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We aimed to evaluate the effectiveness and safety of radiofrequency ablation (RFA) for non-surgical treatment of locally recurrent thyroid cancers, in both well-differentiated and medullary thyroid carcinomas (DTC and MTC) that are not amenable to traditional treatments.We conducted a retrospective review of 48 patients with 103 recurrent tumors (81 DTC, 22 MTC) who underwent ultrasound-guided RFA. Patients were followed for 12-37 months to observe the outcomes and complications.64 tumors (62.1%) completely disappeared at the last follow-up visit with 61 (59.2%) being resolved within 12 months. Technical success (volume reduction ratio (VRR) 50%) was 96% (n = 99) in all tumors. The mean largest diameter of treated tumors decreased from 11.2 ± 5.3 to 2.4 ± 3.4 mm (p value 0.001), and the mean volume decreased from 501.0 ± 807.0 to 41.6 ± 97.1 mmRFA is a safe and effective alternative to repetitive surgeries in recurrent loco-regional DTCs as well as MTCs.Level 3, Non-randomized controlled cohort/follow-up study.

Thyroid remnant after thyroidectomy is a major predictor for future recurrence of thyroid cancers; for which assessment, the accuracy of imaging is not optimal. To evaluate the value of the technetium uptake in the neck compared with neck ultrasonography, this application is used to predict future recurrence of differentiated thyroid cancer (DTC). The neck technetium uptake (NTU) value was acquired 20 min after injection of 1 mCi technetium by a camera. Patients were scheduled for forthcoming iodine ablation. Baseline risk factors were collected. Patients were followed for 10.5 (7 to 12) months when the records of the whole body scan, thyroglobulin, anti-thyroglobulin, neck ultrasonography, and the history of repeated iodine and surgical treatments were collected. The correlation of NTU and recurrence were studied. Out of 73 participants, 63 patients completed the study with established recurrence status and a valid NTU assessment. Baseline lymph node invasion (34.6% vs 80.0%; all 41.9%), extra-thyroid extension (17.0% vs 50.0%; all 22.2%), and tumor size (2.3 ± 2.1 vs 5.2 ± 2.4; all 2.7 ± 2.4) were higher in patients with future recurrence. But the NTU was similar in subjects with and without recurrence (−0.2 ± 0.7 vs 1.7 ± 6.3; all 59 ± 5.3). NTU was significantly lower in subjects with surgeries more extensive than thyroidectomy (P = 0.03). Recurrence cannot be predicted by NTU, but NTU may be used as a surrogate factor to determine the extent and completeness of the thyroidectomy surgery.

Magnetic resonance imaging (MRI) and computed tomography (CT) are not always conclusive for the detection of cerebral venous sinus thrombosis (CVST). 99mTc-HMPAO-labeled platelets may be useful in cases with high clinical suspicion. Three patients with headaches with or without intraparenchymal hemorrhage that were highly suspected to have CVST, despite inconclusive anatomical imaging, were selected for inclusion in the study. Platelets were extracted by two rounds of centrifugation from 49 ml of the patient’s whole blood. The platelets were labeled with 99mTc-HMPAO and any unbound 99mTc was removed by centrifugation. The re-suspension of 99mTc-HMPAO-labeled platelets in cell-free plasma was reinjected into the patients. After 2 h, planar and single photon emission computed tomography (SPECT) images of the head were obtained. Extensive clots were detected in all three patients, illustrated in the planar image and even clearer in the SPECT images. We propose that 99mTc-HMPAO-labeled platelet scan is a favorable imaging method for patients suspected to have CVST with inconclusive CT and MRI results.

Needle insertion during electromyography (EMG) may cause varying levels of pain that could lead to inaccurate assessment and premature termination of the procedure. The aim of this study is to compare paracetamol 325 mg/tramadol 37.5 mg with placebo in relieving pain before EMG. This is a randomized, crossover, placebo-controlled, double-blind clinical trial; forty-four healthy individuals, including 27 males with a mean age of 35.3 years (range 18-59 years), entered this study. The needles were inserted unilaterally 2 h after administration of two analgesic tablets of paracetamol 325 mg/tramadol 37.5 mg or two placebo tablets. The pain was scored through a 100-mm visual analog scale (VAS) immediately and 2 h after the procedure. The side effects were also recorded. Within a week, the procedure was repeated on the other upper limb, changing the treatment and placebo. The immediate and 2-h VAS scores were notably lower after administration of treatment compared to placebo (immediate pain: 17.5 ± 12.8 vs. 32.1 ± 16.0, P

Patients with diabetes have higher stress-to-rest mean left ventricular volume (SRLVV) ratio in myocardial perfusion imaging (MPI) and hyperhomocysteinemia. We studied the effect of folate therapy on SRLVV ratio and plasma homocysteine levels in patients with diabetes. Forty patients were enrolled and thirty-two completed the study. The patients underwent a 2-day pharmacological stress test and rest MPI before and 2 months after treatment with either 5 mg folic acid or placebo. SRLVV ratios were calculated, and plasma homocysteine levels were measured, before and after treatment. Among the 32 patients who completed the study, 15 received folic acid and 17 received placebo. The age of subjects (folate 51.5 ± 6.1 years; placebo 50.6 ± 8.1 years), male/female ratio (folate 6/11; placebo 9/6),or MPI findings (proportion of normal results: folate 80.0 %; placebo 94.1 %) were similar between the two groups. The baseline SRLVV ratio was similar between groups (folate: 1.00 ± 0.09 vs. placebo: 0.97 ± 0.13); however, the post-treatment SRLVV ratio was significantly lower (P

