Brachytherapy boost (BT-boost) or stereotactic body radiation therapy boost (SBRT-boost) for high-risk prostate cancer (HR-PCa).

Systematic review for the treatment of high-risk prostate cancer (HR-PCa, D'Amico classification risk system) with external body radiation therapy (EBRT)+brachytherapy-boost (BT-boost) or with EBRT+stereotactic body RT-boost (SBRT-boost). In March 2020, 391 English citations on PubMed matched with search terms "high risk prostate cancer boost". Respectively 9 and 48 prospective and retrospective studies were on BT-boost and 7 retrospective studies were on SBRT-boost. Two SBRT-boost trials were prospective. Only one study (ASCENDE-RT) directly compared the gold standard treatment [dose-escalation (DE)-EBRT+androgen deprivation treatment (ADT)] versus EBRT+ADT+BT-boost. Biochemical control rates at 9 years were 83% in the experimental arm versus 63% in the standard arm. Cumulative incidence of late grade 3 urinary toxicity in the experimental arm and in the standard arm was respectively 18% and 5%. Two recent studies with HR-PCa (National Cancer Database) demonstrated better overall survival with BT-boost (low dose rate LDR or high dose rate HDR) compared with DE-EBRT. These recent findings demonstrate the superiority of EBRT+BT-boost+ADT versus DE-EBRT+ADT for HR-PCa. It seems that EBRT+BT-boost+ADT could now be considered as a gold standard treatment for HR-PCa. HDR or LDR are options. SBRT-boost represents an attractive alternative, but the absence of randomised trials does not allow us to conclude for HR-PCa. Prospective randomised international phase III trials or meta-analyses could improve the level of evidence of SBRT-boost for HR-PCa.

The development of a clinically useful tool for predicting the development of psychological disorder following injury.

OBJECTIVES: To identify factors significantly associated with post-traumatic stress disorder (PTSD), anxiety, and depression at 3 months post-injury; to develop a generic model to predict the occurrence of PTSD, anxiety, and depression at 3 months post-injury; and to validate this model in a test data set of patients. DESIGN: Prospective cohort study. METHODS: Participants were 823 patients attending an emergency department (ED) following accidental injury. Baseline questionnaires were completed, with 1 and 3 months postal follow-ups. Predictor variables demonstrating significant associations with two of the three outcome measures (3-month HAD anxiety and depression scores and PTSD symptoms) were included in multivariate regression models for each outcome. Non-significant predictor variables were removed until all remaining independent variables made the most significant contribution to each of the three models. Models were validated using a test dataset. RESULTS: Previous history of mental health problems, neuroticism score and having PTSD symptoms at 1 month predicted adverse outcomes at 3 months. When used on the test datasets, the areas under the receiver operating curve (ROC) curve for the models predicting outcomes at 3 months were: PTSD=0.91 (sensitivity=88.5%); anxiety=0.87 (sensitivity=93.7%); and depression=0.87 (sensitivity=96.7%). CONCLUSIONS: The final model performed moderately well across the three outcomes and may be useful clinically as a generic rule-out tool to identify those who will not require follow up, watchful waiting or intervention.

Risk factors for psychological distress following injury.

OBJECTIVES: To identify predictors of psychological morbidity among injured patients admitted to an Emergency Department (ED). DESIGN: A prospective cohort study. PARTICIPANTS: Participants were consecutive male ED attenders. 210 (97.7%) patients consented to participate. At one month, 128 (61.0%) responded, at six months, 114 (54.3%), at eighteen months 96 (45.7%). MAIN OUTCOME MEASURES: Measures immediately following injury were the Hospital Anxiety and Depression Scale, the Eysenck Personality Questionnaire and the McGill pain questionnaire. Recovery at one month was recorded using the SF-36 Health Survey, COPE scale, Perceived Stress Scale and Revised Impact of Events Scale. At six and eighteen months outcome was measured using the General Health Questionnaire (28 items) and Revised Impact of Events Scale. Multivariate analysis identified pre-morbid, accident-related and recovery factors influencing outcome at six and eighteen months. RESULTS: The strongest predictors of outcome were initial levels of anxiety and depression, prior history of mental health problems, early PTSD symptoms and involvement in litigation. These factors predicted between 40-60% of the variance at six months (p<0.001), and 50-60% of the variance in psychological distress at eighteen months (p<0.001). CONCLUSION: Factors identifying individuals at-risk from psychological distress following injury include those related to the immediate response and the recovery phases of injury. Further development is needed to convert identified predictors into a comprehensive screening tool for clinical use.

