Difference between papillary and follicular thyroid carcinoma outcomes: an experience from Egyptian institution

Objective

Differentiated thyroid carcinomas (DTCs) are classified into papillary thyroid carcinoma (PTC) and follicular thyroid carcinoma (FTC). DTCs are analyzed as a single group in clinical studies that investigated the prognostic factors and prognosis of these malignancies. However, the biological behaviors of these carcinomas significantly differ. In the present study, we aimed to detect differences in the outcomes between PTC and FTC in Mansoura University Hospital in Egypt.

Methods

A total of 558 patients with histologically proven thyroid carcinomas from January 2003 to December 2012 were retrospectively enrolled. The clinical and pathological data of patients were reviewed.

Results

Large primary tumor size, lymph node involvement, extrathyroid extension, and distant metastasis were significant poor prognostic factors for overall survival (OS) in old PTC patients. Cox hazard analysis showed that the patient’s age, extra thyroid extension, and distant metastasis were the only independent prognostic factors. In FTC patients, only the distant metastasis and degree of tumor invasion were significant poor prognostic factors in OS univariate analysis. However, these factors were nonsignificant in multivariate analysis. The 10-year OS rates were 97% and 89% for PTC and FTC, respectively (P=0.003). The 10-year disease-free survival (DFS) rates were 77.2% in PTC vs. 65% in FTC (P=0.179).

Conclusion

The significant prognostic factors vary between the two types of DTCs. Therefore, PTC and FTC patients need to be analyzed and reported independently. PTC survival is widely and significantly affected by age, extrathyroid extension, and distant metastasis. By contrast, these factors were nonsignificant in FTC, which showed poorer survival than PTC.KEYWORDS : Thyroid cancer, differentiated thyroid, papillary, follicular, Egypt     

Survival After Accidental Extrahepatic Distribution of Y90 Microspheres to the Mesentery During a Radioembolization Procedure

We present the acute management and outcome of a patient after an accidental mesenteric distribution of Y90 microspheres during radioembolization (RE). This report describes and highlights: (1) the incidence of a significant reflux during a RE session while injecting into a replaced right hepatic artery from the superior mesenteric artery, (2) the appearance of diffuse mesenteric Y90 distribution in bremsstrahlung-imaging, (3) the management protocol with the radiation protection agent amifostine, (4) the development of typical adverse effects in the expected time window, and (5) survival of the patient without long-term sequelae. This report should sensitize physicians to this particular problem and may help to avoid as well as manage similar radioembolization incidences.     

Unmet refractive need and its determinants in Shahroud, Iran

Uncorrected refractive error plays a significant role in poor vision and blindness, and its correction is the most cost-effective intervention in eye care. In this study, we report the status of the unmet refractive need and the role of economic inequality in determining the level of this need in Shahroud, Iran. This cross-sectional nested case-control study was performed on 5,190 individuals aged 40-64 years. Cases and controls were individuals with uncorrected visual acuity worse than 0.3 LogMAR in the better eye who showed at least 0.2 LogMAR improvement after correction. Cases were individuals whose presenting vision was worse than 0.3 in the better eye but improved by at least 0.2 LogMAR after correction. Controls were individuals in whom the difference between the presenting and corrected vision was less than 0.2 LogMAR. The prevalence of the unmet need was 5.7 % and it was more prevalent in women (6.5 %) than in men (4.6 %) (p = 0.003). There was a gap of 19.6 % between the two groups of high and low economic status. The Oaxaca-Blinder decomposition method revealed that differences in the education level of the two groups accounted for half of this gap. Spectacle usage is better in Iran than in some other developing countries; however, in this study, about 40 % of those who required spectacles did not have them.     

Left atrial deformation analysis as a predictor of severity of coronary artery disease

Background

Two-dimensional (2D) speckle-tracking strain imaging is a novel method for assessment of regional myocardial deformation that uses tracking of acoustic speckles or kernels rather than Doppler myocardial velocities. It has been suggested that Left atrial (LA) strain as measured by 2D speckle tracking can be used to evaluate dynamic LA function.

