ABSTRACT
Papillary thyroid carcinoma (PTC) is the most common histological category of thyroid cancer. In recent years, there has been an increasing number of studies on lncRNAs in PTC. Long intergenic non-protein coding RNA 887 (LINC00887) is a critical oncogene in developing other cancers. LINC00887 is upregulated in PTC samples but its role in PTC is currently unclear. This study aimed to investigate the impact the disruption of LINC00887 expression has on PTC progression. We performed a CRISPR/Cas9 strategy for the truncation of LINC00887 in BCPAP and TPC1 cell lines. Functional assays showed that LINC00887 knockdown in both TPC1 and BCPAP cells reduced cell proliferation, colony formation and migration, delayed the cell cycle, and increased apoptosis. These results strengthened the role of LINC00887 in cancer and showed for the first time that this lncRNA could be a potential oncogene in PTC, acting as a tumor promoter. Modulation of the immune system may be one of the etiopathogenic mechanisms of LINC00887 in PTC, as shown by the observed influence of this lncRNA on PD-L1 expression. In addition, the biological pathways of LINC00887 identified to date, such as EMT, the Wnt/ß-catenin signaling pathway or the FRMD6-Hippo signaling pathway may also be relevant regulatory mechanisms operating in PTC.
Subject(s)
Carcinoma, Papillary , RNA, Long Noncoding , Thyroid Cancer, Papillary , Thyroid Neoplasms , Humans , Carcinoma, Papillary/genetics , Carcinoma, Papillary/metabolism , Cell Line, Tumor , Cell Movement/genetics , Cell Proliferation/genetics , Gene Expression Regulation, Neoplastic , RNA, Long Noncoding/genetics , Thyroid Cancer, Papillary/genetics , Thyroid Cancer, Papillary/pathology , Thyroid Neoplasms/genetics , Thyroid Neoplasms/pathology , Up-Regulation/geneticsABSTRACT
Objective: The aim of this study is to describe the characteristics, survival and prognostic factors of a cohort of patients with bone metastases (BMs) from differentiated thyroid carcinoma (DTC). Methods: This was a multicenter retrospective observational study including patients diagnosed with BMs from DTC between 1980 and 2021. A Cox regression was performed to study prognostic factors for 5- and 10-year survival. Kaplan-Meier and log-rank tests were performed for the survival analysis and comparison between groups. Results: Sixty-three patients were evaluated. Median follow-up from BM diagnosis was 35 (15-68) months. About 30 (48.4%) patients presented with synchronous BMs. Regarding histology, 38 (60.3%) had the papillary variant. BMs were multiple in 32 (50.8%) patients. The most frequent location was the spine (60.3%). Other metastases were present in 77.8%, mainly pulmonary (69.8%). Concerning treatment, 54 (85.9%) patients received I131, with BM uptake in 31 (49.2%) and 25 (39.7%) received treatment with multikinase inhibitors. Regarding complications, 34 (54%) patients had skeletal-related events, 34 (54%) died and 5- and 10-year overall survival was 42.4% and 20.4%, respectively. Significant prognostic factors in the multivariate analysis were the presence of lymph node involvement (hazard ratio (HR): 2.916; 95% confidence interval (CI): 1.013-8.391; P = 0.047) and treatment with I131 (HR 0.214 (95% CI 0.069-0.665); P = 0.008) at 5 years, the presence of other metastases (HR 6.844. 95% CI 1.017-46.05; P = 0.048) and treatment with I131 (HR 0.23 (95% CI 0.058-0.913); P = 0.037) at 10 years. Conclusions: Our study reflects the management of patients with bone metastases from differentiated thyroid carcinoma in real clinical practice in several centers in southern Spain. Overall survival at 5 and 10 years was lower in patients who were not treated with I131, had nodal involvement and/or had other metastases.
