Papillary thyroid carcinoma: The new,age-related TNM classification system in a retrospective analysis of 199 patients

The new, age-related TNM classification system of papillary thyroid carcinoma was applied in a retrospective analysis of 199 patients operated on during the 24-year period from 1956 through 1979 at the Second Department of Surgery, Helsinki University Central Hospital. According to the new staging system, 103 patients (under 45 years of age) and 96 T1 patients (45 years of age and older) were categorized into stage I. The incidence of carcinoma-positive cervical lymph nodes was highest among patients under 30 years of age at primary surgery. During the follow-up period of 6–29 years, cervical lymph node involvement was verified at reoperation in 20 patients (10%). Distant metastases (bone or lung) developed in 11 patients (5.5%). thirty-one patients (16%) died from carcinoma. The prognostic value of stage grouping, in terms of metastatic tendency and cancer mortality, was clearly demonstrated in the present material, suggesting the suitability of this simplified, new, age-related staging system in clinical practice.

---

Resumen La nueva clasificación TNM relacionada con la edad, del carcinoma papilar de la tiroides fue aplicada en un análisis retrospectivo de 199 pacientes operados en un período de 24 anos entre 1956 y 1979 en el Segundo Departamento de Cirugía del Hospital Central de la Universidad de Helsinki. De acuerdo con el nuevo sistema de estadificación, 103 pacientes menores de 45 años y 96 pacientes T1 de 45 años o más, fueron categorizados como estado I. La incidencia de ganglios cervicales positivos fue maxima entre los pacientes menores de 30 anos en el momento de la primera cirugía. En el curso del seguimiento de 6–29 años, se verificó invasión glanglionar cervical en reoperación en 20 pacientes (10%). Metástasis distantes (hueso o pulmón) aparecieron en 11 pacientes (5.5%). Treinta y un pacientes (16%) murieron por carcinoma. El valor pronóstico de la agrupación por estadificación, en términos de metastásis y mortalidad por cáncer, fue bien demostrada en este material chínico, lo cual sugiere la confiabilidad del nuevo y simplicado método de clasificación segÚn la edad, en la cual todo paciente menor de 45 años, no importa cuales sean las categorias T y N, son clasificados como estado I.

---

Résumé Le nouveau système TNM de classification du carcinome papillaire de la thyroÏde en fonction de l'âge a été appliqué dans l'analyse rétrospective de 199 patients opérés sur une période de 24 ans, de 1956 à 1979, dans le 2ème Département de Chirurgie de l'Hôpital Central de l'Université d'Helsinki. Selon cette nouvelle classification, 103 patients T1 âgés de moins d 45 ans et 96 patients T1 de 45 ans et plus ont été répertoriés dans le stade I. L'incidence des adénopathies cervicales était plus fréquente chez les patients âgés de moins de 30 ans lors de la première intervention. Pendant la période de suivi allant de 6 à 29 ans, l'état des ganglions du cou a été contrôlé par réopération chez 20 patients (10%). Des métastases à distance (os ou poumon) se sont développées chez 11 patients (5.5%). Trenteet-un patients (16%) sont morts du cancer. La valeur pronostique du regroupement par âge, en terme de tendance métastasique et de mortalité, a été clairement démontrée dans cette étude, suggérant l'emploi de ce nouveau système de classification simplifié en fonction de l'âge dans la pratique clinique.

     

Methylprednisolone esters of hyaluronic acid in ophthalmic drug delivery: in vitro and in vivo release studies

Films and microspheres were prepared from various esters of hyaluronic acid. A model drug, methylprednisolone, was either physically incorporated into the polymer matrix or chemically bound to the polymer backbone through an ester linkage. In vitro release from films with covalently bound drug was much slower (t_50% = 71 h) than that for physically dispersed drug (t_50% = 2.5−17 h). Methylprednisolone concentrations in the tear fluid of New Zealand rabbits were measured after ocular application of drug (approx. 420 μg) in different dosage forms. When methylprenisolone was physically dispersed in the polymer matrix, in vivo drug release from matrices was slower than that observed in vitro. Compared with a suspension control, peak methylprednisolone concentrations in tear fluid were 9–14 times lower after administration of drug in polymer films and AUC_{0–8 h} values were 4–7 times higher. These results imply that hyaluronic acid ester preparations can increase the residence time of methylprednisolone in the tear fluid of rabbits.     

