[Poorly differentiated "insular" carcinoma of the thyroid: long-term survival]. / Il carcinoma scarsamente differenziato "insulare" della tiroide: sopravvivenza a distanza.

Poorly differentiated "insular" thyroid carcinoma is a rare, aggressive and often lethal variant of thyroid cancer. Thirty-one cases of this entity were encountered over a 18-yr period. In most of them surgical therapy consisted of total or near-total thyroidectomy. Six patients had distant metastases and/or mediastinal or tracheal infiltration at presentation. Fifteen out of 25 apparently cured after surgery (60%) developed recurrence in the neck and/or distant sites. Radioiodine was employed to destroy thyroid remnants (22 cases) and subsequently to treat persistent/recurrent disease (17 cases). Thirteen patients showed radioiodine uptake in neoplastic lesions and in 3 cases complete resolution was observed. After a mean follow-up of 4.5 years (range 1-16) 6 patients had died of their tumor, 12 are alive with persistent/recurrent disease, 13 do not show any evidence of disease. This experience confirms that "insular" carcinoma tends to have an aggressive behavior, but therapy can be effective. Recognition of this entity is therefore important for planning adequate surgical approach and subsequent patient management.

Antiarrhythmic and antifibrillatory properties of McN-4130 in several animal models.

McN-4130 is an experimental compound having antiarrhythmic and antifibrillatory activity in several animal models. In anesthetized, open-chest pigs subjected to total occlusion and subsequent reperfusion of the left anterior descending coronary artery, McN-4130 dose-dependently (2.5-10.0 mg/kg i.v.) protected against fibrillation and death. Mean arterial pressure was not significantly affected, but heart rate was dose-dependently reduced. In anesthetized normal dogs, McN-4130 increased ventricular fibrillation threshold for up to 45 min. This increase in fibrillation threshold was associated with concurrent increases in ventricular conduction time and ventricular effective refractory period. In conscious dogs subjected to occlusion of the left anterior descending coronary artery 24 h previously, McN-4130, 2.5 and 5.0 mg/kg i.v., significantly reduced the rate of ventricular arrhythmias for up to 45 min. McN-4130 was more effective and had a longer duration of action than comparable doses of lidocaine and disopyramide. McN-4130 was orally effective in this model at 10 mg/kg. These results indicate that McN-4130, a structurally unique experimental antiarrhythmic compound, may be useful as a ventricular antiarrhythmic agent with antifibrillatory properties.

Facial bone fractures in children.

From the aforementioned study, the following conclusions can be stated: (1) Patients ranged from 2 to 15 years of age, with no one age group being more susceptible to facial fractures. This fact is contrary to previous findings. (2) No true orbital blow-out fractures were found in patients less thn 7 years of age, primarily because of the lack of maxillary sinus development in that age group. The most rapid development of the maxillary sinus occurs between the ages of 7 to 15 years. (3) In patients from 2 to 7 years of age, fractures occurred at an even ratio of boys and girls. From 8 to 15 years of age there was a boy: girl ratio of about 4.5:1. Of the sixty-seven total patients in the study, boys outnumbered girls by a ratio fo 2.4:1. In order, the condyle, orbit, and mandible were the most common fracture sites observed in the study. This fact is in agreement with past studies. There was no predominant site for any age group or sex. While falls were singly responsible for the greatest number of facial fractures, automobile-related trauma accounted for 47.7 percent of facial fractures in children. In the majority of cases multiple mandibular fractures were of the bilateral condylar type. Hospitalization of patients with automobile-related fractures was approximately 3 days longer than that of patients whose fractures occurred from other causes. More than two thirds of the patients in the study had associated trauma-related medical and dental injuries.