Stan Van Uum - Academia.edu (original) (raw)
Papers by Stan Van Uum
Thyroid, Jun 1, 2020
Background: Well-differentiated thyroid cancer (DTC) presents at a more advanced stage in men tha... more Background: Well-differentiated thyroid cancer (DTC) presents at a more advanced stage in men than in women, and the mortality in men is higher than that in women. However, it is not clear whether DTC recurrence is affected by sex independent of stage at presentation. The objective of the present study was to assess if male sex is an independent risk factor for recurrence of DTC. Methods: The Canadian Collaborative Network for Cancer of the Thyroid (CANNECT) is a collaborative registry to describe patterns of care for thyroid cancer. We included patients from the CANNECT registry with DTC diagnosed at age 18 or older between 2000 and 2010. We compared men and women with respect to presentation, management, and recurrence risk, stratified for American Joint Committee on Cancer (AJCC) stage. Results: We included 2595 patients, 2067 (79.7%) women and 528 (20.3%) men. Men presented with more advanced AJCC stage (p < 0.001), T stage (p < 0.001), N stage (p < 0.001), and M stage (p = 0.002) There was no difference in follow-up duration between women (7.7-4.0 [meanstandard deviation] years) and men (7.7-4.0 years, p = 0.985). Overall recurrence was 2.2% (n = 46) for women and 8.5% (n = 45) for men (p < 0.001). In multivariate analysis adjusted for AJCC stage, men were at significantly greater risk for DTC recurrence than women (adjusted hazard ratio 2.72 [95% confidence interval [CI] 1.78-4.20]; p < 0.001). In multivariate analysis adjusted for tumor-node-metastasis (TNM) stage, men were at significantly greater risk for DTC recurrence than women (adjusted hazard ratio 2.31 [CI 1.48-3.60]; p < 0.001). Conclusions: Our study confirms that the risk for recurrence of DTC is higher in men than in women. Although men tend to present with more advanced-stage disease, the difference in recurrence risk persists when adjusted for stage of presentation. It needs to be determined whether sex should influence follow-up intensity and/or duration.
Journal of Neuro-ophthalmology, May 11, 2023
Blood, Oct 1, 2000
In a collaborative multicenter case-control study, we investigated the effect of factor V Leiden ... more In a collaborative multicenter case-control study, we investigated the effect of factor V Leiden mutation, prothrombin gene mutation, and inherited deficiencies of protein C, protein S, and antithrombin on the risk of Budd-Chiari syndrome (BCS) and portal vein thrombosis (PVT). We compared 43 BCS patients and 92 PVT patients with 474 population-based controls. The relative risk of BCS was 11.3 (95% CI 4.8-26.5) for individuals with factor V Leiden mutation, 2.1(95% CI 0.4-9.6) for those with prothrombin gene mutation, and 6.8 (95% CI 1.9-24.4) for those with protein C deficiency. The relative risk of PVT was 2.7 (95% CI 1.1-6.9) for individuals with factor V Leiden mutation, 1.4 (95% CI 0.4-5.2) for those with prothrombin gene mutation, and 4.6 (95% CI 1.5-14.1) for those with protein C deficiency. The relative risk of BCS or PVT was not increased in the presence of inherited protein S or antithrombin deficiency. Concurrence of either acquired or inherited thrombotic risk factors was observed in 26% of the BCS patients and 37% of the PVT patients. We conclude that factor V Leiden mutation and hereditary protein C deficiency appear to be important risk factors for BCS and PVT. Although the prevalence of the prothrombin gene mutation was increased, it was not found to be a significant risk factor for BCS and PVT. The coexistence of thrombogenic risk factors in many patients indicates that BCS and PVT can be the result of a combined effect of different pathogenetic mechanisms.