Subject(s)
Adenocarcinoma , Thyroid Neoplasms , Humans , Prognosis , Thyroid Neoplasms/diagnosis , Retrospective Studies , Lymph Nodes/pathologyABSTRACT
Thyroid carcinoma (TC) can be classified as medullary (MTC) and non-medullary (NMTC). While most TCs are sporadic, familial forms of MTC and NMTC also exist (less than 1% and 3-9% of all TC cases, respectively). Germline mutations in RET are found in more than 95% of familial MTC, whereas familial NMTC shows a high degree of genetic heterogeneity. Herein, we aimed to identify susceptibility genes for familial NMTC and non-RET MTC by whole exome sequencing in 58 individuals belonging to 18 Spanish families with these carcinomas. After data analysis, 53 rare candidate segregating variants were identified in 12 of the families, 7 of them located in previously TC-associated genes. Although no common mutated genes were detected, biological processes regulating functions such as cell proliferation, differentiation, survival and adhesion were enriched. The reported functions of the identified genes together with pathogenicity and structural predictions, reinforced the candidacy of 36 of them, suggesting new loci related to TC and novel genotype-phenotype correlations. Therefore, our strategy provides clues to possible molecular mechanisms underlying familial forms of MTC and NMTC. These new molecular findings and clinical data of patients may be helpful for the early detection, development of tailored therapies and optimizing patient management.
Subject(s)
Carcinoma , Thyroid Neoplasms , Humans , Exome Sequencing , Thyroid Neoplasms/genetics , Thyroid Neoplasms/pathology , Germ-Line MutationSubject(s)
Thyroid Neoplasms , Humans , Thyroid Neoplasms/diagnostic imaging , Thyroid Neoplasms/pathology , NeckABSTRACT
Objetivos: El incremento de la población mayor ha hecho que se eleve el porcentaje de personas con demencia que requieren una atención especializada dirigida a mantener o retrasar su declive cognitivo y físico. El objetivo de esta investigación ha sido analizar si un grupo de personas con demencia mejoran cognitivamente al ser atendidos por cuidadores profesionales que han sido formados en un módulo de estimulación cognitiva del programa CUIDA-2 siguiendo los principios de la atención centrada en la persona. Metodología: La muestra estuvo formada por 47 personas con demencia (divididas en grupo tratamiento y grupo control) y 5 cuidadores formales de un centro de día de personas con demencia de Granada. El grupo tratamiento de personas mayores fue atendido durante 3 meses por cuidadores que recibieron el programa de formación. Todos los participantes fueron evaluados antes y después de la intervención con diversas pruebas de evaluación cognitiva. Resultados: Las personas con demencia que fueron atendidas por los cuidadores formados en el programa mantuvieron o mejoraron sus puntuaciones en todas las pruebas analizadas, si bien estas mejoras solo fueron significativas en diversas subescalas de los test empleados. Conclusiones: Se ha comprobado que el programa de formación de cuidadores aquí analizado produce un efecto positivo para las personas con demencia, ya que ayuda a mejorar y mantener sus funciones cognitivas. Esta investigación abre nuevas líneas de trabajo en el ámbito de la intervención cognitiva en personas con demencia que pueden ser de gran utilidad cuando se trabaje con esta población (AU)
Objectives: The increase in the elderly population has led to a rise in the percentage of people with dementia who require specialized attention aimed at maintaining or delaying their cognitive and physical decline. The aim of this research was to analyze whether a group of adults with dementia improve cognitively when being attended by professional caregivers who were trained in a cognitive stimulation module of the CUIDA-2 program following the principles of the person-centered-care model. Methodology: The sample consisted on 47 people with dementia (divided into treatment group and control group) and 5 professional caregivers of a day center for people with dementia in Granada. The older people treatment group was treated for three months by caregivers who received the training program. All participants were assessed before and after the intervention with various cognitive assessment tests. Results: People with dementia who were treated by caregivers trained in the program maintained or improved their scores in all the tests analyzed, although these improvements were only significant in various subtest. Conclusions: The caregiver training program produced a positive effect in the adults with dementia, as it helps to improve and maintain their cognitive functions. This research opens new lines of work in the field of cognitive intervention in people with dementia that can be very useful when working with this population (AU)
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Dementia/nursing , Caregivers/education , Professional Training , Cognitive Remediation/education , Cognitive Remediation/methodsABSTRACT