Effect of levothyroxine replacement therapy on coagulation and fibrinolysis in severe hypothyroidism.

OBJECTIVE: We previously demonstrated that patients suffering from moderate hypothyroidism were at increased risk of thrombosis contrasting with the bleeding tendency of those presenting severe hypothyroidism. The latter state is associated with hemostatic anomalies including von Willebrand type 1 disease and increased fibrinolytic capacity. With the exception of von Willebrand type 1 disease, reversibility of hemostatic changes is not established after levothyroxine replacement therapy. Therefore our objective was to analyze the reversibility of these anomalies. MATERIALS AND METHODS: We analyzed the impact of levothyroxine treatment on lipid parameters, fibrinogen, platelet count, D-dimers, alpha2 antiplasmin activity, plasminogen activity, tissue plasminogen activator antigen (t-PA Ag), plasminogen activator inhibitor type 1 antigen (PAI-1 Ag) and coagulation factors (factor VIII coagulant, von Willebrand factor antigen, von Willebrand factor and factor IX) in 23 patients with severe hypothyroidism (TSH level > 50 mU/ I). RESULTS: Mean fibrinogen levels increased by 14.2% while t-PA Ag and PAI-1 Ag increased by 42.6 and 69%, respectively, after correction of hypothyroidism. Interestingly, post-treatment PAI-1 Ag levels tended to be higher in patients with normal-high final TSH levels than in patients with normal-low final TSH levels. Our results suggest that normalization of fibrinolysis is obtained after a transient decrease of fibrinolytic activity. We also confirmed the correction of coagulation factor abnormalities upon levothyroxine replacement therapy. CONCLUSIONS: We demonstrated that the coagulation disorders and the hyperfibrinolytic status of severe hypothyroid patients were corrected upon levothyroxine therapy. However, the clinical consequences of the transient decrease of the fibrinolytic activity during the course of TSH normalization need further studies.

Evaluation of alternative computer input devices used by people with disabilities.

The aim of this study was to evaluate a range of alternative computer input devices suitable for people with disabilities and to provide comparative data that will enable health care professionals and users to make informed choices when selecting products. Our focus was on the potential advantages and disadvantages of individual product features as they related to the abilities and needs of different users. A sample of 14 alternative keyboards and pointing devices commonly used by people with disabilities were appraised by 35 disabled adults. A multi-disciplinary panel of independent assessors also appraised the products. We identified key factors regarding the set-up, personal acceptability, ease of use, design features, compatibility and potential limitations of each device. We found that difficulties in accessing computers could sometimes be reduced or overcome by adjusting the existing workstation and customizing computer settings rather than through additional technology. However, successful computer access often requires a combined approach, as a single piece of equipment will rarely provide a complete solution. If alternative computer input devices are necessary, it is likely that the hardware settings will need customizing.

Education for people with progressive neurological conditions can have negative effects: evidence from a randomized controlled trial.