Journal of the Endocrine Society, May 1, 2021
Item does not contain fulltex
Journal of Bone and Mineral Research, Oct 31, 2022
ABSTRACTHypoparathyroidism (HypoPT) is a rare disorder characterized by hypocalcemia in the prese... more ABSTRACTHypoparathyroidism (HypoPT) is a rare disorder characterized by hypocalcemia in the presence of a low or inappropriately normal parathyroid hormone level. HypoPT is most commonly seen after neck surgery, which accounts for approximately 75% of cases, whereas approximately 25% have HypoPT due to nonsurgical causes. In both groups of patients, conventional therapy includes calcium and active vitamin D analogue therapy aiming to maintain serum calcium concentration in the low normal or just below the normal reference range and normalize serum phosphorus, magnesium concentrations, and urine calcium levels. The limitations of conventional therapy include wide fluctuations in serum calcium, high pill burden, poor quality of life, and renal complications. Parathyroid hormone (PTH) replacement therapy may improve the biochemical profile in those in whom conventional therapy proves unsatisfactory. Based on a systematic review and meta‐analysis of the literature, the panel made a graded recommendation suggesting conventional therapy as first line therapy rather than administration of PTH (weak recommendation, low quality evidence). When conventional therapy is deemed unsatisfactory, the panel considers use of PTH. Because pregnancy and lactation are associated with changes in calcium homeostasis, close monitoring is required during these periods with appropriate adjustment of calcium and active vitamin D analogue therapy to ensure that serum calcium remains in the mid to low normal reference range in order to avoid maternal and fetal complications. Emerging therapies include molecules with prolonged PTH action as well as different mechanisms of action that may significantly enhance drug efficacy and safety. © 2022 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).
Journal of Vision, Sep 1, 2015
Patients suffering from pituitary macroadenomas - pituitary tumors larger than 10mm - often have ... more Patients suffering from pituitary macroadenomas - pituitary tumors larger than 10mm - often have visual deficits, typically bilateral hemianopsia, because of chiasmal compression. Treatment of macroadenomas is usually successful, and thus such patients provide a unique opportunity for studying neuroplasticity in the human visual system and its consequences for vision. This case study focuses on patient BS, a 48-year-old man, who had a large prolactinoma, a common pituitary tumor, and, as a consequence, a severe visual field loss. We used functional magnetic resonance imaging (fMRI) to map the retinotopic organization of primary visual cortex (V1) of patient BS before and after successful treatment of his prolactinoma with cabergoline over the course of 13 months. In addition, we used the same fMRI protocol to examine the organization of V1 in a healthy age- and gender-matched control participant with normal vision. Humphrey's perimetry was used to assess the integrity of the visual fields, before and after the completion of treatment for patient BS, and over two successive scans in the healthy control. The Humphrey field exam revealed significant visual improvement after treatment and this recovery was accompanied by substantial changes in V1 activation. Before the start of treatment, the amount of cortical tissue in V1 which was activated by the retinotopic stimuli was only 21% that of the healthy control participant. After treatment, the amount of activation normalized to approximately 90% of that of the control participant. The organization of retinotopic representations in V1 also normalized after treatment. These results illustrate that the visual system is capable of repair following conservative medical treatment, opening the door for assessing the effects of compression on different components of the optic nerve and tract. Meeting abstract presented at VSS 2015.
![Research paper thumbnail of [Generalized histoplasmosis due to endogenous reactivation of a latent infection in an HIV-seronegative man]](https://attachments.academia-assets.com/110560288/thumbnails/1.jpg)
](PubMed, Jul 15, 1995
A 63-year-old, Dutch, HIV-seronegative man presented with anal pain and itch of 6 months' duratio... more A 63-year-old, Dutch, HIV-seronegative man presented with anal pain and itch of 6 months' duration, a perianal ulcer and a solitary colon ulcer. Crohn's disease was suspected; the patient was treated with corticosteroids, but later died. Autopsy revealed disseminated histoplasmosis, a fungal disease rare in the Netherlands. The patient had visited Honduras. This case report illustrates that disseminated histoplasmosis may mimic Crohn's disease leading to a delay in the diagnosis.
