Πέμπτη 3 Μαρτίου 2022

Primary Pyomyositis of Levator Scapulae

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This case report describes a young woman who presented with a suspected deep neck space infection who was subsequently found to have an intramuscular abscess in the left levator scapulae muscle.
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Τετάρτη 2 Μαρτίου 2022

How Many Nodes to Take? Lymph Node Ratio Below 1/3 Reduces Papillary Thyroid Cancer Nodal Recurrence

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Introduction

Papillary thyroid carcinoma (PTC) accounts for the majority of thyroid malignancies; risk of PTC recurrence over a 30-year period is approximately 30%, of which 70% occur as nodal metastases. Patients with nodal disease who are treated with therapeutic dissection are at higher risk for recurrence, but optimal nodal yield has not been defined. We aim to determine variables predictive of nodal recurrence of PTC within the first 5 years of surgery, with a focus on lymph node ratio (LNR), to inform clinical decision-making.

Methods

Retrospective chart review identified 41 patients with nodal recurrence of PTC and 284 without nodal recurrence following thyroid surgery from 2000 to 2015. Cohorts were compared with regards to clinical history, surgical findings, and tumor characteristics.

Results

The fraction of the patients who underwent therapeutic central or lateral lymph node dissection was significantly higher in the nodal recurrence cohort. Maximum tumor size, presence of extrathyroidal extension, largest lymph node focus, LNR, postoperative thyroglobulin level, and administration of postoperative radioactive iodine were significantly increased in the PTC nodal recurrence group. LNR greater than 0.3 held the highest level of significance as a binary cutoff and captured the larger proportion of patients in the nodal recurrence cohort (68.3%).

Conclusion

This study demonstrates characteristics to help assess risk of nodal recurrence of PTC and suggests LNR of lower than 0.3 is optimal to reduce risk of recurrence. The next steps include cohort studies to validate findings and weight variable analysis to optimize the extent of surgical therapeutic dissection.

Level of Evidence

4 Laryngoscope, 2022

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Survival of adult patients with solid cancer

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Bull Cancer. 2022 Feb 26:S0007-4551(22)00068-6. doi: 10.1016/j.bulcan.2022.01.010. Online ahead of print.

ABSTRACT

INTRODUCTION: Population-based cancer survival is a major indicator of effectiveness of cancer management. This study is the first population-based study to estimate the net survival (NS) of adult cancer patients in Reunion Island, a French overseas department with distinctive epidemiological, cultural, and sociodemographic characteristics.

METHODS: All adult incident cases (n=23,055) of invasive solid tumors diagnosed between 1998 and 2014 and registered in the Reunion Island Cancer Registry were included in the study. The Pohar-Perme estimator was used to estimate 1-, 3-, 5-, and 10-year NS.

RESULTS: 5-year NS ranged from 7% (liver in women) to 97% (thyroid cancer in women) for cancers diagnosed between 2006 and 2014. For the most common cancers, the age-standardized 5-year NS of women was 81% for breast canc er, 58% for colorectal cancer and 62% for cervical cancer. For men, the age-standardized 5-year NS was 85% for prostate cancer, 12% for lung cancer, and 52% for colorectal cancer. Age-standardized 5-year NS increased slightly with the period of diagnosis (from 1998-2005 to 2006-2014) for prostate, breast, head and neck, lung, colorectal (women), and stomach (men) cancers, remained stable for colorectal (men) cancer, and decreased slightly for cervical and stomach (women) cancers.

DISCUSSION: Overall, NS was lower in Reunion Island than in mainland France. While the epidemiological, cultural, and sociodemographic characteristics of the Reunionese population likely explain some of the observed differences compared to mainland France, site-specific studies are needed to explore the different determinants of survival in Reunion Island.

PMID:35232576 | DOI:10.1016/j.bulcan.2022.01.010

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Thyroid and Parathyroid Conditions: Hyperthyroidism

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FP Essent. 2022 Mar;514:11-17.

ABSTRACT

Hyperthyroidism is an excess in thyroid hormone production caused by such conditions as Graves disease, toxic multinodular goiter, and toxic adenoma. Overt hyperthyroidism is defined as a low or undetectable thyrotropin (TSH) level with elevated triiodothyronine (T3) or thyroxine (T4) values, whereas subclinical hyperthyroidism is defined as low or undetectable TSH with normal T3 and T4 levels. Symp toms of hyperthyroidism include nervousness, heat intolerance, weight loss, and fatigue. The long-term consequences of unmanaged or poorly managed hyperthyroidism include increased risk of all-cause mortality, cardiovascular events, atrial fibrillation, sexual dysfunction, and osteoporosis. Overt and subclinical hyperthyroidism can be managed effectively with antithyroid drugs (eg, propylthiouracil, methimazole) or with definitive therapies (eg, radioactive iodine ablation, thyroidectomy). Subclinical hyperthyroidism is not always treated, although close monitoring is needed to prevent disease complications or progression to overt hyperthyroidism. Treatment for subclinical hyperthyroidism is recommended for patients 65 years or older with TSH levels lower than 0.10 mIU/L. Treatment also is recommended for symptomatic patients or those with cardiac or osteoporotic risk factors. Thyroid storm is a life-threatening complication of unmanaged or inadequately managed hyperthyroidism that warrants urgent treatment in a hospital setting.

PMID:35235281

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Τρίτη 1 Μαρτίου 2022

Asiatic acid improves high-fat-diet-induced osteoporosis in mice via regulating SIRT1/FOXO1 signaling and inhibiting oxidative stress

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Histol Histopathol. 2022 Mar 1:18446. doi: 10.14670/HH-18-446. Online ahead of print.

