Differentiated thyroid cancer with extrathyroidal extension: prognosis and the role of external beam radiotherapy.

A study was performed to identify variables that affected cause-specific survival (CSS) and local relapse-free rate (LRFR) in patients with differentiated thyroid cancer (DTC) and extrathyroid extension (ETE) and to examine the role of external beam radiotherapy (XRT). Prognostic factors were similar to those found in studies of all patients with DTC. In patients with postoperative gross residual disease treated with radiotherapy, 10-year CSS and LRFR were 48% and 90%.

Dietary iodine restriction in preparation for radioactive iodine treatment or scanning in well-differentiated thyroid cancer: a systematic review.

Background: Dietary iodine is often restricted before radioactive iodine (RAI) scanning or treatment of well-differentiated thyroid cancer. Our objective was to examine the impact of a low-iodine diet (LID) before RAI treatment or scanning on the following outcomes: (i) the efficacy of thyroid remnant ablation (or residual disease elimination), (ii) urinary iodine measurements, (iii) RAI kinetics, and (iv) long-term thyroid cancer outcomes.

Methods: We performed a systematic review of the English literature.

Impact of rapid leukodepletion on the outcome of severe clinical pertussis in young infants.

Objectives: Bordetella pertussis is a common, underrecognized, and vaccine-preventable cause of critical illness with a high mortality in infants worldwide. Patients with severe cases present with extreme leukocytosis and develop refractory hypoxemia and pulmonary hypertension that is unresponsive to maximal intensive care. This may reflect a hyperviscosity syndrome from the raised white blood cell (WBC) count.

A usability study of a computerized decision aid to help patients with, early stage papillary thyroid carcinoma in, decision-making on adjuvant radioactive iodine treatment.

Objective: We tested the usability of a patient-directed decision aid (DA), intended for patients with early stage papillary thyroid carcinoma (PTC) deciding to accept or reject adjuvant radioactive iodine (RAI) treatment. This decision is complicated by uncertainty of the medical evidence relating to potential treatment benefits.

Methods: The DA was tested by 12 thyroid cancer survivors, 7 thyroid specialty physicians, and 30 lay individuals with no history of thyroid cancer.

Adjuvant chemoradiation for gastric cancer with infusional 5-fluorouracil and cisplatin: a phase I study.

Objective: This phase I study aimed to determine the maximal tolerated dose of cisplatin administered every 2 weeks with infusional 5-fluorouracil (5FU) and concurrent radiation therapy (RT) in patients after complete resection of gastric adenocarcinoma.

Methods: Patients with resected stage IB to IV (M0) gastric adenocarcinoma were treated with 12 weeks of infusional 5FU (200 mg/m(2) daily) and with RT (45 Gy in 25 fractions starting on day 16). Cisplatin was administered in escalating doses (0, 20, 30, and 40 mg/m(2)) in weeks 1, 3, 5, and 7.

A Portable CT Scanner in the Pediatric Intensive Care Unit Decreases Transfer-Associated Adverse Events and Staff Disruption.

Introduction: Computerized tomography (CT) is an important diagnostic tool in the management of critically ill children, especially those with neurosurgical problems such as traumatic brain injury. Traditionally, such scans require transfer to the radiology department (RD) at times of extreme physiological instability, such as incipient cerebral herniation, and exposes children with actual, or potential, spinal injuries to the risks of transfer. Moving children from pediatric intensive care (PIC), often overnight, also depletes units of senior staff.

Decision aid on radioactive iodine treatment for early stage papillary thyroid cancer--a randomized controlled trial.

Background: Patients with early stage papillary thyroid carcinoma (PTC), are faced with the decision to either to accept or reject adjuvant radioactive iodine (RAI) treatment after thryroidectomy. This decision is often difficult because of conflicting reports of RAI treatment benefit and medical evidence uncertainty due to the lack of long-term randomized controlled trials.

Methods: We report the protocol for a parallel, 2-arm, randomized trial comparing an intervention group exposed to a computerized decision aid (DA) relative to a control group receiving usual care.

Semiquantitative assessment of immunohistochemistry for mismatch repair proteins in Lynch syndrome.

Aims: To assess semiquantitative immunohistochemistry as used in the diagnosis of Lynch syndrome.

Methods And Results: Tumour sections from 51 mutation carriers and 17 controls were stained with antibodies against MLH1, MSH2, MSH6 and PMS2. Intensity of immunoreactivity and percentage positivity were recorded on scales of 0-3 and 0-4, respectively.

