Radioiodine I-31 therapy in the management of thyroid cancer. A prospective study

The therapeutic value of I-131 ablation therapy following thyroidectomy for thyroid cancer was evaluated in 54 patients in a prospective study of 25 years. Thirteen (24%) patients had follicular, 24 (44%) papillary, 13 (24%) mixed papillary-follicular, two (4%) Hurthle cell and two (4%) had undifferentiated cell type tumor. Twenty-four (44.5%) patients had metastases at the time of I-131 therapy mainly to cervical and mediastinal lymph nodes, and less frequently to bone, brain, lung, and liver. After surgical thyroidectomy, the mean cumulative dose of I-131 required to achieve therapeutic ablation of functioning post-surgical remnants or tumor metastases was 163.4 mCi. The recurrence rate for patients with metastases was 56% and those without metastases was 25%. Ten patients showed recurrence of I-131 accumulating tissue five to 10 years after initial total ablation. The total mean cumulative dose of I-131 administered for both followup diagnostic studies, and initial and follow-up therapy was 245.3 mCi. Seven deaths were attributable to thyroid cancer, five with differentiated and two with anaplastic cell type tumors. Three of the four patients with differentiated cell type tumors had metastases to brain or bone. Their response to therapy was similar to those patients with anaplastic cell type tumors. In contrast, there were no deaths due to thyroid cancer when total ablation was achieved and maintained. After ablation, all patients were maintained on maximum tolerated doses of thyroid extract or thyroxin. No significant complications attributable to the therapeutic doses of I-131 employed in this series were noted.     

Prevalence of autoantibodies associated with glomerulonephritis, unaffected after extracorporeal shock wave lithotripsy for renal calculi, in a three-year follow-up

A very rare case of full trisomy 18 associated with multiple hepatoblastomas is reported. The patient also had ventricular septal defect and patent ductus arteriosus, which were repaired at 6 months of age. After the cardiac surgery, she was noted to have an abdominal mass and an elevated serum alpha-fetoprotein level. A partial hepatic lobectomy was performed at 7 months of age, and the resected tumor was diagnosed as a fetal-type hepatoblastoma. At 2 years and 4 months of age, a chest radiography disclosed an elevated left diaphragm, and abdominal ultrasonography demonstrated a tumor in the left hepatic lobe. The resected tumor was also diagnosed as a fetal-type hepatoblastoma. Chromosomal analysis demonstrated that the karyotypes of peripheral blood and hepatic tumor cell obtained on two occasions were both 47,XX, +18. She has no evidence of recurrence at 3 years of age without specific therapy.     

Institutionalization and the effectiveness of social reinforcement: A three-year follow-up study.

49 familial retarded children who had been tested on a simple 2-part satiation game 3 years earlier were retested on the same game. The children were divided into high and low preinstitutional social deprivation groups, and 2 reinforcement conditions were employed. On the original testing a positive relationship was found between social deprivation experienced and the effectiveness of social reinforcement (p     

A three-year follow-up of older adult participants in a memory-skills training program.

This study examined the long-term effects of participation in a self-taught memory training program. In all, 27 memory training and 13 nontraining participants were assessed at approximately 3-year follow-ups. Assessment of these groups prior to the introduction of training had revealed nonsignificant differences in memory performance but marked differences in level of memory complaints, with training participants evidencing higher levels of complaints. The current assessment again demonstrated overall nonsignificant differences in memory performance but significant differences in memory complaints between the two groups. More specifically, the training group evidenced significant decreases in memory performance over the 3-year interval, but no significant changes in memory complaints were observed for either group. Thus, memory training appeared to have little long-term effect on memory functioning. Future research should explore long-term maintenance strategies in memory training with older adults. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Synovial immunohistochemical changes after high tibial osteotomy for osteoarthritis of the knee. Two-year prospective follow-up

PURPOSE: To evaluate a program designed to help high school students with depressive symptomology to effectively cope. DESIGN: Two-phase experimental study. METHODS: Rural high school students (N = 222), ages 14 through 19 years, were surveyed to identify teens with depressive symptomatology, identify stressful life events and coping styles of at-risk subjects, and evaluate a cognitive-behavioral group intervention to enhance students' coping and affect levels of depression. Students with depressive symptomatology were randomized into control (n = 18) or intervention (n = 23) groups. Intervention subjects were treated with a nurse-led, 8-week cognitive skills group, conducted at school. RESULTS: On posttesting, the intervention groups demonstrated reduced depressive symptoms in females and a wider range of coping compared with controls. CLINICAL IMPLICATIONS: School-based nurses are in an ideal position to provide assessment, referral, and intervention programs in the natural setting of the school. Results of this study indicate that such programs can be implemented successfully in schools and have the potential to promote mental health in teenagers.     

