Prognostic factors in patients with advanced differentiated thyroid cancer treated with multikinase inhibitors - a single Brazilian center experience

xlomafota13 shared this article with you from Inoreader Prognostic factors in patients with advanced differentiated thyroid cancer treated with multikinase inhibitors - a single Brazilian center experience Via radioactive iodine Arch Endocrinol Metab. 2021 Apr 29:2359-3997000000364. doi: 10.20945/2359-3997000000364. Online ahead of print. ABSTRACT OBJECTIVE: The aim of this study was to describe the real-world experience multikinase inhibitors (MKI) in the treatment advanced differentiated thyroid carcinoma (DTC) refractory to radioactive iodine (RAIR) therapy. METHODS: We reviewed the records of all patients with MKI-treated DTC from 2010 to 2018. Progression free survival (PFS), response rates (RR) and adverse events (AE) profiles were assessed. Clinical parameters were compared between groups with different outcomes (disease progression and death) to identify possible prognostic factors and benefit from treatment. RESULTS: Forty-four patients received MKI for progressive RAIR DTC. Median PFS was 24 months (10.2-37.7) and median overall survival (OS) was 31 months. Best overall response was complete response in one patient (4.5%), partial response in nine (20.4%), stable disease in twenty-two (50%), and progressive disease (PD) in twelve (27.3%). Seventy-two point 7 percent patients had clinical benefit and AE were mild in most cases (82.7%). Progressive patients were more likely to have FDG positive target lesion than those who did not progress (p = 0.033) and higher maximum SUV on target lesions (p = 0.042). Presence of lung-only metastasis and lower thyroglobulin (Tg) during treatment was associated with stable disease (p = 0.015 and 0,049, respectively). Patients wi th shorter survival had larger primary tumor size (p = 0.015) and higher maximum SUV on target lesions (p = 0.023). CONCLUSION: Our findings demonstrate safety and effectiveness of MKI in patients with advanced RAIR DTC. We were able to identify as possible prognostic markers of better outcomes: absence of FDG uptake on target lesions, lower maximum SUV on PET-CT, presence of lung-only metastasis and lower Tg during treatment. PMID:33939907 | DOI:10.20945/2359-3997000000364 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

ὁ δὲ ἡγεμὼν ἔφη· τί γὰρ κακὸν ἐποίησεν; οἱ δὲ περισσῶς ἔκραζον λέγοντες· σταυρωθήτω

Blood flow distribution after end-to-side anastomosis with wide arteriotomy in extremity free flap surgery

xlomafota13 shared this article with you from Inoreader Blood flow distribution after end-to-side anastomosis with wide arteriotomy in extremity free flap surgery Via Journal of plastic, reconstructive & aesthetic surgery : JPRAS J Plast Reconstr Aesthet Surg. 2021 Mar 28:S1748-6815(21)00112-1. doi: 10.1016/j.bjps.2021.03.022. Online ahead of print. ABSTRACT PURPOSE: Although many studies have investigated the optimal anastomotic procedure for the end-to-side (ETS) procedure with a free flap, no study has focused on the size of the arteriotomy. Some surgeons have recently described the effectiveness of ETS with wide arteriotomy, but the postoperative haemodynamics remains unclear for free flaps created using this technique. The aim of this study was to use ultrasonography to evaluate the postoperative blood flow distribution after ETS with a wide arteriotomy in extremity free flap surgery. METHODS: We evaluated 20 free flaps in 18 consecutive patients who received an ultrasonographic examination after free flap surgery using the ETS technique with wide arteriotomy for arterial anastomosis. All flaps were examined after surgery and blood flow was calculate d for the flap and recipient vessels. RESULTS: All 20 flaps survived, but one flap developed asymptomatic arterial thrombosis and 19 flaps were analysed. For the ETS technique with wide arteriotomy, peripheral circulation was well preserved in all flaps. Comparison of flap types showed that blood flow was significantly higher in myocutaneous flaps than in fasciocutaneous flaps, but there was no significant difference according to the size of the arteriotomy. CONCLUSIONS: Given the range of arteriotomy performed using the ETS with a wide arteriotomy technique, the blood flow volume in the flap depended on the type of flap but not on the size of the arteriotomy. A steal phenomenon related to the creation of a wide window in the receipt artery was not found in the analysed retrospective cohort. PMID:33896743 | DOI:10.1016/j.bjps.2021.03.022 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Clinical course of venous thromboembolism following abdominally based microsurgical breast reconstruction: A case series

