Dyshormonogenetic goiter-like changes in a child with congenital hypothyroidism and a euthyroid adult.

Dyshormonogenetic goiter is a rare entity that presents in patients who typically have a history of congenital hypothyroidism, and generally arises from a genetic mutation compromising the production of functional thyroxine or thyroglobulin. Clinically, physical manifestations of goiter can result if left untreated. Histologically, the thyroid lesions usually show prominent bridging fibrosis, multiple thyroid nodules with different architectures, microfollicular arrangement, scant colloid, and enlarged vesicular or hyperchromatic nuclei. Cytologically, the features of the lesion are not distinguishable from follicular lesion and follicular neoplasm. We describe two patients exhibiting similar histological and cytological features resembling dyshormonogenetic goiter with cytologic misinterpretation as follicular neoplasm. One was a child with an established history of congenital hypothyroidism. The other was an adult euthyroid patient who presented with an associated parathyroid adenoma. These findings further affirm that cytologically and histologically, morphologic features associated with dyshormonogenetic goiter can also be found in patients without a history of congenital hypothyroidism.

Metastatic hepatocellular carcinoma with associated spinal cord compression.

Metastatic hepatocellular carcinoma is a rare occurrence in the United States. The prognosis is poor, with a survival time of months from the time of diagnosis. This article reports a case of myelopathy that developed from metastases in a patient with no significant medical history. The patient was treated with decompressive laminectomy followed by adjuvant radiotherapy. A review of the literature demonstrated that most cases from hepatocellular carcinoma metastasizing to the spinal cord involve either the thoracic or lumbar levels and arise from the right liver lobe or both lobes. Major risk factors included positive hepatitis B virus serologies. This article also discusses current trends in management of epidural spinal cord compression. Although treatment with chemotherapy has not shown any benefit, surgical management has been shown to decrease morbidity and mortality in some patients.

New Zealand drivers study: developing a methodology for conducting a follow-up study of newly licensed drivers.

PROBLEM: In recent years, there has been a significant reduction in traffic crash injury among young people, but they continue to be overrepresented in the traffic crash statistics. To improve this situation, sound scientific evidence is needed to develop effective policies and programs. METHOD: The aim of the proposed study is to provide this evidence by examining early driving and driving-related experiences of newly licensed drivers as they progress through the learner-, restricted-, and full-license stages of the graduated licensing system and to determine the impact of these experiences on subsequent negative traffic-related outcomes (risky driving behavior, injury traffic crashes, noninjury traffic crashes, infringements, convictions). Given the size and complexity of the proposed study, a comprehensive pilot study was undertaken to determine the feasibility of conducting a New Zealand-wide cohort study of newly licensed drivers. RESULTS: This article describes the pilot study process and the methodology that has been developed for the New Zealand-wide study.

What do general practice patients know about their prescription medications?

AIM: To explore the knowledge that general practice patients have about their prescription medications and identify demographic predictors of poor medication knowledge. METHODS: This is a questionnaire survey of a large New Zealand urban general practice serving a range of socioeconomic groups. Patients attending this practice completed a questionnaire about their prescription medications. Their responses were validated using practice records and pharmaceutical reference manuals. RESULTS: Seven hundred and forty five medication questionnaires were submitted by 344 patients. The medication name was correct in 85% of these questionnaires; therapeutic action was correct in 79% of responses; indication for medication was correct in 87% of responses; while dosage was correctly recalled in 83% of responses. Age and household income were associated with accurate recall of medication names (p = 0.006 and p = 0.002 respectively), and income was associated with accurate knowledge of the therapeutic action of medication (p = 0.04). General practitioners and specialists were patients primary source of information about medications. CONCLUSIONS: Patient knowledge about their medications was much higher than in previous studies conducted in hospital settings. Our findings reinforce the educational role of the general practitioner and specialist when prescribing. This is particularly important when prescribing for patients who are elderly, retired and have a low income.