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Excellent Prognosis (excellent + prognosis)
Selected AbstractsNonsymptomatic Generalized Epilepsy in Children Younger than Six Years: Excellent Prognosis, but Classification Should Be Reconsidered after Follow-up: The Dutch Study of Epilepsy in ChildhoodEPILEPSIA, Issue 7 2002C. M. Middeldorp Summary: ,Purpose: To assess the prognosis and the accuracy of the epilepsy classification in young children with nonsymptomatic generalized epilepsy. Methods: Of the cohort of the Dutch Study of Epilepsy in Childhood (n = 466), all children younger than 6 years with a diagnosis of idiopathic (IGE) or cryptogenic (CGE) generalized epilepsy either at intake (n = 108) and/or after 2 years of follow-up (n = 102) were included. The number of reclassifications after 2 years was determined, and the reasons for reclassification were analyzed. All children receiving a diagnosis of IGE or CGE at 2 years were followed up for 5 years to study their outcome in terms of terminal remission (TR). Data on their level of intellectual functioning were collected at the start of this analysis. Results: The epilepsy syndrome was reclassified in 17 children. In 14 of them, the seizure type also was reclassified, and in three, the course of the epilepsy determined the new epilepsy type. Two other children had a reclassification of their seizure types without a change of the epilepsy type. Many children were categorized as having IGE not otherwise specified. In all probability, this is a heterogeneous group, containing patients with various epilepsy syndromes, with generalized tonic,clonic seizures as a common hallmark. Of the 102 children with IGE or CGE at 2 years of follow-up, 75% had a TR of >6 months after 2 years, and 85% a TR of ,1 year after 5 years. Conclusions: In a fair proportion of children with nonsymptomatic generalized epilepsy in this age group, it is not possible to classify firmly the epilepsy and/or the seizures immediately after the intake. Instead, they are reclassified during the course of the disease. This and the apparent heterogeneity of the category IGE not otherwise specified point to inherent drawbacks of the current International League Against Epilepsy (ILAE) classification of epilepsy and epileptic syndromes. The prognosis of IGE at this young age is generally excellent. [source] Changes in Panayiotopoulos syndrome over timeEPILEPSIA, Issue 2009Giuseppe Capovilla Summary In its first description (1989), Panayiotopoulos syndrome was defined as an idiopathic epilepsy syndrome with an excellent prognosis, characterized by a clinical ictal triad of nocturnal seizures, tonic deviation of the eyes, and vomiting. The electroencephalographic and clinical features of this condition were highly suggestive of occipital lobe involvement. Subsequently, the concept of this benign age-related focal epilepsy has been expanded over the years, including a wider and larger spectrum of seizure manifestations far beyond the occipital manifestations, and for which the eponym of Panayiotopoulos syndrome (PS) has been adopted. However, many theoretical and practical points, including diagnostic, genetic, and pathophysiologic issues remain still unresolved for PS. [source] Early (mucosal) gastric cancer with synchronous osteosclerotic bone metastases: a case reportEUROPEAN JOURNAL OF CANCER CARE, Issue 4 2010G. ANAGNOSTOPOULOS md ANAGNOSTOPOULOS G., SAKORAFAS G.H., KOSTOPOULOS P., MARGANTINIS G., TSIAKOS S. & PAVLAKIS G. (2010) European Journal of Cancer Care Early (mucosal) gastric cancer with synchronous osteosclerotic bone metastases: a case report Early gastric cancer (EGC) is defined as an adenocarcinoma confined to the gastric mucosa or submucosa, regardless of the presence of lymph node metastases. Early gastric cancer carries an excellent prognosis, with a 5-year survival rate at least 85% in most series. However, there are rare cases where distant metastases exist. Bone metastases are rare in gastric cancer; osteoblastic bone metastases are even rarer. We report a patient with EGC (mucosal) and synchronous osteosclerotic bone metastasis. To our knowledge, this is the first reported case of submucosal EGC with synchronous bone metastases. The patient was operated and he received adjuvant chemotherapy and radiotherapy. He died 18 months after gastric surgery from generalized disease. [source] The relevance of the bleeding severity in the treatment of acquired haemophilia , an update of a single-centre experience with 67 