Can We Discharge Dynamically Risk-Stratified Low-Risk (Excellent Response to Treatment) Thyroid Cancer Patients After 5 Years of Follow-Up?

Aims

The 2014 British Thyroid Association thyroid cancer guidelines recommend lifelong follow-up of thyroid cancer patients. This is probably unnecessary, can cause patient anxiety, is time consuming and places significant demand on National Health Service resources. It has been suggested that low-risk differentiated thyroid cancer (DTC) patients could be discharged to primary care once they are 5 years from diagnosis and treatment. The aim of this study was to investigate the potential safety of this practice.

A Review of Primary Thyroid Lymphoma: Molecular Factors,Diagnosis and Management

Purpose/aim: To focus on current aspects of primary thyroid lymphoma (PTL), which is a rare clinical entity usually manifested by a rapidly growing mass in the neck that can cause pressure symptoms.

Materials and Methods: Relevant papers in PubMed published through June 2017 were selected to track updated information about PTL with an emphasis on diagnosis and novel therapeutic management.

Results: The most frequent cases include non-Hodgkin lymphoma derived from B-cells, mainly diffuse large B-cell lymphoma (DLBCL) followed by mucosa-associated lymphoid tissue (MALT) lymphoma or a mixed type. Other subtypes are less common. Lymphomas derived from T-cells and Hodgkin lymphomas are extremely rare. Hashimoto's autoimmune thyroiditis has been implicated as a risk factor for lymphoma. At the molecular level, the Wnt5a protein and its receptor Ror2 are involved in the course of the disease. Ultrasonography, fine needle aspiration (FNA) biopsy, and core or open biopsy combined with new diagnostic facilities contribute to an accurate diagnosis. An increased potential exists for a cure without the need for a radical surgical procedure. Modern chemoradiation therapy plus the monoclonal antibody rituximab, which acts against CD20, have limited the need for surgical interventions and provide an excellent outcome in most cases. However, some cases have resulted in treatment failure or recurrence.

Conclusions: A multidisciplinary approach must be used to define the management policy in each case. Future efforts by researchers are likely to be focused on the molecular level.     

Differentiated Thyroid Cancer in Children: A UK Multicentre Review and Review of the Literature

Aims

To obtain an overview of the management and outcomes of children aged 18 years or younger diagnosed with differentiated thyroid carcinoma of follicular cell origin across the UK, by collecting and analysing data from the limited number of centres treating these patients. This multicentre data might provide a more realistic perspective than single-institution series.

斜侧入路体位摆放预防甲状腺手术体位综合征的效果

目的：评估斜侧入路手术体位摆放预防甲状腺手术体位综合征的效果。方法：回顾性分析2019年6月至2019年12月温州医科大学附属第一医院甲乳外科行甲状腺手术的患者,分为传统手术组（132例）和斜侧入路手术组（81例）,观察两组患者手术体位综合征的发生情况,同时观察两组患者术中情况,包括切口长度、失血量、手术时间、术野暴露质量等指标。结果：传统手术组与斜侧入路手术组患者性别（33/99 vs.20/61,P =1.000）、年龄[（52.4±9.4）岁 vs.（ 51.5±10.2）岁,P =0.546]、失血量[（16.80±2.64）mL vs.（16.72±2.61）mL,P =0.815）和手术时间[（64.25±5.45）min vs.（ 63.00±6.58）min,P =0.135]差异均无统计学意义;与传统手术组相比,斜侧入路手术组患者在不延长手术时间的前提下,其切口更短[（6.47±0.78）cm vs.（ 4.93±0.32）cm,P＜0.001],手术体位综合征发生更少（耐受差发生率42.4% vs. 16.0%,P＜0.001;头痛61.4% vs. 24.7%,P ＜0.001;恶心呕吐49.2% vs. 17.3%,P ＜0.001）,术野暴露质量更佳（1级暴露率49.2% vs. 72.8%,P =0.001）。结论：斜侧入路手术体位摆放使手术体位从头部极度后仰改善到头部稍后仰,能有效减少甲状腺手术体位综合征的发生,是一种安全可行的方法。     

Metástasis coroidea como primera manifestación de carcinoma papilar de tiroides: a propósito de un caso

The case is presented of 78 year-old who consulted due to decreased visual acuity in right eye for several months. Indirect ophthalmoscopy revealed an orange-yellow coloured choroidal mass at the posterior pole, without retinal detachment. Computed tomography showed a thyroid mass in the isthmus, as well as multiple pulmonary nodules and metastatic foci. The findings of transbronchial lung biopsy were compatible with metastatic dissemination. Fine-needle aspiration biopsy of thyroid nodule was diagnostic for a with columnar cell variant of papillary thyroid cancer. Positron emission tomography confirmed papillary thyroid carcinoma. The patient underwent total thyroidectomy and radioactive iodine therapy.     

Acrylamide exposure impairs blood-cerebrospinal fluid barrier function

Previous studies show that chronic acrylamide exposure leads to central and peripheral neu- ropathy. However, the underlying mechanisms remained unclear. In this study, we examined the permeability of the blood-cerebrospinal fluid barrier, and its ability to secrete transthyretin and transport leptin of rats exposed to acrylamide for 7, 14, 21 or 28 days. Transthyretin levels in cerebrospinal fluid began to decline on day 7 after acrylamide exposure. The sodium fluorescein level in cerebrospinal fluid was increased on day 14 after exposure. Evans blue concentration in cerebrospinal fluid was increased and the cerebrospinal fluid/serum leptin ratio was decreased on days 21 and 28 after exposure. In comparison, the cerebrospinal fluid/serum albumin ratio was increased on day 28 after exposure. Our findings show that acrylamide exposure damages the blood-cerebrospinal fluid barrier and impairs secretory and transport functions. These changes may underlie acrylamide-induced neurotoxicity.