Percutaneous ethanol injections in the treatment of secondary hyperparathyroidism

INTRODUCTION: Renal insufficiency is the most common etiology of secondary hyperparathyroidism. In case of resistance for conservative treatment, methods of choice are surgical intervention or percutaneous ethanol injections. AIM OF THE STUDY: The aim of the study was to evaluate usefulness of percutaneous ethanol injection therapy in the treatment of patients with secondary hyperparathyroidism. MATERIAL AND METHODS: We performed percutaneous 96% ethanol injections under USG guideance in 51 patients: 22 women (mean age 49.6 years) and 29 men (46.6 yrs). The base level of parathormone was 689.35 pg/ml. We managed to visualize one parathyroid gland in 34 patients, 2 in 12, 3 in 5 patients. The mean volume of a single gland was 0,8 cm3. All the injections were performed with the use of needle number 6. We repeated injections in case of no effects. One injection was performed in 18 patients, 2 in 18, 3 in 13, 5 in 1 and 6 in 1 patient. Before and after the treatment patients were examined with USG, scintigraphy and densitometry. Serum levels of calcium (Ca), phosphorus (P), parathormone (PTH) and alkaline phosphatase (FA) activity were also obtained. The main criteria for success was decrease in parathormone level of 50% or more in comparison with pre-injection level or to less than 200 pg/ml. RESULTS: In the whole group of patients after the first month, positive results were observed in 67%. There were no changes in 23%, and PTH level increased in 10%. After 6 months-positive results in 53%, no change in 35% and increase in 12%. We noted the best results in patients with PTH less than 800 pg/ml-72% of them had positive results after 1 as far as after the 6 month. CONCLUSIONS: Percutaneous ethanol injections are valuable method of treatment of secondary hyperparathyroidism. The best results can be obtained if PTH level is less than 800 pg/ml, one parathyroid gland dominating over the rest is visualised in USG, and if patient responds after 1 or at least 2 injections.     

Percutaneous ethanol injection in treatment of benign nonfunctional and hyperfunctional thyroid nodules

In recent years a new method of treatment of thyroid disorders, percutaneous ethanol injection (PEI), has been successfully used as an alternative to surgery for the management of benign nodules. In this study 103 females and 5 males (34.4 +/- 11.3 yrs) with nonfunctional cystic (23) or solid (38) nodules, and also 47 with hyperfunctional solid nodules, were treated with single or repeated ethanol injections. In all patients, the cytological studies, ultrasound evaluation and the levels of free triiodothyronine (fT3), free thyroxine (fT4), and thyrotropin or thyroids-stimulating hormone (TSH) before and after ethanol administration, were determined. The patients were followed up for 12-36 months. The size of the benign nonfunctional nodules was totally reduced in 49.9% of cases with solid and in 60.9% of patients with cystic nodules. Hyperthyroidism was cured in 91.5% of patients. The PEI procedure was connected with a few significant complications only, in relation to the localization of nodules. It was cheap, possible on an outpatient basis, easy to perform and acceptable to patients. Since the cost of thyroidectomy is high and the complication rate significant, PEI is a suitable substitute treatment especially for some patients with small toxic benign nodules of the thyroid gland.     

Bromocriptine treatment in tall adolescents: two years of clinical experience

34 adolescents referred for excessive height prediction (HP) (11 boys with HP greater than 196 cm, 23 girls with HP greater than 180 cm) were treated for 9-15 months with bromocriptine (5-7.5 mg/day). Minor and transient side effects were observed in 20% of the subjects at the beginning of the treatment. Treatment had to be stopped in 1 boy complaining of asthenia and headache. Puberty developed normally, 19 girls experienced menarche during treatment and 1 continued regular menses. Bromocriptine treatment induced: (1) a significant decrease (p less than 0.001) in growth velocity from (mean +/- SEM) 8.6 +/- 0.4 to 5.3 +/- 1.5 cm/year in boys and from 7.1 +/- 0.2 to 4.6 +/- 0.6 cm/year in girls; (2) a twofold mean increase in skeletal maturation rate. Adult HP was reduced significantly from 202 +/- 1.4 to 195.4 +/- 1.2 cm in boys, and from 184 +/- 0.7 to 179.8 +/- 0.7 in girls. These results confirm our previous report suggesting that bromocriptine is a valuable alternative to sex steroid treatment in order to limit the final height in excessively tall adolescents.     

