Pregnancy has no significant impact on the prognosis of differentiated thyroid cancer

ABSTRACT Objective: To evaluate the impact of pregnancy on differentiated thyroid carcinomas (DTC) behavior Subjects and methods: Retrospective study of patients diagnosed with DTC before or during pregnancy and treated with standard therapy. In women diagnosed with DTC before pregnancy, we evaluated the occurrence of progression according to categories of response to therapy based on imaging and non-stimulated thyroglobulin (TG) levels. Results: Of 96 analyzed patients, 76 became pregnant after DTC treatment and 20 were diagnosed with DTC during pregnancy. Among women who became pregnant after a DTC diagnosis, no difference was observed regarding response to therapy before and after pregnancy. Disease progression after pregnancy was documented in six of these patients, while seven of them presented progression before pregnancy but were only treated after delivery. Patients with DTC diagnosed during pregnancy had a higher rate of distant metastases at diagnosis (30%) compared with the patients who became pregnant after DTC diagnosis (9.2%, p = 0.01). Conclusion: Pregnancy had no impact on the natural course of DTC. Disease progression after pregnancy was limited and probably related to more aggressive disease and higher risk stratification at diagnosis. Still, mild disease progression may have occurred asymptomatically in some patients.

Impact of historic histopathologic sample review on the risk of recurrence in patients with differentiated thyroid cancer

ABSTRACT Objective To compare the historic risk of recurrence (RR) and response to therapy to risk stratification estimated with historical pathology reports (HPRs) and contemporary re-review of the pathological slides in patients with differentiated thyroid cancer (DTC). Subjects and methods Out of 210 DTC patients with low and intermediate RR who underwent total thyroidectomy and remnant ablation in our hospital, 63 available historic pathologic samples (HPS) were reviewed. The RR and the response to therapy were evaluated considering historical histological features (histological type, tumor size, capsular invasion, number of lymph node metastases) and then, reassessed after observing additional histological features (vascular invasion, extrathyroidal extension, size of lymph node metastases, presence of extranodal extension, and/or status of the resection margins). Results A change in the RR category was observed in 16 of 63 cases (25.4%). Out of 46 patients initially classified as low RR, 2 patients were reclassified as intermediate RR, 4 as high RR, and 1 as noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP). Out of 17 patients initially classified as intermediate RR, 3 were reassigned to the low RR group, 5 as high RR, and 1 as NIFTP. The percentages of structural incomplete response at final follow-up changed from 2.2 to 0% (p = 1) in patients with low RR and from 6.3 to 20% (p = 0.53) in patients with intermediate RR. Conclusion A detailed report of specific features in the HPR of patients with DTC might give a more accurate RR classification and a better estimation of the response to treatment.

Respuesta terapéutica en enfermos con tuberculosis multidrogorresistente / Response to therapy in multiple drug resistant tuberculosis patients

Introducción: la tuberculosis multidrogorresistente constituye un problema médico de gran importancia, porque implica la diseminación de microorganismos para los que es necesario aplicar medicamentos de la llamada "segunda línea", cuya efectividad es menor, requiere un tiempo de tratamiento más prolongado que aumenta la frecuencia de efectos indeseables, además de ser mucho más costoso que el tratamiento convencional. Objetivos: identificar la respuesta terapéutica al tratamiento individualizado en pacientes tuberculosos multidrogorresistentes no seropositivos al VIH. Métodos: se realizó un estudio descriptivo en una muestra de enfermos tuberculosos multidrogorresistentes tratados por al menos 1 año con esquemas individualizados, entre los años 2000 y 2010 en el Hospital Neumológico "Benéfico Jurídico". Se obtuvieron los datos de las historias clínicas individuales y las fichas bacteriológicas. Resultados: de los 42 pacientes, 85,7 % era de hombres y la edad media resultó 48,8 años. La categoría de caso más frecuente que motivó el ingreso fue la de crónico (40,5 %). El tiempo medio para el resultado negativo del examen directo fue de 4,6 meses y del cultivo 6 meses; resultó menor en los pacientes clasificados como fracasos y mayor en los clasificados como recaída. El mayor porcentaje de curación se obtuvo en los pacientes clasificados como crónicos y fracasos, con 23,8 y 21,4 %, respectivamente. Conclusiones: el cumplimiento del tratamiento individualizado directamente observado para tuberculosis multidrogorresistente resultó eficaz en más de la mitad de los casos.