patientsHAEMOPHILIA, Issue 102 2010H. ZEITLER Summary., Acquired haemophilia (AH), an autoimmune disorder with clinical features ranging from harmless haematomas to life-threatening bleedings, still has a mortality rate of up to 25%. Owing to its low frequency (1,4 × 106), standardized treatment protocols for its variable manifestations are not available. In case of prominent severe bleedings, the treatment should aim at rapid elimination of the antibody to protect patients from bleedings and on reinduction of long-term immune tolerance. Clinical data, short- and long-term treatment results of 67 patients diagnosed by our centre are presented. Patients were treated depending on their bleeding severity either by an immunosuppressive treatment alone, or in case of life-threatening bleedings, by a combined protocol (modified Bonn,Malmö protocol, MBMP) consisting of antibody depletion through immunoadsorption, intravenous immunoglobulin treatment, immunosuppression and high-dose factor VIII (FVIII) substitution. Mild bleedings occurred in two patients who were treated successfully alone by immunosuppression. Complete remission (CR) was achieved in 90% of the patients treated with MBMP (60). Of the six patients (10%) who achieved a partial remission (PR), four suffered from cancer. Mortality under MBMP was not seen. In contrast, five patients, in whom diagnosis of AH was delayed, experienced fatal outcome during surgical interventions before initiation of MBMP treatment. Prognosis in AH depends mainly on its prompt diagnosis. Treatment procedures should be adapted to bleeding severity and inhibitor titres. Under these conditions, AH is a potentially curable autoimmune disorder with an excellent prognosis. [source] Primary non-Hodgkin lymphoma of the humerus following traumatic injury: case reportHEMATOLOGICAL ONCOLOGY, Issue 3 2003V. Stemberga Abstract A case of primary non-Hodgkin lymphoma of the right humerus which occurred in a 21-year-old male patient after an impact to the right shoulder in a car accident in July 1983 is described. Seventeen years after the injury, due to a civil lawsuit, the biopsy material was revised. Immunohistochemical analysis showed CD20 and CD79a positivity on large pleomorphic cells, while small reactive lymphocytes were CD3, Bcl-2 and CD20 positive. Molecular analysis carried out with PCR revealed a monoclonal B-lymphocyte population. The diagnosis of diffuse large peripheral B cell lymphoma of the bone was confirmed. The present case concurs with the literature on primary bone lymphoma, in which the diagnostic problem, trauma-related presentation and an excellent prognosis of malignant tumour are emphasized. Copyright © 2003 John Wiley & Sons, Ltd. [source] Unifocal Langerhans cell histiocytosis of the oral mucosaJOURNAL DER DEUTSCHEN DERMATOLOGISCHEN GESELLSCHAFT, Issue 7 2009Susanna Fistarol Summary A 24-year-old man was admitted for a painful gingival ulcer. Histology and immunohistochemistry of a lesional biopsy revealed the diagnosis of Langerhans cell histiocytosis (LCH). To rule out multifocal disease, a complete staging was performed. There was no evidence of bony lesions or any other organ involvement. The diagnosis of LCH restricted to the oral mucosa was established. The complete oral lesion was ablated by CO2 laser and subsequently treated topically with triamcinolone acetonide. The patient is still in remission after one year of follow-up. LCH confined to the oral mucosa is rare. It presents usually as an inflammatory or ulcerative lesion, easily leading to misinterpretation and delayed diagnosis. Patients with limited unifocal mucocutaneous disease, as in the present case, usually have an excellent prognosis. However, the oral lesion may represent an early sign of LCH, predating and progressing to an aggressive life-threatening multiorgan disease. [source] Thin basement membrane nephropathy and IgA glomerulonephritis: Can they be distinguished without renal biopsy?NEPHROLOGY, Issue 5 2007DAVID K PACKHAM SUMMARY: Background: Thin basement membrane nephropathy (TBMN) and IgA glomerulonephritis (IgA gn) are the most common primary glomerular conditions diagnosed on renal biopsy, performed for microscopic haematuria or microscopic haematuria with proteinuria. While up to 50% of patients with IgA gn will develop chronic renal failure, most patients with TBMN enjoy an excellent prognosis. Because TBMN is estimated to occur in up to 1% of the general population, differentiation between the two conditions without resort to renal biopsy is