with wound healing (5.6%). The mortality rate amounted to 5.7%. Mortality was most often associated with bowel obstruction (29.2%), surgery for acute bowel ischemia (25.5%), and bowel perforation (20.7%). The mean duration of hospitalization was 7.9 days.1. In comparison to elective surgery, emergency abdominal operations, particularly in elderly patients are related with a higher mortality rate. 2. In elderly patients, the high mortality rate and substantial number of complications is associated with the advanced primary disease and severe coexisting comorbidities, which significantly reduce the overall health condition.

To evaluate procalcitonin (PCT) utility as a marker of medullary thyroid cancer (MTC).Calcitonin (CT) and PCT levels were measured in MTC patients and patients with serious bacterial infections. 70 patients were enrolled in the study: 6 MTC active patients: 4 with disseminated, unreoperable disease and 2 re-operated patients, in whom markers were checked before and after surgery; 23 MTC patients in remission after radical surgery; 11 non-toxic nodular goiter (NTNG) patients; 30 patients with severe, bacterial infection or sepsis.All MTC active patients had greatly elevated CT and PCT levels. In two re-operated patients, marker levels decreased but were still above the reference range. In 15 MTC patients in remission, the levels of either marker were not increased. Both markers were slightly increased in 3 patients in this group, while CT was elevated in 5 patients. In all but 1 patient in the NTNG group, both marker levels were not elevated. Among patients with bacterial infection, PCT and CT levels showed no increase in 8 patients, both markers were elevated in 10 patients, and an increase of PCT levels was seen in 10 patients while of CT only in 2 patients. Correlations between CT and PCT values were very strong in MTC patients (r = 0.95; p = 0.004 for active MTC, r = 0.60; p = 0.002 for MTC patients in remission) and in patients with NTNG (r = 0.77; p = 0.02). In patients with infection, both parameters were completely independent (r = 0.002; p = 0.99).PCT measurement could be an alternative to CT measurement for evaluation of MTC status.

Calcitonin, the best known marker for medullary thyroid cancer (MTC), has several laboratory limitations which limit its use in the routines of non-specialized laboratories. Procalcitonin, the precursor of calcitonin, is free from these drawbacks. The aim of this study was to compare calcitonin and procalcitonin levels in MTC patients with active disease or in remission, and in patients with non-toxic nodular goiter (NTNG).Forty-three serum samples, obtained from 40 patients (6 MTC active disease patients, 23 MTC patients in remission, and 11 NTNG patients), were tested for calcitonin and procalcitonin levels. The levels of both markers were measured in 2 MTC patients with active disease before and after surgery. One was re-operated due to neck relapse, the other one due to liver metastases.Both procalcitonin and calcitonin levels were considerably higher in all MTC patients with the active disease. In two re-operated patients, the levels of both markers decreased after surgery but remained above the reference range. In the remission group of MTC patients, 18 had both markers within the reference range, 2 had slightly elevated calcitonin, and 3 patients exhibited both markers slightly increased. In the NTNG group, all but one patient had normal procalcitonin and calcitonin levels. Analysis revealed a significant correlation between procalcitonin and calcitonin levels (r = 0.7383; p0.0001).Procalcitonin has a similar distribution of values as calcitonin and may be used for evaluation of MTC status in some situations when accurate CT estimation is not achievable.

Single N-acetylglucosamine residues attached by O-linkage to serine or threonine (O-GlcNAc) are an abundant, dynamic and inducible post-translational modification of cytoplasmic and nuclear proteins. This study analyzes the activity of the enzyme involved in the removal of these sugar residues, i.e. beta-N-acetylglucosaminidase (O-GlcNAcase) as well as the level of O-GlcNAc in benign and malignant thyroid lesions. Our results demonstrate increased activity of the enzyme in thyroid cancers in comparison to non-neoplastic lesions and adenomas. O-GlcNAc-modified proteins in thyroid cells have a predominantly nuclear distribution and are more abundant in non-neoplastic lesions than in tumors. Understanding the aberrant O-GlcNAc metabolism in thyroid cancer cells may be helpful for developing new diagnostic or treatment methods.

