Thyroid biological evaluation: critical study

Laboratory tests to assess thyroid gland function have changed considerably over the past few years, with the development of techniques allowing for the direct routine determination of unbound thyroid hormones (tri and tetra-iodothyronine), the "ultra-sensitive" assay of serum concentrations of TSH (thyroid-stimulating hormone) and finally, the radioimmunological assay of anti TSH-receptor antibodies. In our study, which excluded patients having an excess of iodine or who had serious disease of an organ other than the thyroid, we assessed the impact of these parameters respectively on various disease categories. An innovation has been made in that anti TSH-receptor antibody assay is now possible in everyday practice while up to the present this was only possible in the hospital setting and with a limited number of cases: this titer is important as a classification parameter in diagnosing Grave's disease and has prognostic importance to monitor treatment of patients suffering from this disorder. The "ultrasensitive" version of measuring thyrotropic hormone requires a new strategy: TSH assessment becomes the first-line diagnosis test to evaluate thyroid function because it differentiates from control subjects, as well as patients with hyper ou hypothyroidism who are not receiving therapy. In other cases, dosing of the free hormones T3 and T4 remains a vital supplementary test.     

Combined chemoradiotherapy in small cell lung cancer

Combined chemoradiotherapy is the established standard of care for limited stage small cell lung cancer; it provides cure in 15% to 25% of patients. Early concurrent therapy imparts a 5% long-term survival benefit compared with sequential therapy. Hyperfractionated delivery of radiotherapy may provide a small incremental benefit when compared with standard fractionation. Radiotherapy dose escalation and reduced radiotherapy volumes are feasible; however, survival benefit has not been confirmed. Cisplatin and etoposide remain the preferred chemotherapy agents. New chemotherapeutic agents and novel treatment approaches are under intense investigation.     

Laparoscopic partial nephrectomy

PURPOSE OF REVIEW: This review defines the current role, indications, contraindications, advances, complications, and outcomes of laparoscopic partial nephrectomy in the management of renal tumors. RECENT FINDINGS: Recent publications have widened the scope for the application of this technology. The new advances in the management of renal tumors and the tools for tumor excision, renal parenchymal reconstruction, hemostasis, renal vascular control to establish renal ischemia, and the ability to avoid positive surgical margins have made the procedure safe and feasible in the hands of an experienced laparoscopist. SUMMARY: The trend toward nephron-sparing surgery has become stronger even in the presence of normal contralateral functioning kidney. Data on oncologic efficacy are promising, and partial nephrectomy is becoming a standard therapy for renal tumors less than 4 cm in size in many centers. Laparoscopic partial nephrectomy has evolved significantly during the past 10 years in our experience as well as that of others. It cannot be considered as a standard yet, but it is being performed in rapidly increasing numbers with good surgical efficiency and oncologic efficacy parallel to that of open surgery.     

Massive intractable hematuria secondary to cyclophosphamide

A case of massive intractable hematuria following cyclophosphamide therapy is presented. This patient had bilateral vesicoureteral reflux. The treatment consisted of occluding both ureters with Fogarty catheters while formalin was instilled into the bladder. The urine has cleared with no further gross hematuria. This has been accomplished in another patient with unilateral vesicoureteral reflux with equal success.     

An 8-week open-label trial of a 6-day course of mifepristone for the treatment of psychotic depression

OBJECTIVE: Several investigations suggest that mifepristone leads to the rapid amelioration of psychotic depression. However, these studies were of short duration (1 week or less) and included subjects who were taking other psychotropic medications. The goals of this study were to extend these findings by conducting an 8-week trial of mifepristone for subjects with psychotic depression who were taking no concomitant psychiatric medications. METHOD: Twenty subjects with a DSM-IV major depressive episode with psychotic features (for convenience we use the term psychotic depression) taking no psychotropic medications were given a 6-day course of mifepristone and followed as inpatients for a total of 8 weeks. Nonblinded ratings using the Hamilton Rating Scale for Depression (HAM-D) and Clinical Global Impressions scale (CGI) were performed at baseline and at the end of weeks 1, 4, and 8. The Brief Psychiatric Rating Scale (BPRS) was also administered at baseline and after weeks 4 and 8. Subjects were recruited between February 2003 and December 2003. RESULTS: Significant improvements in HAM-D and CGI scores were shown after 1 week and between weeks 1 and 4 but not between weeks 4 and 8. BPRS scores improved significantly after week 4, while the improvement in BPRS scores between weeks 4 and 8 was of borderline significance. CONCLUSION: Mifepristone appears to be a useful intervention for psychotic depression, leading to significant improvements even after a 1-week course of administration. Issues related to its optimal dosing and to prediction of response are discussed, as are the implications of lack of a placebo group and the use of nonblinded ratings in the present study.