desirable. Methods: This retrospective analysis of 248 patients diagnosed on renal biopsy as having either TBMN or IgA gn, sought to identify clinical or biochemical factors which would have enabled confident differentiation between the two conditions to be made without resort to renal biopsy. Results: No single clinical or pathological variable adequately discriminated between the two conditions. Impaired renal function and heavy proteinuria were highly specific for IgA gn but lacked sensitivity in differentiating from TBMN. Isolated microscopic haematuria (IMH) was a more common finding in patients diagnosed with TBMN but, as a discriminator between TBMN and IgA gn, lacked sufficient specificity. However, if assumptions were made based on the differing incidence of a positive family history between IgA gn and TBMN, then specificity of >99% could be achieved. Conclusion: TBMN and IgA gn cannot be distinguished on the basis of clinical or pathological variables alone. However, in patients with IMH and a positive family history of either IMH or biopsy-proven TBMN, there is usually no need for renal biopsy. [source] Adenoid basal carcinoma of the uterine cervix: Report of two cases with reference to adenosquamous carcinomaPATHOLOGY INTERNATIONAL, Issue 7 2005Norihiro Teramoto Adenoid basal carcinoma (ABC) of the uterine cervix is a rare neoplasm with excellent prognosis. Differential diagnosis between ABC and an ABC-like lesion of adenosquamous cell carcinoma (ASC) of the cervix is important due to their contrasting prognosis. Reported herein are two cases of ABC that have been compared with seven ASC exhibiting ABC-like lesions from approximately 2600 resected uterine cervical malignancies diagnosed at Shikoku Cancer Center. The two ABC were incidentally found in the uterine cervix of 69-year-old and 59-year-old Japanese women due to cervical intraepithelial neoplasia grade 3 and to squamous cell carcinoma, respectively. The ABC consisted of infiltrating nests of basaloid cells with low nuclear atypia. The patients remained alive without recurrence for 9 years and 18 months, respectively. An ABC-like lesion was defined as basaloid cell nests simulating ABC, but with some features indicating malignant potential. However, the differential diagnosis was sometimes difficult because two of seven ABC-like lesions were originally diagnosed as ABC. Immunohistochemically, cytokeratin 7 was negative for the basaloid cells of two ABC, but positive for six of six ABC-like lesions of ASC, while cytokeratin 8 was positive for both ABC and ASC. This cytokeratin pattern might provide a good tool for distinguishing between ABC and an ABC-like lesion of ASC when the histological findings are equivocal. [source] Prognostic Significance of Oncogenic Markers in Ductal Carcinoma In Situ of the Breast: A Clinicopathologic StudyTHE BREAST JOURNAL, Issue 2 2009Sevilay Altintas MD Abstract:, Ductal carcinoma in situ (DCIS) is a heterogeneous malignant condition of the breast with an excellent prognosis. Until recently mastectomy was the standard treatment. As the results of the National Surgical Adjuvant Breast and Bowel Project-17 trial and the introduction of the Van Nuys Prognostic Index (VNPI) less radical therapies are used. Objectives are to identify clinicopathologic and biologic factors that may predict outcome. Cases of DCIS diagnosed in two Belgian University Centers were included. Paraffin-embedded material and Hematoxylin and Eosin stained slides of DCIS cases were reviewed and tumor size, margin width, nuclear grade, and comedo necrosis were assessed. Molecular markers (estrogen receptor, progesterone receptor, HER1-4, Ki67, and c-myc) were assayed immunohistochemically. Applied treatment strategies were correlated with the prospective use of the VNPI score. Kaplan,Meier survival plots were generated with log-rank significance and multiple regression analysis was carried out using Cox proportional hazards regression analysis; 159 patients were included with a median age of 54 years (range 29,78); 141 had DCIS and 18 DCIS with microinvasion. The median time of follow-up was 54 months (range 5,253). Twenty-three patients developed a recurrence (14.5%). The median time to recurrence was 46 months (range 5,253). Before the introduction of the VNPI, 37.5% of the DCIS patients showed a recurrence while thereafter 6.7% recurred (p < 0.005). Two recurrences occurred in the VNPI group I (7.1%); seven in the VNPI group II (8.5%) (median time to recurrence 66.3 months) and 14 in the VNPI