OBJECTIVES: To test the effects of a home-based educational intervention in reducing the incidence and the risk of falls and pressure sores in adults with progressive neurological conditions. DESIGN: Randomized controlled trial with 12 months follow-up. SETTING: Participants' homes in the City of Nottingham. PARTICIPANTS: One hundred and fourteen people with progressive neurological conditions recruited from general practices in Nottingham, including 53 with Parkinson's disease and 45 with multiple sclerosis. INTERVENTIONS: In the education group (EG), baseline data were reviewed by an expert panel which advised on actions most likely to promote each individual's physical, social and psychological well-being. An occupational therapist (OT) then visited EG participants to provide education and information and to discuss a personalized 12-month health action plan. The comparison group (CoG) received standardized printed information delivered to their home. MAIN MEASURES: Numbers of participants reporting falls and skin sores at two-monthly phone calls during the follow-up period of 12 months. RESULTS: The EG reported significantly more falls during the follow-up period and at 12 months (adjusted odds ratio 2.83 (95% CI 1.07-7.47), p=0.036) and significantly more skin sores (adjusted odds ratio 12.74 (95% CI 1.14-142.6), p =0.039) than the CoG. There was no difference between CoG and EG in the Nottingham Extended Activities of Daily Living score, but EG patients showed a significant rise in this score over the study period of 1.62 (95% CI 0.69-2.55, p=0.002). CONCLUSIONS: Our findings provide evidence that education for people with progressive neurological conditions can have negative effects.

Adrenal insufficiency after adrenal hemorrhage.

Acute adrenal hemorrhage (AAH) is an extremely rare disorder, especially in adults, and may be difficult to diagnose because of its nonspecific presentation. We report a case of AAH following a sepsis, resulting in persistant adrenal insufficiency contrasting with the radiologic normalisation of the adrenals on computed tomography (CT) scan imaging.

Relationship of circulating C-reactive protein levels to thyroid status and cardiovascular risk in hyperlipidemic euthyroid subjects: low free thyroxine is associated with elevated hsCRP.

The mechanism(s) by which low circulating levels of thyroid hormones may lead to development of premature atherosclerosis remain to be established. These mechanisms include indirect effects of thyroid hormones on cardiovascular risk factors such as plasma lipoproteins, homocysteine and fibrinogen. High-sensitivity C-reactive protein (hsCRP) has been identified as an independent predictor of cardiovascular events. We presently investigated the relationship between hsCRP and free thyroxine (FT4) levels in a large population of euthyroid hyperlipidemic patients (n=429, mean age: 47.1 years, 28% of current smokers). None of these subjects presented a recent history of infection or inflammatory disease and those taking drugs known to influence thyroid or hsCRP were excluded. Serum FT4 levels were measured by radioimmunoassay and CRP, by a high-sensitivity immunoassay. In the population of non-smokers, plasma FT4 levels were negatively and significantly correlated with those of hsCRP (r=-0.13, P=0.02). Significant correlations between FT4 levels and age (r=-0.16, P=0.003), glycemia (r=-0.14, P=0.01), and fibrinogen (r=-0.18, P=0.001) were equally observed. Upon division of the population on the basis of FT4 tertiles, the mean level of hsCRP was significantly higher in non-smoker patients with the lowest FT4 tertile as compared to those displaying the highest FT4 level (3.04mg/l versus 1.77mg/l, respectively, P<0.05). No correlation between FT4 levels and CRP was found in smokers.In conclusion, we demonstrate that hsC-reactive protein is significantly negatively correlated with free thyroxine levels in non-smoker hyperlipidemic patients, suggesting that low thyroxine levels in euthyroid hyperlipidemic subjects constitute a new biomarker of elevated cardiovascular risk.

Abnormal illness behaviour and locus of control in patients with functional bowel disorders.

