Biological behavior of familial papillary thyroid microcarcinoma: Spanish multicenter study.

PURPOSE: Familial papillary thyroid microcarcinoma (FPTMC) can present a more aggressive behavior than the sporadic microcarcinoma. However, few studies have analyzed this situation. The objective is to analyze the recurrence rate of FPTMC and the prognostic factors which determine that recurrence in Spain. METHODS: Spanish multicenter longitudinal analytical observational study was conducted. Patients with FPTMC received treatment with curative intent and presented cure criteria 6 months after treatment. Recurrence rate and disease-free survival (DFS) were analyzed. Two groups were analyzed: group A (no tumor recurrence) vs. group B (tumor recurrence). RESULTS: Ninety-four patients were analyzed. During a mean follow-up of 73.3 ± 59.3 months, 13 recurrences of FPTMC (13.83%) were detected and mean DFS was 207.9 ± 11.5 months. There were multifocality in 56%, bilateral thyroid involvement in 30%, and vascular invasion in 7.5%; that is to say, they are tumors with histological factors of poor prognosis in a high percentage of cases. The main risk factors for recurrence obtained in the multivariate analysis were the tumor size (OR: 2.574, 95% CI 1.210-5.473; p = 0.014) and the assessment of the risk of recurrence of the American Thyroid Association (ATA), both intermediate risk versus low risk (OR: 125, 95% CI 10.638-1000; p < 0.001) and high risk versus low risk (OR: 45.454, 95% CI 5.405-333.333; p < 0.001). CONCLUSION: FPTMC has a recurrence rate higher than sporadic cases. Poor prognosis is mainly associated with the tumor size and the risk of recurrence of the ATA.

Assessing the feasibility of two hybrid MBR systems using PAC for removing macro and micropollutants.

The removal of 10 organic micropollutants (OMPs) was studied in two MBRs using different types of membrane (flat sheet microfiltration, MF, and hollow fiber ultrafiltration, UF) operated under aerobic conditions with direct dosing of powdered activated carbon (PAC) in the mixed liquor. In both reactors high COD degradation and nitrification were achieved (>95%), while nitrate removal was only observed after PAC addition. The adsorbent improved the operation of both systems (sludge properties and microbial diversity) which resulted in an enhancement of the quality of the final effluent. The operation with both types of membrane was feasible being the UF system slightly better in terms of the quality of the final effluent. The strategy of 250 mg/L of PAC additions every 35 days was validated according to the results obtained for the removal of the most recalcitrant OMPs, such as diclofenac and carbamazepine. Concerning the type of membrane, only significant differences were observed for diclofenac and roxithromycin, which were better removed in the UF configuration. These differences were attributed to sorption and/or further biotransformation processes occurring in the cake layer.

Family Screening in Familial Papillary Carcinoma: The Early Detection of Thyroid Disease.

INTRODUCTION: Blood relatives of patients with familial papillary thyroid carcinoma (FPTC) have a higher rate of thyroid disease. This study analyzed the utility of a screening protocol for thyroid disease on blood relatives of patients with FPTC. STUDY POPULATION: Members of families diagnosed with FPTC. INCLUSION CRITERIA: (1) first- and second-degree relatives; and (2) older than age 11 years. Screening: This includes the subject's clinical history, a physical examination, blood tests, and an ultrasound examination. CONTROL GROUP: A nonrelated healthy population paired by age and sex with the study group. RESULTS: Sixty-eight percent of blood relatives (128/189) accepted having the screening. The results showed 44.5 % (n = 57) of the relatives did not have disease, 44 % (n = 56) had benign thyroid disease, and 11.5 % (n = 15) had a disease suggestive of malignancy. After the screening, surgery was indicated in 26 patients, and the final results of the study were: (1) 44.5 % (n = 57) were healthy subjects; (2) 50 % (n = 64) had benign thyroid disease (26 cases with a functional disease, and/or 56 with an organic disease); and (3) 5.5 % (n = 7) had malignant thyroid disease. The first-degree relatives had a higher tendency to have the disease than second degree ones (64 vs. 46 %; p = 0.0482). In the control group, the incidence of thyroid cancer was 1.3 % compared with 5.5 % in the study group (p = 0.0182). CONCLUSIONS: Screening allows for the early detection of papillary carcinoma and benign thyroid disease and for this reason we recommend that it is performed periodically. However, more studies, with larger sample sizes, are needed to determine the benefit of screening.

Ultrasonographic risk factors of malignancy in thyroid nodules.