The treatment of spontaneous intracerebral hemorrhage. A prospective randomized trial of surgical and conservative treatment

In a prospective study, 52 patients with a spontaneous supratentorial intracerebral hematoma (ICH) were randomly assigned to receive emergency surgery or conservative treatment within 48 hours after the bleed. Patients with a decreased level of consciousness and/or a severe neurological deficit were admitted to the study. The overall mortality rate at 6 months was 42%: 10 (38%) of the 26 patients in the conservative group and 12 (46%) of the 26 in the surgical group. Six (20%) of the 30 survivors at 6 months were able to conduct their activities of daily living independently: five (31%) of the 16 patients in the conservative group and one (7%) of the 14 in the operative group. These differences are not statistically significant. The mortality rate of semicomatose or stuporous patients (Glasgow Coma Scale score 7 to 10) was statistically significantly lower in the surgical group (none of the four patients) than in the conservative group (four of five patients) (p less than 0.05); however, all surviving patients in this subgroup were severely disabled. The study suggests that surgical treatment of this category of patients with ICH does not offer any definite advantage over conservative treatment. In semicomatose or stuporous patients, surgery may improve the length of survival, but the quality of life remains poor.     

Cognitive deficits related to computed tomographic findings after surgery for a ruptured intracranial aneurysm

A consecutive series of 118 patients operated on for ruptured intracranial arterial aneurysms was studied. Ninety-six of them could be adequately examined with a battery of psychological tests and computed tomographic scans 1 year after a subarachnoid hemorrhage. Seventeen orthopedic control patients with no history of brain damage were also tested. The pattern of cognitive deficits was strongly related to the findings on the computed tomographic scans. Patients with left lateral infarctions had deficits on performances requiring verbal efficiency, including memory and classification tasks, whereas patients who had right lateral infarctions were poor on a visuoconstructional task (the copying of Rey's Figure). These deficits were pronounced when lateral infarction was associated with diffuse brain damage. Patients with frontal medial infarctions had low scores on memory tests; the inefficiency in verbal fluency, categorical reasoning, and memory was related to diffuse brain damage. The patients who had no infarctions did not differ significantly from the control group. Cognitive impairments after left lateral and frontal medial infarctions, as well as diffuse brain damage, correlated with the Glasgow Outcome Scale.     

Challenges and obstacles of ocular pharmacokinetics and drug delivery

Modern biological research has produced increasing number of promising therapeutic possibilities for medical treatment. These include for example growth factors, monoclonal antibodies, gene knockdown methods, gene therapy, surgical transplantations and tissue engineering. Ocular application of these possibilities involves drug delivery in many forms. Ocular drug delivery is hampered by the barriers protecting the eye. This review presents an overview of the essential factors in ocular pharmacokinetics and selected pharmacological future challenges in ophthalmology.     

Serum basal hormone concentrations and muscle mass in aging women: effects of strength training and diet

This study examined the effects of strength training and diet on serum basal hormone concentrations and muscle mass in aging women. Fifty-one women age 49 to 74 y were divided into two groups: strength training and nutritional counseling (n = 25), and strength training (n = 26). Both groups performed strength training twice a week for 21 wk. Nutritional counseling was given to attain sufficient energy and protein intake and recommended intake of fat and fiber. We found that the cross-sectional area of the quadriceps femoris increased by 9.5 +/- 4.1% in the nutritional counseling group versus 6.8 +/- 3.5% in the strength training only group after training (P < 0.052). Nutritional counseling evoked dietary changes such as increases in the proportion of energy from protein and the ratio of polyunsaturated and saturated fatty acids. Strength training increased testosterone and testosterone/sex hormone-binding globulin ratio after the first half of training, but these returned to baseline values at the end of the entire training period. Changes in serum basal hormone concentrations did not differ between the groups. Our results support the conclusion that nutritional counseling can contribute to the increase in the muscle cross-sectional area during prolonged strength training in aging women.