OBJECTIVES: Psychosocial factors have been examined in functional bowel disorders (FBD), including irritable bowel syndrome (IBS) and chronic idiopathic constipation (CIC). Abnormal illness behaviour (AIB) has been investigated in IBS patients as evidence of underlying psychological distress and as influencing health-care-seeking behaviour. Health locus of control may also contribute to health-care-seeking behaviour, as possession of an external locus of control places responsibility for health status onto professionals. Thus, external locus of control may also be more prominent in FBD patients. This study examined whether FBD patients displayed more AIB and an external health locus of control compared with organic disease and non-patient controls. DESIGN: A cross-sectional comparison group design was employed. METHOD: Fifty-three CIC patients were compared with matched control groups of 50 IBS patients, 51 Crohn's disease patients and 53 non-patient participants. Questionnaire measures included the Illness Behaviour Questionnaire, the Multi-dimensional Health Locus of Control, the GHQ, and the SCL-90R. RESULTS: FBD patients did not differ from Crohn's disease patients on measures of AIB, but all three patient groups differed from non-patient participants. Crohn's disease patients possessed a higher external locus of control compared with FBD patients and non-patient controls. There was a general association between AIB and psychopathology. CONCLUSIONS: FBD patients did not report more AIB or a higher external locus of control regarding their health status, compared with organic disease controls, but did differ from non-patients. The presentation of AIB was related to increased psychopathology, suggesting that AIB may be related to psychological distress, irrespective of patient status.

The psychological burden of injury: an 18 month prospective cohort study.

OBJECTIVES: To determine the prevalence of post-trauma psychological problems among a cohort of male accident and emergency department patients admitted to hospital. To identify the changes in their psychological symptoms over an 18 month follow up period. METHODS: A prospective cohort study of male accident and emergency department patients who were admitted for treatment of an injury. Baseline interview recorded demographic details and accident details. Standardised questionnaires measured baseline psychological state and personality type. Follow up at six weeks, six months, and 18 months after injury was by face to face interview or postal questionnaire and recorded progress since injury, and documented psychological status through the use of standardised questionnaires to detect psychiatric disorder and symptoms of post-traumatic stress disorder (PTSD). RESULTS: 210 male patients were recruited into the study. Psychiatric disorder was identified in 47.6% of responders at six weeks, and 43.4% at six months after injury. This improved significantly at 18 months. PTSD symptoms were moderate in 25%-30% and severe in 5%-14% and did not change significantly over the study period. A significant relation was found between previous psychiatric history and psychological symptoms at 18 months after injury. No relation was identified between injury severity and psychological status after injury. CONCLUSION: This study finds a high prevalence of psychological distress in male accident and emergency department patients after injury. Although some symptoms resolve over the follow up period, a proportion remain and may be related to previous psychiatric history. There was no relation identified between severity of injury and psychological morbidity.

A comprehensive endocrine description of Kennedy's disease revealing androgen insensitivity linked to CAG repeat length.

Our study aims to provide a comprehensive view of the endocrine features in Kennedy's disease (KD). Twenty-two men with KD underwent detailed endocrine investigations. Clinical signs of partial androgen resistance were present in more than 80% of the patients, with gynecomastia being the most prominent. Gynecomastia was postpubertal but appeared before muscular weakness in most cases. Thirteen patients had alteration of testicular exocrine function. Hormonal profile of partial androgen resistance was present in 86% of the patients, with an elevated testosterone level in 68%. Androgen insensitivity seems to appear later in life in KD, similar to the development of neurological signs. Although we confirm the previously reported correlation between the CAG repeat length and the early onset of the neurological disease, we describe a significant correlation between repeat length and the age of onset of gynecomastia as well as biological indexes of androgen insensitivity. This is supported by numerous in vitro data correlating variations in the CAG tract with androgen receptor activity; the longer the CAG repeats, the weaker the receptor transactivation. Ours is the first study to show such a clear and prominent pattern of androgen insensitivity in KD. In clinical practice, KD patients are often misdiagnosed as having amyotrophic lateral sclerosis. Careful examination of the endocrine component could avoid such a deleterious misdiagnosis.

A constellation of cardiovascular risk factors is associated with hepatic enzyme elevation in hyperlipidemic patients.

