Management of differentiated adenocarcinoma of thyroid: a ten years experience and a suggested protocol

Through a retrospective study of 320 cases of differentiated adenocarcinoma of thyroid presented to us or referred to Kasr El-Eini Center of Radiation Oncology and Nuclear Medicine [NEMROCK] treated initially surgically followed by other modalities of treatment varying between 131I, external irradiation and/or variable dose of thyroxine, a trial was made to divide such patients into a high risk and another low risk groups. Various treatment modalities were given according to certain parameters. A trial was made to provide a score system for the risk factors of cases of differentiated adenocarcinoma of thyroid to be able to start a prospective study through the suggested protocol of management. The main risk factors were, the age of the patient, the degree of differentiation, whether purely papillary, mixed or purely follicular, the size of the primary lesion and the sex of the patient. Near total thyroidectomy was done for about half of the patients. In the remaining half, lobectomy, hemithyroidectomy or subtotal thyroidectomy was performed. External irradiation was used in less than one fourth of the cases. Post operative variable dose of 131I was given in most of the cases, but our tendency is towards more limited use in the low risk group. In the low risk group we felt that ipsilateral near total lobectomy and contralateral subtotal lobectomy with a very selective neck dissection in presence of palpable nodal disease should be more than enough as a surgical treatment. Total thyroidectomy could carry the hazards of hypoparathyroidism and recurrent laryngeal nerve injury without due benefits in the so-called low risk group of patients. Total or near total thyroidectomy with selective neck dissection could be advocated in the high risk group. Radio-iodine therapy was found to be a safe and effective modality of treatment specially in adults and elderly patients

challenge of recurrent basal cell carcinoma

Recurrent basal Cell Carcinoma "B.C.C." is a much more difficult problem to diagnosis and to treat compared to primary B.C.C. In this work 35 cases of recurrent B.C.C. were studied to conclude the real reasons of recurrence to prevent and to establish an accurate way to follow up and to predict recurrences. A trial was made to choose the best way of ablative and reconstructive steps of treatment. Recurrence rate after treating recurrent B.C.C. in such series was 20% which is near the experience of other authors. This is much higher than the expected recurrences after treating primary B.C.C. Surgery was adopted in 27 cases and radiotherapy in 8 cases. the disease free survival rate at a mean period of 3 years as 81% and 75% for the groups treated by surgery and radiotherapy respectively. The highest rate of a second recurrences was observed in their morphed like lesions [four out of six cases] and lesions around fusion lines [five out of six].Post radiation recurrences were more difficult to predict and to treat; nevertheless the final disease free survival for such group was almost equal to the post surgery recurrences

Risk factors determining the outcome of injection sclerotherapy

A total of 100 patients with bleeding oesophageal varices were treated with injection sclertotherapy. The success rate in the initial control of bleeding, the complications of sclerotherapy and the risk affecting the prognosis of the patients as regards the recurrence of bleeding succeeded in 90% of the cases. The chance of success is less in patients with bad liver function, those with previous attacks of bleeding and the patient with grades III and IV oesophageal varices. Thirteen patients died in hospital in the first postsclerotherapy week. Of the deaths were due to failure of initial control of bleeding. Considering the complications of sclerotherapy apart from deaths due to bleeding from postsclertherapy ulcerations all the other complications were not fatal and included mild pyrexia, chest pain, dysphagia and postobliteration gastric varices. Patients with bad liver function, shrunken liver and previous attacks of bleeding had a higher risk of rebreeding. Patients with bad liver function, previous attacks of bleeding and high grade oesophageal varices also had a higher death rate. It was noticed that most of the deaths in the first 3 months after injection sclerotherapy were due to recurrence of bleeding andthis is the period when the varices are still large and need further injection for obliteration. So we recommend the use of strict carful injection for patients who are at a high risk of rebreeding together with correction of any haemostatic defects and amelioration of ascites if present. Continuation of injection sclerotherpy till complete obliteration of the varices is a must in all cases particularly the high risk group