Journal of Bone and Mineral Research, Nov 14, 2022
ABSTRACTChronic hypoparathyroidism (HypoPT) is associated with significant morbidity and impaired... more ABSTRACTChronic hypoparathyroidism (HypoPT) is associated with significant morbidity and impaired quality of life (QoL). The goals of management for chronic HypoPT include improvement in QoL and the prevention of both hypo‐ and hypercalcemia symptoms and long‐term complications. Several groups have provided consensus statements and guidelines on the management of HypoPT; however, due to limited evidence, these recommendations have largely been based on literature reviews, expert opinion, and consensus statements. The objective of this study was to use a systematic approach to describe current practice for the initial assessment and follow‐up of patients with chronic HypoPT. We developed a survey asking experts in the field to select the responses that best reflect their current practice. The survey found no differences in responses between nonsurgical and postsurgical patient assessment. For new patients, respondents usually performed an assessment of serum lab profile (calcium [either albumin‐adjusted or ionized], magnesium, creatinine, phosphate, 25‐hydroxyvitamin D), 24‐hour urine (creatinine, calcium), and a renal ultrasound to evaluate for the presence of nephrocalcinosis or nephrolithiasis. For follow‐up patients, most respondents perform blood tests and urine tests every 6 months or less frequently. The reported clinical practice patterns for monitoring for complications of chronic HypoPT vary considerably among respondents. Based on the responses in this systematic expert practice survey, we provide practice suggestions for initial assessment and follow‐up of patients with chronic HypoPT. In addition, we highlight areas with significant variation in practice and identify important areas for future research. © 2022 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).
Current Oncology, Jun 1, 2010
Well-differentiated neuroendocrine tumours (netspreviously called "carcinoid tumours") are relati... more Well-differentiated neuroendocrine tumours (netspreviously called "carcinoid tumours") are relatively rare tumours originating from the diffuse neuroendocrine system; they are found most often in the bronchial or gastrointestinal systems. In Canada, gastroenterohepatic nets represent less than 0.25% of oncology cases. Because of the relative rarity of these tumours, diagnostic and therapeutic approaches vary and are often based on individual physician experience. A number of European and North American groups have developed consensus guidelines for the diagnosis and management of well-differentiated gastroenterohepatic nets, and in 2006, Canadian consensus guidelines were published by a Canadian expert group. The updated and expanded current Canadian guidelines are based on a consensus meeting held in Paris, France, in 2008 and are based on the most current literature.
American Journal of Epidemiology, Apr 10, 2009
The authors investigated a large number of stressors and measures of psychological distress in a ... more The authors investigated a large number of stressors and measures of psychological distress in a multicenter, prospective cohort study of spontaneous preterm birth among 5,337 Montreal (Canada)-area women who delivered from October 1999 to April 2004. In addition, a nested case-control analysis (207 cases, 444 controls) was used to explore potential biologic pathways by analyzing maternal plasma corticotrophin-releasing hormone (CRH), placental histopathology, and (in a subset) maternal hair cortisol. Among the large number of stress and distress measures studied, only pregnancy-related anxiety was consistently and independently associated with spontaneous preterm birth (for values above the median, adjusted odds ratio ¼ 1.8 (95% confidence interval: 1.3, 2.4)), with a dose-response relation across quartiles. The maternal plasma CRH concentration was significantly higher in cases than in controls in crude analyses but not after adjustment (for concentrations above the median, adjusted odds ratio ¼ 1.1 (95% confidence interval: 0.8, 1.6)). In the subgroup (n ¼ 117) of participants with a sufficient maternal hair sample, hair cortisol was positively associated with gestational age. Neither maternal plasma CRH, hair cortisol, nor placental histopathologic features of infection/inflammation, infarction, or maternal vasculopathy were significantly associated with pregnancy-related anxiety or any other stress or distress measure. The biologic pathways underlying stress-induced preterm birth remain poorly understood.