Abnormal circulating levels of hepatic enzymes are frequently found in subjects displaying hyperlipidemia or obesity or both. At present, there is a paucity of information on the principal cardiovascular risk factors that are associated with elevated plasma levels of hepatic enzyme activity in hyperlipidemic patients. We analyzed the potential relationships between serum levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT), and gamma glutamyl transferase (GGT) and cardiovascular and metabolic risk factors in a cohort of 8,501 men and women referred to our outpatient clinic for hyperlipidemia by their general practitioner. In this cohort, 27.6% of patients displayed serum levels of ALT above the upper limit of normal values. Both men and women who exhibited ALT levels superior to the upper limit of the normal range had elevated systolic (SBP) and diastolic blood pressure (DBP), body mass index (BMI), alcohol intake, and serum levels of blood glucose, uric acid, total cholesterol, and triglycerides (P <.0035 for all parameters). In a multivariate analysis, BMI, uric acid, and blood glucose remained significantly associated with ALT levels in men and women. We conclude that cardiovascular and metabolic features characterizing the plurimetabolic syndrome, including serum uric acid levels, are associated with significant elevation of hepatic enzyme activities. Because these abnormalities may not only be reversible but also associated with a poor prognosis, further studies are needed to identify those dyslipidemic patients who are at risk for the development of severe hepatic tissue damage.

A re-examination of the relationship between abuse experience and functional bowel disorders.

BACKGROUND: Previous research suggests that sufferers of irritable bowel syndrome (IBS) report a greater prevalence of sexually and physically abusive experiences than patients with organic gastrointestinal disorders and non-patient populations. This has led to suppositions that previous abusive experiences might predispose to the development of functional gastrointestinal disorders. This study aimed to investigate the hypothesis that the prevalence of previous abuse experiences in patients with functional bowel disorders (FBD) is greater than it is in patients with a painful organic bowel disorder and healthy control subjects. METHODS: Fifty-three idiopathic constipation patients were compared with matched control groups of 50 IBS patients, 51 Crohn disease patients and 53 non-patient control subjects. Measures of previous abuse experiences were taken using a self-report questionnaire and a semistructured interview. Other questionnaires of psychological distress were also administered. RESULTS: No significant differences were found between all four groups, both for measures of abuse and for psychological distress. However, patients who reported past abuse, irrespective of their FBD status. demonstrated significantly higher levels of current psychological distress. CONCLUSIONS: These results challenge the current assumption that past abuse experiences may be significant in the later presentation of functional bowel disorders, but suggest that previous abuse experience might be related to a general level of psychopathology.

Pituitary carcinoma: report of an exceptional case and review of the literature.

Pituitary carcinomas are exceptional tumors and constitute 0.1 to 0.2% of pituitary tumors. Their definition includes well-established criteria but distant metastasis is the hallmark required for diagnosis. We report the fourth case of gonadotropic pituitary carcinoma described in the literature. This case illustrates the dramatic outcome of these tumors. The most interesting feature of our case was the loss of differentiation with time, established by retrospective analysis of the primary tumor surgically treated 15 years earlier. Most of the previously reported cases exhibited a majority of adrenocoticotropin and non-functioning pituitary tumors. However, the frequency of non-functioning tumors seems smaller than previously believed. In the discussion, we stress the need to detect these very aggressive tumors as early as possible and identify treatments to improve the dramatic course of these carcinomas.

Elevated C-reactive protein constitutes an independent predictor of advanced carotid plaques in dyslipidemic subjects.

Inflammation plays a key role in the physiopathology of atherosclerosis. C-reactive protein (CRP) has been found to predict cardiac events in healthy subjects and in patients with coronary heart disease. However, the relationship between CRP and subclinical atherosclerosis is not well established. We examined the potential relationship between CRP and common carotid artery intima-media thickness and carotid plaques in dyslipidemic subjects. Dyslipidemic patients (n=1051) were recruited for the study. All patients had a complete clinical examination and systematically underwent ultrasonographic evaluation of the extracranial carotid arteries on a duplex system. The serum concentration of CRP was measured by using a sensitive immunoradiometric assay. In a univariate model, a strong positive relationship was found between CRP and the severity of carotid stenosis (P<0.0001). In multivariate analysis, the association between CRP and the degree of carotid atherosclerosis remained significant for advanced plaques (P=0.0007) in male subjects only. Significant correlations were found between CRP and body mass index (P<0.0001) and between CRP and other markers associated with the metabolic syndrome. In this large dyslipidemic population, elevated CRP is an independent predictor of advanced carotid plaques in male subjects. Body mass index and other markers of the metabolic syndrome (HDL cholesterol, triglycerides, diabetes, and high blood pressure) are significant determinants of CRP levels in this population.