INTRODUCTION: Between 40 and 50 % of the population will have at least one thyroid nodule, although only 5-8 % will have a malignant one. OBJECTIVE: The objective of this study was to establish the ultrasonographic characteristics which allow us to distinguish benignity from malignancy in thyroid nodules. METHODS: In the study population, inclusion criteria are (1) a single thyroid nodule and (2) multinodular goiter and exclusion criteria are (1) previous thyroid surgery and (2) fine needle aspiration (FNA) in the past month. This study is a double-blind prospective study. The study protocol is as follows: (1) clinical study; (2) ultrasound examination; (3) FNA; and (4) surgery-follow-up. The variables analysed are as follows: a multinodular nodule or goitre; colloid degeneration; morphology; margins; hyperechoic rim; rim thickness; rim morphology; size; angle between the major axis and the skin; echostructure; posterior acoustic findings; calcifications; thick colloid; localization of the intrathyroid nodular tissue; and characteristics in the Doppler scan. RESULTS: A total of 221 thyroid nodules were analysed. The following ultrasound findings were associated with malignancy (p < 0.05): a nodule with posterior acoustic shadowing; the echotexture of the nodule; intranodular colloid degeneration; nodule margins; nodular morphology; the presence of thick colloid; the angle between the major axis and the skin; characteristics of the intranodular vessels using color Doppler and Doppler energy; and calcifications. In the multivariate analysis, the following factors persisted as predictors of malignancy: the echotexture of the nodule (odds ratio 12.81), microcalcifications (OR 9.05), and chaotic vascularisation in the Doppler energy (OR 43.47). CONCLUSIONS: The high-resolution ultrasound allowed for a more reliable diagnosis of malignancy. The main findings of malignancy were the hypoechogenicity echotexture, microcalcifications, and chaotic intranodular vessels using Doppler energy.

Surgical treatment of endemic goiter in a nonhospital setting without general anesthesia in Africa.

BACKGROUND: Endemic goiter remains a serious public health problem and 75 % of people affected live in underdeveloped countries where treatment is difficult for various reasons. The aim of this article is to report our experience in African countries with the management and surgical treatment of endemic goiter, performed in a nonhospital setting and without general anesthesia in the context of a collaborative development project by experienced endocrine surgeons. METHODS: Fifty-six black African patients with a goiter were studied. Those in poor general health, the elderly, patients with either small goiters or clinical hyperthyroidism, and those presenting with an acute episode of malaria were excluded from the study. Cervical epidural anesthesia with spontaneous ventilation was used and a partial thyroidectomy was performed. The technique used, its immediate complications, and early and late follow-up were analyzed. RESULTS: Surgery was performed on 31 patients with grades 3 and 4 goiter without mortality and a morbidity rate of 11.9 %, with 97 % of all complications being minor. There were no instances of dysphonia or symptomatic hypocalcemia and the mean stay was 1.57 days (range 1.25-1.93). Follow-up in the first year was 71 % and no case of severe or recurrent hypothyroidism was detected. CONCLUSIONS: Surgery without general anesthesia performed in a nonhospital setting in underdeveloped countries in patients with goiter is a viable option with good results and low morbidity.

Is unicentric familial papillary thyroid microcarcinoma different from multicentric?

BACKGROUND: Familial papillary thyroid microcarcinoma (FPTMC) appears to be more aggressive than sporadic papillary thyroid microcarcinoma (SPTMC). However, there are authors who indicate that unicentric FPTMC has a similar prognosis to SPTMC. The objective is to analyze whether unicentric FPTMC has a better prognosis than multicentric FPTMC. DESIGN AND METHODS: Type of study: National multicenter longitudinal analytical observational study. STUDY POPULATION: Patients with FPTMC. STUDY GROUPS: Two groups were compared: Group A (unicentric FPTMC) vs. Group B (multicentric FPTMC). STUDY VARIABLES: It is analyzed whether between the groups there are: a) differentiating characteristics; and b) prognostic differences. STATISTICAL ANALYSIS: Cox regression analysis and survival analysis. RESULTS: Ninety-four patients were included, 44% (n = 41) with unicentric FPTMC and 56% (n = 53) with multicentric FPTMC. No differences were observed between the groups according to socio-familial, clinical or histological variables. In the group B a more aggressive treatment was performed, with higher frequency of total thyroidectomy (99 vs. 78%; p = 0.003), lymph node dissection (41 vs. 15%; p = 0.005) and therapy with radioactive iodine (96 vs. 73%; p = 0.002). Tumor stage was similar in both groups (p = 0.237), with a higher number of T3 cases in the group B (24 vs. 5%; p = 0.009). After a mean follow-up of 90 ± 68.95 months, the oncological results were similar, with a similar disease persistence rate (9 vs. 5%; p = 0.337), disease recurrence rate (21 vs. 8%; p = 0.159) and disease-free survival (p = 0.075). CONCLUSIONS: Unicentric FPTMC should not be considered as a SPTMC due to its prognosis is similar to multicentric FPTMC.