Influences of obesity and weight loss on thyroid hormones. A 3-3.5-year follow-up study on obese subjects with surgical bilio-pancreatic by-pass

Fifty-seven patients newly presenting to their GP with dyspepsia agreed to take part in a pharmacist-led clinic which tested and treated for Helicobacter pylori. Of these patients, 63% (36/57) tested positive and received eradication therapy. For 78% (28/36), eradication was successful with the first course of treatment, 89% (25/28) remaining symptom-free over the six-month follow-up. Eradication was successful for a further 17% (6/36) after a second attempt; again, these patients remained free of symptoms over the follow-up period. Thus, of the initial patients, 54% (31/57) were successfully treated, with no further symptoms. Such results had significant consequences on the expected direct cost of management per patient from a GP viewpoint. Using decision analysis it was found that H. pylori eradication for patients presenting with dyspepsia for the first time could result in considerable cost savings per patient in the long term.     

Renal hemodynamics after lung transplantation. A prospective study

Renal function impairment is common after solid organ transplantation, due to the nephrotoxicity of cyclosporine. Moreover, in patients with severe respiratory failure, renal function is often impaired. This renal function impairment may predispose patients to further renal function impairment after lung transplantation. Therefore, renal hemodynamics were measured in 44 patients before lung transplantation and 1, 6, 12, 18, 24, and 30 months after transplantation. After transplantation, a decline in renal function occurred, with a progressive fall in glomerular filtration rate (GFR) of 33 +/- 4% at 12 months and 42 +/- 9% at 30 months. Effective renal blood flow fell by 22 +/- 5% at 12 months and remained stable thereafter. Changes in effective renal plasma flow (ERPF) were less pronounced than those of effective renal blood flow, due to a fall in hematocrit after transplantation. Blood pressure and renal vascular resistance increased significantly, consistent with the effects of cyclosporine. Prior to transplantation, renal function impairment with intense renal vasoconstriction had been found in a subset of the patients. Remarkably, the decrease in renal function after transplantation was less pronounced in patients with renal function impairment prior to transplantation, as indicated by significant negative correlations between pretransplantation GFR and the percentage change in GFR after transplantation, and pretransplantation ERPF and the percentage change in ERPF after transplantation. This suggests that the net course of renal hemodynamics after lung transplantation is the result of the opposed effects of cyclosporine nephrotoxicity and the favorable effects of the normalization of respiratory status. In conclusion, after lung transplantation a decline in renal function occurs that is less pronounced in patients with renal function impairment and intense renal vasoconstriction prior to transplantation. Such a renal function impairment, therefore, should not be considered a contraindication to lung transplantation.     

Visual performance after photorefractive keratectomy. A prospective study

OBJECTIVE: To prospectively examine the effect of excimer laser photorefractive keratectomy (PRK) on best-corrected visual performance using psychophysical tests that were likely to be more sensitive to image degradation than high-contrast Snellen visual acuity. DESIGN: Prospective cases series. PATIENTS: A cohort of 18 subjects with an average of -5.08 diopters (D) of myopia (SD = +/- 1.63 D) was tested before PRK and at 3, 6, and 12 months after PRK. INTERVENTION: Photorefractive keratectomy was performed using a laser (Excimed UV200, Summit Technology, Waltham, Mass) and a polymethylmethacrylate mask; a 5-mm ablation zone was used. MAIN OUTCOME MEASURES: Best-corrected high-contrast visual acuity, best-corrected low-contrast visual acuity (18% Weber contrast), and best-corrected letter-contrast sensitivity. Measurements were repeated with dilated pupils and in the presence of a glare source. RESULTS: One year after PRK, the mean best-corrected high-contrast visual acuity was reduced by half a line (P = .01), and the mean best-corrected low-contrast visual acuity was reduced by 1 1/2 lines (P = .002). The losses were somewhat greater when the subject's pupils were dilated and a glare source was used. The reduction in dilated low-contrast visual acuity was positively correlated with the decentration of the ablation zone (r = 0.47), providing evidence of an association between corneal topography and the functional outcome of PRK. CONCLUSION: Low-contrast visual acuity losses after PRK are notably greater than high-contrast visual acuity losses for best-corrected vision. Low-contrast visual acuity is a sensitive measure for gauging the outcome success and safety of refractive surgery.     

