Showing papers by "Spyridon N. Karras published in 2013"

Vitamin D in human reproduction: a narrative review

Abstract: Summary Background: Special attention has been given to the effect of vitamin D supplementation on fertility outcomes in both sexes. Aims: The purpose of this narrative review was to elucidate the role of vitamin D in male and female reproduction, providing current evidence from both animal and human studies. Materials and Methods: Using PubMed and Medline, we searched for publications during the last 30 years regarding the role of vitamin D in human reproduction. Results: Accumulating evidence from animal and human studies suggests that vitamin D is involved in many functions of the reproductive system in both genders. In women, vitamin D status has been associated with in vitro fertilization (IVF) outcome, features of polycystic ovarian syndrome (PCOS) and endometriosis. Although several data converge towards a beneficial effect of vitamin D supplementation in metabolic disturbances in women with PCOS, a significant knowledge gap precludes the establishment of a clear cause-effect relationship. In men, vitamin D status has been associated with semen quality and sperm count, motility and morphology. There is evidence for a favourable effect of vitamin D supplementation on semen quality, testosterone concentrations and fertility outcomes. Discussion: Studies with superior methodological characteristics are needed in order to establish a role for vitamin D on the treatment of female and male infertility. Conclusions: Recent data on vitamin D provide new insights in the complex pathogenesis and treatment of infertility.

An observational study reveals that neonatal vitamin D is primarily determined by maternal contributions: implications of a new assay on the roles of vitamin D forms.

Abstract: Vitamin D concentrations during pregnancy are measured to diagnose states of insufficiency or deficiency. The aim of this study is to apply accurate assays of vitamin D forms [single- hydroxylated [25(OH)D2, 25(OH)D3], double-hydroxylated [1α,25(OH)2D2, 1α,25(OH)2D3], epimers [3-epi-25(OH)D2, 3-epi-25(OH)D3] in mothers (serum) and neonates (umbilical cord) to i) explore maternal and neonatal vitamin D biodynamics and ii) to identify maternal predictors of neonatal vitamin D concentrations. All vitamin D forms were quantified in 60 mother- neonate paired samples by a novel liquid chromatography -mass spectrometry (LC-MS/MS) assay. Maternal characteristics [age, ultraviolet B exposure, dietary vitamin D intake, calcium, phosphorus and parathyroid hormone] were recorded. Hierarchical linear regression was used to predict neonatal 25(OH)D concentrations. Mothers had similar concentrations of 25(OH)D2 and 25(OH)D3 forms compared to neonates (17.9 ± 13.2 vs. 15.9 ± 13.6 ng/mL, p = 0.289) with a ratio of 1:3. The epimer concentrations, which contribute approximately 25% to the total vitamin D levels, were similar in mothers and neonates (4.8 ± 7.8 vs. 4.5 ± 4.7 ng/mL, p = 0.556). No correlation was observed in mothers between the levels of the circulating form (25OHD3) and its active form. Neonatal 25(OH)D2 was best predicted by maternal characteristics, whereas 25(OH)D3 was strongly associated to maternal vitamin D forms (R2 = 0.253 vs. 0.076 and R2 = 0.109 vs. 0.478, respectively). Maternal characteristics explained 12.2% of the neonatal 25(OH)D, maternal 25(OH)D concentrations explained 32.1%, while epimers contributed an additional 11.9%. By applying a novel highly specific vitamin D assay, the present study is the first to quantify 3-epi-25(OH)D concentrations in mother - newborn pairs. This accurate assay highlights a considerable proportion of vitamin D exists as epimers and a lack of correlation between the circulating and active forms. These results highlight the need for accurate measurements to appraise vitamin D status. Maternal characteristics and circulating forms of vitamin D, along with their epimers explain 56% of neonate vitamin D concentrations. The roles of active and epimer forms in the maternal - neonatal vitamin D relationship warrant further investigation.

Pharmacokinetic evaluation of cabozantinib for the treatment of thyroid cancer

Abstract: Introduction: Conventional treatment modalities for thyroid cancer lead to complete remission in only one-third of patients with distant metastases. On the other hand, medullary thyroid cancer (MTC) and anaplastic thyroid cancer (ATC), although rare, are responsible for a significant percentage of thyroid cancer-related deaths. New treatments are needed to treat such patients Areas covered: The aim of this review is to provide the latest information on cabozantinib (CBZ), a new tyrosine kinase inhibitor (TKI) that is currently used mainly as a treatment of MTC. The authors collated data that were retrieved from a PubMed literature search. Expert opinion: CBZ targets multiple cell-signaling pathways involved in the molecular pathogenesis of thyroid cancer. These are namely VEGF receptor-2, hepatocyte growth factor receptor and rearranged during transfection receptor. Furthermore, it is a drug which may be used in cases where conventional therapies (mainly for MTC) are proved ineffective or have shown poor ...