Changes in lipoprotein(a) levels and hormonal correlations during a weight reduction program.

BACKGROUND AND AIM: To examine the effects of a weight reduction program on serum lipoprotein(a) [Lp(a)] levels and investigate whether the hormonal modifications occurring during weight loss may explain the changes in Lp(a) levels. METHODS AND RESULTS: This longitudinal clinical intervention study of a low-calorie diet involved 62 healthy obese patients (21 men aged 32 +/- 9.6 years and 41 women aged 37 +/- 14.6 years). Their anthropometric parameters (weight, height, body mass index, waist-to-hip ratio), fasting serum lipid levels, hormones (total testosterone, estradiol, total triiodothyronine, insulin), sex hormone binding globulin (SHBG) and blood sugar levels were determined at baseline and after six weeks of dietary treatment. A 7.5% loss in initial body weight was achieved and there was a statistically significant decrease in serum total cholesterol, LDL-cholesterol, HDL-cholesterol and triglycerides (p < 0.001). No changes in Lp(a) levels were observed in the study population as a whole, but there was a 17.6% (p < 0.05) reduction in the subjects with high pre-treatment Lp(a) values (> 20 mg/dL). The decrease in Lp(a) levels closely correlated with initial Lp(a) levels (r = 0.81 p < 0.001), but did not correlate with changes in anthropometric parameters or the hormonal modifications occurring during the weight loss. CONCLUSIONS: A low-calorie diet associated with weight loss in obese subjects may have beneficial effects on serum Lp(a) levels in patients with high pre-treatment Lp(a) concentrations. This effect seems to be independent of the hormonal changes observed during weight loss.

[Metabolism of atherogenic lipoproteins]. / Le métabolisme des lipoprotéines athérogènes.

Early development of atherosclerosis results from a complex multifactorial process where lipoprotein anomalies play a predominant role. The metabolism of lipoproteins is regulated by numerous reactions between the structural components of the lipoproteins and the receptors and/or enzymes with which they interact. Among the well-characterized anomalies, the elevation of small and dense LDL and/or the diminution of HDL levels are in first line of the factors involved in the formation of atheromatous plaques. LDL play a direct role by penetrating the intima of the arteries and HDL play an reverse transport of cholesterol from cells to the liver. There has been a long debate concerning risk related to triglyceride rich lipoproteins (TGRL), and more particularly the increase in VLDL. However, a large number of studies have demonstrated that these ephemeral lipoproteins can acquire major atherogenic potential when their level is increased and/or they are associated with perturbed metabolism leading to an accumulation of remnants. Current investigation methods have shown that LDL and HDL-cholesterol levels are excellent markers of LDL and HDL concentrations. Inversely, triglyceride levels provide little information concerning the nature of the elevated TGRL and fasting hypertriglyceridemia, even if moderate, should therefore be considered as a warning sign of persistent atherogeneous remnants in the fasting state.

Smaller LDL particle size in women with polycystic ovary syndrome compared to controls.