Do hernia operations in african international cooperation programmes provide good quality?

BACKGROUND: Hernia is especially prevalent in developing countries where the population is obliged to undertake strenuous work in order to survive, and International Cooperation Programmes are helping to solve this problem. However, the quality of surgical interventions is unknown. The objective of the present study was to evaluate the quality of hernia repair processes carried out by the Surgical Solidarity Charity in Central African States. MATERIALS AND METHODS: A total of 524 cases of inguinal hernia repair carried out in Cameroon and Mali during 2005 to 2009 were compared with 386 cases treated in a Multicentre Spanish Study (2003). General data (clinical, demographic, etc.), type of surgery, complications, and effectiveness and efficiency indicators were collected. RESULTS: Preoperative studies in the Spanish group were greater in number than in the African group. The use of local anesthesia was similar. Antibiotic prophylaxis was higher in the African group (100% to 75.4%). The use of mesh was similar. The incidence of hematomas was higher in the Spanish group (11.61% to 4.61%), but the incidence of infection of the wound and of hernia recurrence was similar, although follow-up was only carried out in 20.97% in the African group (70% in the Spanish group). Hospital stay of more than 24 h was higher in the Spanish group. CONCLUSIONS: The standard quality of surgery for the treatment of hernia in developing countries with few instrumental means, and in sub-optimal surgical conditions is similar to that provided in Spain.

[Dyadic self-care interventions in chronic heart failure in hospital settings: a systematic review].

Dyadic self-care in chronic heart failure (CHF) is key to ensure treatment continuity, reduce complications and readmissions, and minimise caregiver burden, but it requires specific strategies. The aim of the study was to identify dyadic self-management interventions in CHF in hospital settings by means of a systematic literature review conducted in the Pubmed, CINAHL and PsycInfo databases. Methodological quality was assessed according to CASPe and Joanna Briggs Institute tools. The main components of the interventions were identified: delivery format; dimensions and strategies used (cognitive-attitudinal, affective-emotional and behavioural); providers and recipients; measurement instruments used; and effectiveness. Most of the studies demonstrated improved outcomes, especially in depression and/or anxiety symptoms, adherence to treatment, diet and weight control. Innovative interventions that include components of the three dimensions identified and the use of valid, reliable and specific scales to measure outcomes are recommended.

Prognostic value of histological and immunohistochemical characteristics for predicting the recurrence of medullary thyroid carcinoma.

INTRODUCTION: In medullary thyroid carcinoma, there is currently no consensus about the prognostic value of histological and immunohistochemical parameters. This study was designed to analyze the value of various histological and immunohistochemical characteristics for predicting the recurrence of medullary carcinoma. METHODS: A total of 55 cases of medullary thyroid carcinoma have been reviewed. These were operated on consecutively between 1971 and 2004 after histological confirmation. The data referring to clinical characteristics and evolution were taken from the patient's clinical history. The macroscopic, microscopic, and immunohistochemical characteristics of the tumors were taken from the pathological anatomy report. RESULTS: In 14 (27%) cases, there was recurrence of the disease. The disease-free interval at 1 year was 88 +/- 5%; at 5 years 73 +/- 7%; at 10 years 73 +/- 7%; at 15 years 61 +/- 10%; and at 20 years or more 61 +/- 10%. Of the histological parameters, only vascular invasion (0.0098) was related to a higher relapse rate. No epidemiological variable or immunohistochemical marker was associated with relapse. However, it was found that staging (P = 0.0102), as well as tumor size (P = 0.0211) and lymph node affectation (P = 0.0012), are factors significantly related to relapse of the disease. According to Cox's regression model, the only variable with a statistically significant effect was vascular invasion (P = 0.0056; odds ratio = 5.2308). CONCLUSIONS: The overall recurrence rate was 27%, and the main independent prognostic factor of recurrence was tumoral vascular invasion at diagnosis. Staging, tumor size, and lymph node metastasis are prognostic factors of recurrence, although they are not significant in the multivariate analysis.

Leiomyosarcoma of the iliac vein.

