Interpretation of normative thyroid volumes in children and adolescents: is there a need for a multivariate model?

The use of thyroid ultrasonography for determination of thyroid volume requires reliable reference criteria. The current World Health Organization/International Council for the Control of Iodine Deficiency Disorders (WHO/ICCIDD) reference has been questioned since iodine-sufficient children have been found throughout the world with distinctly smaller thyroid volumes. A difference in part explained by a systematic bias when generating the WHO/ICCIDD reference data. The objective with this study was to evaluate normative thyroid volumes in our region and, if possible, develop a multivariate model for their interpretation. Thyroid ultrasonography was performed and anthropometrical measurements were taken in 561 children and adolescents. The best predictor for thyroid volume in both girls and boys was body surface area (BSA), followed by age, weight, and height. References for normative thyroid volumes were calculated for each of the predictors. When these references were compared with other references throughout the world, the age-specific references were in good accord, but distinct differences were found between our BSA-specific references and other references based on a majority of children younger than ours. Using multivariate analyses, BSA and age were found to significantly influence thyroid volume, independently of each other. Multiple regression models by gender using BSA and age as predictors for thyroid volume were constructed. Using these models the difference between the BSA-specific references could be markedly reduced. To interpret thyroid volume accurately we propose the use of a multivariate model using age and BSA as predictors of thyroid volume.

Appendiceal abscesses: primary percutaneous drainage and selective interval appendicectomy.

OBJECTIVE: To present our results of non-surgical primary management of appendiceal abscesses using ultrasonic percutaneous drainage under local anaesthesia, and selective interval appendicectomy. DESIGN: Retrospective study. SETTING: University hospital, Sweden. SUBJECTS: 24 patients with appendiceal abscesses 3-12 cm in size. INTERVENTIONS: Primary ultrasonic percutaneous drainage under local anaesthesia, antibiotic treatment, and selective surgical treatment. MAIN OUTCOME MEASURES: Long-term follow-up. RESULTS: All patients had their abscesses drained successfully without complications. One patient continued to have fever, but eventually responded to conservative treatment and in one the bowel was perforated by the drain but again this was treated conservatively. Four abscesses recurred. Seven patients underwent planned interval appendicectomy. Another three patients were also operated on-one for caecal adenocarcinoma, and two for persisting symptoms and enterocutaneous fistulas. CONCLUSIONS: Appendiceal abscesses can be effectively drained percutaneously using ultrasound-guided drainage under local anaesthesia, without complications. Recurrent appendicitis is common, and malignancy is a substantial risk in elderly patients. Modern laparoscopic appendicectomy and early postoperative discharge makes interval appendicectomy a valid treatment option after primary non-surgical management of appendiceal abscesses.

Duration of prophylaxis against venous thromboembolism with enoxaparin after surgery for cancer.

BACKGROUND: Abdominal surgery for cancer carries a high risk of venous thromboembolism, but the optimal duration of postoperative thromboprophylaxis is unknown. METHODS: We conducted a double-blind, multicenter trial in which patients undergoing planned curative open surgery for abdominal or pelvic cancer received enoxaparin (40 mg subcutaneously) daily for 6 to 10 days and were then randomly assigned to receive either enoxaparin or placebo for another 21 days. Bilateral venography was performed between days 25 and 31, or sooner if symptoms of venous thromboembolism occurred. The primary end point with respect to efficacy was the incidence of venous thromboembolism between days 25 and 31. The primary safety end point was bleeding during the three-week period after randomization. The patients were followed for three months. RESULTS: The intention-to-treat analysis of efficacy included 332 patients. The rates of venous thromboembolism at the end of the double-blind phase were 12.0 percent in the placebo group and 4.8 percent in the enoxaparin group (P=0.02). This difference persisted at three months (13.8 percent vs. 5.5 percent, P=0.01). Three patients in the enoxaparin group and six in the placebo group died within three months after surgery. There were no significant differences in the rates of bleeding or other complications during the double-blind or follow-up periods. CONCLUSIONS: Enoxaparin prophylaxis for four weeks after surgery for abdominal or pelvic cancer is safe and significantly reduces the incidence of venographically demonstrated thrombosis, as compared with enoxaparin prophylaxis for one week.