The Lancet Diabetes & Endocrinology, 2020
ΤAs the use of opioids is becoming a global epidemic and has led to a rise in expanding, so has t... more ΤAs the use of opioids is becoming a global epidemic and has led to a rise in expanding, so has the occurrence and recognition of their impact consequences on the endocrine system. Nonetheless, opioid-induced endocrinopathies still remain under-diagnosed, mainly due to symptom under-reporting by patients and lack of awareness in clinicians. Hypogonadism is the most well recognised consequence but These include hypogonadism, inhibitory effects on the hypothalamo-pituitary-adrenal axis and negative impact on bone health also require attention.. Hyperprolactinaemia may also be detected, whereas, clinically relevant thyroid dysfunction has not been identified. EThe effects on other hormones have not been as yet clearly defined. At present, consensus or evidence-based guidelines on how to diagnose and manage these endocrinopathies are lacking. ANonetheless, assessment of gonadal and adrenal function (particularly if in the presence of high index of clinical suspicion), and, as well as evaluation of bone health are advised in these patients. Discontinuation or reduction of the opioid dose and appropriate hormone replacement are management approaches for hypogonadism and hypoadrenalism. Further research is needed to fully elucidate the impact of opioids at all levels of the endocrine system and the optimal management of their consequences.Further research facilitating the development of evidence-based guidelines on the diagnosis and optimal management of opioid-induced endocrinopathies is eagerly awaited.
Journal of Oncology, 2016
Introduction. Recombinant human thyroid stimulating hormone (rhTSH) is approved for preparation o... more Introduction. Recombinant human thyroid stimulating hormone (rhTSH) is approved for preparation of thyroid remnant ablation with radioactive iodine (RAI) in low risk patients with well differentiated thyroid cancer (DTC). We studied the safety and efficacy of rhTSH preparation for RAI treatment of thyroid cancer patients with nodal metastatic disease. Methods. A retrospective analysis was performed on 108 patients with histopathologically confirmed nodal metastatic DTC, treated with initial RAI between January 1, 2000, and December 31, 2007. Within this selected group, 31 and 42 patients were prepared for initial and all subsequent RAI treatments by either thyroid hormone withdrawal (THW) or rhTSH protocols and were followed up for at least 3 years. Results. The response to initial treatment, classified as excellent, acceptable, or incomplete, was not different between the rhTSH group (57%, 21%, and 21%, resp.) and the THW group (39%, 13%, and 48%, resp.; = 0.052). There was no significant difference in the final clinical outcome between the groups. The rhTSH group received significantly fewer additional doses of RAI than the THW group (= 0.03). Conclusion. In patients with nodal-positive DTC, preparation for RAI with rhTSH is a safe and efficacious alternative to THW protocol.
Scientific Reports, Dec 4, 2020
The dynamics of cerebral blood flow (CBF) at the onset of hypoglycemia may play a key role in hyp... more The dynamics of cerebral blood flow (CBF) at the onset of hypoglycemia may play a key role in hypoglycemia unawareness; however, there is currently a paucity of techniques that can monitor adult CBF with high temporal resolution. Herein, we investigated the use of diffuse correlation spectroscopy (DCS) to monitor the dynamics of CBF during insulin-induced hypoglycemia in adults. Plasma glucose concentrations, cortisol levels, and changes in CBF were measured before and during hypoglycemia in 8 healthy subjects. Cerebral blood flow increased by 42% following insulin injection with a delay of 17 ± 10 min, while the onset of hypoglycemia symptoms was delayed by 24 ± 11 min. The findings suggest that the onset of CBF increments precedes the appearance of hypoglycemia symptoms in nondiabetic subjects with normal awareness to hypoglycemia, and DCS could be a valuable tool for investigating the role of CBF in hypoglycemia unawareness.
Annals of Internal Medicine: Clinical Cases, 2023
Circulation, Nov 3, 2009
Adenylyl cyclase (ADCY) is a critical regulator of metabolic and cardiovascular function. The phe... more Adenylyl cyclase (ADCY) is a critical regulator of metabolic and cardiovascular function. The phenotypic effect of a recently discovered hyper-functional ADCY6 S674 variant is unclear. The hypothes...
