Outcomes of active surveillance of EU-TIRADS 5 thyroid nodules.

OBJECTIVE: Active surveillance of cytologically proven microcarcinomas has been shown as a safe procedure. However, fine needle aspiration biopsy (FNAB) is not recommended by European Thyroid Association (ETA) and American Thyroid Association (ATA) guidelines for highly suspicious nodules ≤ 10 mm. The aim of the study was to assess the outcomes of active surveillance of EU-TIRADS 5 nodules ≤ 10 mm not initially submitted to FNAB. PATIENTS AND METHODS: 80 patients with at least one EU-TIRADS 5 nodule ≤ 10 mm and no suspicious lymph nodes, accepting active surveillance, were included. RESULTS: Mean baseline diameter and volume were 5.4 mm (±2.0) and 64.4 mm3 (±33.5), respectively. After a median follow-up of 36.1 months, a volumetric increase ≥ 50% occurred in 28 patients (35.0%) and a suspicious lymph node in 3 patients (3.8%). Twenty-four patients underwent an FNAB (30.0%) after at least a 1 year follow-up of which 45.8% were malignant, 8.3% benign, 33.3% undetermined and 8.3% nondiagnostic. Sixteen patients (20.0%) underwent conversion surgery after a median follow-up of 57.2 months, confirming the diagnosis of papillary carcinoma in 15/16 cases (not described in 1 histology report), all in remission at 6-12 months postoperative follow-up. CONCLUSION: Applying ETA and ATA guidelines to avoid FNA of EU-TIRADS 5 sub-centimeter nodules and proceeding to active surveillance of such nodules in selected patients is a safe procedure. Thus, US-FNAB could be postponed until the nodule shows signs of progression or a suspicious lymph node appears, with no added risk for the patient.

A promising pediatric peritoneal dialysis experience in a resource-limited setting with the support of saving young lives program.

In the Democratic Republic of Congo (DRC), acute kidney injury (AKI) contributes to the high rate of child mortality owing to the conjunction of poverty, deficiency of qualified health-care providers in pediatric nephrology, and the lack of pediatric dialysis programs. We aimed to describe the recent experience of the first pediatric acute peritoneal dialysis (PD) program in DRC. This is a retrospective cohort study on epidemiology, clinical features and outcomes of children admitted from January 2018 to January 2019 at the University Hospital of Kinshasa for AKI and treated with PD. This pediatric PD program started by a team of one physician and one nurse who were trained in the local production of PD fluids and bedside catheter insertion technique in Benin Republic. The training was jointly supported by the Flemish Inter-University Council (VLIR) TEAM project and Saving Young Lives (SYL) program of ISN, ISPD, EuroPD, and IPNA. From January 2018 to January 2019, 49 children (aged 4 months-15 years) were admitted for AKI mainly due to severe malaria and sepsis. Dialysis was indicated in 35 of 49 (71.4%), 32 of 35 (91.4%) were treated with PD, two with hemodialysis (HD) in adult ward and one died at admission. Data of the two patients transferred for HD were not available for follow-up. The main indications were uremia and prolonged anuria. Of 32 dialyzed patients, 24 (75%) recovered normal renal function 3 months after discharge. Peritonitis was observed in 2 of 32 (6.2%) patients and the mortality was 18.7%. This promising experience proves that with simple means including use of locally produced dialysis fluids and low peritonitis rates, we can effectively save lives of children suffering from AKI.

[Non-pharmacological methods for the treatment of pain in children and adolescents]. / Les traitements non médicamenteux dans la prise en charge de la douleur de l'enfant et de l'adolescent.

This article deals with non-pharmacological methods for the treatment of pain in children and adolescents: acupuncture, homeopathy, transcutaneous electrical nerve stimulation, massage, relaxation, heat therapy, and hypnosis. These specialized techniques are used separately, either alone or in association with pharmacological methods. They have the specificity of considering the patient as a whole, including the biological and psycho-affective aspects. These methods are being developed more often, increasingly used but are still far from being systematic.

[Diagnosis of ectopic mediastinal parathyroid adenomas: value of cardiac MRI]. / Diagnostic des adénomes parathyroïdiens ectopiques médiastinaux: apport de l'IRM cardiaque.

Primary hyperparathyroidism is due to an adenoma in 85% of cases. In 10% of cases, the parathyroid adenoma may be in an ectopic location. Ten per cent of these ectopic adenomas are located in the mediastinum. Imaging modalities performed in persistent or recurrent hyperparathyroidism include ultrasound, MIBI scintigraphy, venous blood sampling, helical CT and MRI. The authors report 3 cases of ectopic adenoma located in the mediastinum, where pre-operative diagnosis was confirmed using cardiac MRI sequences.

A comparison of intra- and interpersonal interlimb coordination: coordination breakdowns and coupling strength.

Intra- and interpersonal interlimb coordination of pendulums swung from the wrist was investigated. For both kinds of coordination, the steady state and breakdown of bimanual rhythmic coordination as indexed by the time series of the relative phase angle phi were studied under the manipulation of coordination mode, frequency of oscillation, and the difference in the eigenfrequencies (preferred tempos) of the individual oscillating limbs. The properties observed for both intra- and interpersonal coordination were those predicted by a dynamical model of rhythmic coordination that considers the coordinated limbs coupled to be nonlinear oscillators. Using a regression method, the coupling strengths of the coupled system were recovered. As predicted by the dynamical model, the strength of the dynamic was generally greater for the in-phase than the anti-phase mode and decreased with increasing frequency. Further, the strength of the interpersonal interlimb coupling was weaker than that of intrapersonal interlimb coupling.

[Myxoma of the left atrium and advanced renal failure]. / Myxome de l'oreillette gauche et insuffisance rénale avancée.

A 34 years old woman with a history of childhood rheumatic fever presented with a number of episodes of systemic embolism over a 10 years period attributed to mitral stenosis despite long-term anticoagulant therapy. All preoperative electrocardiograms showed sinus rhythm. After one episode of recurrent embolism (brain, limbs) requiring femoral embolectomy, she developed oligo-anuric renal failure and needed 21 days of hemodialysis. She made a full recovery. Several years later, she presented with chronic progressive renal failure. The diagnosis of left atrial myxoma was eventually made at echocardiography: surgical excision was successful. Periodic hemodialysis was started six months later. The authors use this case to illustrate unusual presentations of myxoma and above all their vascular complications; the possibility of embolic renal disease leading to advanced renal failure is discussed, a complication of left atrial myxoma which seems to be very rare.

[Severe catatonia, schizophrenia and hereditary coproporphyria. A case report (author's transl)]. / Catatonie grave, schizophrénie et coproporphyrie héréditaire.

A patient with schizophrenia for many years presented after an attempted suicide, a severe drug-induced catatonia. In these circumstances, an hereditary coproporphyria was discovered. Clinical and pathophysiological interrelationships between the two syndromes are discussed.