xlomafota13 shared this article with you from Inoreader Clinical course of venous thromboembolism following abdominally based microsurgical breast reconstruction: A case series Via Journal of plastic, reconstructive & aesthetic surgery : JPRAS J Plast Reconstr Aesthet Surg. 2021 Mar 29:S1748-6815(21)00110-8. doi: 10.1016/j.bjps.2021.03.020. Online ahead of print. ABSTRACT BACKGROUND: Venous thromboembolism (VTE) is a potentially devastating complication following abdominally based microsurgical breast reconstruction, with a reported incidence of 0.08-4%. The authors aim to describe disease presentation and clinical course following VTE diagnosis in patients within their practice. METHODS: A retrospective chart review identified patients who underwent microsurgical breast reconstruction from January 2007 through December 2018. Patients with VTE diagnosed within 90 days of surgery were included. Demographics, co-morbidities, signs and symptoms, and characteristics of oncologic, surgical, and post-operative care were analyzed. RESULTS: Seven hundred one patients underwent microsurgical breast reconstruction. Eleven patients with pulmonary embolism (PE) and four with deep vein thrombosis (DVT) were identified, resulting in VTE incidence of 2.1% (0.57% DVT, 1.6% PE). Patients were on average 51 years old and had an average body mass index (BMI) of 31.7 kg/m2. Two had a history of VTE, and none had a known hypercoagulable disorder. Using the 2005 Caprini model, all were high risk and seven were highest risk. Among those with PE, the most common symptom was shortness of breath, and the most common signs were desaturation or supplemental oxygen requirements. VTE was diagnosed on average 14.2 days post-operatively (range 2-52 days). CONCLUSION: VTE is an infrequent complication following abdominally based microsurgical breast reconstruction. We recommend a high index of suspicion in women reporting shortness of breath or having desaturation, especially in those with high BMI, high Caprini scores, post-operative complications, or early return to the operating room. PMID:33896741 | DOI:10.1016/j.bjps.2021.03.020 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Case Report: A New Entity: Multiple Differentiated Variant of Papillary Thyroid Carcinoma With Advanced Clinical Behavior

xlomafota13 shared this article with you from Inoreader Case Report: A New Entity: Multiple Differentiated Variant of Papillary Thyroid Carcinoma With Advanced Clinical Behavior Via radioactive iodine Front Endocrinol (Lausanne). 2021 Apr 7;12:654638. doi: 10.3389/fendo.2021.654638. eCollection 2021. ABSTRACT There are many histological morphological types of papillary thyroid carcinoma (PTC), but the most frequently seen types are conventional. A single PTC commonly has a conventional and/or a variant morphological pattern. PTC with multiple (more than two) well-differentiated morphological patterns are extremely rare. We herein report the rare case of a 48-year-old male with ini tial diaphragmatic, pancreatic, and liver tumors from PTC. Then, the PTC was discovered following resection of these tumors, an ultrasound-guided fine-needle aspiration (US-FNA) cytology of a huge mass in the thyroid's left lobe revealed a PTC. After postoperative recovery, physical and ultrasound examinations identified an irregular large nodule in the thyroid's isthmus and left lobe, several swollen lymph nodes in the left neck, a mass in the left gluteus maximus, and several masses in both the bilateral parotid and salivary regions. The US-FNA's pathological examination confirmed metastatic PTCs in the left gluteus maximus and bilaterally in the parotid and salivary glands. An 18-fluorodeoxyglucose positron-emission tomography and computed tomography scan revealed abnormal uptakes in numerous locations (e.g., thyroid's isthmus and left lobe, bilateral parotid gland, and subcutaneous tissues). The patient underwent palliative therapy-including total thyroidectomy, bilateral centra l neck dissection, left lateral neck dissection, and excision of the bilateral parotid and salivary glands. A whole-body scan post-therapeutic radioactive iodine ablation revealed exclusive thyroid bed uptake. The patient subsequently underwent thyroid stimulating hormone (TSH) repression therapy and chemotherapy with lenvatinib, and thereafter achieved stable clinical conditions. Further histopathological analysis of the PTC revealed multiple differentiated morphological patterns in the single tumor located in the isthmus and left lobe of the thyroid, and in some metastatic lesions. Different metastatic lesions also presented different morphological patterns of PTC. In conclusions, we identified a new entity of PTC as a multiple differentiated variant of PTC (MDV-PTC) with an aggressive clinical nature. PMID:33897621 | PMC:PMC8058471 | DOI:10.3389/fendo.2021.654638 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Intra-operative ocular ultrasonography of iodine-125 brachytherapy plaques in patients with uveal melanoma

