Predictors of poor outcome following liver biopsy for the investigation of new hepatic space occupying lesion/s.

BACKGROUND: Ultrasound-guided percutaneous liver biopsy (UPLB) is currently performed mainly to determine if new hepatic space occupying lesions (SOL) represent benign, primary malignant, or metastatic disease. This study sought to investigate the outcome of UPLB in this setting. METHODS: In a retrospective study, patients with a new hepatic SOL who underwent UPLB during 1/2006-12/2016 were included and followed to 12/2018. Clinical data and pathology reports were reviewed. Mortality within 60 days and no change in patients' management following UPLB were defined as medically futile. RESULTS: Included 140 patients, 50% male, mean age 68.8 ± 11.5 years; 112 patients died, all of malignant disease. 32 patients (23%) died within 60 days of UPLB. Median post-UPLB survival was 151 days. Survival was significantly shorter in patients with >1 hepatic lesion (n = 108) or an extrahepatic malignant lesion (n = 77) (p = 0.0082, p = 0.0301, respectively). On Cox Proportional Hazards analysis, significant predictors of mortality within 60 days of UPLB were: age as a continuous variable, (HR 1.070, 95% CI 1.011-1.131, p = 0.018), serum albumin <2.9 g/dL, (HR 4.822 95% CI 1.335-17.425, p = 0.016) and serum LDH >1500 U/L (HR 9.443, 95% CI 3.404-26.197, p < 0.0001). CONCLUSIONS: In patients with these features or with disseminated disease, liver biopsy should be carefully reconsidered.

Association between anemia at three different time points and new-onset diabetes after kidney transplantation--a retrospective cohort study.

PURPOSE: Anemia has been reported to be associated with diabetes, but the association between new-onset diabetes after transplantation (NODAT) and anemia has not been reported. METHODS: Patients who underwent kidney transplantation and did not have diabetes prior to transplantation were included in this study. Hemoglobin levels and the prevalence of anemia (hemoglobin <12 g/dL in females and <13 g/dL in males) were evaluated at three time points (prior to transplantation, 6 months following transplantation or 1 month before the development of NODAT, 2 years following transplantation, or following the development of NODAT) and were compared between those who developed NODAT and those who did not. Variables associated with the development of anemia were compared between the two groups. RESULTS: A total of 266 kidney transplant recipients were included, of which 71 (27%) developed NODAT during the time of the follow-up. Hemoglobin and hematocrit levels and the prevalence of anemia were similar in those with and without NODAT at all three time points evaluated. Ferritin levels, prior to transplantation and mean corpuscular volume (MCV) posttransplantation post-NODAT development, were slightly but significantly lower in those with NODAT, although both were within the normal range. CONCLUSIONS: Pretransplantation ferritin levels and posttransplantation post-NODAT development MCV are inversely associated with the development of NODAT in kidney transplants.

[CLINICAL CHARACTERISTICS OF MALE PATIENTS WITH OSTEOPOROSIS REFERRED TO THE ENDOCRINE CLINIC OF A TERTIARY HOSPITAL].

INTRODUCTION: Osteoporosis in men is underdiagnosed and undertreated. The prevalence of male osteoporosis increases with age and it becomes a significant public health burden. Currently, there are a few clinical studies on male osteoporosis with limited knowledge of effective therapeutic options. AIMS: Our study aimed to characterize men with osteoporosis in a referral metabolic clinic in Rabin Medical Center at the Beilinson Campus. METHODS: In this study we retrospectively analyzed the medical records of 270 consecutive male patients with osteoporosis diagnosed and treated in our clinic during 2013. RESULTS: A total of 270 of 1940 (14%) patients with osteoporosis in our clinic were males. The mean age of men with osteoporosis was 67.9 ± 13.6; 113 (40%) men suffered from osteoporotic fractures, 57 of them (51%) had vertebral fractures, 28 (25%) had more than one fracture. Osteoporotic fracture was the first presentation of osteoporosis in 82% of men with fractures (age of presentation 62.2 ± 14.5). Furthermore, 141 patients (52%) had vitamin D insufficiency (25OHD levels < 60 nmol/l, normal 75-250 nmol/l), and the mean level was 39.9±12.6 nmol/l. Secondary osteoporosis was identified in 166 (61%) men. The most common etiologies were chronic glucocorticoid treatment (45%), hypogonadism (36%), hypercalciuria (23.4%) and hyperparathyroidism (19%). Most men (223) received bisphosphonates as primary therapy and alendronate was the mostly commonly prescribed agent. CONCLUSIONS: Osteoporosis in men usually remains an underdiagnosed disorder until an osteoporotic fracture occurs. Secondary causes for osteoporosis are commonly encountered, of which glucocorticoid treatment and hypogonadism are the most prevalent etiologies. Increasing awareness of osteoporosis in men may prevent the deleterious consequences of this disabling, yet treatable disease.

