Browsing by Author "Fardella C."

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    An ultrasound score to predict the presence of papillary thyroid carcinoma. Preliminary reportDiseño de una escala ecográfica predictora de malignidad en nódulos tiroideos: Comunicación preliminar
    (2009) Domínguez J.M.; Baudrand R.; Arteaga E.; Campusano C.; González G.; Mosso L.; Fardella C.; Domínguez J.M.; Baudrand R.; Arteaga E.; Campusano C.; González G.; Mosso L.; Arias T.; Pizarro A.; Gómez M.; Fardella C.; Cruz F.; Torres J.; Solar A.; Cavada G.; NCD Risk Factor Collaboration (NCD-RisC)
    Background: Thyroid nodules are common and associated to a low risk of malignancy. Their clinical assessment usually includes a fine neddle aspiration biopsy (FNAB). Aim: To identify ultrasonographic characteristics associated to papillary thyroid carcinoma (PTC) and generate a score that predicts the risk of PTC. Material and methods: Retrospective review of all fine needle aspiration biopsies of the thyroid performed in a lapse of two years. Biopsies that were conclusive for PTC were selected and compared with an equal amount of randomly selected biopsies that disclosed a benign diagnosis. Results: One hundred twenty two biopsies of a total of 1,498 were conclusive for PTC. Univariate analysis showed associations with PTC for the presence of micro-calcifications (Odds ratio (OR) 49.2: 95% confidence intervals (CI) 18.7-140.9), solid predominance (OR 25.1; 95% CI 6-220), hypoechogenicity (OR 23.5, 95% CI 6.5-122.6), irregular borders (OR 17, 95% CI 7.2-42.9), lymph node involvement (OR 12.3, 95% CI 2.7-112), central vascularization (OR 12.2, 95% CI 4.8-33.3), local invasion and hyperechogenicity (OR 0.2; CI 95% CI 0.03-0.6). Multivariate analysis disclosed microcalcifications (OR 28.1; CI 95% 8.9-89), hypoechogenicity (OR 9.4; 95% CI 1.5-59.5) and irregular borders (OR 4.7; CI 95% 1.5-15) as the variables independently associated with the presence of PTC. The prevalence of PTC in the presence of the three variables was 97.6% (Likelihood ratio (LR) 45) and 5.4% in their absence (LR 0.06). Conclusions: This scale predicts the presence or absence of PTC using simple ultrasound characteristics.
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    Clinical features of 17 patients with familial non medullary thyroid carcinomaCarcinoma familiar del tiroides no medular (CFTNM): Características de presentación en 17 casos
    (2007) Mosso G. L.; Velasco S.; Cardona B.; Fardella C.; González G.; López J.M.; Rodríguez J.A.; Arteaga E.; Salazar I.; Solar A.; González H.; Cruz F.; Mosso G. L.; NCD Risk Factor Collaboration (NCD-RisC)
    Background: Papillary thyroid carcinoma can have familial aggregation. Aim: To compare retrospectively familial non medullary thyroid carcinoma (FNMTC) with sporadic papillary thyroid carcinoma (PTC). Material and methods: Retrospective analysis of medical records of patients with thyroid carcinoma. An index case was defined as a subject with the diagnosis of differentiated thyroid carcinoma with one or more first degree relatives with the same type of cancer. Seventeen such patients were identified and were compared with 352 subjects with PTC. Results: The most common affected relatives were sisters. Patients with FNMTC were younger than those with PTC. No differences were observed in gender, single or multiple foci, thyroid capsule involvement, surgical border involvement, number of affected lymph nodes and coexistence of follicular hyperplasia. Patients with FNMTC had smaller tumors and had a nine times more common association with lymphocytic thyroiditis. Five patients with FNMTC had local recurrence during 4.8 years of follow up. Conclusions: Patients with FNMTC commonly have an associated chronic thyroiditis, are younger and have smaller tumors than patients with PTC.
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    Possible pathogenetic role of 11β-hydroxysteroid dehydrogenase type 1 (11βHSD1) gene polymorphisms in arterial hypertensionRegiones polimórficas del gen 11β-hidroxiesteroide deshidrogenasa tipo 1 (11βHSD1) en hipertensión arterial esencial: Posible rol etiopatogénico
    (2008) Morales M.; Carvajal C.; Ortiz E.; Mosso L.; Artigas R.; Fardella C.; Owen G.; Morales M.; Fardella C.