Background: Up to 30% of differentiated thyroid cancer (DTC) will develop advanced-stage disease (aDTC) with reduced overall survival (OS). Objective: The aim of this study is to characterize initial diagnosis of aDTC, its therapeutic management, and prognosis in Spain and Portugal. Methods: A multicentre, longitudinal, retrospective study of adult patients diagnosed with aDTC in the Iberian Peninsula was conducted between January 2007 and December 2012. Analyses of baseline characteristics and results of initial treatments, relapse- or progression-free survival ((RP)FS) from first DTC diagnosis, OS, and prognostic factors impacting the evolution of advanced disease were evaluated. Results: Two hundred and thirteen patients (median age: 63 years; 57% female) were eligible from 23 hospitals. Advanced disease presented at first diagnosis (de novo aDTC) included 54% of patients, while 46% had relapsed from early disease (recurrent/progressive eDTC). At initial stage, most patients received surgery (98%) and/or radioiodine (RAI) (89%), with no differences seen between median OS (95% CI) (10.4 (7.3-15.3) years) and median disease-specific-survival (95% CI) (11.1 (8.7-16.2) years; log-rank test P = 0.4737). Age at diagnosis being <55 years was associated with a lower risk of death (Wald chi-square (Wc-s) P < 0.0001), while a poor response to RAI to a higher risk of death ((Wc-s) P < 0.05). In the eDTC cohort, median (RP)FS (95% CI) was of 1.7 (1.0-2.0) years after RAI, with R0/R1 surgeries being the only common significant favourable factor for longer (RP)FS and time to aDTC ((Wc-s) P < 0.05). Conclusion: Identification of early treatment-dependent prognostic factors for an unfavourable course of advanced disease is possible. An intensified therapeutic attitude may reverse this trend and should be considered in poor-performing patients. Prospective studies are required to confirm these findings.
ABSTRACT
Bone is the second most common distant metastasis site in differentiated thyroid cancer (DTC) and is normally associated with the presence of other metastases, which are usually radioiodine-resistant. The presence of bone metastasis (BM) determines low survival and greater morbidity due to the frequency of skeletal-related events (SREs), which can be a serious complication of BM. There is evidence that antiresorptive therapy (AT) reduces SREs in other solid tumors, but not yet in DTC BM, for which data are scant. The same is true for systemic therapy with multikinase inhibitors (MKIs). In general, the results for MKI use are well known, although the effect on BM has rarely been evaluated. While MKIs are indicated in current clinical practice guidelines, studies evaluating the benefits and risks of concomitant treatment with MKIs and AT are lacking, and the available data come from small samples in retrospective studies. The objective of this article is to review the latest evidence for concomitant MKIs and AT.
Subject(s)
Adenocarcinoma , Antineoplastic Agents , Bone Neoplasms , Thyroid Neoplasms , Adenocarcinoma/drug therapy , Antineoplastic Agents/adverse effects , Bone Neoplasms/drug therapy , Humans , Iodine Radioisotopes/adverse effects , Phenylurea Compounds/therapeutic use , Protein Kinase Inhibitors/adverse effects , Quinolines , Retrospective Studies , Thyroid Neoplasms/pathologyABSTRACT
BACKGROUND AND OBJECTIVES: The ageing population and the increasing dependency associated with it, makes the caregiver a highly relevant figure nowadays. The present study analyzes the socio-demographic differences between family and professional caregivers and their satisfaction and implication in a training program for caregivers. METHODS: The sample consisted of 59 caregivers of older people (37 were family caregivers and 22 professional caregivers) which received and implemented a caregivers training program in their daily care functions. These caregivers were trained in communication skills and cognitive stimulation strategies so they could use them in their daily care activities with the older adults under their care during a period of 3 months. All the participants were assessed with a socio-demographic questionnaire, 2 questionnaires to analyze their satisfaction with their work and the training received and one questionnaire to analyze their ability to detect and react to memory and behavior problems in the older adults they attended. RESULTS: The results showed socio-demographic differences, improvements in satisfaction in family caregivers and a greater commitment in their daily work after the treatment in both groups although these effects could be due to different reasons. CONCLUSIONS: The research shows the benefits of carrying out training programs for caregivers as they significantly increase the quality and satisfaction with caregiving. The study also displays the need to adjust such programs taking into account that the socio-demographic characteristics and training needs are different depending on whether de caregiver is a family member or a professional.
