Total thyroidectomy versus hemithyroidectomy for patients with follicular neoplasm. A cost-utility analysis.

INTRODUCTION: Thyroid nodules are a common condition. Overall, 20% of the nodules assessed with FNAB correspond to the follicular pattern. A partial thyroidectomy is the minimal procedure that should be performed to determine the nature of these nodules. Some authors have suggested performing a total thyroidectomy based on the elimination of reoperation and ultrasound follow-up. The aim of this study was to evaluate the most cost-useful surgical strategy in a patient with an undetermined nodule, assessing complications, reoperation, recurrence and costs. MATERIAL AND METHODS: A cost-utility study was designed to compare hemithyroidectomy and total thyroidectomy. The outcomes were complications (definitive RLN palsy, permanent hypoparathyroidism, reoperation for cancer, and recurrence of the disease), direct costs and utility. We used the payer perspective at 5 years. A deterministic and probabilistic sensitivity analysis was completed. RESULTS: In a deterministic analysis, the cost, utility and cost-utility ratio was COP $12.981.801, 44.5 and COP $291.310 for total thyroidectomy and COP $14.309.889, 42.0 and $340.044 for partial thyroidectomy, respectively. The incremental cost-utility ratio was -$535.302 favoring total thyroidectomy. Partial thyroidectomy was more cost-effective when the risks of RLN injury and definitive hypoparathyroidism were greater than 8% and 9% in total thyroidectomy, respectively. In total, 46.8% of the simulations for partial thyroidectomy were located in the quadrant of more costly and less effective. CONCLUSION: Under a common range of complications, and considering the patient's preference and costs, total thyroidectomy should be selected as the most cost-effective treatment for patients with thyroid nodules and follicular patterns.

Prognosis of patients with thyroid cancer who do not undergo surgical treatment: a SEER database analysis

BACKGROUND: The treatment for thyroid cancer is surgical. However, some patients do not undergo operations because of comorbidities or other reasons. There is little information about the prognosis of these patients. The aim of the present study was to describe patients with well differentiated thyroid carcinoma who did not undergo surgical treatment and to identify differences in prognostic variables and survival compared with patients treated surgically. METHODS: We conducted a retrospective review of a prospective cohort collected by the National Cancer Institute obtained from the Surveillance, Epidemiology and End Results (SEER) Program. All patient files with a diagnosis of thyroid cancer were selected (38,493 cases). Finally, 12,416 cases were used for the analysis. Treatment was divided into surgical or nonsurgical groups. Five-year survival rates were estimated and classified by the SEER stage. RESULTS: Eighty-six patients did not receive surgical treatment. These patients were older, had more advanced tumours and their treatment was less associated with complementary radiotherapy. Five-year overall survival rates were 96.7% for surgical patients vs. 56.8% for nonsurgical patients (p<0.001). The overall survival in the nonsurgery group for localised tumours decreased 14.9%, for regional tumours decreased 49.9% and for distant tumours decreased 61.8%. DISCUSSION: The patients who did not undergo surgical treatment showed less than 5-year overall survival. The SEER database does not offer information about comorbidities that could explain these differences (AU)

[Neuronal migration disorders]. / Trastornos de migración neuronal.

Neuronal migration disorders represent a group of congenital nervous system malformations that affect the process whereby millions of neuroectodermic cells move from germinal matrix to the loci, where they will reside for life. They produce important changes in cytoarchitecture, lamination and normal neuronal physiology, particularly in cerebral cortex. These disorders appear as sporadic cases, genetically determined or caused by external agents as infections, intoxications and radiations, etc. The better identified nosological entities include: schizencephaly, lissencephaly, pachygyria, polymicrogyria, neuronal heterotopias and agenesis of corpus callosum. Patients usually present early symptoms and signs of disease and epilepsy is a dominant manifestation. By means of studies of craneal computed tomography (CCT), magnetic resonance (MR), positron emission tomography (PET), single-photon emission computed tomography (SPECT) and immunohistochemical and Golgi studies (IHG), it has been recently shown that nervous system dysgenesis can be a frequent cause of many refractory epilepsies and epileptic syndromes considered as cryptogenic. When these disorders are associated with dismorphic stigmas, genetics syndromes such as Miller-Dieker, Zellweger and Aicardi should be suspected.