ABSTRACT

Asiatic acid can attenuate osteoporosis through suppressing adipogenic differentiation and osteoclastic differentiation. Oxidative stress enhances osteoclastic differentiation but represses osteogenic differentiation to promote osteoporosis. However, the role and mechanism of asiatic acid in osteoporosis have not been reported. Firstly, mice were fed with high-fat-diet (HFD) with or without asiatic acid for 16 weeks. Data from an automatic biochemical analyzer showed that HFD induced down-regulation of high-density lipoprotein (HDL) and an increase of serum levels of triglyceride (TG), total cholesterol (TC) and low-density lipoprotein (LDL). However, asiatic acid administration attenuated the decrease of HDL and increase of serum TG, TC and LDL in osteoporotic mice. Secondly, HFD induced high levels of malondialdehyde (MDA) and reactive oxyg en species (ROS), low levels of superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) in osteoporotic mice. However, the levels of MDA, ROS, SOD and GSH-Px in osteoporotic mice were reversed by asiatic acid administration. (this section is unclear and requires revision) Asiatic acid administration reduced expression of c-telopeptide of type 1 collagen (CTX-1), enhanced alkaline phosphatase (ALP) and procollagen type 1 N-terminal propeptide (P1NP) in HFD-induced osteoporotic mice. (this section is unclear and requires revision) Thirdly, asiatic acid promoted calcium deposition in bone marrow cells and osteogenic differentiation in osteoporotic mice, but decreased ALP in bone marrow cells. Lastly, asiatic acid enhanced SIRT1 and nuclear FOXO1 (Nu-FOXO1) expression, while it reduced Acetyl FOXO1 (Ac-FOXO1) in osteoporotic mice. In conclusion, asiatic acid might inhibit oxidative stress and promote osteogenic differentiation through activating SIRT1/FOXO1 to attenuate HFD-induc ed osteoporosis in mice.

PMID:35229281 | DOI:10.14670/HH-18-446

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Graves' disease in children and adolescents in Iceland

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Laeknabladid. 2022 Mar;108(3):123-129. doi: 10.17992/lbl.2022.03.680.

ABSTRACT

INTRODUCTION: Graves' disease is an autoimmune disease in which autoantibodies cause an increase in the production of thyroid hormones, and is the most common cause of thyrotoxicosis in children. Symptoms in children are often more obscure than in adults. The aim of the study is to assess the incidence of Graves' disease in children and adolescents in Iceland over the span of two decades (2001-2021), and furthermore to investigate if the incidence rate has increased, as well as to describe treatment options and disease recurrence.

MATERIAL/METHODS: This retrospective descriptive study included all children diagnosed with Graves' disease in the years 2001-2021 in Iceland. Information was obtained from the Directorate of Health's drug database and from ICD-10 diagnoses at Landspítali - The National University Hospital.

RESULTS: In total, 57 children and adolescents were diagnosed with Graves', the overall incidence rate was 3.5/100,000 person-years. Gender ratio was 1:2.7 (male : female) and the mean age at diagnosis was 13.6 for boys and 13.9 years for girls. Of those 12 individuals currently receiving drug therapy (21.8%), four patients have had disease relapse. Thirteen patients reached an euthyroid state with medication (23.7%), 25 received treatment with radioactive iodine (45.5%) and 5 underwent surgery (9.1%). Boys were more likely to relapse. Disease recurrence w as 31.8%.

CONCLUSION: The incidence of Graves' disease did not increase during the study period. The disease was more common in girls, although the gender ratio was lower than expected. Antithyroid drugs were the first choice in treatment and radioactive iodine was the most common permanent treatment option. Disease recurrence was common. A possible relationship between the duration of the original drug therapy and disease recurrence should be investigated.

PMID:35230257 | DOI:10.17992/lbl.2022.03.680

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Δευτέρα 28 Φεβρουαρίου 2022

Quality of Life and Functionality of Head and Neck Cancer Patients Are Diminished As a Function of Sarcopenia and Obesity

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Ear Nose Throat J. 2022 Feb 28:1455613221076791. doi: 10.1177/01455613221076791. Online ahead of print.

ABSTRACT

BACKGROUND: Health-related quality of life (QoL) is a measure that allows us to know the patient's perception of well-being and how it is affected by their disease and treatments. In cancer patients, sarcopenia has been associated with low scores on various instruments used to assess the QoL; however, little information is available on the effects of sarcopenia an d sarcopenic obesity on the QoL of patients with head and neck cancer (H&NC).

METHODS: In this cross-sectional study with 71 H&NC patients aged between 40 and 80 years, we describe the scores on the instruments EORTC QLQ C-30 and EORTC QLQ-H&N35 according to the sarcopenia phenotype (NSG, nonsarcopenic group; SG, sarcopenic group; and SOG, sarcopenic obesity group), hand-grip strength, gait speed, total lymphocyte count, albumin, cholesterol and C-reactive protein, and the relationships between these variables.

RESULTS: The prevalence of sarcopenia and sarcopenic obesity was 48% and 28%, respectively. The QoL analysis showed that NSG had higher scores on the physical functioning scale [NSG 93 (83-100); SG 73 (52-88); SOG 83 (53-93), P = .009] and lower scores on the fatigue scale [NSG 11 (0-22); S 39 (30-67); SOG 44 (14-56); P = .004]. The NSG had a higher hand-grip strength (31.1 kg) than SG (24.1 kg, P = .007) and SOG (26.3 kg, P = .001), and a lower C-reac tive protein. The SG and SOG showed no differences between them.

CONCLUSIONS: Patients with sarcopenia or sarcopenic obesity have lower physical performance and a higher level of fatigue than nonsarcopenic patients. This loss of function can maintain or worsen sarcopenia due to the patient's self-restraint in physical exertion that encourages an increase in muscle tissue.

PMID:35226551 | DOI:10.1177/01455613221076791

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