Subject(s)
Caregivers , Family , Aged , Caregivers/psychology , Cognition , Family/psychology , Humans , Personal Satisfaction , Surveys and QuestionnairesABSTRACT
Antecedentes y objetivo: El envejecimiento y el incremento de la dependencia asociado al mismo hacen del cuidador una figura de gran relevancia en la actualidad. El presente estudio analiza las diferencias sociodemográficas entre cuidadores familiares y profesionales así como el grado de satisfacción e implicación de ambos grupos en un programa de formación de cuidadores.Métodos: La muestra constó de 59 cuidadores de personas mayores (37 cuidadores familiares y 22 profesionales) que recibieron e implementaron un programa de formación de cuidadores en sus funciones de cuidados diarias. Estos cuidadores fueron formados en estrategias de comunicación y estimulación cognitiva para que las implementaran con las personas mayores que cuidaban durante un periodo de 3 meses. Todos los participantes fueron evaluados con un cuestionario sociodemográfico, con 2 instrumentos para analizar su satisfacción con el cuidado y con la formación recibida y con un cuestionario en el que se analizaba la capacidad que tenían para detectar y reaccionar ante problemas de memoria y de conducta de las personas mayores a las que atendían.Resultados: Los resultados mostraron diferencias sociodemográficas entre ambos grupos de cuidadores, mejoras tras el tratamiento en la satisfacción laboral de los cuidadores familiares y una mayor implicación en su trabajo diario en ambos grupos de cuidadores aunque dichos efectos puedan ser debidos a diferentes motivos.Conclusiones: La investigación realizada muestra las ventajas de llevar a cabo programas de formación de cuidadores ya que logran incrementar la calidad y la satisfacción con el cuidado. También se muestra la necesidad de adaptar dichos programas ya que las características sociodemográficas y las necesidades formativas son diferentes en función de si el cuidador es un familiar o un profesional. (AU)
Background and objectives: The ageing population and the increasing dependency associated with it, makes the caregiver a highly relevant figure nowadays. The present study analyzes the socio-demographic differences between family and professional caregivers and their satisfaction and implication in a training program for caregivers.Methods: The sample consisted of 59 caregivers of older people (37 were family caregivers and 22 professional caregivers) which received and implemented a caregivers training program in their daily care functions. These caregivers were trained in communication skills and cognitive stimulation strategies so they could use them in their daily care activities with the older adults under their care during a period of 3 months. All the participants were assessed with a socio-demographic questionnaire, 2 questionnaires to analyze their satisfaction with their work and the training received and one questionnaire to analyze their ability to detect and react to memory and behavior problems in the older adults they attended.Results: The results showed socio-demographic differences, improvements in satisfaction in family caregivers and a greater commitment in their daily work after the treatment in both groups although these effects could be due to different reasons.Conclusions: The research shows the benefits of carrying out training programs for caregivers as they significantly increase the quality and satisfaction with caregiving. The study also displays the need to adjust such programs taking into account that the socio-demographic characteristics and training needs are different depending on whether de caregiver is a family member or a professional. (AU)
Subject(s)
Humans , Adult , Middle Aged , Aged , Aged, 80 and over , Caregivers , Cognitive Remediation , Education , Surveys and QuestionnairesABSTRACT
INTRODUCTION: Immune checkpoint inhibitors (ICPI) have improved progression-free survival in several solid tumors. Side effects are related to overstimulation of the immune system. Thyroid dysfunction (TD) is the most common endocrine immune-related adverse event of ICPI. OBJECTIVE: To describe the clinical presentation and the course of TD in cancer patients treated with ICPI referred to an endocrinology outpatient clinic. MATERIAL AND METHODS: This was a descriptive, retrospective and multicenter study of patients with TD associated with ICPI in six Spanish hospitals. RESULTS: 120 patients (50.8% women), mean age 60⯱â¯12 years were included. The initial TD was hypothyroidism in 49% of patients and hyperthyroidism in 51%, with an average of 76 (41-140) and 43 (26-82) days respectively between the onset of ICPI and the analytical alteration. Significantly, the earlier the first analytical determination was, the greater the prevalence of hyperthyroidism. A turnover was observed in 80% of subjects during follow-up, mostly from hyperthyroidism to hypothyroidism. Twenty-one percent received double ICPI therapy. The most frequent form of presentation in monotherapy was hypothyroidism (57%), and in double therapy it was hyperthyroidism (77%) (pâ¯=â¯0.002). Patients under double therapy showed thyroid alterations earlier than those in the monotherapy group (pâ¯=â¯0.001). After a follow-up of 205 (112-360) days, half of the patients continued under levothyroxine treatment. CONCLUSIONS: Hypothyroidism and hyperthyroidism present in a similar proportion in cancer patients undergoing ICPI therapy. Our results suggest that transitory hyperthyroidism may not be detected in a relevant number of cases. In addition, TD in double therapy presents earlier. This should be taken into account in the follow-up protocols of these patients.