    Background: Cortisol has been implicated in hypertension and lately reported to be regulated at the pre-receptor level by the 11βHSD1 enzyme, which converts cortisone (E) to cortisol (F). Over expression of this enzyme in adipose tissue could determine an increase in available cortisol that interacts with the mineralocorticoid receptor (MR) in renal, brain and heart tissue, leading to similar hypertensive effects as in 11βHSD2 impaired patients. Several polymorphisms have been reported in HSD11B1 gene (CA15, CA19 and InsA83557), which could modify HSD11B1 gene expression or activity. Aim: To determine the distribution and prevalence of CA15, CA19 and InsA83557 in the HSD11B1 gene, and to correlate these results with biochemical parameters in cortisol/ACTH (HPA) and renin-angiotensin-aldosterone (RAA) axis in patients with essential hypertension (EH). Patients and Methods: We studied 113 EH patients (76 non-obese and 37 obese, with a body mass index >30 kg/m 2) and 30 normotensive adults (NT). In each patient, we measured serum levels of F, E, serum aldosterone (SA), plasma renin activity (PRA), adrenocorticotrophic hormone (ACTH), the urinary free cortisol/creatinine (UFF/Cr), F/ACTH and SA/PRA ratios. Each polymorphism was studied by PCR and 8% polyacrylamide gel electrophoresis. Statistical associations were evaluated by Pearson correlations and the genetic equilibrium by the Hardy-Weinberg (H-W) equation. Results: We found all three polymorphisms in the EH and the NT group, both in genetic equilibrium. In obese essential hypertensives, the CA15 polymorphism showed association with SA/PRA ratio (r =0.189, p =0.012) and F/ACTH (r =0.301, p 0.048); CA19 also showed correlation with F/ACTH in obese EH (r =-0.220, p 0.009). The InsA83557 polymorphism correlated with UFF/Cr in both EH (r =0.206; p =0.03), and in obese EH (r =0.354; p =0.05). Conclusions: The CA15 and CA19 polymorphism correlated with changes in biochemical parameters in HPA and RAA axis of obese essential hypertensives. These changes may result of modifications in the expression of 11βHSD1, leading to increased cortisol and aldosterone levels independent of ACTH and renin control, respectively.
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    Usefulness of intraoperative parathormone measurement to predict surgical cure in primary hyperparathyroidismUtilidad de la PTH intraoperatoria como predictor de curación quirúrgica en hiperparatiroidismo primario
    (2009) Domínguez J.M.; Velasco S.; Arteaga E.; Campusano C.; Fardella C.; López J.M.; Mosso L.; Rodríguez J.A.; González G.; Goñi I.; León A.; González H.; Claure R.
    The aim of the surgical treatment of primary hyperparathyroidism (PHPT) is to achieve its complete cure, evidenced by a normal serum calcium in the postoperative period. Measurement of intraoperative serum parathormone (PTH) can be useful to predict complete cure of the disease. Aim: To assess the usefulness of intraoperative PTH measurement to predict complete cure of PHPT. Material and methods: Serum PTH was measured to all patients operated for PHPT between 2003 and 2008, before and five and ten minutes after the excision of the parathyroid gland causing the disease. The criteria for complete cure were a normal serum calcium at 24 hours and 6 months after surgery and the pathological confirmation of parathyroid gland excision. Results: Eighty eight operated patients, aged 58±15 years (72 females) were studied. Sixty four percent were asymptomatic and their preoperative serum calcium was 11.6±1.2 mg/dl. A normal serum calcium was achieved in 86 patients (98%) at 24 hours and 50 of 52 patients followed for six months (96%). The pathological study disclosed an adenoma in 69 (78%), and multiglandular disease in 16 (18%), a parathyroid cancer in one and a normal gland in one patient. Intraoperative PTH predicted early and definitive cure in 97% and 100% of patients with a single adenoma, respectively. Among patients with multiglandular disease, the predictive figures were 94% and 100%, respectively. Conclusions: Intraoperative PTH measurement efficiently predicts early and definitive surgical cure of PHPT.