ABSTRACT
OBJECTIVE: A systematic review to assess the efficacy of tamoxifen in the management of idiopathic pubertal gynecomastia. DATA SOURCES: Searches were conducted using the databases of Medline (search engine PubMed) and Web of Science®. STUDY SELECTION: Studies reporting the use of Tamoxifen for the treatment of gynecomastia in adolescents. OUTCOME MEASURE: Resolution of gynecomastia. RESULTS: A total of 164 publications were found; 59 were selected for retrieval and six were included in the review. There were no randomized controlled studies; the studies found have methodological flaws but show promising results. No clinical side-effects were reported or observed. CONCLUSION: Tamoxifen may be effective for the treatment of pubertal gynecomastia, and it seems safe to use. Randomized controlled studies are necessary to confirm this indication.
Subject(s)
Adolescent Development/drug effects , Estrogen Antagonists/therapeutic use , Evidence-Based Medicine , Gynecomastia/drug therapy , Tamoxifen/therapeutic use , Adolescent , Estrogen Antagonists/adverse effects , Humans , Male , Off-Label Use , Tamoxifen/adverse effectsSubject(s)
Ambulatory Care Facilities/economics , Blood Glucose Self-Monitoring/economics , Blood Glucose Self-Monitoring/methods , Diabetes Mellitus, Type 1/economics , Electronic Mail , Appointments and Schedules , Blood Glucose Self-Monitoring/instrumentation , Cost Savings , Diabetes Mellitus, Type 1/diagnosis , Humans , ModemsABSTRACT
Functioning pulmonary metastases are the most common distant lesions of differentiated thyroid cancer. About 50% of patients with such metastases die within 10 years. The impact of iodine-131 therapy is controversial. In this study we examined: (1) the early diagnostic value of post-surgery (131)I ablation for lung invasion and (2) the survival of patients receiving periodic (131)I therapy. Between January 1970 and December 1995 we provided initial treatment for 509 patients with thyroid cancer. Most of them (74%) underwent total thyroidectomy and (131)I ablation. Functioning pulmonary metastases occurred in 20 patients. All these patients received periodic (131)I therapy for as long as (131)I uptake persisted. Additional therapy consisted of lung surgery in three patients and local treatment of bone lesions in four patients. Follow-up data were recorded up to December 2001. Functioning pulmonary metastases occurred late in one patient, and were visible on the post-surgery (131)I therapy scan in the other 19 patients. At diagnosis of lung invasion, 11 patients had negative chest X-ray findings, and serum thyroglobulin levels were not suggestive of metastatic disease in 56% of these cases. One of the 11 patients with negative chest X-ray findings died with a neck recurrence, two have persistent pulmonary (131)I uptake, and the other eight are in apparent remission after receiving an average cumulative (131)I activity of 338 mCi (12.51 GBq). The nine patients with positive chest X-ray findings received an average of 939 mCi (34.74 GBq); two of them died, five are continuing to receive therapy and two are in apparent remission. Overall survival at 10 years is 84%. The average follow-up of the 17 survivors is 12.7 years. These results suggest that patients with functioning pulmonary metastases, even in advanced stages, may survive for many years on (131)I therapy. Early diagnosis, during post-surgery (131)I scanning, of radiologically inapparent metastases is associated with a better prognosis.
Subject(s)
Iodine Radioisotopes/therapeutic use , Lung Neoplasms/epidemiology , Lung Neoplasms/radiotherapy , Thyroid Neoplasms/epidemiology , Thyroid Neoplasms/radiotherapy , Adolescent , Adult , Aged , Aged, 80 and over , Child , Female , France/epidemiology , Humans , Lung Neoplasms/mortality , Lung Neoplasms/secondary , Male , Middle Aged , Prognosis , Radiotherapy, Adjuvant , Risk Assessment/methods , Survival Rate , Thyroid Neoplasms/mortality , Thyroid Neoplasms/surgery , Treatment OutcomeABSTRACT
The usefulness of preoperative radionuclide scanning of the parathyroid glands in patients with primary or secondary hyperparathyroidism was long controversial because available techniques were of limited diagnostic efficacy. Technetium-99m-labeled sestamibi (99Tc-sestamibi) is a new radiopharmaceutical agent easily detected by gamma cameras. The first parathyroid imaging studies done with 99Tc-sestamibi about 10 years ago used a double-phase technique to separate thyroid and parathyroid tissue. Although promising, this method was less than ideal, particularly in multiple gland primary hyperparathyroidism and in secondary hyperparathyroidism. For several years, we have been using subtraction between two images acquired simultaneously, one with 99Tc-sestamibi, which binds to thyroid and parathyroid tissue, and the other with 123-iodine, which binds only to thyroid tissue. The remarkable efficacy of this technique in both primary and secondary hyperparathyroidism invites a reappraisal of the place of radionuclide imaging as a preoperative localization procedure done to reduce the need for repeat surgery. The usefulness of this technique in selecting candidates for unilateral surgery among patients with primary hyperparathyroidism is discussed.