Aims and backgroundThe increased expression of galectin-1 on the mRNA and protein level observed in malignant thyroid tumors in comparison with benign lesions suggests that this protein may be associated with malignant transformation of thyroid epithelium. Extracellular and membrane glycoproteins are the main known ligands for this galactose-binding lectin. However, immunofluorescence studies have shown that galectin-1 is found predominantly in the intracellular compartment. The aim of this study was to examine intracellular carbohydrate ligands of galectin-1 in the thyroid, with particular attention to potential differences in their expression levels between benign and malignant lesions.MethodsIdentification of cytosolic and nuclear glycoproteins binding galectin-1 was performed by affinoblotting after separation of proteins in 8% polyacrylamide slab gels and electrotransfer onto Immobilon-P membranes. For semiquantitative analysis of glycoproteins binding galectin-1, an enzyme-linked lectino-solid-phase assay (ELLSA) was used.ResultsThe predominant cytosolic glycoproteins binding galectin-1 had molecular masses of 50, 55, 59, 64, 85–87, 100, and 133 kDa and nuclear glycoprotein had a molecular mass of 75 kDa. There were no evident differences in glycoprotein patterns between benign and malignant thyroid lesions. The results obtained by ELLSA did not show any significant differences in lectin binding by cytosolic and nuclear proteins of thyroid lesions either.ConclusionsOn the basis of these results it is tempting to suggest that interactions between galectin-1 and intracellular glycoconjugates are not critical for malignant transformation in the thyroid gland.

The aim of the prospective study was the evaluation of primary, subclinical, normocalcemic hyperparathyroidism (PHPT) incidence in patients, operated on because of non-toxic (NTG), toxic (TG) goiter and papillary thyroid cancer (PTC).The study was performed in the group of 196 patients operated on NTG (115 patients), TG (43 patients) and PTC (38 patients). All patients had never been operated because of goiter. No patient had clinical symptoms of PHPT. Calcium concentration (Ca), phosphorus concentration (P) and alkaline phosphatase activity (ALP) in blood serum were measured in all patients a day before operation. When those parameters were out of range, parathormone concentration (PTH) in blood serum was measured. In the case of elevated PTH concentration PHPT was diagnosed. Furthermore, in order to exclude renal failure and insufficiency tests for creatinine and urea concentrations in blood serum and urinalysis were performed.There was no case of increased Ca concentration among 158 patients with benign goiter. The values of at least one measured parameters (P or ALP) were abnormal in 47 out of 158 patients with benign goiter (29.7%). Increased PTH concentration (mean 101.5 pg/ml) was in 16 of 47 patients (10.1% of 158 patients). Normocalcemic PHPT was diagnosed in 12 (10.4%) NTG patients and 4 (9.3%) TG patients. In patients with PTC hypercalcemia was not affirmed. In 7 (18.42%) cases of 38 PTC patients P concentration and ALP activity were abnormal. Increased PTH concentration (84.85 pg/ml) was found in one female with PTC with normal values of P and ALP. Incidence of PHPT was observed in 2.63% of PTC patients.1. There was no significant difference of PHPT incidence between various type of goiter. 2. In our study coexistence of PTC and normocalcemic, asymptomatic PHPT is rare.

