A poetry program for the very elderly-Narrative perspective on one therapeutic model.

The focus of this report is a poetry program that the author has been conducting at a nursing home/short-stay rehabilitation facility for the past three and a half years. The program involves reading poetry to groups of very elderly residents who have significant mental and/or physical disabilities. This article includes a description of the program and the author's observations of its beneficial effects. Poetry readings were also given to individual seniors who have significant dementia. The therapeutic value of the program to the elders and to the person reading the poetry to the elders is discussed.

Conservative management of well-differentiated thyroid cancer.

BACKGROUND: Controversy exists over the optimal surgical treatment of well-differentiated thyroid cancer. Conservative surgical management reduces the risk of complications and maintains an overall survival rate equivalent to the more extensive approach. METHODS: We conducted a retrospective review of all patients with well-differentiated thyroid cancer greater than 1 cm (180 patients) who underwent surgery between 1982 and 2002 by a single general surgeon at our institution. The prevailing philosophy was to be as conservative as possible, and the predominant resection was lobectomy and isthmusectomy on the affected side. RESULTS: In total, 90% of patients were in a definable low-risk group: 75% had conservative surgery with 4 recurrences and no mortality, 25% had extensive surgery with 3 recurrences and no mortality. The other 10% were in a definable high-risk group: 90% had extensive surgery with 9 recurrences and 4 deaths. Overall, there were 22 sites of recurrence in 16 patients. There was no recurrence in the residual thyroid tissue, with a median follow-up of 10 years. Three recurrences occurred in the resected thyroid bed; each of these patients had undergone extensive surgery. Twelve recurrences were in lymph nodes; 67% of these patients had extensive surgery. All except 1 of 7 distant metastases occurred in the high-risk group, despite the patient having undergone extensive local surgery. Recurrence did not affect survival in the low-risk group. The extensive surgery group had a 3.4% incidence of recurrent laryngeal nerve injury and a 1.1% incidence of permanent hypocalcemia, with none in the conservative surgery group. CONCLUSION: Conservative surgery for low-risk patients with well-differentiated thyroid cancer appears to be sufficient and avoids complications without significantly increased risk for local, regional or distant recurrence.

Cavernous hemangioma of the breast: mammographic and sonographic findings and follow-up in a patient receiving hormone-replacement therapy.

We report the case of a 78-year-old woman who had been receiving hormone-replacement therapy (HRT) for 6 years and had a 4-month history of a painless nodule in the 9 o'clock position in her right breast. Mammography performed 4 years previously had shown a 4-mm bilobed, ovoid, well-defined nodule in that location; mammography performed 1 year previously had shown that the nodule had increased to 6 mm. We performed mammographic and sonographic examinations, which revealed a 10-mm ovoid nodule in the same 9 o'clock position in the right breast. The imaging findings appeared to indicate benignity, but because of the increasing size of the nodule, we undertook an ultrasound-guided large-core needle biopsy. The histopathologic diagnosis was typical cavernous hemangioma. It was not excised, but HRT was discontinued. Follow-up mammography and sonography 8 months later showed that the nodule had decreased to 6 mm. We believe that the HRT played a contributory role in the increasing size of this patient's cavernous hemangioma. The use of ultrasound-guided large-core needle biopsy is reliable enough to ascertain the benignity of such masses and can thus avoid, if it is clinically appropriate, the need for their surgical removal.