The FASEB Journal, Apr 1, 2013
Journal of Neurology, Neurosurgery, and Psychiatry, Oct 1, 2004
Thyroid, Jun 1, 2020
Background: Well-differentiated thyroid cancer (DTC) presents at a more advanced stage in men tha... more Background: Well-differentiated thyroid cancer (DTC) presents at a more advanced stage in men than in women, and the mortality in men is higher than that in women. However, it is not clear whether DTC recurrence is affected by sex independent of stage at presentation. The objective of the present study was to assess if male sex is an independent risk factor for recurrence of DTC. Methods: The Canadian Collaborative Network for Cancer of the Thyroid (CANNECT) is a collaborative registry to describe patterns of care for thyroid cancer. We included patients from the CANNECT registry with DTC diagnosed at age 18 or older between 2000 and 2010. We compared men and women with respect to presentation, management, and recurrence risk, stratified for American Joint Committee on Cancer (AJCC) stage. Results: We included 2595 patients, 2067 (79.7%) women and 528 (20.3%) men. Men presented with more advanced AJCC stage (p < 0.001), T stage (p < 0.001), N stage (p < 0.001), and M stage (p = 0.002) There was no difference in follow-up duration between women (7.7-4.0 [meanstandard deviation] years) and men (7.7-4.0 years, p = 0.985). Overall recurrence was 2.2% (n = 46) for women and 8.5% (n = 45) for men (p < 0.001). In multivariate analysis adjusted for AJCC stage, men were at significantly greater risk for DTC recurrence than women (adjusted hazard ratio 2.72 [95% confidence interval [CI] 1.78-4.20]; p < 0.001). In multivariate analysis adjusted for tumor-node-metastasis (TNM) stage, men were at significantly greater risk for DTC recurrence than women (adjusted hazard ratio 2.31 [CI 1.48-3.60]; p < 0.001). Conclusions: Our study confirms that the risk for recurrence of DTC is higher in men than in women. Although men tend to present with more advanced-stage disease, the difference in recurrence risk persists when adjusted for stage of presentation. It needs to be determined whether sex should influence follow-up intensity and/or duration.
Journal of Neuro-ophthalmology, May 11, 2023
Blood, Oct 1, 2000
In a collaborative multicenter case-control study, we investigated the effect of factor V Leiden ... more In a collaborative multicenter case-control study, we investigated the effect of factor V Leiden mutation, prothrombin gene mutation, and inherited deficiencies of protein C, protein S, and antithrombin on the risk of Budd-Chiari syndrome (BCS) and portal vein thrombosis (PVT). We compared 43 BCS patients and 92 PVT patients with 474 population-based controls. The relative risk of BCS was 11.3 (95% CI 4.8-26.5) for individuals with factor V Leiden mutation, 2.1(95% CI 0.4-9.6) for those with prothrombin gene mutation, and 6.8 (95% CI 1.9-24.4) for those with protein C deficiency. The relative risk of PVT was 2.7 (95% CI 1.1-6.9) for individuals with factor V Leiden mutation, 1.4 (95% CI 0.4-5.2) for those with prothrombin gene mutation, and 4.6 (95% CI 1.5-14.1) for those with protein C deficiency. The relative risk of BCS or PVT was not increased in the presence of inherited protein S or antithrombin deficiency. Concurrence of either acquired or inherited thrombotic risk factors was observed in 26% of the BCS patients and 37% of the PVT patients. We conclude that factor V Leiden mutation and hereditary protein C deficiency appear to be important risk factors for BCS and PVT. Although the prevalence of the prothrombin gene mutation was increased, it was not found to be a significant risk factor for BCS and PVT. The coexistence of thrombogenic risk factors in many patients indicates that BCS and PVT can be the result of a combined effect of different pathogenetic mechanisms.