We sought to assess whether extensive surgical treatment, postsurgical radioiodine therapy, or both decrease the risk of locoregional recurrence (LR) after curative primary treatment in children and adolescents diagnosed with differentiated thyroid cancer (DTC) at ageor=18 y.To determine the incidence of and identify predictive factors for thyroid bed recurrence (TBR) or lymph node recurrence (NR), we performed a chart review and retrospective multivariate Cox regression analysis on 235 patients with DTC diagnosed at ageor=18 y and managed with curative intent at our tertiary referral center from 1973 to 2002; 40 of these patients had distant metastases at diagnosis. We also determined overall and recurrence-free survival and generated curves for these variables using Kaplan-Meier and Cox univariate analysis.During a median follow-up of 82 mo (range, 5-402 mo), no DTC-related deaths occurred, 203 (86%) children remained recurrence-free, and 32 (14%) children had LR, including TBR in 9 (28% of LR), NR in 20 (63% of LR), and both in 3 (9% of LR). Among patients treated with radical intent and showing no distant metastases, the most recent thyroglobulin level was1 ng/mL in all but 4% of cases. The median time from the first surgery to LR was 37 mo (range, 9-280 mo). In multivariate analysis, significant risk factors for TBR were less than total thyroidectomy and lack of postsurgical radioiodine treatment (respective risk increases of 9.5 [P = 0.04] and 11 times [P = 0.03]). For NR, classic papillary histology, incomplete primary lymph node management (i.e., lack of modified lymphadenectomy of affected lymph nodes or lack of confirmation of disease-free nodes by intraoperative staging), and absence of adjuvant radioiodine therapy were independent significant predictive factors that increased the recurrence risk by 1.9 (P = 0.02), 3.3 (P = 0.02), and 3.2 (P = 0.02) times, respectively. Age or sex did not correlate with LR risk.In DTC patientsor=18 y of age, extensive initial therapy-consisting of total thyroidectomy combined with modified lymphadenectomy performed in case of lymph node metastases and followed by radioiodine therapy--is associated with a substantial decrease of DTC LR risk.

Enhanced sialylation represents one of the most frequently occurring alterations of the sugar chain structure in various cancers. However, up to now, sialylation of intracellular proteins of thyroid carcinomas has never been investigated. The aim of this study was comparative analysis of cytoplasmic and nuclear sialoglycoproteins isolated from thyroid benign and malignant tumors as well as non-neoplastic lesions. The sialylation level and types of sialic acid linkages were analysed by lectin blotting and enzyme linked lectino-solid-phase assay (ELLSA) using Sambucus nigra (SNA) and Maakia amurensis (MAA) agglutinins. The presence of alpha2,6 and alpha2,3 linked sialic acid residues was detected in all types of thyroid lesion specimens but there were some differences in the banding and intensity patterns. Analysis of SNA and MAA binding by ELLSA method showed that in the majority of cancer samples the level of sialic acid residues was lower than in non-neoplastic lesions and adenomas. Our present results suggest that decrease in sialylation rather than increase is a characteristic feature of malignant transformation in the thyroid.

Medullary thyroid carcinoma (MTC) is usually more advanced at presentation than differentiated thyroid cancers and often has distant metastases. The primary treatment of MTC is total thyroidectomy and regional lymph node dissection. The efficacy of these procedures has been limited by the aggressiveness of the disease and metastatic spread at the time of surgery. Persistently elevated levels of calcitonin (CT) and carcinoembryonic antigen (CEA) or their increase postoperatively are indicative for residual or recurrent disease. Conventional imaging methods such as ultrasonography, computed tomography, magnetic resonance imaging and MIBI scintigraphy usually fail to find the source of calcitonin. Better imaging properties have been shown by DMSA scintigraphy, somatostatin receptor scintigraphy or by positron emission tomography (PET). The aim of the study was to evaluate the diagnostic accuracy of PET for the localisation of occult MTC in patients after surgery with increased concentrations of CT, in whom conventional imaging procedures have not been successful.The PET investigation using (18)F-fluoro- 2-deoxy-D-glucose combined with computed tomography ((18)FDG-PET/CT) was performed at the Department of Nuclear Medicine (Oncology Centre in Bydgoszcz) between January and October 2004. In five patients with postoperative calcitonin ranging from 164 to2000 ng/l (normal10 ng/l) no tumour lesions were found using other imaging methods.In four of five cases, responsible lesions with a higher metabolism of FDG, indicating MTC tissue (remnants or metastases), were localised. In one patient no focus of FDG accumulation was found despite high CT concentration. PET detected tumour manifestations in the neck and the mediastinum in two patients, in the lung and the left adrenal gland in one case and in the neck and the liver in another patient. As a result of surgery for the removal of a residual tumour or metastases the accuracy of diagnosis was confirmed by histopathology in all four cases and a decrease in CT and CEA levels was observed in 3/4 cases. The metabolic imaging findings by PET/CT ensured that the surgery on these patients was successful.For the detection of occult residual or metastatic MTC lesions, (18)FDG-PET is a valuable procedure in imaging diagnostics.

