Papillary thyroid carcinoma in children: risk factors and complications of disease recurrence.

INTRODUCTION: Optimal treatment of recurrent papillary thyroid carcinoma (PTC) in children remains controversial. We reviewed our experience with recurrent PTC to better identify children diagnosed with it. AIMS: The objective of this study was to determine the risk factors, optimal treatment, complications, and prognosis of recurrent PTC in children. METHODS: This is a retrospective review of all thyroid resections for children aged 18 years or younger who have PTC at a single institution from 1987 to 1999. RESULTS: Thirty-six children, 7 boys (19%) and 29 girls (81%), underwent initial cervical exploration for PTC. Lymph node involvement was noted in 25 patients (69%); however, there was no distal disease. An equal number of children underwent subtotal thyroidectomy (n = 18) and total (n = 18) thyroidectomy as their initial operation. Papillary thyroid carcinoma recurrences developed in 17 patients (47%) a median of 7 months (range, 1-43 months) after their initial operation. Recurrence was more common for patients with lymph node involvement (P < .01) and multiple nodules (P < .05) at presentation. Recurrence developed in 5 patients after subtotal thyroidectomy and in 12 patients after total thyroidectomy. Sixteen children with recurrent PTC had a second operation and 6 required a third operation. Total operative complications included 2 patients with permanent hypocalcemia and 1 patient with permanent recurrent laryngeal nerve injury, all of whom had a total thyroidectomy. No patient died; however, 3 continue to harbor disease. Mean follow-up for patients with PTC was 65 months (range, 15 to 144 months). CONCLUSIONS: Thyroid resection combined with selective use of radioactive iodine ablation is a safe and effective treatment for recurrent PTC in children. The best predictors of this recurrent disease are lymph node involvement and multiple thyroid nodules at presentation.

Help of third-year medical students decreases first-year medical students' negative psychological reactions on the first day of gross anatomy dissection.

The assistance of third-year medical students (MS3) may be an easy, inexpensive, educational method to decrease physical and emotional stress among first-year medical students (MS1) on the first day of gross anatomy dissection. In the academic years 2000-2001 and 2001-2002, a questionnaire on the emotional and physical reactions on the first day of dissection was distributed to 84 MS1 at Mayo Medical School (Rochester, MN); 74 (88%) responded. Student perceptions were assessed on a 5-point Likert scale. The 42 second-year medical students (MS2) whose first academic year was 1999-2000 were used as a control group, because they had not had assistance from MS3. MS2 completed the same questionnaire (59% response rate). Data were collected from MS1 on the day of their first gross anatomy dissection. The most frequent reactions were headache, disgust, grief or sadness, and feeling light-headed. Significant differences (alpha < 0.05) were found with use of the chi(2) test to compare the emotional and physical reactions of MS1 and MS2. MS1 had significantly fewer physical reactions (64% vs. 88%), reporting lower levels of anxiety (23% vs. 48%), headache (14% vs. 36%), disgust (9% vs. 20%), feeling light-headed (11% vs. 24%), and reaction to the smell of the cadaver and laboratory (8% vs. 52%). MS1 commented that having MS3 at the dissection table was extremely helpful. They relied less on their peers and felt they learned more efficiently about the dissection techniques and anatomical structures. Using MS3 as assistants is one method to reduce fear and anxiety on the first day of gross anatomy dissection.