Percutaneous renal denervation for the treatment of resistant essential hypertension; the first Dutch experience

Background

In a subpopulation of patients with essential hypertension, therapeutic targets are not met, despite the use of multiple types of medication. In this paper we describe our first experience with a novel percutaneous treatment modality using renal artery radiofrequency (RF) ablation.

Methods

Patients who were resistant to at least three types of antihypertensive medical therapy (office systolic blood pressure?≥?160 mmHg; n?=?9) or who did not tolerate medication (n?=?2) were selected. Between July and November 2010, a total of 11 patients received percutaneous RF treatment. Patients were followed up for 1 month after treatment. Urine and blood samples were taken to evaluate the effects on renal function and neurohumeral factors.

Results

No periprocedural complications or adverse events during follow-up were noted. A reduction of mean office blood pressure was seen from 203/109?±?32/19 mmHg at baseline to 178/97?±?28/21 mmHg at 1 month follow-up (mean difference 25?±?12 mmHg, p?<?0.01). Also, we noted a significant decrease in aldosterone level (391?±?210 pmol/L versus 250?±?142 pmol/L; p?=?0.03), while there was no decrease in plasma renin activity (190?±?134 fmol/L/s versus 195?±?163 fmol/L/s; p?=?0.43). No change in renal function was noted.

Conclusion

Catheter-based renal denervation seems an attractive novel minimally invasive treatment option in patients with resistant hypertension, with a low risk of serious adverse events.     

ESWL treatment of urinary stones in children--the overview of 14 years of experience

Extracorporeal shock wave lithotripsy (ESWL) treatment has been used at Department of Urology, University Hospital "Osijek", Croatia, since July 1988. Until December 2001 seven thousand and eight hundred patients underwent ESWL for urinary stones, 68 of them were children (0.87%). Sixty-eight children aged 4 to 15 years (average 10.14 years) underwent ESWL. They were treated for the total of 91 stones: 35 (38.46%) caliceal, 23 (25.27%) in pyelon, 7 (7.69%) in pyeloureteric segment and 14 (15.38%) ureteral. Staghorn calculi were found in 6 (6.59%) patients and multiple stones (four or more stones in the same kidney) in 6 (6.59%). There was total of 95 ESWL sessions performed in 68 patients (1.39 session per patient). Fifty-six patients (82.35%) without residual stones found at the control plain film and sonography of urinary tract were considered "stone free". Addition of 5 patients with clinically insignificant residual fragments (less than 4 mm) increases overall success rate to 89.70%. ESWL is a simple, safe and effective procedure in the management of urolithiasis in childhood. Clinical experience of our institution confirms ESWL as the first line treatment for kidney stones in the pediatric age patients.     

Potential diagnostic markers in nodular lesions of the thyroid gland: an immunohistochemical study

Aims: The differential diagnosis of thyroid nodules in routine practice can be problemmatic for both pathologists and clinicians. Effective treatment requires a determination of the biological nature of the lesions. For this reason, ancilliary diagnostic markers along with histological examination of the nodules may be useful. The objective of this study was to evaluate the diagnostic usefulness of novel markers in the diagnosis of hyperplastic and neoplastic nodules. Methods: Forty eight thyroid lesions forming four diagnostic groups including adenomatous goiters (AS), follicular adenomas (FA), follicular (FC) and papillary carcinomas (PC) were examined using standard immunohistochemical methods. Monoclonal antibodies against galectin-3, matrix metalloproteinases (MMPs) -2 and -7 and endothelial markers CD31 and CD105 were used. Results: The cytoplasmatic expression of galectin-3 was positive in all cases of papillary carcinoma. Moreover, statistically significant differences between fused groups of benign (AS and FA) and malignant lesions (FC and PC) were found Fischer's exact test (p = 0.0001). No significant differences in cytoplasmic expression of MMPs -2 and -7 and in vascular density assessed by using of both endothelial markers between benign lesions and malignant tumors were revealed. Conclusions: Galectin-3 appears to be a useful marker in the diagnosis of papillary carcinoma only. The matrix metalloproteinases-2 and -7 are not helpful in distinguishing hyperplastic and neoplastic thyroid nodules. Endothelial markers do not appear to be suitable for thyroid differential diagnosis. A panel of antibodies in the differential diagnosis of thyroid nodular lesions would seem most suitable and further studies with larger sets of patients are awaited.     