The optimal surgical treatment of children with differentiated thyroid cancer remains an important point of discussion. Especially the need for completion operation is questioned in young patients. Our objective was to examine the rate of residual neoplastic disease after non radical initial operation.From the 235 children diagnosed with differentiated thyroid cancer, 131 (56%) needed completion operation due to incomplete primary surgery. Completion operation involved thyroid bed, lymph nodes or both respectively in 91 (39%), 13 (6%) and 27 (11%) cases. Risk factors responsible for residual disease were evaluated by means of logistic regression analysis.Residual disease was detected in 46 (35%) of reoperated children (25% in thyroid bed and 85% in lymph node of lateral neck compartment). Sex and age did not influence the risk of residual disease in thyroid bed or lymph nodes. Papillary type of cancer and multifocality increased risk of residual disease in thyroid bed respectively by the factor of 15 (95% CI: 2-125) and 2.3 (95% CI: 1.2-4.4). Infiltration of thyroid capsule did not correlate with the risk of residual disease. Lymph node metastases in primary operation increased risk of residual disease by the factor of 16 (95% CI: 1.2-245). Histopathology, multifocality of primary tumour or infiltration of lymph node capsule did not influence the risk of residual disease in lymph nodes of lateral neck compartment.In children with differentiated thyroid cancer residual disease is diagnosed in about 1/3 of non radically operated cases. This high incidence justifies completion operations. The risk of residual disease is significantly increased in papillary thyroid cancer, multifocal tumours and cases with lymph node metastases.

Recurrent differentiated thyroid cancer generally occurs first in the neck. Ultrasound is sensitive in detecting enlarged cervical lymph nodes but is not specific enough. Ultrasound-guided fine-needle biopsy increases the specificity but still may fail to detect a recurrence of the disease in the cystic metastatic lymph nodes. The aim of the study was to estimate the value of Tg concentration in the needle washout after fine-needle aspiration of suspicious lymph nodes.The 105 patients studied had presented one or more enlarged suspicious cervical lymph nodes. All had undergone total thyroidectomy and (131)I ablative therapy. Serum thyroglobulin (Tg) concentration was within the 0.15-711.5 ng/ml range (mean 22.24 ng/ml) and Tg recovery range 94-100%. The positive Tg washout concentration cut-off value was established as equal to the mean plus two standard deviations of the Tg washout concentration of patients with negative cytology.Lymph node involvement was diagnosed by cytology in 15 patients and in 28 lymph nodes. Positive Tg washout concentration was found in 22 patients and in 48 lymph nodes. All the lymph nodes which turned out to have positive cytology had a positive Tg washout concentration. All lymph nodes with positive cytology were positive in pathology. Seven patients and 20 lymph nodes with negative cytology were positive in the Tg washout concentration test. All but one patients and all but two lymph nodes with a positive Tg washout concentration had positive pathology.1. Ultrasound-guided fine-needle biopsy is not sensitive enough to detect all metastatic lymph nodes. 2. The Tg washout concentration test is 100% sensitive in the detection of metastatic lymph nodes. 3. Cytology in ultrasound- guided fine-needle biopsy is 100% specific. 4. The Tg washout concentration test carries a risk of false-positive results. 5. Both methods should be used for early detection of metastatic lymph nodes in patients with differentiated thyroid cancer.

