Predictive role of nontumoral sodium iodide symporter activity and preoperative thyroid characteristics in remission process of thyroid cancer patients

Objective

The target of radioiodine ablation therapy (RIAT) after complete tumor removal is the nontumoral remnant tissue. We aimed to evaluate sodium iodide symporter (NIS) expression in nontumoral thyroid tissue in differentiated thyroid cancer (DTC) patients who have complete but delayed structural response (DSR) to RIAT after surgery. Preoperative thyroid characteristics such as volume and nontumoral histology were also investigated for both DSR and its control group as potential predictors of insufficient NIS activity in this study.

Methods

Total of 600 patients with postoperative remnant thyroid tissue and who were in remission after RIAT spontaneously, were included in the study. Patients with positive diagnostic whole body scan (DxWBS) with thyroid bed uptake and stimulated serum Tg level <2 ng/mL at first year visit after initial therapy were defined as DSR group. Immunohistochemical staining of NIS protein was performed on the nontumoral tissue sections from surgery and semi quantified in terms of density and intensity. DSR and its control group were also compared in terms of NIS expression, radioiodine (RAI) uptake on post-therapy scan and preoperative thyroid characteristics.

Results

When compared with the control group, the density and intensity of NIS expression as well as the intensity of RAI uptake were significantly lower in DSR group (p = 0.001). There were also significant differences between groups regarding preoperative thyroid characteristics; i.e. preoperative thyroid volumes were significantly higher and the presence of concurrent benign thyroid disease was significantly more common in DSR group (p = 0.035, p = 0.001). Hashimoto thyroiditis was 8.59 times higher (95 % CI; 2.31–31.96) and multinodular goiter was 7.50 times higher (95 % CI; 1.88–29.91) among DSR group when compared with the control group.

Conclusions

Our findings suggest that insufficient NIS activity in nontumoral thyroid tissue associates with DSR in DTC patients who have postoperative remnant tissue. Preoperative thyroid characteristics such as volume and concomitant benign thyroid disease may have an important role in predicting the complete response time to RIAT in these patients.     

Fenestrated angiocatheter for extensive subcutaneous emphysema

A minimally invasive technique using fenestrated angiocatheters has been described in adult literature for the treatment of extensive subcutaneous emphysema. Here we report a 30 month old infant who developed extensive subcutaneous emphysema and pneumomediastinum, which was relieved by application of microdrainage catheters.     

Pediatric silicone oil surgery

PURPOSE: To evaluate clinical characteristics, surgical aspects, and visual outcomes of pediatric patients who underwent pars plana vitrectomy and silicone oil injection for complicated retinal detachment. PATIENTS AND METHODS: The records of 24 patients (25 eyes) younger than 18 years were retrospectively reviewed. All patients underwent pars plana vitrectomy and silicone oil injection for complicated retinal detachment between January 1995 and June 2004 in the Ophthalmology Department of Dokuz Eylul University, Izmir, Turkey. All patients had follow-up at or beyond 6 months. RESULTS: Nineteen (79.2%) boys and 5 (20.8%) girls were included. Mean age was 12.6 years (standard deviation, +/- 3.5; range, 5 to 17). Five eyes (20%) had blunt ocular trauma. Eleven eyes (44%) had penetrating trauma. Three eyes (12%) had high myopia. Four eyes (16%) had congenital cataract surgery. One eye (4%) had redetachment 1 month after vitreoretinal surgery performed at another clinic. One case had bilateral proliferative vitreoretinopathy with an undefined cause. The retina remained attached in 18 (72%) of 25 eyes at the final examination (17 were totally attached; 1 was partially attached). Mean follow-up was 23.4 months (standard deviation, +/- 20.5; range, 6 to 108). Postoperative visual acuity improved to 1/10 or better only in 6 eyes (24%) at the last examination. CONCLUSION: In pediatric patients with complicated retinal detachment, silicone oil injection for intraocular tamponade is an option for treatment, but visual outcome is poorer than for adults.     