OBJECTIVE: Women with polycystic ovary syndrome (PCOS) have an increased risk of cardiovascular disease. The contribution of lipid abnormalities to this higher risk, in particular atherogenic modifications of low density lipoprotein (LDL) such as a shift towards smaller LDL, has not been properly explored. We aimed to examine LDL size variation in relation to androgens and other risk factors in women with PCOS. DESIGN: Comparison of clinical and biochemical measurements in women with PCOS and women with normal ovarian function, of similar age and body mass index (BMI). PATIENTS: Thirty-one women with PCOS and 27 controls were studied. Patients were recruited from the outpatient endocrine clinic. MEASUREMENTS: Fasting total cholesterol, triglycerides (TG), high density lipoprotein (HDL), LDL, glucose, insulin, gonadotrophins, androgens, oestradiol, 17 OH progesterone and SHBG were measured. LDL particle diameter was calculated based on distance travelled in polyacrylamide native gels. Recumbent blood pressure was measured automatically. RESULTS: LDL particle size appeared to be significantly smaller in hyperandrogenic PCOS as compared to regularly cycling women (P = 0006), independent of variations in lipid levels. SHBG was the only independent predictor of LDL size in this population, with a strong correlation, which persisted after adjustment for all confounding variables. CONCLUSIONS: Our results suggest that androgen excess and mild insulin-resistance (both responsible for lower SHBG) may have an early modifying effect on low density lipoprotein size in polycystic ovary syndrome women. The denser pattern observed in polycystic ovary syndrome women could by itself constitute a higher cardiovascular risk, even in the absence of overt dyslipidaemia, and contribute to the excess risk of cardiovascular disease reported in this syndrome.

Survival and therapeutic modalities in patients with bone metastases of differentiated thyroid carcinomas.

Data for patients with bone metastases (BMs) of differentiated thyroid carcinoma (DTC) were retrospectively studied to identify factors associated with survival. We especially studied the impact of therapies. Among the 1977 patients followed for DTC in our department from 1958 to 1999, 109 (77 females and 32 males; age range, 20--87 yr) presented BMS: All patients except 1 underwent total thyroidectomy, followed by radioiodine therapy (> or =3.7 gigabecquerels) in 95 cases. Survival rates at 5 and 10 yr were 41% and 15%, respectively. Univariate analyses indicated that a young age at BM discovery (P < 0.005) and the discovery of BM as a revealing symptom of DTC (P < 0.05) were features significantly associated with improved survival as well as radioiodine therapy (P < 10(-4)) and BM complete surgery (P < 0.02). Using multivariate analysis, the detection of BMs as a revealing symptom of thyroid carcinoma (P < 0.0005), the absence of metastasis appearance in other organs than bones during the follow-up (P < 0.03), the cumulative dose of radioiodine therapy (P < 0.0001), and complete BM surgery in young patients (P < 0.04) appeared as independent prognostic features associated with an improved survival.

[Hyperlipidemias: new data and new concepts]. / Hyperlipidémies: nouvelles données et nouveaux concepts.

STATINS: Strategy for management of patients displaying hyperlipidemia has changed since the the first statin has been launched in France more than ten years ago. Following the first primary and secondary prevention studies conducted with hyperlipidemic subjects, results have been extended to patients with cholesterol levels within normal range both in primary (AFCAPS/TexCAPS) and secondary (CARE) prevention. Drug therapy has been simplified with targets tailored to the patient's risk. OPEN QUESTIONS: Despite these important results from intervention studies with statins, other crucial questions remain. Among these questions the first one concerns the possibility that cardiovascular benefits demonstrated with statins are also partly due to other (pleiotropic) effects. This was first hypothesised when statins were proven to be efficacious after short term treatments (one year in the regression studies). The second question is whether we can extend the benefit observed in populations included in published trials to primary prevention of stroke and to the groups less well represented in previous trials including women, elderly patients. The current trends and economic strains of every health care systems have focused on evidence-based medicine and cost-efficacy studies. ROLE OF TRIGLYCERIDES: Beyond LDL-cholesterol there is clear emergence of a role of triglyceride in cardiovascular disease as well as new data on pathophysiology of the so-called reverse cholesterol transport. Recent trials including patients with hypertriglyceridemia as well as a decline of the benefit observed in hypertriglyceridemic patients strongly suggest that the use of statins may have its own limitation. IMPORTANCE OF DIET: Finally, translating results of recent trials in clinical practice remains a challenge for treating physicians who face poor compliance and difficulties in implementing diet in patients.