A prospective study of antibodies against parvovirus B19 in pregnancy

This case report shows the evolution of periapical cemental dysplasia (PCD) lesions over a 13-year period, and demonstrates that PCD lesions mature over time from purely radiolucent to radiopaque.     

Persistence of anti-mumps virus antibodies after a two-dose MMR vaccination. A nine-year follow-up

A two-dose vaccination program against measles, mumps, and rubella (MMR) viruses was started in Finland in 1982. In this program the trivalent MMR-II vaccine (MSD, USA) was offered to children at the ages of 14-18 months and 6 years followed by revaccination 4-5 years later. The vaccination coverage has been high (97%) and MMR infections have practically been eliminated in the Finnish population. In a serological follow-up program sequential serum samples were obtained from 254 children (127 14-18-month-old vaccinees and 127 6-year-old vaccinees) during a 9-year follow-up period. Anti-mumps virus antibody titers were determined by enzyme immunoassay using purified whole mumps viruses as the antigen. In seronegative (n = 120) 14-18-month-old vaccinees the seroconversion rate was 86% (geometric mean titer 1/1670 +/- 1/270). The antibody levels fell rapidly (significance p < 0.01) within the first year of follow-up (mean titer 1/1080 +/- 1/190), but remained relatively stable in subsequent years. After revaccination the seropositivity rate was 95% (mean titer 1/2310 +/- 1/260) and declined more slowly thereafter to 86% (mean titer 1/1510 +/- 1/210) at year 9 of follow-up. The mean antibody titer was significantly (p < 0.05) higher 4 years after the second MMR vaccination when compared with the corresponding time point after the first vaccination. In 6-year-old seronegative vaccinees the increase and decay of anti-mumps virus antibodies after the first MMR vaccination was similar to that seen in the group of younger vaccinees. A two-dose MMR vaccination protocol resulted in a high mumps immunity level in the vaccinated population.     

Quality-of-life changes in patients with thyroid cancer after withdrawal of thyroid hormone therapy

Quality of life (QOL) is an important consideration as patients survive longer with cancer and is an area of increasing interest in patients with thyroid cancer who undergo long-term cancer surveillance. However, there are few disease-specific QOL tools available to evaluate QOL in patients with thyroid cancer. The purposes of this longitudinal, repeated-measures study were to: (1) test a new instrument, the QOL-Thyroid Scale, during thyroid hormone withdrawal; and (2) to evaluate the impact of thyroid hormone withdrawal on patients' perceived changes in quality of life. The sample included 34 subjects (mean age 40 years) undergoing thyroid hormone withdrawal in preparation for scanning procedures. Subjects completed three instruments (demographic data tool, the QOL-Thyroid, and the FACT-G) at four specific time points in relationship to scanning. The results demonstrated that the QOL-Thyroid tool is a reliable and valid measure of QOL. Cronbach's alpha coefficient of r = .78 between QOL-Thyroid and FACT-G indicated good concurrent validity. Second, the impact of thyroid hormone withdrawal on QOL showed significant changes in physical, psychological, and social well-being across the four testing points. The greatest changes occurred between peak hormone withdrawal and thyroxine (T4) therapy. While it is generally known that patients suffer troublesome physical symptoms relating to thyroid hormone withdrawal, the negative psychological, family, and work sequelae are less apparent. In conclusion, the QOL-Thyroid is a reliable and valid measure for use in evaluating patients undergoing scanning procedures and may be used to identify and target teaching and support for high-risk areas in patients lives that are negatively affected by hormone withdrawal.     

The clinical syndrome associated with antiphospholipid antibodies. A diagnosis to be confirmed after a long follow-up

A clinical case of syndrome of antiphospholipid antibodies is reported. The patient is a 10-year-old girl with thrombophlebitis of the right leg associated with the presence of lupus-like anticoagulant antibodies. No secondary pathologies were found. It is not possible, anyway, to make a definitive differential diagnosis between primary and secondary forms of syndrome of antiphospholipid antibodies because of intermediate situations where antiphospholipid antibodies are associated with 2 or 3 ARA criteria for the diagnosis of lupus (lupus-like syndrome). A long term follow-up is therefore necessary.     