Effects of ethanol on the ultrastructure of the hamster thyroid C-cell

The morphology of the thyroid C-cells in golden hamsters after short- and long-term treatment with ethanol was studied. Immunohistochemistry was applied to examine the distribution of the C-cells in the thyroid gland. In the short-term experimental animals, the Golgi complexes and the granular endoplasmic reticulum were well developed and the number of the secretory granules was decreased as compared with those of the control animals. These findings suggest that the cellular activity of the thyroid C-cell is stimulated after short-term treatment with ethanol. The morphology of the thyroid C-cells of the long-term experimental animals was similar to that of the controls. It is conceivable that long-term treatment with ethanol does not affect the function of the C-cell.     

Preliminary immunohistochemical investigations of human thyroid C cells in the simple and hyperactive nodular goitre

The aim of this study was to carry out histomorphological and immunohistochemical analysis of thyroid C cells in 30 patients with simple goitre and hyperactive goitre including Graves-Basedow (G-B) disease, treated surgically. Four tissue samples were always taken from the same internal parts of the gland where the number of C cells in physiological conditions was the highest. C cells were detected in paraffin sections after impregnation with silver salt (Grimelius method) or immunohistochemically, with antibodies against calcitonin, synaptophysin, chromogranin A and neuron-specific enolase. Distinctly less numerous C cells were found in simple and hyperactive goitre than in normal thyroid parenchyma. The majority of C cells showed weak intensity of the examined immunohistochemical reactions. C cells were not observed at all in the texture of nodules well separated by the connective tissue. Proliferative changes concerned only follicular cells.     

The Brazilian experience of sugarcane ethanol industry

Biomass has gained prominence in the last few years as one of the most important renewable energy sources. In Brazil, a sugarcane ethanol program called ProAlcohol was designed to supply the liquid gasoline substitution and has been running for the last 30 yr. The federal government’s establishment of ProAlcohol in 1975 created the grounds for the development of a sugarcane industry that currently is one of the most efficient systems for the conversion of photosynthate into different forms of energy. Improvement of industrial processes along with strong sugarcane breeding programs brought technologies that currently support a cropland of 7 million hectares of sugarcane with an average yield of 75 tons/ha. From the beginning of ProAlcohol to the present time, ethanol yield has grown from 2,500 to around 7,000 l/ha. New technologies for energy production from crushed sugarcane stalk are currently supplying 15% of the electricity needs of the country. Projections show that sugarcane could supply over 30% of Brazil’s energy needs by 2020. In this review, we briefly describe some historic facts of the ethanol industry, the role of sugarcane breeding, and the prospects of sugarcane biotechnology     

The use of sub-surface constructed wetlands for wastewater treatment in the Czech Republic: 10 years experience

Wetlands have been intensively studied in the Czech Republic for more than 30 years, but the first full-scale constructed wetland (CW) for wastewater treatment was built in the Czech Republic in 1989. By the end of 1999, about 100 CWs were put in operation. The majority of the systems are horizontal subsurface flow (HSF) CWs and are designed for the secondary treatment of domestic or municipal wastewater. The size of CWs ranges between 18 and 4500 m² and between 4 and 1100 population equivalent (PE). Most frequently used filtration media are gravel and crushed rock with size fractions of 4/8 and 8/16 mm and Phragmites australis is the most commonly used plant. The treatment efficiency is high in terms of BOD₅ (88.0% for vegetated beds) and suspended solids (84.3% for vegetated beds). The removal of nutrients is lower for vegetated beds, and averages 51 and 41.6% for total phosphorus and total nitrogen, respectively.     

Three injections of human chorionic gonadotropin are as effective as ten injections in the treatment of cryptorchidism

Two schedules of human chorionic gonadotropin (hCG) administration were compared in a study of 332 boys (473 testes) aged 1-13 years with cryptorchidism. One group of patients received 10 hCG injections according to the International Health Foundation (IHF) schedule while the other group received 3 hCG injections at intervals of 7-10 days (1-3 years = 3 x 1,000 IU; 3-6 years = 3 x 1,500 IU; 6-10 years = 3 x 3,000 IU; 10-13 years = 3 x 5,000 IU hCG). Results from both schedules were comparable during the first and also during a second treatment period at the age of 1-3 and 3-6 years; between 6 and 13 years of age the IHF schedule was more successful.