Total thyroidectomy with lymphadenectomy is the most typical operation in a case of papillary thyroid cancer. Range of lymph node resection still remains a matter of controversy. In some publications treatment of lymph node metastases doesn't affect survival, so only selective lymph node resection is the extended enough operation. The others remark that, local relapse- the worst prognostic factor, appears the most often in the lymph nodes, so they suggest more aggressive treatment. To solve that problem we try to find more sensitive methods to examine lymph nodes.To compare the results of detection lymph node metastases of papillary thyroid cancer by immunohistochemistry with the results of RT- PCR for thyroglobulin (Tg) mRNA.Each of one hundred eighty four cervical lymph nodes obtained from 24 patients, operated in our Department was divided into 2 halves: one was used for conventional histopathology and immunohistochemistry, the other part was investigated by RT- PCR for Tg mRNA. Immunohistochemical staining for Tg was performed on formalin-fixed, paraffin-embedded sections with anti-Tg antibodies.According to routine, histopathological examination 8 (33.5%) patients had involved lymph nodes. One hundred correspondence of the results of immunohistochemistry and histopathology was observed. We obtained different results of examination of the lymph nodes in 6 (25%) patients. In four patients (16.7%) RT-PCR was more sensitive in detection of positive lymph nodes, in two patients (8.3%) it revealed less metastasized lymph nodes than immunohistochemistry. The remaining 18 patients didn't have any differences, fourteen (58.3%) of them had the negative lymph nodes and four (16.7%) had positive, the same lymph nodes in all examinations. Finally, according to RT-PCR 10 (41.7%) of the patients had metastasized lymph nodes.Tg RT-PCR is a sensitive method of detection of papillary thyroid cancer cells and may help to detect the metastases of papillary thyroid cancer in regional lymph nodes.

NIS gene is located on chromosome 19 and encodes 643 amino acid protein. It belongs to membrane Na+ dependent glucose symporter proteins family. In normal thyroid is located in basolateral membrane of thyreocyte. It plays a main role in concentrating of iodine in thyreocyte and thus in thyroid hormones synthesis. It was proved that NIS expression influences effectiveness of radioactive iodine therapy in well-differentiated thyroid cancers. The aim of this study was to estimate the NIS expression and its dependence with gender, age and stage in thyroid papillary and follicular cancers. The frozen sections of tissue were used as a source of tumor RNA. RT-PCR technique was employed for NIS expression analysis. We did not find dependence between the presence of NIS expression in investigated thyroid cancers and stage of disease estimated according to TNM classification. We also did not find dependence between NIS expression and gender or sex of the patients. Our results suggest that there is no dependence between NIS expression and iodine uptake.

Neoplastic angiogenesis is an essential stage of growth, progression and invasion of solid tumours. The process of basement membrane degradation and remodelling of the extracellular matrix (EMC) involves proteolytic enzymes called metalloproteinases. Among the numerous proteolytic enzymes of this group the key role is played by metalloproteinase-2 (MMP-2) and tissue inhibitor of metalloproteinase 2 (TIMP-2). Tissue expression and concentration of these compounds in body fluids have been used in early diagnostics of tumours development, assessment of tumours advancement and treatment results monitoring. The aim of the study was to evaluate the concentration of MMP-2 and TIMP-2 in blood serum of patients with benign and malignant thyroid tumours and the effect of surgical treatment on these parameters in the postoperative period as well as assessment whether to MMP-2 and TIMP-2 serum concentration in patients with thyroid cancer positively correlates with the clinical staging classification of the International Union Against Cancer (UICC).The study group consisted of 53 patients with various types of thyroid cancer and 23 patients with benign thyroid tumours, while 26 healthy adults served as controls. According to clinical staging classification of thyroid cancer the 32 patients were classified with stage I, 6 with stage II, 8 with stage III and 7 with stage IV. We have found higher mean concentration of MMP-2 in 53 patients with thyroid cancer as compared to the control group and the group of 23 patients with benign thyroid tumours. All patients were treated operatively. Additionally, a significant effect of radical surgical treatment on mean concentration of MMP-2 and TIMP-2 in patients with papillary and follicular thyroid cancer was demonstrated.MMP-2 and its tissue inhibitor TIMP-2 apparently play a significant role in the pathogenesis of thyroid cancer. Evaluation of their concentration in peripheral blood serum may be useful for the differentiation between benign and malignant thyroid tumours. Serum MMP-2 and TIMP-2 concentrations in patients with thyroid cancer did not significantly correlate with the clinical staging of thyroid cancer.