The relation of Two single nucleotide polymorphisms (SNPs) at the adiponectin locus (+45T/G and +276G/T) with coronary artery disease (CAD) is controversial. The aim of the present study was to evaluate the genetic influence of the adiponectin gene polymorphisms in the development of CAD among patients with Type 2 diabetes (T2D). The adiponectin genotypes were detected by polymerase chain reaction and restriction analysis (PCR-RFLP) in our patients. Two adiponectin gene (ADIPOQ) SNPs (i.e. SNPs +45TG and +276GT) were genotyped in 114 Type 2 diabetic subjects with CAD, and 127 Type 2 diabetic patients without CAD. Demographic and anthropometric data along with plasma biochemistry including lipids, glycemic indices, and adiponectin were collected. There was a significant difference in the distribution of genotypes of +45T/G and +276G/T between CAD and non-CAD individuals (P 0.05). Based on our results SNP+276GT is associated with decreased risk of CAD after adjustment for potential confounding factors [adjusted OR = 0.39 (95%CI: 0.22-0.68); P = 0.001]. Similar findings were not observed for the +45TG SNP. Two haplotypes 45T-276T and 45G-276T were associated with a decreased risk of CAD [adjusted OR = 0.47 (95% CI: 0.32-0.94); P = 0.03 and adjusted OR = 0.33 (95% CI: 0.13-0.83); P = 0.02 respectively]. No significant difference was observed between HOMA-IR, BMI, waist circumference, history of hypertension, HbA1C, and lipid concentrations regarding the two SNPs. In conclusion, these findings suggest that T allele of +276GT SNP is significantly associated with decreased risk of CAD in T2D Patients. Also Haplotype analysis showed that two haplotypes 45T-276T and 45G-276T were associated with a decreased risk of CAD.

The pathogenesis of diabetic nephropathy, mainly characterized by macroalbuminuria, is still poorly understood, but it is reported that transforming growth factor-beta (TGF-beta) plays a key role. In vitro evidence suggests that administration of oxidized LDL (ox-LDL) can lead to upregulation of TGF-beta by human glomerular mesangial cells. This study aimed to evaluate the association between macroalbuminuria, ox-LDL, and TGF-beta in diabetic patients. A total of 77 type 2 diabetic patients with macroalbuminuria (albumin excretion rate: AERor = 300 mg/24 h) and 66 patients with normoalbuminuria (AERor = 30 mg/24 h) were recruited. Fasting blood samples were obtained and serum levels of ox-LDL and TGF-beta were determined. Ox-LDL and TGF-beta were significantly higher in patients with macroalbuminuria than in those with normoalbuminuria (98.93 + or - 3.99 vs. 72.45 + or - 2.48 U/l; P0.001 and 6.46 + or - 0.74 vs. 2.49 + or - 0.39 ng/ml; P0.001, respectively). In patients with macroalbuminuria, there was a significant correlation between Ox-LDL and TGF-beta (r = 0.376; P0.01). AER was significantly correlated to ox-LDL (r = 0.302; P0.05) and TGF-beta (r = 0.306; P0.05) in macroalbuminuric patients. This association remained significant after adjustment for potential confounders. Adjustment for TGF-beta (ox-LDL), attenuated the association of ox-LDL (TGF-beta) with AER. In conclusion, this study demonstrated the association of TGF-beta and ox-LDL with albuminuria in macroalbuminuric type 2 diabetic patients, and suggested that this relationship is highly mediated through the correlation between TGF-beta and ox-LDL.

We opted in this study to evaluate the association between metabolic syndrome (MetS) and microalbuminuria in type 2 diabetes. A total of 800 adults (344 males; age 54.8 ± 9.6 years) with type 2 diabetes were studied. MetS was defined by the International Diabetes Federation criteria and microalbuminuria by urinary albumin excretion between 30 and 299 mg/day on at least two of three occasions. Patients with macroalbuminuria and those with poor renal function were not included. Microalbuminuria was present in 237 (29.6%) patients with MetS and increased in prevalence with increasing numbers of metabolic abnormalities (P

The aim of the study was to determine the annual healthcare expenditures of an individual with diabetes in Tehran, between March 2004 and March 2005.This prevalence-based 'cost-of-illness' study was conducted in two phases. In the first phase, 23,707 randomly selected individuals were interviewed to gather a cohort of participants with diabetes. In the second phase, 710 diabetic patients and 904 age- and sex-matched controls were followed up for 1 year at intervals of 3 months and the direct (physician services, medications and devices, hospitalisation, laboratory, paraclinical and transport) and indirect (loss of productivity) expenditures were recorded. The excess costs of a person with diabetes were estimated through comparison with matched controls. The estimates were also extrapolated to the total population of Tehran and Iran. The costs were converted from the Iranian rial to the US dollar (exchange rate September 2004).Total annual direct costs of diabetic and control participants were $152.3 +/- 14.5 and $52.0 +/- 5.8, respectively, which is indicative of 2.92 times higher costs in diabetic patients. The most expensive components of direct costs were medications and devices, and hospitalisation in diabetic patients (28.7% and 28.6%, respectively). Total indirect costs were $39.6 +/- 2.4 and $16.7 +/- 1.1 in diabetic and non-diabetic individuals. The aggregate annual direct costs of diabetes were estimated to be $112.424 +/- 10.732 million and $590.676 +/- 65.985 million in Tehran and Iran, respectively. Diabetes complications contributed 53% of the aggregate excess direct costs of diabetes.Diabetes is an expensive medical problem in Iran and planning of national programmes for its control and prevention is necessary.