The proliferative activity of various thyroid carcinoma forms (papillary, follicular, medullary, anaplastic) was investigated using two second generation antibodies against Ki-67 that can be used on paraffin-embedded sections. Poorly-differentiated carcinomas had a higher proliferation than well-differentiated forms. Papillary carcinoma stained significantly more often with either antibody than follicular carcinoma. A solid growth pattern correlated with high Ki-67 expression while an increase in follicular elements and a high amount of psammoma bodies coincided with lower proliferation.HLA class II expression and infiltrating lymphocytes are prerequisites for an immune defense against cancer. In this study, HLA DR was increased in poorly-differentiated carcinomas, especially in the anaplastic type. The increase in HLA DR was correlated with Ki-67 positivity. On tumor-infiltrating lymphocytes, HLA DR was well expressed in papillary carcinoma and relatively poorly expressed in follicular carcinoma, but there was no significant correlation with carcinoma type or morphological parameters. CD 45 R0, which might recognize memory cells, was found mostly in anaplastic and papillary carcinomas, and correlated well with HLA DR expression. These findings imply that an active but variable immune response is present in thyroid carcinoma.

Diabetes and periodontitis are chronic diseases with an increasing prevalence in the German population. There is a bi-directional relationship between both diseases. Diabetes promotes the occurrence, the progression and the severity of periodontitis. Periodontitis complicates the glycemic control of diabetes, increases the risk of diabetes-associated complications and possibly even of its onset. In view of the existing evidence, that is still not sufficiently communicated within the medical community, an expert panel consisting of four diabetologists and four periodontists has addressed the following questions: What is the effect of diabetes mellitus on periodontitis and on periodontal therapy? What is the effect of periodontitis on diabetes mellitus? What are the practical consequences, that result for interdisciplinary treatment strategies? The treatment of periodontal infections should become an integral part of the management of diabetes, whereas glycemic control is a prerequisite for successful periodontal therapy.

Vorbemerkung 5Aus Sicht der Autoren ist aufgrund der aktuellen Diskussion über die kardiovaskuläre Sicherheit der Glitazone eine Bewertung der Datenlage der Glitazone und speziell von Pioglitazon notwendig. Im Rahmen eines Expertentreffens wurde der Stellenwert der Glitazone in der antidiabetischen Therapie diskutiert und definiert. Wirkmechanismus der Glitazone 5Der Peroxisomen-Proliferator-Aktivierte-Rezeptor gamma (PPARγ) stellt einen Masterregulator im Glukose-und Lipidstoffwechsel dar und ist außer-dem ein Regulator der Gefäßfunktion. Die Stimulation des Rezeptors führt zu einer erhöhten Insulinempfindlichkeit und damit zu einer Verbesserung von Hyperglykämie und insulinabhängiger Dyslipidämie (metabolische Insulinresistenz). Zellbiologische, tierexperimentelle und auch klinische Befunde zeigen, dass die Aktivierung von PPARγ zusätzlich zu antientzündlichen, vasodilatatorischen und antiproliferativen Effekten (vaskulä-re Insulinresistenz) mit antiatherosklerotischer Wirkung führt [1].PPARγ kann durch verschiedene Agonisten stimuliert werden, was zur Transkriptionsaktivierung bzw. -inhibierung unterschiedlicher Gene und in der Folge zur Expression verschiedener Proteinmuster führt. In einer aktuellen Studie wurde die Regulation von Genen in Adipozyten untersucht. Die beiden zugelassenen PPARγ-Agonisten Pioglitazon und Rosiglitazon regulieren insgesamt über 40 untersuchte Gene. Davon werden über die Hälfte von beiden Glitazonen reguliert, 12 ausschließlich von Pioglitazon sowie 5 ausschließlich von Rosiglitazon [19]. Dies weist darauf hin, dass sowohl gemeinsame Klasseneffekte beider Glitazone als auch verschiedene Substanzeffekte von Pioglitazon und Rosiglitazon zu beobachten sind.

Percutaneous ethanol injection therapy (PEIT) in patients with autonomously functioning thyroid nodules (AFTN) has been evaluated with respect to indication for PEIT, treatment procedure, results of therapy and side effects of this treatment. As PEIT has not been tested against the standard procedure of radioiodine treatment and surgery up to now, PEIT should be an alternative treatment for selected patients who cannot or will not be treated by radioiodine therapy or surgery. The clinical data available demonstrate that better results are obtained in patients with euthyroid AFTN or AFTN with subclinical hyperthyroidism as compared to patients with AFTN and overt hyperthyroidism, particularly in small thyroid nodules (thyroid nodular volume less than 15 ml). After PEIT significant reduction of thyroid nodular volume can be achieved (reduction 21 to 88 %). Adverse events of PEIT are few and usually mild and with special respect to transient dysphonia, strongly correlated with the technical skills of the operator. Limitations of PEIT are mainly the need of repeat ethanol injections in order to achieve a complete cure of AFTN. In conclusion, a prospective controlled randomized clinical study has to be carried out in patients with AFTN in order to define the role of PEIT in comparison to the standard therapies (radioiodine treatment, surgery), in the treatment of patients with AFTN conclusively.