Introduction: multiple drug resistant tuberculosis is an increasingly significant medical problem, because it means the spread of microorganisms for which "second line" drugs are required to eliminate them; therapeutic effectiveness is lower, it takes longer to treat it, leading to more adverse effects in addition to being more expensive than the conventional treatment. Objective: to identify the response to individualized treatment in multiple drug resistant tuberculosis patients, who are non-HIV seropositive. Method: a descriptive study was conducted in a sample of multiple drug resistant patients, who were treated for a year under individualized courses of treatment from 2000 to 2010 in Hospital Neumológico "Benéfico Jurídico". Data were collected from their medical histories and from bacteriological records. Results: out of 42 patients, 85.7 % were males and the average age was 48.8 years. The most common category on admission was chronically-ill patient (40.5 %). The average time for negative results in direct exam was 4.6 months and in culturing was 6 months; this indicator was lower in patients regarded as failures and higher in those classified as relapses. The highest healing percentage was found in chronic patients and in those classified as failures, accounting for 23.8 and 21.4 % respectively. Conclusions: the compliance with individualized treatment under direct observation in multiple drug resistant tuberculosis proved to be effective in over half of the cases.

Prognostic factors of a good response to initial therapy in children and adolescents with differentiated thyroid cancer

BACKGROUND: Therapeutic approaches in pediatric populations are based on adult data because there is a lack of appropriate data for children. Consequently, there are many controversies regarding the proper treatment of pediatric patients. OBJECTIVE: The present study was designed to evaluate patients with differentiated thyroid carcinoma diagnosed before 20 years of age and to determine the factors associated with the response to the initial therapy. METHODS: Sixty-five patients, treated in two tertiary-care referral centers in Rio de Janeiro between 1980 and 2005 were evaluated. Information about clinical presentation and the response to initial treatment was analyzed and patients had their risk stratified in Tumor-Node- Metastasis; Age-Metastasis-Extracapsular-Size; distant Metastasis-Age-Completeness of primary tumor resection-local Invasion-Size and American-Thyroid-Association classification RESULTS: Patients ages ranged from 4 to 20 years (median 14). The mean follow-up was 12,6 years. Lymph node metastasis was found in 61.5 percent and indicated a poor response to initial therapy, with a significant impact on time for achieving disease free status (p = 0.014 for response to initial therapy and p<0,0001 for disease-free status in follow-up). Distant metastasis was a predictor of a poor response to initial therapy in these patients (p = 0.014). The risk stratification systems we analyzed were useful for high-risk patients because they had a high sensitivity and negative predictive value in determining the response to initial therapy. CONCLUSIONS: Metastases, both lymph nodal and distant, are important predictors of the persistence of disease after initial therapy in children and adolescents with differentiated thyroid cancer.

The Response to Therapy and Outcome in Adult Focal Segmental Glomerulosclerosis / 대한내과학회지

BACKGROUND: The response to therapy in adult patients with nephrotic syndrome caused by rimary focal segmental glomerulosclerosis (FSGS) was discouraging, but recent reports have shown high remission rate. Of these patients in remission, few progressed to end stage renal disease. METHODS: we analyzed author's experiences in 42 Korean adults with primary FSGS between January 1986 and December 1995 in attempt to know the response to therapy and outcome. RESULTS: 1) Twenty-six of 42 patients(62%) had nephrotic range proteinuria, and renal insufficiency (serum creatinine>1.4 mg/dL) was present in 14 patients(34%). Nephrotic patients had higher serum level of creatinine than that of nonnephrotic patients, and there was no difference between the two groups in blood pressure, age, and hematuria. 2) Twenty-six patients with nephrotic range proteinuria received combined treatment with prednisolone and cyclophosphamide. Complete remission (proteinuria300 mg/d) was observed in 10 cases(39%), and partial remission(2.50g/d) in 11 cases(42%), with mean remission time of 4.12.2 months after initiation of treatment. They had remission within 6 months of therapy except one. Relapse was noticed in 11 cases (52%) during follow-up. 3) None of responder group progressed to ESRD, while two of 5 non-responders progressed to ESRD, but there was no significant difference in slope of inverse creatinine between two groups. 4) The degree of proteinuria, initial serum creatinine, age, and sex did not affect the patient's response to therapy 5) The risk factors related to progression of renal failure were the initial serum creatinine level and degree of proteinuria. CONCLUSION: Nephrotic adult patients with primary FSGS may benefit from a more prolonged course of therapy with prednisolone and cyclophosphamide.