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A known amount of Radioiodine (131I or 123I) is administered orally to the patient and the percentage taken by the thyroid is measured by a thyroid probe. The thyroid probe is a simple probe with a single 2 cm thick sodium iodine crystal with a single hole lead collimator coupled to a photomultiplier tube. After administration, counts of the anterior neck over the thyroid are measured at specified times and are corrected for background by subtracting thigh counts. Measuring the counts at 2-4 hours represents the uptake phase and at 24 hours represents the organification phase [4]. However, the trapping function of the isotope has been used for thyroid uptake along with the scintigraphy using a Gamma Camera. Areas of interest are drawn over the thyroid gland and its background region, which are then normalized for pixel size and for the time of acquisition. Scintigraphy Thyroid scintigraphy images the distribution of radiotracer in the functional thyroid tissue. Planar images are acquired 20 minutes after injection of the radiotracer (99mTc- pertechnetate or 123Iodine), with patient in a sitting or supine position with hyperextended neck under a large field of view gamma camera detector equipped with low energy parallel collimator or a pin hole collimator. Anatomical reference is obtained by placing a radioactive marker over the sternal notch and the chin. Images are acquired in anterior, right anterior oblique and left anterior oblique views, with each image for approximately 100,000 counts or for 5 minutes. Additional images using pinhole collimator can be performed which allows superior image resolution compared to parallel hole collimators [3-5]. Normal thyroid scintigraphy demonstrates symmetric uniform uptake in both the lobes (Figure 1). There may be increased intensity of uptake seen in the middle of the lobes where the gland is thicker as compared to the poles. Figure 1: Normal 99mTc-pertechnetate thyroid scintigraphy showing symmetric uniform uptake in both the lobes. Figure 2c: Toxic multinodular goiter: 99mTc-pertechnetate scan demonstrates inhomogenous tracer distribution with high uptake within the hyperfunctioning nodules and suppression of the extranodular non autonomous tissue. The nodule concentrates the radiotracer avidly with suppression of the remainder of the gland and low background activity (Figure 3). Uptake is suppressed in the entire gland although the disease may be patchy or regional [1,3]. As a result of the ongoing replacement of the normal thyroid follicles by lymphocytes and fibrous tissue, there is eventual reduction in thyroid function because thyroid hormone production by the gland is impaired leading to goiter and hypothyroidism [6].

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Nous pouvons ainsi voir que des classes sont similaires et ne devraient pas etre opposees dans les etudes (adenomes macro folliculaires et goitres multi- nodulaires). Les adenomes micro folliculaires se distinguent fortement des adenomes macro folliculaires et des carcinomes. Les tumeurs oncocytaires ne peuvent pas etre reliees aux carcinomes folliculaires ou papillaires. Elles peuvent constituer une classe a part entiere en considerant que le dereglement mitochondrial est associe a une proliferation augmentee. La predominance de la signature metabolique pourrait masquer la similarite de ces tumeurs aux deux precedentes classes. Les meta-analyses de donnees sont delicates puisque les valeurs mesurees ne sont pas forcement compatibles. Nous ne pouvons pas distinguer plus precisement leur affinite envers les carcinomes folliculaires ou papillaires. Un choix restreint de genes predicteurs dans ces signatures peut classer automatiquement les tissus avec de bonnes performances. Ces tumeurs ont ete ignorees des analyses anterieures utilisant les biopuces qui se sont focalisees sur la separation des tumeurs bien definies. Grace au jeu de donnees utilise dans le premier travail (voir ci-dessus), nous avons etudie ces tumeurs pour affiner leur classification. Nous avons utilise des tests permutes pour evaluer les correlations des echantillons avec les profils des classes de carcinomes.

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The Biosynthesis of Fatty Acids Apart from diet fatty acids can be synthesized in the body. Denovo synthesis of fatty acids take place in cytosol of liver, lactating mammary gland, adipose tissue and renal cortex. The formation of malonyl CoA is the committed step in fatty acid synthesis For the synthesis, all the enzymes are required in the form of fatty acid Synthase complex. Activate fatty acids are attached to glycerophosphate to form phosphatidic acid,by acyl transferase. Biosynthesis of Cholesterol Cholesterol is synthesized in the cell cytosol and endoplasmic reticulum from acetylCoA. Liver and intestine account each for 10% of the total cholesterol synthesized in the body. Squalene undergoes cyclization, loses three carbon atoms,aquire a double bond,forms cholesterol Regulation of Cholesterol Synthesis: Acetyl CoA is converted to Mevalonate. Catabolism of Cholesterol: Intestinal Bacteria converts cholesterol to coprostanol which is excreted in feces. Solublity of cholesterol depends on the ratio of phospholipids, bile salts to cholesterol. Due to infections bile acids are destroyed which leads to decreases solubility of cholesterol. The patients are treated with chenodeoxycholic acid to solublize the cholesterol or the stones are removed by surgical intervention. It causes obstruction to blood flow, leading coronary heart disease, stroke, myocardial infarction etc. The process is initiated when there is injury to endothelial cells of blood vessels. Atherogenesis is the process by which atherosclerotic plaques form, a critical step in the disease, atherosclerosis. Foam cells attract other white blood cells, which leads to accumulation of more cholesterol. Ultimately, this accumulation of cholesterol becomes one of the chief chemical constituents of the atherosclerotic plaque that forms at the site. If the damage to the intima continues, there is infiltration of platelets at the site. Foam cells and platelets aggregate, and release substances resulting in atheromatic plaque. Glucocerebroside accumulates in liver, spleen, brain and bone marrow, due to the deficiency of glucocerebrosidase. Hexoseaminidase is absent as a result gangliosides accumulate in brain, spleen and retina. Fatty Liver: Excess accumulation triglycerides in liver causes fatty liver,Liver cirossis and failure of liver function.

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Roth L (1065) Inclusions of nonneoplastic thyroid tissue fetal goiter due to defective thyroglobulin synthesis. Strauss A, Trujillo M (1986) Lithium-induced goiter and (1983) [Adenoma or adenomatous goiter with the clini- voice changes. Meij S, Hausman R (1978) Occlusive phlebitis, a diag- Malignant lymphoma of the thyroid.

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