Subject(s)
Hyperthyroidism , Hypothyroidism , Immune Checkpoint Inhibitors/adverse effects , Neoplasms , Thyroid Diseases , Aged , Female , Humans , Hyperthyroidism/drug therapy , Hypothyroidism/chemically induced , Male , Middle Aged , Neoplasms/drug therapy , Retrospective Studies , Thyroid Diseases/chemically inducedABSTRACT
Endocrinology and Nutrition is a medical specialty covering the study and treatment of diseases of the endocrine system, metabolism and those derived from the nutritional process, including knowledge of diagnostic techniques and dietary and therapeutic measures. In order to develop these activities and plan the management of resources allocated for this purpose, the so-called Portfolio of Services of the specialty has to be defined. A Portfolio of Services is defined as the set of techniques, technologies or procedures through which care services are provided in a healthcare centre, department or institution. It is an essential tool for organization of a hospital Unit or Department by defining the roles and procedures of its healthcare professionals, and also for structuring the resources required to perform the activity. It also allows for defining how to use these resources and identifying the objectives to be achieved, improving the quality of clinical care. Finally, the definition and preparation of the portfolio of services makes it possible to have an inventory of the offer of healthcare services and to detect new healthcare needs.
ABSTRACT
Objetivos: Elaborar un registro de situación de los Servicios y Unidades de Endocrinología y Nutrición (S°EyN) del Sistema Nacional de Salud (SNS) y valorar sus recursos asistenciales para desarrollar, a partir de los resultados obtenidos, propuestas de políticas de mejora en los S°EyN. Material y métodos: Estudio descriptivo transversal de los pacientes atendidos en los S°EyN en hospitales generales de agudos del SNS en 2016. Se utilizaron datos obtenidos mediante RECALSEEN 2017, una encuesta «ad hoc» diseñada específicamente para este fin y de las altas dadas por los S°EyN registradas en el CMBD del SNS (2015). Resultados: De un total de 125 hospitales generales de agudos de más de 200 camas instaladas del SNS español, se han obtenido 88 respuestas de los S°EyN, que representan el 70%. El 47% de los S°EyN que respondieron eran servicios y el 31% secciones. El promedio de endocrinólogos por S°EyN era de 7,4±4,4, siendo la tasa media de endocrinólogos por cada 100.000 habitantes de 2,3±1. Las actividades asistenciales más relevantes eran la consulta (promedio de 12,3 primeras consultas por mil habitantes y año), hospital de día (mediana de 2.000 sesiones/año) e interconsulta hospitalaria (mediana de 900 interconsultas/año). El 83% de los S°EyN incorporaban una Unidad de Nutrición Clínica. La dotación de dietistas, técnicos en nutrición y bromatólogos en las Unidades de Nutrición Clínica era baja. En relación con la gestión de la calidad se detectó un amplio margen de mejora; solamente un 35% de los S°EyN tenían responsable de calidad y el 38% había implantado una gestión por procesos para aquellos más frecuentemente atendidos por la unidad. Existen notables diferencias en estructura, recursos y actividad de los S°EyN entre Comunidades Autónomas. Conclusiones: La encuesta RECALSEEN 2017 es útil para el análisis de los S°EyN. La notable variabilidad hallada en los indicadores de estructura, actividad y gestión probablemente indica relevantes diferencias y, por tanto, un amplio margen de mejora