xlomafota13 shared this article with you from Inoreader Intra-operative ocular ultrasonography of iodine-125 brachytherapy plaques in patients with uveal melanoma Via radioactive iodine J Contemp Brachytherapy. 2021 Apr;13(2):126-134. doi: 10.5114/jcb.2021.105279. Epub 2021 Apr 14. ABSTRACT PURPOSE: Brachytherapy with iodine-125 (125I) has been extensively used as a conservative treatment for uveal melanoma (UM). Surgical technique for correct placement of episcleral radioactive plaques (ERP) in UM cases with posterior choroidal location and/or small size can be difficult and inaccurate. In this study, the correct positioning of plaques was assessed by intra-operative ultrasound control. MATERIAL AND METHODS: This was a longitudinal, retrospective study of consecutive 20 patients with UM (small-medium size and/or posterior location) who received 125I brachytherapy. Location of plaques was adjusted by intra-operative ocular ultrasonography control. To perform ocular intra-operative ultrasonography, a 10 MHz probe was used to longitudinal and transverse bases in corresponding dummy plaques. RESULTS: The study included 8 males and 12 females, with a mean age of 66.3 years (SD = 14.53), 5 right eyes (RE) and 15 left eyes (LE). In ultrasound examination, 4 UMs were of mushroom morphology and the rest nodular. Means of the size of UM by ultrasound were (mm): Lb: 10.60 (SD = 2.24) × Tb: 9.88 (SD = 1.54) × H: 4.02 (SD = 1.44) (3 cases corresponding to small size of collaborative ocular melanoma study (COMS), and 17 cases to medium). The plaques used were between 14 and 20 mm in diameter, with an average distance b etween the edge of greater base of the tumor and the edge of plate of 2.44 mm (SD = 0.34). It was necessary to surgically reposition the plaque in 4 cases (20%). CONCLUSIONS: Intra-operative ultrasound control improves the accuracy of radioactive plaque placement for the treatment of medium-small UMs in posterior location. Probably, this technique should be applied in all cases of brachytherapy, regardless of the isotope chosen and the location of tumor mass, in order to perfectly adjust therapeutic position. PMID:33897785 | PMC:PMC8060954 | DOI:10.5114/jcb.2021.105279 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Treatment Modalities and Survival Outcomes for Sinonasal Diffuse Large B‐Cell Lymphoma

xlomafota13 shared this article with you from Inoreader Treatment Modalities and Survival Outcomes for Sinonasal Diffuse Large B‐Cell Lymphoma Via The Laryngoscope Objectives/Hypothesis This study utilizes a large population national database to comprehensively analyze prognosticators and overall survival (OS) outcomes of varying treatment modalities in a large cohort of sinonasal diffuse large B‐cell lymphoma (SN‐DLBCL) patients. Study Design Retrospective database study. Methods The National Cancer Database was queried for all SN‐DLBCL cases diagnosed from 2004 to 2015. Kaplan–Meier log‐rank test determined differences in OS based on clinical covariates. Cox proportional‐hazards analysis was used to determine clinical and sociodemographic covariates predictive of mortality. Results A total of 2,073 SN‐DLBCL patients were included, consisting of 48% female with a mean age of 66.0 ± 16.2 years. Overall, 82% of patients were Caucasian, 74% had early‐stage disease, and 49% had primary tumors in the paranasal sinuses. Early‐stage patients were more likely to receive multi‐agent chemoradiotherapy compared to multi‐agent chemotherapy alone (P < .001). Multivariable Cox proportional‐hazards analysis revealed chemoradiotherapy to confer significantly greater OS improvements than chemotherapy alone (hazard ratio [HR]: 0.61; P < .001). However, subset analysis of late‐stage patients demonstrated no significant differences in OS between these treatment modalities (P = .245). On multivariable analysis of chemotherapy patients treated post‐2012, immunotherapy (HR = 0.51; P = .024) demonstrated significant OS benefits. However, subset analysis showed no significant advantage in OS with administering immunothe rapy for late‐stage patients (P = .326). Lastly, for all patients treated post‐2012, those receiving immunotherapy had significantly improved OS compared to those not receiving immunotherapy (P < .001). Conclusions Treatment protocol selection differs between early‐ and late‐stage SN‐DLBCL patients. Early‐stage patients receiving chemotherapy may benefit from immunotherapy as part of their treatment paradigm. Level of Evidence III Laryngoscope, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.