group III (28.5%) (median time to recurrence 40.2 months) (disease-free survival [DFS]: p < 0.05). A Cox proportional hazards regression analysis indicated that tumor size, margin width, pathologic class, and age were independent predictors of recurrence, but none of the studied molecular markers showed this. Overexpression of HER4 in the presence of HER3 was found to be associated with a better DFS (p < 0.05). This study confirms the value of the VNPI score and questions the benefit of an aggressive approach in the low-risk DCIS lesions. Independent predictors for recurrence included size, margin width, pathologic class, and age, but none of the molecular markers were part of it. Overexpression of HER4 in the presence of HER3 was associated with a better DFS. [source] Survival impact of treatment options for papillary microcarcinoma of the thyroidTHE LARYNGOSCOPE, Issue 10 2009Harrison W. Lin MD Abstract Objectives/Hypothesis: Evaluate the impact of medical and surgical interventions on the survival of patients with papillary microcarcinoma (PMC) of the thyroid, a common tumor with an increasing worldwide incidence. Study Design: Cross-sectional population analysis of a prospectively maintained database. Methods: Cases of nonmetastatic PMC treated with cancer-directed surgery with or without postoperative radioactive iodine (RAI) therapy were extracted from the Surveillance, Epidemiology and End Results Database (1988,2005). Kaplan-Meier disease-specific survival (DSS) and overall survivals were compared according to extent of thyroidectomy and use of RAI therapy. Cox regression analysis was performed to determine the influence of these factors on survival. Results: A total of 7,818 cases of PMC were identified. Overall actuarial survival rates at 10 and 15 years were 96.6% and 96.3%, respectively. DSS was 99.9% at both time intervals, with a total of 10 thyroid cancer-related deaths. There were no significant differences in DSS for patients who underwent total thyroidectomy, near-total/subtotal thyroidectomy, or lobectomy (P = .239). DSS for patients receiving RAI therapy was not significantly different than that of patients who did not (P = .504). On multivariate analysis, only increasing age at diagnosis, successfully predicted poor DSS (P = .001), whereas gender (P = .481), use of RAI therapy (P = .633), and extent of thyroidectomy (P = .104) did not. Conclusions: PMC carries an excellent prognosis with respect to both overall and disease-specific survival that is independent of surgical extent and the use of RAI therapy. An isolated, fine-needle,aspiration proven unilateral PMC focus in a patient lacking evidence of metastatic disease may be treated with lobectomy alone. Laryngoscope, 2009 [source] Retrospective review of extra-pulmonary small cell carcinoma at King Chulalongkorn Memorial Hospital cases during 1998,2005ASIA-PACIFIC JOURNAL OF CLINICAL ONCOLOGY, Issue 2 2010Thep CHALERMCHAI Abstract Objective: The aim of this study was to review cases of extra-pulmonary small cell carcinoma (EPSCC), including their clinical manifestations and treatment outcomes. Methods: We retrospectively reviewed the medical records and pathological reports of patients who were diagnosed with EPSCC from 1998 to 2005. Results: Overall 21 EPSCC patients were eligible for this study. The most common primary sites were the gastrointestinal organs and the nasal cavity. Eleven patients (52.3%) had limited disease (LD) and 10 patients (47.7%) had extensive disease (ED). Nine patients underwent radical surgery alone, four received only radical radiation and two received only palliative chemotherapy. Two patients received adjuvant radiation or chemotherapy following surgical resection and one received a combination of all three treatment modalities. Three patients declined specific treatment and were treated with best supportive care. The median overall survival in the ED group was only 3 months (range 1,16 months), compared to 30 months (range 20,61 months) for LD. EPSCC of pancreas demonstrated a favorable clinical outcome with treatment, whereas primary EPSCC of the liver, esophagus and rectum had an aggressive natural history and a poor response to treatment. Conclusion: Our report suggests that EPSCC may have a different biology from that of pulmonary small cell carcinoma. When detected at an early stage, EPSCC may have an excellent prognosis with treatment. Additional studies involving more patients with EPSCC are warranted to further define the optimal roles of each treatment