Rate of non-invasive follicular thyroid neoplasms with papillary-like nuclear features depends on pathologist's criteria: a multicentre retrospective Southern European study with prolonged follow-up.

PURPOSE: To determine the rate of non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) in a multi-institutional series from the Iberian Peninsula and describing this NIFTP cohort. METHODS: Retrospective study of papillary thyroid carcinoma (PTC) or well-differentiated tumours of uncertain malignant potential (WDT-UMP) diagnosed between 2005 and 2015 and measuring ≥5 mm in adult patients from 17 hospitals. Pathological reports were reviewed to determine the cases that fulfil the original criteria of NIFTP and histology was reassessed. Rates were correlated with the number of PTC and its follicular variant (FVPTC) of each institution. Demographic data, histology, management, and follow-up of the reclassified NIFTP cohort were recorded. RESULTS: A total of 182 cases with NIFTP criteria were identified: 174/3372 PTC (rate: 5.2%; range: 0-12.1%) and 8/19 WDT-UMP (42.1%). NIFTP rate showed linear correlation with total PTC (p: 0.03) and FVPTC (p: 0.007) identified at each centre. Ultrasound findings were non-suspicious in 60.1%. Fine-needle cytology or core biopsy diagnoses were undetermined in 49.7%. Most patients were treated with total thyroidectomy. No case had nodal disease. Among patients with total thyroidectomy, 89.7% had an excellent response evaluated 1 year after surgery. There were no structural persistence or relapses. Five patients showed residual thyroglobulin after 90 months of mean follow-up. CONCLUSIONS: NIFTP rate is low but highly variable in neighbouring institutions of the Iberian Peninsula. This study suggests pathologist's interpretation of nuclear alterations as the main cause of these differences. Patients disclosed an excellent outcome, even without using the strictest criteria.

[Right ventricular dysfunction and ischemia in pulmonary embolism]. / Disfunción e isquemia ventricular derecha en la embolia pulmonar.

Patients with pulmonary embolism and right ventricle dysfunction (determined with clinical, hemodynamic or echocardiographic methods) are a subgroup at high risk for complications. One of the pathogenic factors of right ventricular dysfunction in pulmonary embolism is myocardial ischemia, usually secondary to hemodynamic overload, and sometimes worsened by underlying coronary artery disease. We described a patient with pulmonary embolism and dyskinesia of the right ventricular free wall, related to chronic atherosclerotic occlusion of the right coronary artery proximal to the acute marginal branches that irrigate the free wall.

Detection of a healthy carrier of HCV with no evidence of antibodies for over four years.

BACKGROUND: Posttransfusion HCV has been notably reduced over recent years as a result of the systematic testing for antibodies to HCV in blood donors. However, the risk of transfusing blood-derived components from virus-carrying donors still remains. A diagnosis is reported here of HCV in a regular blood donor who had no antibodies during the entire time she was followed up. CASE REPORT: The pharmaceutical company responsible for fractioning the plasma detected a donor who was a carrier of HCV, confirmed by PCR, but whose tests to detect anti-HCV were systematically negative. The donor had given blood on five previous occasions, from which 14 components were manufactured. Of the 11 components traced, six had been transfused, and in the two cases in which study of the anti-HCV was possible in the recipients, the result was positive. It was possible to check the blood samples from the donor from May 1997 to March 2002 (58 months). The tests to detect anti-HCV were all negative, while the PCR and core antigen tests were positive. CONCLUSION: The incorporation of RNA detection or HCV core antigen techniques in blood banks may reduce the residual risk of contracting posttransfusion HCV. Measures such as the correct traceability of the components, the existence of a specimen bank, or follow up of the recipients of blood-derived components would help to improve the quality of blood banking with percentage of survivability and case investigations.