Early detection of biochemically occult autonomous thyroid nodules

Objective: Autonomously functioning thyroid areas may be associated with subclinical or overt hyperthyroidism, but may exist even in the presence of normal TSH. This study was aimed at comparing the rate of autonomously functioning areas and their cardiac sequelae in patients with nodular goitre studied with the usual and a novel approach. Design and methods: In total 490 adult outpatients with thyroid nodular goitre, living in a mild iodine-deficient area, were selected in our referral centre for thyroid diseases from 2009 to 2014 on the basis of a suspicion of thyroid functional autonomy. They were divided in three groups according to a non-conventional approach (excessive response to thyroxine treatment: group 1) or conventional approach (low/normal TSH with clinical suspicion or low TSH: groups 2 and 3). All patients of the study with the suspicion of thyroid functional autonomy underwent thyroid scan with radioactive iodine (I131) uptake (RAIU). Results: The percentage of confirmed thyroid functional autonomy was 319/490, being significantly higher in group 3 than in groups 1 and 2 (81.5 vs 64.7 vs 52.6%; chi-square P < 0.0001). However, the diagnosis with non-conventional approach was made at a significant earlier age (P < 0.0001). Cardiac arrhythmias as well as atrial fibrillation were similarly detected by conventional and non-conventional approaches (chi-square test: P = 0.2537; P = 0.8425). Conclusions: The hyper-responsiveness to thyroxine treatment should induce the suspicion of thyroid functional autonomy at an early stage, allowing to detect autonomous functioning areas in apparently euthyroid patients

Hashimoto's thyroiditis and autoimmune gastritis

The term "thyrogastric syndrome" defines the association between autoimmune thyroid disease and chronic autoimmune gastritis (CAG), and it was first described in the early 1960s. More recently, this association has been included in polyglandular autoimmune syndrome type IIIb, in which autoimmune thyroiditis represents the pivotal disorder. Hashimoto's thyroiditis (HT) is the most frequent autoimmune disease, and it has been reported to be associated with gastric disorders in 10-40% of patients while about 40% of patients with autoimmune gastritis also present HT. Some intriguing similarities have been described about the pathogenic mechanism of these two disorders, involving a complex interaction among genetic, embryological, immunologic, and environmental factors. CAG is characterized by a partial or total disappearance of parietal cells implying the impairment of both hydrochloric acid and intrinsic factor production. The clinical outcome of this gastric damage is the occurrence of a hypochlorhydric-dependent iron-deficient anemia, followed by pernicious anemia concomitant with the progression to a severe gastric atrophy. Malabsorption of levothyroxine may occur as well. We have briefly summarized in this minireview the most recent achievements on this peculiar association of diseases that, in the last years, have been increasingly diagnosed

A case report of thyroid carcinoma confined to ovary and concurrently occult in the thyroid. Is conservative treatment always advised?

Introduction: Struma ovarii is an ovarian teratoma, represented in more than 50% by thyroid tissue. Five percent of struma ovarii cases have been proven to be malignant and, as in the thyroid gland, papillary thyroid carcinoma is the most common histotype arising in struma ovarii. Because of the unusual occurrence of this tumor, its management and follow-up after pelvic surgery is still controversial. Usually, total thyroidectomy followed by radioiodine treatment is the choice treatment in metastatic malignant struma ovarii, while these procedures are still controversial in non-metastatic thyroid cancer arising in struma ovarii. Case Presentation: We report a female with follicular variant of papillary thyroid carcinoma arising in struma ovarii. After pelvic surgery, thyroid morphofunctional examinations were performed and a single nodular lesion in the left lobe was discovered. The patient underwent total thyroidectomy and histological examination showed a papillary carcinoma. Radioiodine-ablation of residual thyroid tissue was performed and levothyroxine mildly-suppressive treatment was started. Conclusions: A more aggressive treatment should not be denied for malignant struma ovarii without any evidence, even when apparently confined into the ovary. However, in selected cases, aggressive treatment may be advisable to decrease the risk of recurrence and to allow an accurate follow-up