modality. [source] Surgical treatment of carpal flexural deformity in 72 horsesAUSTRALIAN VETERINARY JOURNAL, Issue 5 2008RE Charman Carpal flexural deformities (CFD) are frequently encountered in the horse, with both congenital and acquired forms described. The success of surgical correction of CFD, both in terms of the ability to achieve a straight palmar carpal angle and the impact on future athletic performance, requires further investigation. Objective To report the surgical management and outcome of treatment of flexural deformity of the carpus in 72 horses up to 12 months of age. Method Information was obtained from the medical records of horses surgically treated for CFD and through follow-up contact with owners. At the time of examination each case was graded on the severity of the flexural deformity as grade 1, 2, or 3, in order of ascending severity. Surgical treatment consisted of tenotomy of the ulnaris lateralis and flexor carpi ulnaris muscles. Re-assessment of the palmar carpal angle was made in the immediate postoperative period and again from at least 8 months after surgery via telephone contact with owners and/or breeders. A successful outcome was defined as achievement of a straight palmar carpal angle. Long term outcome was assessed in terms of fulfilment of intended use for horses reaching 3 years of age at the time of the study. Results A total of 135 surgical procedures were performed on 72 horses. A successful outcome was recorded in 111 limbs (82%). Excluding cases lost to follow-up, surgical correction was more successful in restoring a straight palmar carpal angle in grade 1 limbs (25/25, 100%) compared to grade 2 limbs (78/87, 89%) and grade 3 limbs (8/14, 57%). For those horses that had reached 3 years of age, 26 of 36 Thoroughbreds started in a race (72%) and 12 of 14 non-Thoroughbreds fulfilled their intended use (86%). Conclusion Tenotomy of the ulnaris lateralis and flexor carpi ulnaris tendons for treatment of grade 1 and 2 CFD's has an excellent prognosis for restoration of a straight palmar carpal angle and for intended athletic pursuit of the horse. In cases of grade 3 CFD, the prognosis following surgery is guarded, especially in neonates. Horses treated in this study were up to 12 months of age, indicating that this deformity may not always be self-limiting as previously thought, and treatment may be required for successful resolution of flexural deformity of the carpus in older animals. The results of this study will help veterinarians to make recommendations regarding the surgical treatment of CFDs. [source] Outcome of pylorus-preserving gastrectomy for early gastric cancerBRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 9 2008S. Morita Background: Pylorus-preserving gastrectomy has been introduced as a function-preserving operation for early gastric cancer in Japan. The aim of this study was to investigate the safety and radicality of the procedure. Methods: Between 1995 and 2004, 611 patients with apparent early gastric cancer in the middle third of the stomach had pylorus-preserving gastrectomy. The short-term surgical and long-term oncological outcomes of these operations were assessed. Results: The accuracy of preoperative diagnosis of early gastric cancer was 94·3 per cent. Nodal involvement was seen in 62 patients (10·1 per cent). There were no postoperative deaths. Complications developed in 102 patients (16·7 per cent). Major complications, such as leakage and abscess, were observed in 19 (3·1 per cent). The most common complication was gastric stasis, occurring in 49 (8·0 per cent). The overall 5-year survival rate in patients with early gastric cancer was 96·3 per cent. Conclusion: Pylorus-preserving gastrectomy is a safe operation with an excellent prognosis in patients with early gastric cancer. It is recommended as the standard procedure for early gastric cancer in the middle third of the stomach. Copyright © 2008 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source] Prognosis of small thyroid cancer in patients with Graves' diseaseBRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 4 2006S. Kikuchi Background: To find the best ways to follow up patients with small thyroid cancer (STC; 1 cm or less in diameter) and concomitant Graves' disease, this study examined whether such patients had the same excellent prognosis as those with STC without Graves' disease. Methods: Between 1970 and 1996, 2199 patients were diagnosed as having STC by pathology after thyroidectomy. Of those, 509 patients (33 males and 476 females, mean age 43·5 years) underwent thyroidectomy for Graves' disease. Control patients with STC without Graves' disease were matched for age, sex, treatment year and tumour size (33 males and 476 females, mean age 44·0 years). Results: Patients with STC and Graves' disease had a longer disease-free survival than those with STC alone (99 and 93 per cent at 20 years' follow-up, respectively; P < 0·001). The Cox's proportional hazard analysis showed that concomitant Graves' disease and age at surgery are more significant factors for predicting disease-free survival than surgical procedures. Conclusion: Patients who undergo thyroidectomy for Graves' disease and are found to have STC have an excellent prognosis and longer disease-free survival than patients with STC alone. Copyright © 2006 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source] Is there a benefit to sentinel lymph node biopsy in patients with T4 melanoma?CANCER, Issue 24 2009Csaba Gajdos MD Abstract BACKGROUND: Controversy exists as to whether patients with thick (Breslow depth >4 mm), clinically lymph node-negative melanoma require sentinel lymph node (SLN) biopsy. The authors examined the impact of SLN biopsy on prognosis and outcome in this patient population. METHODS: A review of the authors' institutional review board-approved melanoma database identified 293 patients with T4 melanoma who underwent surgical excision between 1998 and 2007. Patient demographics, histologic features, and outcome were recorded and analyzed. RESULTS: Of 227 T4 patients who had an SLN biopsy, 107 (47%) were positive. The strongest predictors of a positive SLN included angiolymphatic invasion, satellitosis, or ulceration of the primary tumor. Patients with a T4 melanoma and a negative SLN had a significantly better 5-year distant disease-free survival (DDFS) (85.3% vs 47.8%; P < .0001) and overall survival (OS) (80% vs 47%; P < .0001) compared with those with metastases to the SLN. For SLN-positive patients, only angiolymphatic invasion was a significant predictor of DDFS, with a hazard ratio of 2.29 (P = .007). Ulceration was not significant when examining SLN-positive patients but the most significant factor among SLN-negative patients, with a hazard ratio of 5.78 (P = .02). Increasing Breslow thickness and mitotic rate were also significantly associated with poorer outcome. Patients without ulceration or SLN metastases had an extremely good prognosis, with a 5-year OS >90% and a 5-year DDFS of 95%. CONCLUSIONS: Clinically lymph node-negative T4 melanoma cases should be strongly considered for SLN biopsy, regardless of Breslow depth. SLN lymph node status is the most significant prognostic sign among these patients. T4 patients with a negative SLN have an excellent prognosis in the absence of ulceration and should not be considered candidates for adjuvant high-dose interferon. Cancer 2009. © 2009 American Cancer Society. [source] Chromophobe renal cell carcinomaCANCER, Issue 7 2004Analysis of 61 cases Abstract BACKGROUND Chromophobe renal cell carcinoma (CRCC) is often associated with a favorable prognosis. However, to the authors' knowledge, only few clinical data are available regarding this variant of tumor. In the current study, the authors report their experience with CRCC over the last 14 years. METHODS Since 1989, 61 patients have been treated at the study institution for CRCC. Tumor characteristics and patient outcome were analyzed retrospectively. Data were obtained from the patients' medical records. RESULTS The mean age of the patients was 58 years. Of the 61 tumors, 68.8% were discovered incidentally. The mean tumor size was 6.9 cm. Fifty-seven patients (93.4%) were treated with radical nephrectomy and 4 patients (6.6%) underwent partial nephrectomy. According to the 1997 TNM classification, the pathologic tumor stage was T1 in 65.6% of cases, T2 in 31.1% of cases, and T3a in 3.3% of cases. All tumors were staged as N0M0. Nuclear grade was low (1 or 2) in 88.5% of cases. In no case of CRCC was a sarcomatoid component observed. At a mean follow-up of 49.5 months (range, 5,135 months), no patient had experienced tumor recurrence or disease progression, and none had died of renal carcinoma. CONCLUSIONS In the authors' experience, CRCC carries an excellent prognosis, possibly due to the high rate of low-stage and low-grade tumors. Cancer 2004;100:1406,10. © 2004 American Cancer Society. [source] Papillary microcarcinoma of the thyroid,Prognostic significance of lymph node metastasis