Objectives: To elaborate a diagnosis of the situation regarding the assistance in the Services and Units of Endocrinology and Nutrition (S°EyN) of the National Health System of Spain (SNHS) and to develop, based on the results obtained, proposals for improvement policies in the S°EyN. Material and methods: Cross-sectional descriptive study of the patients treated in the S°EyN departments of acute general hospitals of the SNHS in 2016. Data were obtained through RECALSEEN 2017, an "ad hoc" survey designed specifically for this purpose, and the Minimum Basic Data Set of discharges given by the S°EN of the SNHS (2015). Results: 88 responses of S°EyN have been obtained forma total of 125 acute general hospitals of more than 200 beds installed in the SNHS (70% answers). 47% of the S°EyN respondents were services and 31% sections. The average of endocrinologists by S°EyN was 7.4±4.4, and the average rate of endocrinologists per 100,000 inhabitants was 2.3±1. The most relevant care activities were the consultation (average of 12.3 first consultations per thousand inhabitants and year), day hospital (median of 2,000 sessions/year) and in-hospital consultations (median of 900 in-hospital consultations/year). 83% of S°EyNhad a Clinical Nutrition Unit. The number of dietitians, nutrition technicians and nutritionists in the Clinical Nutrition Unit was low. In relation to quality management, a large margin for improvement was detected; only 35% of S°EyN had a responsible of quality and 38% had implemented process management for those most frequent processes in the unit. There were notable differences in structure, resources and activity of S°EyN between Autonomous Communities. Conclusions: RECALSEEN 2017 survey is a useful tool for the analysis of S°EyN. The remarkable variability found in the structure, activity and management indicators probably indicates significant differences and, therefore, a wide margin for improvement
Subject(s)
Humans , Hospital Units , Patient Care/statistics & numerical data , National Health Systems/organization & administration , Registries/standards , Endocrinologists/statistics & numerical data , Health Policy , Cross-Sectional Studies , 34002 , 28599 , Food Service, Hospital/organization & administration , Food Service, Hospital/standards , Endocrinologists/organization & administration , Endocrinologists/supply & distributionABSTRACT
No disponible
Subject(s)
Humans , Male , Child, Preschool , Hyperandrogenism/diagnosis , Multiple Endocrine Neoplasia Type 1/complications , Adrenal Hyperplasia, Congenital/diagnosis , Hyperandrogenism/drug therapy , Hyperandrogenism/etiology , Child , Multiple Endocrine Neoplasia Type 1/genetics , Magnetic Resonance Spectroscopy/methods , Hydrocortisone/administration & dosageABSTRACT
OBJECTIVES: To elaborate a diagnosis of the situation regarding the assistance in the Services and Units of Endocrinology and Nutrition (S°EyN) of the National Health System of Spain (SNHS) and to develop, based on the results obtained, proposals for improvement policies in the S°EyN. MATERIAL AND METHODS: Cross-sectional descriptive study of the patients treated in the S°EyN departments of acute general hospitals of the SNHS in 2016. Data were obtained through RECALSEEN 2017, an "ad hoc" survey designed specifically for this purpose, and the Minimum Basic Data Set of discharges given by the S°EN of the SNHS (2015). RESULTS: 88 responses of S°EyN have been obtained forma total of 125 acute general hospitals of more than 200 beds installed in the SNHS (70% answers). 47% of the S°EyN respondents were services and 31% sections. The average of endocrinologists by S°EyN was 7.4±4.4, and the average rate of endocrinologists per 100,000 inhabitants was 2.3±1. The most relevant care activities were the consultation (average of 12.3 first consultations per thousand inhabitants and year), day hospital (median of 2,000 sessions/year) and in-hospital consultations (median of 900 in-hospital consultations/year). 83% of S°EyNhad a Clinical Nutrition Unit. The number of dietitians, nutrition technicians and nutritionists in the Clinical Nutrition Unit was low. In relation to quality management, a large margin for improvement was detected; only 35% of S°EyN had a responsible of quality and 38% had implemented process management for those most frequent processes in the unit. There were notable differences in structure, resources and activity of S°EyN between Autonomous Communities. CONCLUSIONS: RECALSEEN 2017 survey is a useful tool for the analysis of S°EyN. The remarkable variability found in the structure, activity and management indicators probably indicates significant differences and, therefore, a wide margin for improvement.