The effect of monthly ibandronate on bone mineral density and bone turnover markers in patients with haemophilia A and B and increased risk for fracture

Abstract: Haemophilia A and B have been associated with increased prevalence of low bone mineral density (BMD). However, no study has so far evaluated the effects of anti-osteoporotic therapy on BMD in haemophilia.The primary endpoint of this prospective study was to estimate the effect of 12-month therapy of oral ibandronate 150 mg/month on BMD in patients with haemophilia A and B. Secondary endpoint was its effect on turnover markers (BTM) of bone resorption [serum C-terminal telopeptide of type 1 collagen (sCTX), tartrate-resistant acid phosphatase band 5b] and bone formation (osteocalcin and bone-specific alkaline phosphatase. Ten adult patients with T-score < –2.5 SD or Z-score < –2 and/or increased risk of fracture according to FRAX model were included. All received 1,000 mg/day calcium carbonate with 800 IU/d cholecalciferol. Males with haemophilia A (n=7) or B (n=3) (mean age 43.5 ± 13.5 years) were studied. Ibandronate resulted in an increase in lumbar BMD (from 0.886 ± 0.169 to 0.927 ± 0.176 g/cm2, 4.7%, p=0.004). No change in BMD of total hip (from 0.717 ± 0.128 to 0.729 ± 0.153 g/cm2, p=0.963) or femoral neck (0.741 ± 0.135 to 0.761 ± 0.146 g/cm2, p=0.952) was noticed. Ibandronate led to a decrease in sCTX (from 0.520 ± 0.243 to 0.347 ± 0.230 ng/ml, –29.9%, p=0.042). No change was observed in other BTM. Ibandronate was generally well-tolerated. In conclusion, ibandronate significantly improved BMD in lumbar spine and reduced bone resorption in adults with haemophilia at increased risk of fracture. Its effect on hip BMD and bone formation markers was not significant.

Thyroid papillary carcinoma arising in ectopic thyroid tissue within a branchial cleft cyst

Abstract: Ectopic thyroid tissue comprises a rare clinical entity which can clinically manifest with the whole spectrum of thyroid disorders, including thyroid malignancy. Thyroid carcinoma arising in ectopic thyroid tissue is extremely rare, with only a few cases described in the literature so far. We present a very unusual case of a primary papillary thyroid carcinoma arising in a left lateral branchial cyst, describing our diagnostic and therapeutic approach for this uncommon clinical entity. This is the first case where recombinant thyrotropin was used along with radioiodine treatment in primary ectopic thyroid cancer.

Severe eyelid oedema in Graves’ ophthalmopathy

Abstract: We report a case of severe eyelid oedema due to Graves’ ophthalmopathy (GO). The aim was to present a case report and review of the literature about eyelid oedema due to GO. The case report includes a history of patient data and literature review. The patient was offered intravenous methylprednisolone and gave consent. A dosage of 500 mg intravenous methylprednisolone once weekly for 6 weeks, followed by 250 mg intravenous methylprednisolone once weekly for 6 weeks, with a total treatment period of 12 weeks was given. Up to day, minor improvement has been observed. Severe eyelid oedema due to GO is a rare manifestation of Graves’ disease. In cases of active and moderate-to-severe disease, treatment with intravenous glucorticoids is recommended alone or with orbital radiotherapy, followed by rehabilitative surgery.

EDITORIAL: Is the Beneficial Effect of Mediterranean Diet on Cardiovascular Risk Partly Mediated through Better Blood Pressure Control?

Abstract: 1 Endocrinology Clinic, Hippocration Hospital, Thessaloniki, Greece; 2 Department of Internal Medicine, Military Hospital of Thessaloniki, Thessaloniki, Greece; 3 Second Prop. Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki, Greece; 4 Department of Endocrinology and Metabolism, Agios Pavlos Hospital, Thessaloniki, Greece

Vitamin D deficiency in patients with haemophilia: an underestimated commorbidity.