Comparison of the Accuracy and Reproducibility of Focused Abdominal Sonography for Trauma Performed by Emergency Medicine and Radiology Residents

We compared the diagnostic accuracy of emergency medicine residents (EMRs) and radiology residents (RRs) in performing focused abdominal sonography for trauma (FAST). The cohort in this prospective study comprised 200 unstable patients (163 males and 37 females; mean ± standard deviation of age, 34.3 ± 16.4 y) who presented with trauma. These patients were evaluated using FAST, first by EMRs and subsequently by RRs. Patients with positive FAST results underwent further diagnostic procedures such as computed tomography, diagnostic peritoneal lavage and laparotomy. Those with negative FAST results underwent clinical follow-up for 72 h until their condition deteriorated or they were discharged. Sensitivity, specificity, positive and negative predictive values and accuracy in evaluating free intraperitoneal fluid were 80%, 95%, 57%, 98% and 94% when FAST was performed by EMRs and 86%, 95%, 59%, 98% and 94% when FAST was performed by RRs. The level of agreement between EMRs and RRs was moderate (κ = 0.525). FAST is a useful screening tool for initial assessment of free abdominal fluid in patients with trauma. Our results indicate that EMRs can perform sonography on trauma patients as successfully as RRs.     

Environmental and health monitoring study in dry cleaning departments

The aim of the present work is to evaluate the potential exposures to perchloroethylene in the dry cleaning departments in a group of seven first‐class Egyptian hotels; conditions which contribute to excessive levels and possible health effects in the exposed workers. Environmental monitoring of the workplaces was done through air samples, being collected from the breathing zones in the dry cleaning departments, carried out in different stages during washing process: close to press machine, flat iron, mannequin, spotting table and while charging the cleaning machine with the solvent. Atmospheric samples were analyzed by gas chromatography technique. The environmental study showed that the PCE levels were much exceeded in many workplaces, compared to the recommended TLV‐TWA. A group of 53 dry cleaners are included in the present work, in addition to 30 unexposed office workers, served as a control group. Both groups were thoroughly interviewed and examined clinically stressing on the condition of their CNS and PNS. Blood samples were collected and analyzed (spectrophotometrically) for the measurement of liver and renal function tests. Urine samples were collected and analyzed for the determination of the urinary trichloroacetic acid. Headache, nervousness, dizziness and vertigo were the most prevalent symptoms elicited in the exposed workers, followed by symptoms of respiratory and gastrointestinal irritation and skin and mucous membranes’ reactions. Gloves and stokings’ hypoaesthesia affected about l/4th of the exposed workers, followed by tremors (22.64%), first cranial nerve affection (11.32%), and disturbed reflexes (5.66%). Other signs elicited in the exposed workers were in the form of skin manifestations (16.98%), pallor (7.55%), and jaundice (2 cases). Insignificant systolic and diastolic high blood pressures were elicited in the exposed workers compared to the controls. Higher values of blood urea, serum creatinine, SGOT, total proteins, and urinary trichloroacetic acid were elicited in the exposed workers compared to the controls, whereas, lower figures of albumin were elicited in the exposed workers than in the controls. However, in spite of such differences, there was no statistical significance for those differences except for the urinary trichloroacetic acid (t = 3.6, ρ < 0.05). Duration of exposure proved to have no significant effect on most of the bioindicators, being examined in the present study. The study recommended a pre employment medical examination for the subjects recommended to work in dry cleaning, as well as a periodic medical examination to elicit the early manifestations due exposure to PCE. Various engineering control measures must be taken into consideration, when we try to improve the workplaces being studied. Personal protective measures could be considered the last effective line of defense against the various health hazards being faced by the working population in such an important economic activity.     

