Is radioactive iodine- 131 treatment related to the occurrence of non-synchronous second primary malignancy in patients with differentiated thyroid cancer?

Objective Much controversy relates to the risk of non-synchronous second primary malignancies (NSSPM) after radioactive iodine treatment (RAI-131) in differentiated thyroid cancer (DTC) patients. This study evaluated the relationship between RAI-131 and NSSPM in DTC survivors with long-term follow-up. Materials and methods Retrospective analysis of 413 DTC cases was performed; 252 received RAI-131 and 161 were treated with thyroidectomy alone. Exclusion criteria were: prior or synchronous non-thyroidal malignancies (within the first year), familial syndromes associated to multiple neoplasms, ionizing radiation exposure or second tumors with unknown histopathology. Results During a mean follow-up of 11.0 ± 7.5 years, 17 (4.1%) patients developed solid NSSPM. Patients with NSSPM were older than those without (p = 0.02). RAI-131 and I-131 cumulative activity were similar in patients with and without NSSPM (p = 0.18 and p = 0.78, respectively). Incidence of NSSPM was 5.2% in patients with RAI-131 treatment and 2.5% in those without RAI-131 (p = 0.18). Using multivariate analysis, RAI-131 was not significantly associated with NSSPM occurrence (p = 0.35); age was the only independent predictor (p = 0.04). Under log rank statistical analysis, after 10 years of follow-up, it was observed a tendency of lower NSSPM-free survival among patients that received RAI-131 treatment (0.96 vs . 0.87; p = 0.06), what was not affected by age at DTC diagnosis. Conclusion In our cohort of DTC survivors, with a long-term follow-up period, RAI-131 treatment and I-131 cumulative dose were not significantly associated with NSSPM occurrence. A tendency of premature NSSPM occurrence among patients treated with RAI-131 was observed, suggesting an anticipating oncogenic effect by interaction with other risk factors.

Valor do teste ergométrico na detecção de isquemia miocárdica silenciosa em pacientes diabéticos / Exercise stress test for the detection of silent myocardial ischemia indiabetic patients

Em portadores de diabetes mellitus (DM), o diagnóstico de doença arterial coronariana (DAC) é comumente tardio devido à presença de isquemia miocárdica silenciosa (IMS). O objetivo do presente estudo foi avaliar os fatores de risco cardiovascular e a freqüência de IMS, em portadores de DM. Foram estudados 125 indivíduos: 42 portadores de DM e de hipertensão arterial (HA) (grupo 1), 22 portadores de DM, sem HA (grupo 2); 32 portadores de HA, sem DM (grupo 3) e 29 indivíduos sem DM e HA (grupo 4). Foram obtidos dados sobre duração do DM, história familiar de coronariopatia, história de tabagismo, dosagens de colesterol total e HDL, triglicérides, creatinina plasmática e relação albumina-creatinina, em amostra isolada de urina. Todos os indivíduos foram submetidos a avaliação cardiológica e teste ergométrico (TE). O índice de massa corporal foi semelhante entre os grupos. Os valores de colesterol total foram 207±38mg/dL, 231±35mg/dL, 214±47mg/dL, 216±51mg/dL (ns); HDLcolesterol: 47±13mg/dL, 42±7mg/dL, 41±8mg/dL, 48±15mg/dL (ns), LDL colesterol: 123±36mg/dL, 165±70mg/dL, 152±62mg/dL, 139±48mg/dL (p<0,05, grupos 1 e 4 vs grupos 2 e 3), triglicérides: 196±175mg/dL, 164±51mg/dL, 176±108mg/dL, 158±68mg/dL (ns), nos grupos 1, 2, 3 e 4, respectivamente. O TE foi positivo para isquemia miocárdica em 19 (15,2%) indivíduos, sendo 14 (73,7%) do grupo 1. A elevada freqüência de IMS observada em portadores de DM e HA sugere que a realização do TE seja incorporada na avaliação de rotina dessa população de risco.

Coronary artery disease (CAD) in patients with diabetes mellitus (DM) is diagnosed late in part due to silent myocardial ischemia (SMI). The aim of this study were to evaluate cardiovascular risk factors and the frequency of SMI in patients with DM. One-hundred and twenty-five individuals were studied: 42 diabetic hypertensive patients (group 1), 22 diabetic normotensive patients (group 2); 32 non-diabetic hypertensive patients (group 3) and 29 non-diabetic normotensive individuals (group 4). Data on DM duration, family history for coronary disease, cigarette smoking, total and HDL cholesterol, triglycerides, creatinine and urinary albumin-urinary creatinine ratio were obtained. Cardiovascular evaluation and exercise stress test (EST) were performed for all subjects. Mean body massindex was similar in the 4 groups. Values of total cholesterol were 207±38 mg/dL, 231±35 mg/dL, 214±47 mg/dL, 216±51 mg/dL (ns); HDL-cholesterol: 47±13 mg/dL, 42±7 mg/ dL, 41±8 mg/dL, 48±15 mg/dL (ns), LDL cholesterol: 123±36 mg/dL, 165±70 mg/dL, 152±62 mg/dL, 139±48 mg/dL (p<0,05, group 1 and 4 vs groups 2 and 3), triglycerides: 196±175 mg/dL, 164±51 mg/dL, 176±108 mg/dL, 158±68 mg/dL (ns), in groups 1, 2, 3and 4, respectively. Nineteen subjects (15,2%) had a positive EST for myocardial ischemia. Among them, 14 (73,7%) were from group 1. The high frequency of SMI observed in diabetic hypertensive patients suggests that EST should be considered as a routine test for evaluation of this high-risk population.