The role of neck ultrasound in the follow-up of low- and intermediate- risk papillary thyroid cancer.

Introduction: The optimal time for a neck ultrasound (US) in the follow-up of papillary thyroid cancer (PTC) after the first year is undetermined. We aimed to verify the utility of routine neck US in the surveillance of patients diagnosed with low- and intermediate-risk PTC with no evidence of disease at the one-year assessment. Subjects and methods: We conducted a retrospective longitudinal study of patients with low- and intermediate-risk PTC with normal neck US, unstimulated serum thyroglobulin (Tg) < 1 ng/mL and negative anti-Tg antibodies at the one-year follow-up. Patients were divided into group 1 [undetectable Tg (<0.20 ng/mL)] and group 2 [detectable Tg but < 1 ng/mL]. The negative predictive value (NPV) of the one-year unstimulated Tg at the five-year and last follow-up visits was calculated. Results: We included n = 88 patients in group 1 and n = 8 patients in group 2. No patient from group 1 presented suspicious US findings at the five-year evaluation [NPV: 100.0% (95% confidence interval (CI): 95.5%-100.0%)], and at the last visit, only one patient had developed a lymph node classified as suspicious [NPV: 98.8% (95% CI: 93.2%-100.0%); mean follow-up: 6.7 years]. In group 2, two patients' USs presented suspicious findings at the five-year evaluation [NPV: 75.0% (95% CI: 34.9%-96.8%)]. At the last visit, only one patient persisted with suspicious findings in the US [NPV: 87.5% (95% CI: 47.4%-99.7%); mean follow-up: 6.5 years]. Conclusion: Low- and intermediaterisk PTC with an excellent response to treatment at the one-year assessment can be safely monitored with regular unstimulated Tg assessments. Conclusions should not be drawn for Tg levels between 0.20-0.99 ng/mL.

Popliteal Artery Pseudoaneurysm after Closing Wedge High Tibial Osteotomy.

INTRODUCTION: High tibial osteotomy (HTO) is an adequate procedure for the treatment of medial unicompartmental knee arthritis in the varus knee. It is technically demanding and has a significant complication rate. Although rare, vascular injury is potentially the most serious complication. CASE REPORT: We present the case of a 50-year-old male who developed a popliteal artery pseudoaneurysm needing surgical intervention following closing wedge (CWHTO). The patient presented with worsening pain and progressive neurological symptoms. The osteotomy healed normally but the neurological symptoms showed only minor improvement over the 2-year follow-up period. CONCLUSIONS: Even with proper surgical technique, CWHTO presents a small inherent risk of injury to the popliteal neurovascular structures. Prompt recognition and treatment of this injury are of paramount importance for a good long-term outcome. Further studies are necessary to determine if open wedge HTO would be a safer surgical option.

Painful Nonunion after Missed Juvenile Tillaux Fracture in an Athlete - Case Report and Description of a New Fixation Technique.

INTRODUCTION: The Tillaux fracture is a rare subtype of tibial physeal fracture that usually occurs in adolescents. There are only a few case series or reports published in the literature and, to our knowledge, this is the first time, a painful nonunion is reported after this type of fracture. CASE REPORT: A 13-year-old athlete presented to our orthopedic department because of persistent pain after an acute ankle injury 2months before. She was diagnosed with a Tillaux fracture that eventually progressed to nonunion after conservative treatment. Surgery was performed to treat the nonunion, and the fracture fragment was fixed using a soft suture anchor. CONCLUSION: The Tillaux fracture pattern requires a high level of clinical suspicion and careful evaluation since it can be misdiagnosed as a simple ankle sprain in adolescents and progress to persistent ankle pain without appropriate treatment.Our surgical technique of suture anchor fixation avoids the risk of fragmentation of the fracture fragment and was able to provide an excellent clinical result.

Smoking and gastric cancer: systematic review and meta-analysis of cohort studies.

OBJECTIVE: We conducted a systematic review of studies addressing the relation between cigarette smoking and gastric cancer to estimate the magnitude of the association for different levels of exposure and cancer locations. METHODS: Published cohort, case-cohort, and nested case-control studies were identified through PubMed, Scopus, and Web of Science searches, from inception to July 2007. Relative risk (RR) estimates referring to the comparison of two categories of exposure (e.g., current smokers vs. never smokers) were combined using a random effects model. Generalized least squares regression was used for trend estimation. Heterogeneity was quantified using the I (2) statistic. RESULTS: Forty-two articles were considered for the systematic review. Comparing current smokers with never smokers: the summary RR estimates were 1.62 in males (95% CI: 1.50-1.75; I (2) = 46.0%; 18 studies) and 1.20 in females (95% CI: 1.01-1.43; I (2) = 49.8%; nine studies); the RR increased from 1.3 for the lowest consumptions to 1.7 for the smoking of approximately 30 cigarettes per day in the trend estimation analysis; smoking was significantly associated with both cardia (RR = 1.87; 95% CI: 1.31-2.67; I (2) = 73.2%; nine studies) and non-cardia (RR = 1.60; 95% CI: 1.41-1.80; I (2) = 18.9%; nine studies) cancers. CONCLUSION: Our study provides solid evidence to classify smoking as the most important behavioral risk factor for gastric cancer.