Abnormalities of the thyroid in survivors of childhood Hodgkin's disease.

AIM: The progress made in the treatment of Hodgkin's disease (HD) has resulted in long-term survival rates >90%, therefore late sequelae of treatment, especially endocrine diseases, have become more important. Hypothyroidism is the most frequent thyroid disease but hyperthyroidism, thyroid nodules and cancer are also frequent. Thyroid cancer begins to appear 5-10 years after neck irradiation and risk persists for decades. Therefore it is important a careful and long-term follow-up of these patients. METHODS: This report analyzed the thyroid function of thirteen patients successfully treated for childhood HD according to three different protocols of therapy. Treatment modalities were correlated to the occurrence of thyroid dysfunction. RESULTS: After a median follow-up of 8.3 years, nine out of thirteen patients were found to have thyroid abnormalities. Six patients developed hypothyroidism, one patient developed hyperthyroidism, two patients showed only ultrasound abnormalities. CONCLUSIONS: The patients treated with lower radiotherapy (RT) doses and restricted RT extension showed a lower incidence of thyroid abnormalities compared to patients treated with higher RT dose and extended RT field. This study, even though performed in a small cohort of patients, confirms the high incidence of thyroid abnormalities in patients treated for HD and strengthens the importance of a long-term follow-up.

Transoesophageal echocardiography in patients without arterial and major cardiac sources of embolism: difference between stroke subtypes.

We studied the records of 175 consecutive patients referred to our neurologic ward between January 1994 and February 2000 with a diagnosis of ischaemic cerebrovascular disease (ICVD) (stroke or transient ischaemic attack - TIA) who underwent transoesophageal echocardiography (TEE). We excluded patients with large vessel disease, high-risk embolic cardiopathies and other rare causes of stroke. According to clinical and neuroimaging findings, patients were divided into two groups. The lacunar (LAC) group (69/175 (39.4%)) and the nonlacunar (N-LAC) one (106/175 (60.6%)). The control population consisted of 78 consecutive patients, referred to the echocardiography laboratory for TEE without history of ICVD and known heart disorders. Patent foramen ovale (PFO) frequency was significantly higher in case patients than in control subjects (55/175 (31.4%) vs. 13/78 (16.6%); p = 0.02). Among case patients, PFO was more prevalent in the N-LAC group than in the LAC one (43/106 (40.6%) vs. 12/69 (17.4%); p = 0.0005). A large degree of shunt occurred in 53.5% of N-LAC patients and in 16.7% of LAC ones (p = 0.04). Atrial septal aneurysm (ASA) was detected in 12% of case patients and 1.3% of control subjects (p = 0.003) and was more frequent in the N-LAC group than in the LAC one (16 vs. 5.8%; p = 0.05). Mitral prolapse (MP) was present in 6/175 (3.4%) ICVD patients (vs. 1/78 among controls) in most cases associated with myxomatous valve redundancy. Aortic arch atheromas (AA) were detected in 12% of ICVD patients and in 10.2% of controls. The frequency was 9.4% in N-LAC and 15.9 in LAC. No complicated AA (plaque thickness >4 mm, ulcerated atheroma, superimposed thrombus) were detected. After multivariate analysis, PFO (OR = 3.8; 95% CI = 2.7-7.9) and ASA (OR = 8.01; 95% CI = 3.0-16.1) appeared to be independent predictors of ICVD. PFO (OR = 2.24; 95% CI = 1.24-4.92) was also independently associated with N-LAC stroke subtype and its importance was even higher in younger patients. Our study provides further evidence that TEE is a helpful diagnostic tool in stroke patients without arterial and major cardiac sources of embolism. However, its utility differs according to type and localization of the ischaemic lesion being more relevant in patient with N-LAC infarctions.