Journal of the Endocrine Society, May 1, 2021
Item does not contain fulltex
Journal of Bone and Mineral Research, Oct 31, 2022
ABSTRACTHypoparathyroidism (HypoPT) is a rare disorder characterized by hypocalcemia in the prese... more ABSTRACTHypoparathyroidism (HypoPT) is a rare disorder characterized by hypocalcemia in the presence of a low or inappropriately normal parathyroid hormone level. HypoPT is most commonly seen after neck surgery, which accounts for approximately 75% of cases, whereas approximately 25% have HypoPT due to nonsurgical causes. In both groups of patients, conventional therapy includes calcium and active vitamin D analogue therapy aiming to maintain serum calcium concentration in the low normal or just below the normal reference range and normalize serum phosphorus, magnesium concentrations, and urine calcium levels. The limitations of conventional therapy include wide fluctuations in serum calcium, high pill burden, poor quality of life, and renal complications. Parathyroid hormone (PTH) replacement therapy may improve the biochemical profile in those in whom conventional therapy proves unsatisfactory. Based on a systematic review and meta‐analysis of the literature, the panel made a graded recommendation suggesting conventional therapy as first line therapy rather than administration of PTH (weak recommendation, low quality evidence). When conventional therapy is deemed unsatisfactory, the panel considers use of PTH. Because pregnancy and lactation are associated with changes in calcium homeostasis, close monitoring is required during these periods with appropriate adjustment of calcium and active vitamin D analogue therapy to ensure that serum calcium remains in the mid to low normal reference range in order to avoid maternal and fetal complications. Emerging therapies include molecules with prolonged PTH action as well as different mechanisms of action that may significantly enhance drug efficacy and safety. © 2022 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).
Journal of Vision, Sep 1, 2015
Patients suffering from pituitary macroadenomas - pituitary tumors larger than 10mm - often have ... more Patients suffering from pituitary macroadenomas - pituitary tumors larger than 10mm - often have visual deficits, typically bilateral hemianopsia, because of chiasmal compression. Treatment of macroadenomas is usually successful, and thus such patients provide a unique opportunity for studying neuroplasticity in the human visual system and its consequences for vision. This case study focuses on patient BS, a 48-year-old man, who had a large prolactinoma, a common pituitary tumor, and, as a consequence, a severe visual field loss. We used functional magnetic resonance imaging (fMRI) to map the retinotopic organization of primary visual cortex (V1) of patient BS before and after successful treatment of his prolactinoma with cabergoline over the course of 13 months. In addition, we used the same fMRI protocol to examine the organization of V1 in a healthy age- and gender-matched control participant with normal vision. Humphrey's perimetry was used to assess the integrity of the visual fields, before and after the completion of treatment for patient BS, and over two successive scans in the healthy control. The Humphrey field exam revealed significant visual improvement after treatment and this recovery was accompanied by substantial changes in V1 activation. Before the start of treatment, the amount of cortical tissue in V1 which was activated by the retinotopic stimuli was only 21% that of the healthy control participant. After treatment, the amount of activation normalized to approximately 90% of that of the control participant. The organization of retinotopic representations in V1 also normalized after treatment. These results illustrate that the visual system is capable of repair following conservative medical treatment, opening the door for assessing the effects of compression on different components of the optic nerve and tract. Meeting abstract presented at VSS 2015.
PubMed, Jul 15, 1995
A 63-year-old, Dutch, HIV-seronegative man presented with anal pain and itch of 6 months' duratio... more A 63-year-old, Dutch, HIV-seronegative man presented with anal pain and itch of 6 months' duration, a perianal ulcer and a solitary colon ulcer. Crohn's disease was suspected; the patient was treated with corticosteroids, but later died. Autopsy revealed disseminated histoplasmosis, a fungal disease rare in the Netherlands. The patient had visited Honduras. This case report illustrates that disseminated histoplasmosis may mimic Crohn's disease leading to a delay in the diagnosis.