Incidence of Nonthyroidal Primary Malignancy and the Association with (131)I Treatment in Patients with Differentiated Thyroid Cancer.

BACKGROUND: The occurrence of nonthyroidal primary malignancy (NTPM) and the potential association of with radioiodine (RAI) treatment are important concerns in patients with differentiated thyroid cancer (DTC), but incidence data are conflicting. The aims of the present study were to investigate the incidence of NTPM and its association with RAI treatment in a cohort of DTC patients treated at a single tertiary medical center. METHODS: The data of 1943 patients with DTC recorded in the Rabin Medical Center Thyroid Cancer Registry were cross-matched with data from the Israeli National Cancer Registry to identify those diagnosed with an NTPM. Patient medical files were reviewed. Second primary malignancy (SPM) was defined as new malignancy diagnosed at least two years after DTC diagnosis. RESULTS: For 1434 of the 1943 patients (73.8%), the American Joint Committee on Cancer TNM stage was 1-2. The mean follow-up was 9.3 years. Of the 1943 patients, 1574 (81%) were treated with RAI, and 1467 were followed for at least 2 years, and of these, 1145 patients (78%) received a cumulative dose of ≤200 mCi. A total of 409 NTPMs were diagnosed in 368/1943 patients with DTC (18.9%; 265 female, mean age 53.9 ± 15 years), including 173 SPMs (42.3%) in 166/368 patients. The most common NTPM and SPM was breast cancer followed by hematologic malignancies. In patients followed for ≥2 years, SPMs were diagnosed in 9% of RAI-treated patients and 10.5% of non-RAI-treated patients. SPM rates were 10.2% and 7.8% for a cumulative RAI dose of ≤100 mCi and >100 mCi respectively. Hazard ratios for SPM in patients that received/did not receive RAI treatment was 1.27 (95% confidence interval 0.88-1.82; p = 0.1). There was no correlation between first or cumulative RAI dose and diagnosis of SPM. CONCLUSIONS: NTPMs are not uncommon in patients with DTC and usually antecede the DTC. In a population of mostly low-risk DTC patients, in whom limited activities of RAI are usually administered, this treatment is apparently not associated with an overall increased risk of SPMs compared with subjects not receiving RAI treatment.

Papillary thyroid cancer: factors involved in restaging N1 disease after total thyroidectomy and radioactive iodine treatment.

CONTEXT: The presence of cervical lymph node metastases is a strong predictor of persistent disease in papillary thyroid cancer (PTC). OBJECTIVE: The objective of the study was to investigate factors associated with improved outcome in patients with PTC and lymph node metastases. DESIGN: Retrospective Cohort Setting: The study was conducted at a tertiary university-affiliated medical center. PATIENTS: PATIENTS treated for PTC and N1 disease since 1995 participated in the study. Partial thyroidectomy, distant metastases, and poor differentiation were the exclusion criteria. INTERVENTIONS: The intervention was a data search of the Thyroid Registry. MAIN OUTCOME MEASURES: Significant association of clinical and disease-related factors with persistent disease was measured. RESULTS: Of 800 patients treated for PTC during the study period, 182 (69% female; mean age at diagnosis 46.5 ± 15 y) had N1 disease (47% N1a, 53% N1b). Most (93.4%) had a classical/follicular variant; 65% had T1-2 disease; and 42.6% had extrathyroid extension. All patients were treated with total thyroidectomy and radioactive iodine (mean first dose 147 ± 26 mCi). Lateral neck dissection was performed in 53% patients. Mean follow-up was 9.2 ± 4.5 years. On regression analysis, factors significantly and independently associated with persistent disease at 1 year (94 of 182, 52%; 40% of N1a group, 59% of N1b group) were primary tumor size, focality, and extrathyroid extension and at the last follow-up (62 of 182, 34%; 27% of N1a group, 33% of N1b group), primary tumor size, 1-year stimulated thyroglobulin level, and cumulative I(131) dose. Stimulated thyroglobin less than 2.1 ng/mL at 1 year predicts the absence of disease at the last follow-up with an 86% negative predictive value. CONCLUSION: PATIENTS with PTC and N1 disease treated with total thyroidectomy and radioactive iodine have a significant risk of persistent disease at early and late follow-up. The extension of the primary tumor at diagnosis appears to be the only significant predictor of persistency in these patients.