Zinc and copper status in children with bronchial asthma and atopic dermatitis

The study comprised 40 children of both sexes aged from 2 to 12 years, 22 suffering from bronchial asthma and 18 suffering from atopic dermatitis. Twenty healthy children of comparable age and sex to the patients were studied as controls. All the children were subjected to full history including dietetic questionnaire, thorough examination, and to estimation of serum IgE, serum ceruloplasmin, and zinc and copper levels in both serum and hairs. The mean concentrations of zinc in serum and hairs were respectively 70.3 +/- 13.2 micrograms/100 ml and 167.5 +/- 23.0 micrograms/gm in asthmatic cases and 65.9 +/- 11.7 micrograms/100 ml and 164.8 +/- 23.6 micrograms/gm in those with atopic dermatitis. These levels were significantly (p less than 0.001) decreased in comparison to the control values (88.4 +/- 11.0 micrograms/100 ml and 194.5 +/- 18.6 micrograms/gm). On the other hand, a significant (p less than 0.001) increase in serum and hairs copper was demonstrated in both allergic groups compared to the controls. Mean copper values were respectively 79.5 +/- 8.06 micrograms/100 ml and 18.7 +/- 1.9 micrograms/gm in the asthmatic cases and 81.4 +/- 8.4 micrograms/100 ml and 17.8 +/- 2.08 micrograms/gm in cases with atopic dermatitis. The control mean concentrations were 67.95 +/- 6.37 micrograms/100 ml and 14.5 +/- 2.53 micrograms/gm respectively. Significant (p less than 0.001) higher levels of serum ceruloplasmin were observed in the allergic patients compared to the controls and were correlated with the hypercupremia. The results were discussed and a good dietetic intake of high biological value protein and zinc supplement was recommended to these patients in order to correct their disturbances especially the hypozincemia which could lead to exaggeration of their allergic conditions. The field of trace elements metabolism has grown rapidly over the past few years, particularly after the development of novel techniques as the atomic absorption spectrophotometry which had allowed the reliable measurements of several trace elements in tissues and so had opened a new field for many researches (Henkin, 1976). Zinc and copper are involved in cell and tissue growth. Zinc plays an important role in DNA and protein synthesis and is intimately involved with copper as cofactors in several important enzyme systems. The effects of many pathological conditions as congestive heart failure, pneumonia, rheumatic heart diseases, bronchitis, recurrent infection, hemolytic anemia, psoriasis, and malnutrition on the levels of serum zinc, copper, and other trace elements have been of interest to investigators for a number of years (Sinha and Gabrieli, 1970; David et al., 1984).(ABSTRACT TRUNCATED AT 400 WORDS)     

Treadmill running reverses retention deficit induced by morphine

Human and animal studies have suggested that exercise has benefits overall health and cognitive function. The aim of this study was to investigate the effect of treadmill running on passive avoidance learning and memory deficit in morphine-treated rats. The passive avoidance learning was measured in different time intervals (1, 2 and 24 h as well as 1 week and 1 month). Four groups of rats were included as follows: control, morphine-treated, exercised-saline and exercised-morphine-treated group. The electrical foot shock and treadmill training (2 h at a speed of 5 m/min for 10 days) were applied for all the groups. The data obtained was analyzed using unpaired Students t-test and ANOVA test with group as the independent variable, and performance in each session (avoidances and crossings) as the dependent variables. The results show that the total time staying in dark box was decreased in exercised-saline and exercised-morphine-treated rats by treadmill running (P<0.05). The avoidance learning was significantly reduced in morphine-treated group as indicated by the increased total time of staying in the dark box compared with the control group (P<0.05). We could conclude that exercise increased the delay time of entry to the dark electrical foot shock box, suggesting that morphine impaired the short-term memory and learning and this was reversed by the treadmill running.     

Destruction of a penile urethra resulting from a snake bite: Uretroplasty using inguinal flap of Mac Gregor

Following a snake bite to the penis, a 69 years old man presented a large defect of hemicircumferential ventral penis, destroying the penile urethra along its entire length exposing the erectile bodies. The authors proposed a two-stage reconstruction of the urethra with an inguinal axial pedicle flap of Mac Gregor. This well-vascularized flap thick after degreasing helped repair the penile urethra along its entire length and make up losses of substance with a good functional and aesthetic result.