ABSTRACT
OBJECTIVE: To analyse the factors that influence the development of recurrent papillary thyroid carcinoma, including the histological variant. DESIGN: Retrospective study. SETTING: Teaching hospital, Spain. SUBJECTS: 200 patients who had papillary thyroid cancers resected between 1970 and 1995. MAIN OUTCOME MEASURES: Prognostic factors and disease-free interval assessed by univariate and multivariate analysis. RESULTS: All patients were followed up for a mean of 9 years (range 4-29). 54 patients presented with recurrent disease (27%) of whom 19 (35%) died of their disease. 5-year, 10-year, and 15-year survival for those with recurrent disease were 75%, 68%, and 60%, respectively. The corresponding figures for the whole series were 93%, 90%, and 84%. The significant variables on multivariate analysis were completeness of resection (p = 0.002), extrathyroid involvement (p < 0.002), presence of lymph node metastases (p = 0.002), and histological variant of the carcinoma (P < 0.001). CONCLUSION: Using these risk factors it is possible to draw up a prognostic index and classify patients as being at low, medium, or high risk of recurrence.
Subject(s)
Carcinoma, Papillary/mortality , Neoplasm Recurrence, Local/mortality , Thyroid Neoplasms/mortality , Adolescent , Adult , Aged , Aged, 80 and over , Carcinoma, Papillary/pathology , Child , Female , Humans , Male , Middle Aged , Neoplasm Recurrence, Local/pathology , Prognosis , Retrospective Studies , Survival Analysis , Thyroid Neoplasms/pathologyABSTRACT
BACKGROUND: Rectus sheath haematoma is a rare cause of abdominal pain. If accurately diagnosed, surgery can be avoided in most cases. This study assessed the role of ultrasonography and computed tomography (CT) in the diagnosis of rectus sheath haematoma. METHODS: Thirty cases of rectus sheath haematoma diagnosed over 18 years were reviewed. Mean patient age was 59 years; there were 20 women and ten men. The results of imaging investigations were reviewed to determine their efficiency. Ultrasonography was performed in 21 patients and CT in nine. RESULTS: Arterial hypertension, anticoagulant therapy and strained coughing were the most frequent predisposing factors. The most common clinical manifestation was abdominal pain with a palpable mass. Leucocytosis occurred in 18 patients and the haematocrit fell in 13 patients but markedly in seven. Ultrasonography was diagnostic in 15 of 21 patients imaged, and CT was diagnostic in all nine. Treatment was conservative in 22 patients. Eight patients required surgery: four for diagnosis and four for treatment. CONCLUSION: Surgery can be avoided in most patients with rectus sheath haematoma. Although the numbers were small, CT appeared to be more accurate than ultrasonography in facilitating the diagnosis.