Viscous-Inviscid Interactions in a Boundary-Layer Flow Induced by a Vortex Array

In this paper we investigate the asymptotic validity of boundary layer theory. For a flow induced by a periodic row of point-vortices, we compare Prandtl's solution to Navier-Stokes solutions at different $Re$ numbers. We show how Prandtl's solution develops a finite time separation singularity. On the other hand Navier-Stokes solution is characterized by the presence of two kinds of viscous-inviscid interactions between the boundary layer and the outer flow. These interactions can be detected by the analysis of the enstrophy and of the pressure gradient on the wall. Moreover we apply the complex singularity tracking method to Prandtl and Navier-Stokes solutions and analyze the previous interactions from a different perspective

Wavefront invasion for a chemotaxis model of Multiple Sclerosis

In this work we study wavefront propagation for a chemotaxis reaction-diffusion system describing the demyelination in Multiple Sclerosis. Through a weakly non linear analysis, we obtain the Ginzburg–Landau equation governing the evolution of the amplitude of the pattern. We validate the analytical findings through numerical simulations. We show the existence of traveling wavefronts connecting two different steady solutions of the equations. The proposed model reproduces the progression of the disease as a wave: for values of the chemotactic parameter below threshold, the wave leaves behind a homogeneous plaque of apoptotic oligodendrocytes. For values of the chemotactic coefficient above threshold, the model reproduces the formation of propagating concentric rings of demyelinated zones, typical of Baló’s sclerosis

Gleam: the GLAST Large Area Telescope Simulation Framework

This paper presents the simulation of the GLAST high energy gamma-ray telescope. The simulation package, written in C++, is based on the Geant4 toolkit, and it is integrated into a general framework used to process events. A detailed simulation of the electronic signals inside Silicon detectors has been provided and it is used for the particle tracking, which is handled by a dedicated software. A unique repository for the geometrical description of the detector has been realized using the XML language and a C++ library to access this information has been designed and implemented.Comment: 10 pages, Late

L'influenza delle semantiche familiari sul processo di coming out

Affrontare il tema del coming out impone l’utilizzo di una prospettiva complessa, che non si limiti a studiarne solamente alcune fasi, ma che lo consideri come un processo non lineare, dinamico, influenzato da molteplici aspetti, prevalentemente relazionali. Gli studi più recenti sull’omosessualità riguardano infatti le modalità con cui le persone costruiscono la propria identità omosessuale nel contesto sociale e familiare. L’obiettivo di questa tesi è quello di individuare l’influenza che le semantiche familiari esercitano sull’intero processo di coming out. E’ stato possibile riscontrare che le semantiche familiari individuate da Ugazio (2012) portino in effetti a traiettorie specifiche e differenti tra loro, come emerso dalle fantasie e i comportamenti erotici, dalla definizione che l’individuo dà di sé rispetto alla propria sessualità, dal grado di coerenza tra queste due variabili, dal livello di omofobia interiorizzata, dalle reazioni attese dai genitori al momento dello svelamento in casa e dalle preoccupazioni dei genitori successivamente alla dichiarazione del figlio. La semantica della libertà, con i suoi valori ed emozioni, sembra rendere il processo di coming out più semplice rispetto alle altre semantiche. Risultati significativi emergono anche in relazione all’assunzione di un positioning più vicino e simile a quello paterno, che invece renderebbe più difficile il processo che va dalla consapevolezza della propria omosessualità allo svelamento in famiglia. Studi futuri, con un campione maggiormente esteso, potranno avvalorare tale tesi e concedere dunque importanti contributi in campo clinico.Face the topic of coming out requires the use of a complex perspective, which is not limited to examining only some stages, but consider it as a non-linear, dynamic process, influenced by several aspects, primarily relational. The latest studies on homosexuality in fact relate to the manner in which people construct their homosexual identity in the social context and family. The aim of this thesis is to identify the influence that family semantic exercise over the whole coming out process. It was noted that family semantic identified by Ugazio (2012) bring in specific trajectories effects and different from each other, as shown by the fantasies and erotic behavior, from the definition that the individual gives himself over to their sexuality, the degree of consistency between these two variables, the level of homophobia, from the expected reactions from parents at the time of the unveiling at home and the parents' concern after the son's statement. The semantics of freedom, with its values and emotions, seems to make the process of coming out easier than other semantic. Significant results also emerge in relation to the assumption of a positioning closer and similar to the father, who instead make it more difficult the process from awareness of his homosexuality to the unveiling family. Future studies, with a more extensive sample, will corroborate this argument and thus provide important contributions in the clinical field