Leiomyosarcoma of the iliac vein is a very uncommon tumor. We report the case of a 55-year-old man with leiomyosarcoma of the left iliac vein. The patient had abdominal pain and hematuria. Abdominal ultrasound and computed tomography scanning demonstrated a well-defined mass in the left inguinal region, probably arising from the left iliac vein. Ultrasound-guided needle-core biopsy was consistent with a malignant growth. The patient was operated on, and a neoplastic multinodular mass attached to the posterolateral wall of the iliac vein was found. The tumor was resected en bloc, and venous reconstruction was undertaken using a saphenous vein segment. The postoperative course was uneventful, and the histologic study of the resected specimen was confirmed microscopically to be a leiomyosarcoma. No signs of recurrence or metastasis were present 29 months after complete surgical resection.

Definitive treatment for persistent hypoparathyroidism in a kidney transplant patient: parathyroid allotransplantation.

Post-surgical hypocalcemia is usually a transitory complication in thyroid and parathyroid surgery that can be resolved quickly, although it becomes a delicate matter when the problem persists. Parathyroid transplantation is the choice of treatment; however, the associated immunosuppression can cause side effects. The following case study shows the transplantation of parathyroid tissue from a patient with secondary hyperparathyroidism to another kidney transplant patient with severe hypocalcemia that was medically intractable. The graft is functioning after 2 years.

Pericardial tamponade as initial presentation of papillary thyroid carcinoma.

We herein describe a 19-year-old woman who presented with pericardial effusion that resulted in heart tamponade. The clinicopathological study revealed papillary carcinoma of the thyroid metastasized to the heart. Although malignant pericardial effusion is a known complication of thyroid cancer, it is rarely the first manifestation and shows a relatively favourable prognosis despite widespread metastases if adequate treatment is given.

[Coagulation and total parenteral nutrition: the effect of 2 lipid emulsions]. / Coagulación y nutrición parenteral total: influencia de dos emulsiones lipídicas.

Among the general complications caused by total parenteral nutrition (TPN), the hematological alterations play an important role, and they have been related to the lipid emulsions. With the objective of studying the influence of two lipid emulsions on the hemocoagulation of patients with TPN, we have done a prospective and double blind study in which 21 patients were randomized into two groups to receive TPN which included lipid emulsions and other components, Group I (n = 10) received a 20% LCT lipid emulsion with the TPN, and group II (n = 11) received a 20% MCT-LCT (50-50) lipid emulsion with the TPN. The following were then studied: activated cephalin time, prothrombin time, percentage of prothrombin time, thrombin and fibrinogen time, hemogram, and proteinogram. The basal values of both groups were similar and after eight days there were no differences in any of the variables when comparing the two groups. We came to the conclusion that both lipid emulsions behaved in a similar fashion, both were clinically well tolerated and neither produced by alteration in hemocoagulation.

Spontaneous retroperitoneal hemorrhage from adrenal artery aneurysm.

Spontaneous adrenal hemorrhage is a very rare but serious disorder of the adrenal gland that can require emergent treatment. We report on a 42-year-old man who underwent selective angiography for diagnosis and treatment of retroperitoneal hemorrhage from small adrenal artery aneurysm. This case gives further details about the value of transluminal artery embolization in the management of visceral aneurysm rupture.

Familial papillary carcinoma of the thyroid: report of three families.

OBJECTIVE: To report our experience of the clinical characteristics, treatment and outcome of familial papillary carcinoma. DESIGN: Descriptive study. SETTING: Tertiary referral centre, Spain. PATIENTS: Eight patients from three families. INTERVENTIONS: Treatment for familial papillary carcinoma of thyroid. MAIN OUTCOME MEASURES: Age, sex, reason for consultation, preoperative investigation, indication for operation and type, variety of papillary carcinoma and characteristics (size, adenopathies, multicentricity and bilaterality), treatment with 131I, and outcome. RESULTS: The mean (SD) age was 46 (14) years, and seven were women. In all but one patient, who was admitted for hypercalcaemia and operated on for primary hyperparathyroidism, cervical palpation and ultrasound showed a thyroid nodule. Needle aspiration suggested papillary carcinoma in 6/7, who were all treated by total thyroidectomy. Four patients with enlarged nodes also had bilateral neck disection. All the papillary carcinomas were well-differentiated, mean (SD) diameter was 1.5 (1) cm and in four were microcarcinomas. Three patients presented with invaded nodes. They were all treated postoperatively with 131I, except the patient with hyperparathyroidism who had a microcarcinoma of 0.5 cm. After a median (range) follow-up of 1 (0, 6-7) years the patients are well, except one had a high thyroglobulin concentration seven years later; however clinical exploration and morphological screening were within normal limits and he was treated with 131I 5.6 x 10(9) Bq. CONCLUSIONS: About a third of familial papillary carcinomas of the thyroid have lymph node involvement at the time of diagnosis, and have a relatively good prognosis if treated in accordance with the stage of the disease.