The range of lymphadenectomy in differentiated thyroid cancer remains still a matter of controversy because of the lack of reliable diagnostic methods for nodal metastases, other than histopathology. To compare the results of detection of lymph node metastases of papillary thyroid cancer by conventional histopathology and immunohistochemistry with the results of reverse transcription–polymerase chain reaction for thyroglobulin mRNA. Each of 166 cervical lymph nodes obtained from 21 patients was divided into two halves: one was used for conventional histopathology and immunohistochemistry, the other part was investigated by molecular examination. We obtained different results from examination of the lymph nodes in six (28.6%) patients. In four patients (19.1%) reverse transcription–polymerase chain reaction (RT-PCR) was more sensitive in detection of positive lymph nodes; in two patients (9.5%) it revealed fewer metastasised lymph nodes than did histopathology. The rest of the patients did not have any differences: 12 (57.1%) of them had negative lymph nodes and three (14.3%) had positive lymph nodes in all examinations. (1) Thyroglobulin (Tg) RT-PCR is an appropriate method of detection for thyroid cancer cells. (2) In combination with histopathology, it might help to qualify patients’ nodal status better.

Differences in glycosylation of nuclear and cytosolic proteins isolated from benign and malignant human thyroid neoplasms were analyzed by lectin blotting and enzyme linked lectino-solid-phase assay using Erythrina cristagalli and Ricinus communis agglutinins. The results reported in this study have not shown any significant differences in lectin binding by nuclear proteins of benign and malignant tumors, however, quantitative and qualitative differences were observed in the patterns of cytosolic glycoproteins. In the majority of carcinomas samples lectin binding to cytosolic proteins was definitely weaker in comparison with adenomas and non-neoplastic specimens, which suggested alterations in glycosylation of cytosolic proteins in malignant tumors.

From 1974 to 1999, 1,001 patients were operated on for thyroid cancer, including 778 (78%) for differentiated thyroid cancer and 223 (22%) for other thyroid malignant neoplasms. Radical operations were performed in 716 (92%) patients with differentiated thyroid cancer and in 85 (38%) patients with other thyroid malignant neoplasms. After surgery, all patients underwent various methods of complementary treatment, depending on cancer type and grading (levothyroxine, 131I, radiotherapy and/or chemotherapy). These patients had no evidence of persistent disease after finishing treatment (Tg, CEA, calcitonin, scintigraphy). We observed recurrences of thyroid cancer, although macroscopic, microscopic, biochemical, and scintigraphic criteria of radicality were present. At 18 months' to 24 years' follow-up, we observed recurrences in 94 (11.7%) of 801 patients treated radically, including in 53 (7.4%) of 716 patients with differentiated thyroid cancer and in 41 (48%) of 85 patients with other thyroid malignancies. Among 37 patients with thyroid bed recurrence, 18 (48.6%) underwent radical operations and 19 (51.4%) palliative ones. Of 33 patients with regional lymph node recurrence, radical operations were performed in 26 (78.8%) and palliative ones in seven (21.2%). Of 24 patients with distant metastases, four (17%) (with single metastasis) underwent surgery (three radical operations and one palliative one). Other methods of treatment were used in the remaining patients. Occurrence of thyroid cancer recurrences in the thyroid bed and lymph nodes indicates that macroscopic, microscopic, and scintigraphic criteria of radicality are not sufficient. Recurrences after radical surgery are more infrequent in patients with differentiated thyroid cancers than in those with other thyroid malignant neoplasms. In many patients, thyroid bed and lymph node recurrences can be removed radically during surgery.