Prolongation of porcine islet xenograft survival in mice after therapy with immunosuppressive peptides

BACKGROUND: Recently, peptides derived from the heavy chain of HLA-B2702 have been shown to modulate immune responses. In this study, we examined the use of these peptides for immunosuppression in a pig to mouse islet xenograft model. METHODS: Purified porcine islets were transplanted in autoimmune (non-obese diabetic) and non-autoimmune (streptozotocin-injected CBA or C57/Bl6) diabetic mice. Various dosing regimens of HLA-derived peptides with and without antilymphocyte therapy were administered to recipient mice. Graft rejection was determined by daily serum glucose determinations, and, at selected time points, grafts were removed to demonstrate function and provide immunohistochemical examination. RESULTS: HLA-derived peptides were demonstrated to prolong graft survival in both pretransplant and posttransplant treatment regimens. This effect was increased with concomitant antilymphocyte therapy. CONCLUSIONS: Further elucidation of the mechanism of action of these immunomodulatory peptides may help in the development of novel immunosuppressive protocols.     

A prospective replication of the protective effects of IQ in subjects at high risk for juvenile delinquency.

The purpose of the study was to test the replicability of a protective effect of high IQ against criminality. Support has been found in prior studies for the hypotheses that Ss at high risk would have an elevated risk of serious criminal involvement, that seriously criminal Ss would have a lower mean IQ score than noncriminal Ss, and that Ss at high risk who had not become involved in serious criminal behavior would have the highest IQs. This report tests these hypotheses in a prospective design. Subjects were 1,037 members of a longitudinal investigation of a New Zealand birth cohort. IQs were examined for male and female Ss who were divided into 4 groups formed on the basis of risk status at age 5 years and delinquency outcome at ages 13 and 15. Analyses were conducted with and without mild delinquents excluded from the nondelinquent groups. We found that male and female delinquents showed significantly lower IQ scores than nondelinquents. By varying S selection procedures, we also found that a very high IQ may help boys, even those at risk, to stay free of delinquency altogether. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Implosive therapy and desensitization therapy with inpatients: A five-year follow-up.

P. A. Boudewyns and A. E. Wilson (see record 1973-02805-001) treated 32 male psychiatric inpatients with either implosive therapy or a desensitization therapy using free association. Immediately following therapy and again at 6- and 12-mo follow-ups, the implosive group had improved more than controls treated with the regular hospital milieu. The present investigation with 28 of the Ss found the implosive group had maintained this improvement even after 5 yrs when compared with controls. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Relaxation therapy for tension headache in the elderly: A prospective study.

We evaluated the effects of an 8-week progressive muscle-relaxation therapy regimen on the headache activity of 10 elderly tension-headache subjects. Posttreatment assessment at 3 months revealed significant decreases in overall headache activity (50% or greater) in 7 subjects. Significant clinical or statistical prepost differences, or both, were also found for the number of headache-free days, peak headache activity, and medication index. This is the first prospective study of tension headache in an elderly population, and, unlike previous retrospective studies, it suggests that relaxation therapy may be an effective intervention in the treatment of such headaches. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Opioid therapy for chronic noncancer back pain. A randomized prospective study

STUDY DESIGN: A randomized, open, long-term, repeated-dose comparison of an anti-inflammatory drug and two opioid regimens in 36 patients with back pain. OBJECTIVES: To examine the long-term safety and efficacy of chronic opioid therapy in a randomized trial of patients with back pain. METHODS: All participants underwent a 4-week washout period of no opioid medication before being randomly assigned to one of three treatment regimens for 16 weeks: 1) naproxen only, 2) set-dose oxycodone, or 3) titrated-dose oxycodone and sustained-release morphine sulfate. All patients then were assigned to a titrated dose of opioids for 16 weeks and then gradually tapered off their medication for 12 weeks. Finally, all participants were monitored for a 1-month posttreatment washout period. Each patient was called once a week for a report on pain, activity, mood, medication, hours awake, and adverse effects and was monitored carefully for signs of abuse and noncompliance. RESULTS: Weekly reports during the experimental phase showed the titrated-dose group to have less pain (P < 0.001) and less emotional distress (P < 0.001) than the other two groups. Both opioid groups were significantly different from the naproxen-only group. During the titration phase, patients also reported significantly less pain and improved mood. Few differences were found in activity or hours asleep, or between average pretreatment and posttreatment phone-interview and questionnaire variables. No adverse events occurred, and only one participant showed signs of abuse behavior. CONCLUSIONS: The results suggest that opioid therapy has a positive effect on pain and mood but little effect on activity and sleep. Opioid therapy for chronic back pain was used without significant risk of abuse. However, tapered-off opioid treatment is palliative and without long-term benefit.