Experience with cefepime versus meropenem as empiric monotherapy for neutropenia and fever in pediatric patients with solid tumors

A prospective, open-label, randomized, comparative study in pediatric cancer patients was conducted to evaluate the efficacy and safety of cefepime and meropenem in the empiric therapy of febrile neutropenic patients. Febrile episodes were classified as microbiologically documented infection, clinical documented infection, or fever of unknown origin. Clinical response to therapy was classified as success or failure. In this period 37 children with solid tumors including lymphoma, 25 males, 12 females, had neutropenia on 65 occasions. Microbiologically documented infections occurred in 21 episodes (32.31%). Frequency of positive bacteria isolated was higher than gram-negative bacteria. There was no infection-related death. There were no statistical differences between the cefepime and meropenem groups for duration of fever or neutropenia, response rate, and necessity for modification. Cefepime appears to be as effective and safe as meropenem for empiric treatment of febrile episodes in neutropenic pediatric cancer patients.     

Isoametropic amblyopia in highly hyperopic children

PURPOSE: The purpose of this study was to evaluate the visual outcome and associated findings in isoametropic amblyopia due to high hyperopia. METHODS: Children with > or = 5 D spherical equivalent hyperopia and < or = 1.5 D anisometropia and < or = 1.5 D cylinder in both eyes were selected. Data were collected on the magnitude of spherical equivalent hyperopia, corrected visual acuity (VA) with the Snellen or Tumbling E charts, age at correction, duration of correction, ocular motility and strabismus. Children who had VA of < or = 0.4 in both eyes were defined as having isoametropic amblyopia. Associations between isoametropic amblyopia and factors affecting VA were analysed. RESULTS: A total of 160 children met the criteria. The mean follow-up was 55.8 months. In all, 31 of the children had isoametropic amblyopia. The mean age at presentation was significantly higher (5.5 years versus 4.1 years; p < 0.05) and strabismus was significantly less prevalent (p = 0.001) in the isoametropic amblyopes than in the high hyperopia group as a whole. A total of 83.9% of the isoametropic amblyopes had best corrected VA > 0.5 at the last visit. The duration of optical correction was positively correlated with the last recorded VA measurement. CONCLUSION: Isoametropic amblyopia is not rare among highly hyperopic children. Visual acuity improves satisfactorily with spectacle correction. The duration of optical correction seems to be an important factor in visual prognosis.     

Risk factors for childhood obesity: Do the birth weight,type of delivery,and mother’s overweight have an implication on current weight status?

Background

The aim of this study was to identify risk factors, including the type of delivery, breastfeeding and its duration, birth weight, the timing of solid food introduction, the mother’s education level at birth, and smoking status during pregnancy, that are associated with obesity in children living in Istanbul.

Methods

This study involving 4990 healthy children aged 2-14 years, at an outpatient clinic in a tertiary care hospital from June 2012 to July 2014.

Results

The overall rates of overweight and obesity in children were 13.1% and 7.8%, respectively. Results demonstrated that 44.5% of children were delivered by caesarean section. In all age groups, 7.8% of children delivered by caesarean section were obese compared with 7.9% of children born vaginally. No significant association between caesarean section delivery and obesity in childhood was found in our study [odds ratio (OR)=0.98, 95% confidence interval (CI)=0.64-2.87, P=0.454]. There was also no association between duration of breastfeeding and the introduction of solid foods before 4 months or after 6 months of age and childhood obesity (OR=0.95, 95% CI=0.69-1.3, P=0.771; OR=0.99, 95% CI=0.64-1.53, P=0.261). Regression analyses revealed that children with birth weights greater than 3801 g or those with maternal body mass index (BMI) equal to or greater than 30 had an increased risk of being obese or overweight (OR=1.78, 95% CI=1.19-2.65; OR=3.95, 95% CI=1.94-5.81).

Conclusions

This study demonstrated that increased birth weight and maternal BMI are significant risk factors for obesity in children living in Istanbul, Turkey. No relation between caesarean section delivery and childhood obesity was found in this study.