Journal of Bone and Mineral Research, Nov 14, 2022
ABSTRACTChronic hypoparathyroidism (HypoPT) is associated with significant morbidity and impaired... more ABSTRACTChronic hypoparathyroidism (HypoPT) is associated with significant morbidity and impaired quality of life (QoL). The goals of management for chronic HypoPT include improvement in QoL and the prevention of both hypo‐ and hypercalcemia symptoms and long‐term complications. Several groups have provided consensus statements and guidelines on the management of HypoPT; however, due to limited evidence, these recommendations have largely been based on literature reviews, expert opinion, and consensus statements. The objective of this study was to use a systematic approach to describe current practice for the initial assessment and follow‐up of patients with chronic HypoPT. We developed a survey asking experts in the field to select the responses that best reflect their current practice. The survey found no differences in responses between nonsurgical and postsurgical patient assessment. For new patients, respondents usually performed an assessment of serum lab profile (calcium [either albumin‐adjusted or ionized], magnesium, creatinine, phosphate, 25‐hydroxyvitamin D), 24‐hour urine (creatinine, calcium), and a renal ultrasound to evaluate for the presence of nephrocalcinosis or nephrolithiasis. For follow‐up patients, most respondents perform blood tests and urine tests every 6 months or less frequently. The reported clinical practice patterns for monitoring for complications of chronic HypoPT vary considerably among respondents. Based on the responses in this systematic expert practice survey, we provide practice suggestions for initial assessment and follow‐up of patients with chronic HypoPT. In addition, we highlight areas with significant variation in practice and identify important areas for future research. © 2022 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).
Current Oncology, Jun 1, 2010
Well-differentiated neuroendocrine tumours (netspreviously called "carcinoid tumours") are relati... more Well-differentiated neuroendocrine tumours (netspreviously called "carcinoid tumours") are relatively rare tumours originating from the diffuse neuroendocrine system; they are found most often in the bronchial or gastrointestinal systems. In Canada, gastroenterohepatic nets represent less than 0.25% of oncology cases. Because of the relative rarity of these tumours, diagnostic and therapeutic approaches vary and are often based on individual physician experience. A number of European and North American groups have developed consensus guidelines for the diagnosis and management of well-differentiated gastroenterohepatic nets, and in 2006, Canadian consensus guidelines were published by a Canadian expert group. The updated and expanded current Canadian guidelines are based on a consensus meeting held in Paris, France, in 2008 and are based on the most current literature.
American Journal of Epidemiology, Apr 10, 2009
The authors investigated a large number of stressors and measures of psychological distress in a ... more The authors investigated a large number of stressors and measures of psychological distress in a multicenter, prospective cohort study of spontaneous preterm birth among 5,337 Montreal (Canada)-area women who delivered from October 1999 to April 2004. In addition, a nested case-control analysis (207 cases, 444 controls) was used to explore potential biologic pathways by analyzing maternal plasma corticotrophin-releasing hormone (CRH), placental histopathology, and (in a subset) maternal hair cortisol. Among the large number of stress and distress measures studied, only pregnancy-related anxiety was consistently and independently associated with spontaneous preterm birth (for values above the median, adjusted odds ratio ¼ 1.8 (95% confidence interval: 1.3, 2.4)), with a dose-response relation across quartiles. The maternal plasma CRH concentration was significantly higher in cases than in controls in crude analyses but not after adjustment (for concentrations above the median, adjusted odds ratio ¼ 1.1 (95% confidence interval: 0.8, 1.6)). In the subgroup (n ¼ 117) of participants with a sufficient maternal hair sample, hair cortisol was positively associated with gestational age. Neither maternal plasma CRH, hair cortisol, nor placental histopathologic features of infection/inflammation, infarction, or maternal vasculopathy were significantly associated with pregnancy-related anxiety or any other stress or distress measure. The biologic pathways underlying stress-induced preterm birth remain poorly understood.