The aim of this study was to investigate post cryotherapy thyroid function status of normal rat thyroid tissue and to determine the topography of temperature of cryotreated tissues and of tissues adjacent to them. Nitrous oxide cryotherapy was performed in 40 male Wistar rats. They were divided into four groups of 10. In group I, the right thyroid lobe was subjected to cryotherapy and the left lobe was not frozen. In group II, both thyroid lobes were cryotreated. In group III, the right lobe was frozen and the left lobe was excised. In group IV, the thyroid was subjected to neither cryotherapy nor surgery. During cryotherapy, the temperature in various places of the thyroid and in the surrounding tissues was measured. Serum thyrotropin concentrations were determined before an experiment and 4 weeks after in all rats. The results of temperature measurements proved that it is possible to limit cryotherapy to certain areas of thyroid tissue and to spare the neighboring tissues, because they are not subjected to temperatures that are damaging. The effectiveness of cryotherapy was confirmed by functional effect. Cryotherapy changed function of thyroid tissue. There was a statistically significant difference between mean baseline and follow-up concentrations in rats of groups II and III. In both groups hypothyroidism occurred post cryotherapy.

In recent years cryotherapy has been more and more frequently used for the treatment of tumors of different organs. Until now, the use of cryotherapy for the treatment of thyroid lesions, as well as histopathologic changes in thyroid tissue after cryotherapy, has not been described. Nitrous oxide cryotherapy of one thyroid lobe in twenty 12-week male Wistar rats was performed. After 2 and 4 weeks, the cryotreated thyroid lobe and the second lobe along with a part of the trachea, esophagus, and the subhyoid muscles adhering to the thyroid were excised and assessed macro- and microscopically. The macroscopic evaluation, performed 2 and 4 weeks postcryotherapy, revealed atrophy of the cryotreated lobe in 4 and 3 rats, respectively, and reduction of the cryotreated lobe dimensions in 6 and 7 rats, respectively. In the specimens of the lobes excised 2 weeks following cryotherapy, examined microscopically, necrosis, granulomatous inflammation, hemorrhages, and hemosiderin deposits were found most often, whereas in the specimens of the lobe excised after 4 weeks lymphocytic inflammation and fibrosis were mainly observed. No microscopic changes were observed in the thyroid lobes that were not frozen or in the parathyroid glands located inside these lobes or extrathyroidally, either ipsilaterally or contralaterally to the cryotreated thyroid lobes. There was no microscopic damage to other tissues adjacent to the thyroid gland. No rat developed vocal cord dysfunction after cryotherapy and no significant changes in serum calcium level before and after cryotherapy were observed. The results obtained show that it is possible to cryoblate thyroid tissue without damaging the tissues adjacent to the thyroid, as well as to spare function of the recurrent laryngeal nerves and parathyroid glands.

The serine/threonine protein kinase Akt is a key molecule in the phosphatidyl inositol 3-kinase pathway that is often overactivated in human cancers. Three Akt isoforms (Akt1, Akt2, Akt3) have been identified in human cells and they show different distribution and have non-redundant functions. The aim of this study was to determine whether the expression, phosphorylation, and localization of Akt1 isoform in human thyroid malignant lesions are different from those in benign lesions. Nuclear and cytoplasmic fractions were isolated from tissue samples and Western blot method was used to detect Akt1 presence in both cellular fractions. Akt1 expression was also assessed by ELISA method. To estimate Akt1 phosphorylation, kinase was immunoprecipitated from cell lysates and tested with anti-phospho-Akt antibodies. The Akt1 expression in majority of thyroid cancer samples was significantly higher than in benign lesions (p

In the present study the role of tumour suppressor genes (TSGs) hypermethylation and genetic instability of LOH/MSI type in thyroid tumorigenesis was assessed. Expression, methylation status and presence of LOH/MSI were analyzed for 8 TSGs selected from imprinted (IR) and non-imprinted (NIR) chromosomal regions in papillary thyroid carcinomas (PTCs) and nodular goitres (NGs). The results show that methylation-induced gene silencing occurs at an early step of thyroid carcinogenesis and involves multiple genes. Genetic changes of LOH/MSI type are less frequent. In PTC samples, the lack of significant differences in the frequency of LOH in IR and NIR suggests that it is not a key mechanism changing the pattern of gene expression. Co-methylation observed both in NG and PTC raises a possibility that, in thyroid tissue, methylation-induced silencing may occur not only in malignant transformation but also in functional context. We did not recognize any of the studied TSGs - in regard to aberrant methylation status or LOH/MSI frequency - as a selective molecular marker in thyroid tumorigenesis.