and multifocalityCANCER, Issue 1 2003Sin-Ming Chow M.B.B.S Abstract BACKGROUND It is known that patients with papillary microcarcinoma (PMC) of the thyroid gland have a very favorable prognosis. The rising incidence of PMC among papillary thyroid carcinoma (PTC) necessitates the identification of prognostic factors and the formulation of treatment protocols. METHODS The authors conducted a retrospective analysis of 203 patients with PMC who were diagnosed on or before 1999 and were treated at the Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong. RESULTS The cause specific survival, locoregional (LR) failure free survival, and distant metastases failure free survival rates at 10 years were 100%, 92.1%, and 97.1%, respectively. Five patients had lung metastases; 2 patients died of their metastases 12.9 years and 14.8 years after diagnosis, and 3 patients achieved clinical remission after radioiodine (RAI) treatment. Twelve patients had LR recurrences. Patients with LR recurrence were highly salvageable with a combination of surgery, RAI treatment, and external radiotherapy; all but one (who refused treatment) were alive without disease at last follow-up. Multivariate analyses did not reveal any independent prognostic factor for survival. The risk of cervical lymph node (LN) recurrence increased 6.2-fold (P = 0.01) and 5.6-fold (P = 0.02) when LN metastases and multifocal disease were present at diagnosis. RAI ablation reduced the LN recurrence rate to 0.27 (P = 0.04). The presence of LN metastasis increased the rate of distant metastasis 11.2-fold (P = 0.03). Age was not a significant factor in predicting disease recurrence or survival. Subdivision by tumor sizes , 5 mm and > 5 mm did not affect the outcome, but no patient with tumors , 5 mm had mortality related to PMC. CONCLUSIONS Despite the overall excellent prognosis for patients with PMC, PMC was associated with a 1.0% disease-related mortality rate, a 5.0% LN recurrence rate, and a 2.5% distant metastasis rate. Therefore, the treatment of patients with PMC should be no different from the treatment of patients with conventional PTC: i.e., complete surgery with consideration for RAI and/or external radiation therapy if poor prognostic factors are present. Cancer 2003;98:31,40. © 2003 American Cancer Society. DOI 10.1002/cncr.11442 [source] Intracranial germinoma: A rare but important differential diagnosis in children with growth retardationACTA PAEDIATRICA, Issue 3 2006Sven Gottschling Abstract Aim: Intracranial germinoma is a rare malignant tumour in childhood with an excellent prognosis under adequate therapy. Finding the right diagnosis at an early stage is difficult because of the slow-growing tumour and the resulting lack of clinical symptoms. Methods: Our patients with histologically secured germinoma were retrospectively assessed concerning growth retardation, pituitary hormone status, magnetic resonance imaging scan results and clinical symptoms to find out whether there is a leading parameter. Results: In all our patients, the leading symptom was growth retardation of at least 2 y before being diagnosed. Conclusion: Growth retardation seems to be a very early sign of germinoma in the suprasellar region. Therefore, early neuroradiological imaging combined with pituitary hormone status should be considered in every paediatric patient with a history of secondary growth retardation. [source] A case of benign acute childhood myositis associated with influenza A (H1N1) virus infectionCLINICAL MICROBIOLOGY AND INFECTION, Issue 2 2010M. Koliou Clin Microbiol Infect 2010; 16: 193,195 Abstract Benign acute childhood myositis (BACM) is a rare transient condition usually occurring at the early convalescent phase of a viral upper respiratory tract illness, normally influenza A, and, more frequently, influenza B infection. It is characterized by acute-onset difficulty in walking as a result of severe bilateral calf pain and by elevated muscle enzymes including creatinine kinase. It is self-limiting because there is rapid full recovery usually within 1 week. We describe the first case of BACM in association with the new pandemic influenza A (H1N1) virus infection in an 11-year-old boy from Cyprus. The child had the typical clinical and laboratory characteristics of this clinical syndrome. Prompt diagnosis of this clinical entity is essential to prevent unnecessary investigations and therapeutic interventions and to reassure the patient and parents of the excellent prognosis. [source] | ||||||||||||||||||||||