Subject(s)
Endocrinology/organization & administration , Health Care Surveys , Hospital Units , Hospitals, General/organization & administration , National Health Programs/organization & administration , Nutritional Sciences/organization & administration , Patient Care , Cross-Sectional Studies , Diagnosis-Related Groups , Endocrine System Diseases/epidemiology , Endocrine System Diseases/therapy , Health Workforce/statistics & numerical data , Hospital Bed Capacity , Hospitals, General/statistics & numerical data , Humans , Interdisciplinary Communication , Intersectoral Collaboration , Nutrition Disorders/epidemiology , Nutrition Disorders/therapy , Patient Care/statistics & numerical data , Patient Discharge/statistics & numerical data , Quality Improvement , Quality of Health Care , Referral and Consultation/statistics & numerical data , Research , SpainSubject(s)
Adrenal Hyperplasia, Congenital/complications , Androgens/blood , Multiple Endocrine Neoplasia Type 1/complications , Puberty, Precocious/etiology , Steroid 21-Hydroxylase/genetics , Adrenal Cortex Neoplasms/diagnosis , Adrenal Hyperplasia, Congenital/blood , Adrenal Hyperplasia, Congenital/diagnosis , Adrenal Hyperplasia, Congenital/drug therapy , Child, Preschool , Diagnosis, Differential , Heterozygote , Hormones/blood , Humans , Hydrocortisone/therapeutic use , Male , Mutation, Missense , Proto-Oncogene Proteins/genetics , Puberty, Precocious/bloodABSTRACT
No disponible
Subject(s)
Humans , Multiple Endocrine Neoplasia/genetics , Adrenal Gland Neoplasms/genetics , Neoplastic Syndromes, Hereditary , Endocrine Glands/pathologyABSTRACT
BACKGROUND: Multinodular goiter (MG) is very common in adults. MG may occur in children in some exceptional circumstances. The objective of this study was to examine two cases of MG in children who relapsed soon after surgery and to discuss the treatment options in pediatric ages. METHODS: Two girls consulted for euthyroid colloid goiter, uninodular goiter and bilateral MG. They were intervened by hemithyroidectomy and total thyroidectomy, respectively, due to the existence of local symptoms. RESULTS: Goiters reappeared 3 years after intervention in both cases. They already appeared as bilaterally MG, and patients underwent a total thyroidectomy, in one case after 1 year of treatment with levothyroxine (LT4). CONCLUSIONS: MG treatment remains controversial. There is an increasing trend to a more radical surgery decreasing recurrence risk. Treatment with LT4 may be tested but it is rarely effective. Regardless of the therapeutic option, these children should be followed up and they should know about the possibility of goiter regeneration and the need for reintervention.
Subject(s)
Goiter, Nodular/surgery , Thyroidectomy/methods , Child , Child, Preschool , Female , Goiter, Nodular/diagnostic imaging , Humans , Recurrence , Treatment Outcome , UltrasonographyABSTRACT
PURPOSE: This study sought to evaluate and compare the utility of 18-F-fluorodihydroxyphenylalanine (18F-DOPA) and 18-F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) for identification of lesions in patients with recurrent medullary thyroid carcinoma (MTC). In addition, we analyzed the correlation between the calcitonin (Ct), carcinoembryonic antigen (CEA) levels, each doubling time (DT), and PET positivity. We evaluated the reliability of the 150 pg/mL Ct cutoff set by the American Thyroid Association guidelines for further imaging (including 18F-DOPA PET/CT). METHODS: We prospectively recruited 18 patients with recurrent MTC, identified by elevation of Ct or CEA. Each patient underwent a 18F-FDG PET/CT and a 18F-DOPA PET/CT. RESULTS: Abnormal uptakes were detected with 18F-DOPA (n=12) and 18F-FDG (n=9), (sensitivity of 66.7% vs. 50%; p<0.01). Twenty-eight lesions were detected with 18F-DOPA vs. 16 lesions with 18F-FDG (1.56±1.5 vs. 0.89±1.18 lesions per patient; p=0.01). None of our patients showed additional lesions with 18F-FDG in comparison to 18F-DOPA. Patient-based detection rate increased significantly with Ct levels ≥150 pg/mL vs. Ct<150 pg/mL for both 18F-DOPA (sensitivity 90.9% vs. 28.6%; p=0.013) and 18F-FDG PET/CT (sensitivity 72.7% vs. 14.3%; p=0.025). Using a CEA cutoff of ≥5 ng/mL, detection rates of 18F-DOPA and 18F-FDG PET/CT were 81.1% and 72.7%, respectively. No correlation between Ct-DT or CEA-DT and PET positivity was found. Histological confirmation was obtained in eight patients. CONCLUSIONS: 18F-DOPA PET/CT appears to be superior to 18F-FDG PET/CT in detecting and locating lesions in patients with recurrent MTC. This technique tends to be especially useful in patients with negative results in other imaging modalities and Ct≥150 pg/mL or CEA≥5 ng/mL.