Abstract: the operation. Decreased doses of Haemate P were continued until the next operation. Prophylactic low molecular weight heparin was started after operation and continued to prevent deep vein thrombosis. Seven days after the first surgery we proceeded with the left side. Smith & Nephew reflection 46 mm OD acetabular cup with two screws was used with an anterolateral approach. At femoral side, Smith & Nephew synergy size 11 prosthesis with press-fit technique was used. The previous protocol for factor infusion was repeated and continued a total of 11 days. Patient was transfused with two units of packed RBCs during operation. Hypotensive anaesthesia was obtained to decrease bleeding and cell saver was used at both surgeries. Patient was mobilized 72 h after the first and 48 h after the second operation. Patient was discharged 6 days after the second operation with Haemate P prophylaxis. She started walking without crutches 6 weeks after the operation with the support of physical therapy (Fig. 1b). In conclusion, we report management of a bilateral hip replacement in a patient with type 3 VWD and DDH. Severe degenerative arthritis of both hips developed in this patient secondary to coincidental coexistence of bilateral DDH. To our knowledge this is the first report of a patient with DDH and VWD in the literature. There were no intraoperative or postoperative complications observed. Blood loss was in expected limits and there was no thrombosis. The patient was discharged 6 days after her second surgery and had an excellent result in terms of mobility and pain. We believe that the success of the procedure relied on multidisciplinary team work of managing the patient and developing a perioperative strategy based on close clinical monitoring. A long-term follow-up is needed for the final result of the case.

Thyroid Dysfunction and Arterial Stiffness. Does the Restoration of Thyroid Function Tests Offer any Benefit

Abstract: A growing body of evidence suggests that hypothyroidism and hyperthyroidism, either as overt or subclinical states, are associated with increased risk for cardiovascular disease (CVD). Except for the increased prevalence of lipid disorders, coagulation abnormalities, endothelial dysfunction, cardiac arrhythmias, ventricular hypertrophy and hyperten- sion have been proposed as the most plausible pathways for this association, increased arterial stiffness (AS) may also play a role. Increased AS has emerged recently as an early indicator of CVD in various studies. On the other hand, thyroid dysfunction, mainly hypothyroidism (overt and subclinical) seems to be associated with increased AS, although data are heterogeneous, emerging from different populations, with various methodologies of AS assessment and with variable pe- riods of observation. Restoration of thyroid function with L-thyroxin replacement seems to reverse AS parameters, whereas data on the effect of normalization of thyroid function in hyperthyroidism on AS are inconsistent. The present re- view provides insights on the association between AS and thyroid dysfunction and discusses the available data about po- tential benefits of the restoration of thyroid function on AS.

Neck abscess associated with a piriform fossa sinus tract in an adult.

Abstract: Perithyroidal inflammatory masses deriving from developmental remnants of the 3rd and 4th brancial pouches are rare. We report a case of an otherwise healthy 31-year-old man, who presented with fever and swelling of the left side of the neck. Neck ultrasound showed a displaced left thyroid lobe with induration of the strap muscles. Fine-needle aspiration biopsy revealed pus, positive for Staphylococcus aureus species. Antibiotic treatment led to rapid clinical improvement and reversal of imaging features, without the need for surgical intervention. This rare clinical entity should be always considered in the differential diagnosis of an inflammatory neck mass.

Recombinant Human Thyrotropin-Aided Radioiodine Therapy in Tracheal Obstruction by an Invading Well-Differentiated Thyroid Carcinoma

Abstract: Papillary thyroid carcinomas (PTCs) usually extend to lymph nodes in the neck and mediastinum. Rarely, they invade the neighboring upper airway anatomical structures. We report a 56-year-old woman who presented with symptoms of upper airway obstruction. Imaging studies revealed a lesion derived from the thyroid which invaded and obstructed the trachea, which appeared to be a highly differentiated PTC. Total thyroidectomy was performed, with removal of the endotracheal part of the mass along with the corresponding anterior tracheal rings. Two months later, a whole body I131 scan after recombinant human thyroid-stimulating hormone (rh-TSH) administration was performed and revealed a residual mass in upper left thyroid lobe. Subsequently, 150 mCi I131 were given following rh-TSH administration. Nine months later, there was no sign of residual tumor. This case is the first one reported in the literature regarding rh-TSH administration prior to RAI ablation in a PTC obstructing the trachea.