The Lancet Diabetes & Endocrinology, 2020
ΤAs the use of opioids is becoming a global epidemic and has led to a rise in expanding, so has t... more ΤAs the use of opioids is becoming a global epidemic and has led to a rise in expanding, so has the occurrence and recognition of their impact consequences on the endocrine system. Nonetheless, opioid-induced endocrinopathies still remain under-diagnosed, mainly due to symptom under-reporting by patients and lack of awareness in clinicians. Hypogonadism is the most well recognised consequence but These include hypogonadism, inhibitory effects on the hypothalamo-pituitary-adrenal axis and negative impact on bone health also require attention.. Hyperprolactinaemia may also be detected, whereas, clinically relevant thyroid dysfunction has not been identified. EThe effects on other hormones have not been as yet clearly defined. At present, consensus or evidence-based guidelines on how to diagnose and manage these endocrinopathies are lacking. ANonetheless, assessment of gonadal and adrenal function (particularly if in the presence of high index of clinical suspicion), and, as well as evaluation of bone health are advised in these patients. Discontinuation or reduction of the opioid dose and appropriate hormone replacement are management approaches for hypogonadism and hypoadrenalism. Further research is needed to fully elucidate the impact of opioids at all levels of the endocrine system and the optimal management of their consequences.Further research facilitating the development of evidence-based guidelines on the diagnosis and optimal management of opioid-induced endocrinopathies is eagerly awaited.
Journal of Oncology, 2016
Introduction. Recombinant human thyroid stimulating hormone (rhTSH) is approved for preparation o... more Introduction. Recombinant human thyroid stimulating hormone (rhTSH) is approved for preparation of thyroid remnant ablation with radioactive iodine (RAI) in low risk patients with well differentiated thyroid cancer (DTC). We studied the safety and efficacy of rhTSH preparation for RAI treatment of thyroid cancer patients with nodal metastatic disease. Methods. A retrospective analysis was performed on 108 patients with histopathologically confirmed nodal metastatic DTC, treated with initial RAI between January 1, 2000, and December 31, 2007. Within this selected group, 31 and 42 patients were prepared for initial and all subsequent RAI treatments by either thyroid hormone withdrawal (THW) or rhTSH protocols and were followed up for at least 3 years. Results. The response to initial treatment, classified as excellent, acceptable, or incomplete, was not different between the rhTSH group (57%, 21%, and 21%, resp.) and the THW group (39%, 13%, and 48%, resp.; = 0.052). There was no significant difference in the final clinical outcome between the groups. The rhTSH group received significantly fewer additional doses of RAI than the THW group (= 0.03). Conclusion. In patients with nodal-positive DTC, preparation for RAI with rhTSH is a safe and efficacious alternative to THW protocol.
Scientific Reports, Dec 4, 2020
The dynamics of cerebral blood flow (CBF) at the onset of hypoglycemia may play a key role in hyp... more The dynamics of cerebral blood flow (CBF) at the onset of hypoglycemia may play a key role in hypoglycemia unawareness; however, there is currently a paucity of techniques that can monitor adult CBF with high temporal resolution. Herein, we investigated the use of diffuse correlation spectroscopy (DCS) to monitor the dynamics of CBF during insulin-induced hypoglycemia in adults. Plasma glucose concentrations, cortisol levels, and changes in CBF were measured before and during hypoglycemia in 8 healthy subjects. Cerebral blood flow increased by 42% following insulin injection with a delay of 17 ± 10 min, while the onset of hypoglycemia symptoms was delayed by 24 ± 11 min. The findings suggest that the onset of CBF increments precedes the appearance of hypoglycemia symptoms in nondiabetic subjects with normal awareness to hypoglycemia, and DCS could be a valuable tool for investigating the role of CBF in hypoglycemia unawareness.
Annals of Internal Medicine: Clinical Cases, 2023
Circulation, Nov 3, 2009
Adenylyl cyclase (ADCY) is a critical regulator of metabolic and cardiovascular function. The phe... more Adenylyl cyclase (ADCY) is a critical regulator of metabolic and cardiovascular function. The phenotypic effect of a recently discovered hyper-functional ADCY6 S674 variant is unclear. The hypothes...
The FASEB Journal, Apr 1, 2013
Journal of Neurology, Neurosurgery, and Psychiatry, Oct 1, 2004