Treating the causes of paediatric hypertension using non-invasive physiological parameters.

Although hypertension is uncommon in childhood, when present, clinicians should investigate the cause and manage appropriately, which can be challenging in children with renal disease. Our knowledge of normal homeostatic mechanisms of blood pressure control, such as the renin-angiotensin system or endothelial function, and the pathophysiology of these systems in hypertensive patients, has significantly advanced in recent years. However, our therapeutic strategy in paediatric hypertension is limited in delineating the underlying physiological derangement of individual patients.

Establishing nurse-led ventilator-associated pneumonia surveillance in paediatric intensive care.

Preventing ventilator-associated pneumonia (VAP) is one of the Department of Health 'Saving Lives' initiatives. Whereas morbidity and mortality from VAP is well-documented in adults, it is poorly studied in children. We describe the establishment of a nurse-led VAP surveillance programme as part of an overall drive for patient safety and healthcare-associated infection reduction.

Changing physician practice: an evaluation of knowledge transfer strategies to enhance physician documentation of cancer stage.

This paper describes the knowledge transfer strategies used by Cancer Care Ontario, in partnership with 14 regional cancer centres, with the aim of improving the cancer stage data in Ontario. As physicians are directly responsible for the documentation of cancer stage, the success of this initiative is directly related to improvements in physician documentation practices. Knowledge transfer strategies included the use of local opinion leaders, educational sessions, and audit/feedback loops.

Recurrence after treatment of micropapillary thyroid cancer.

Background: Despite very low mortality associated with micropapillary thyroid cancer, locoregional recurrence is common and controversy exists regarding optimal surgical treatment and the role of adjunctive radioiodine.

Methods: The National Thyroid Cancer Treatment Cooperative Study Group Registry was analyzed for recurrences in patients with unifocal versus multifocal micropapillary cancer, with or without nodal disease, depending upon the extent of surgery and the use of adjunctive radioiodine. Six hundred eleven patients considered disease-free after initial therapy were followed for 2572 person-years.

Interfraction and respiratory organ motion during conformal radiotherapy in gastric cancer.

Purpose: To quantify the interfraction and breathing organ motion during adjuvant radiotherapy for gastric cancer and assess organ stability in different breathing states.

Methods And Materials: A planning computed tomography (CT) scan and serial study CT scans in free breathing, voluntary inhale and exhale were performed in weeks 1, 3, and 5 of radiotherapy for 22 resected gastric patients. All data sets were fused to register the vertebral bodies.

A novel use of etomidate for intentional adrenal suppression to control severe hypercortisolemia in childhood.

Objective: To describe a novel use for etomidate in critically ill children. Etomidate induction of anesthesia in children is controversial due to adrenal suppression; we review this controversy and describe a therapeutic application of this "side effect" using a continuous etomidate infusion in pediatric intensive care to deliberately suppress critically elevated endogenous cortisol.

Design: Case report.

Clinical practice parameters for hemodynamic support of pediatric and neonatal septic shock: 2007 update from the American College of Critical Care Medicine.

Background: The Institute of Medicine calls for the use of clinical guidelines and practice parameters to promote "best practices" and to improve patient outcomes.

Objective: 2007 update of the 2002 American College of Critical Care Medicine Clinical Guidelines for Hemodynamic Support of Neonates and Children with Septic Shock.

Participants: Society of Critical Care Medicine members with special interest in neonatal and pediatric septic shock were identified from general solicitation at the Society of Critical Care Medicine Educational and Scientific Symposia (2001-2006).

Second primary malignancy risk after radioactive iodine treatment for thyroid cancer: a systematic review and meta-analysis.

Background: The risk of second primary malignancies (SPMs) associated with cancer therapies is an important concern of thyroid cancer survivors and physicians. Our objective was to determine if the risk of SPMs is increased in individuals with thyroid cancer treated with radioactive iodine (RAI), compared to those not treated with RAI.

Methods: We performed a systematic review of the literature and meta-analysis.

Phase I study of individualized stereotactic body radiotherapy of liver metastases.

Purpose: To report on the outcomes of a phase I study of stereotactic body radiotherapy (SBRT) for treatment of liver metastases.

Patients And Methods: Patients with liver metastases that were inoperable or medically unsuitable for resection, and who were not candidates for standard therapies, were eligible for this phase I study of individualized SBRT. Individualized radiation doses were chosen to maintain the same nominal risk of radiation-induced liver disease (RILD) for three estimated risk levels (5%, 10%, and 20%).

The impact of thyroid cancer and post-surgical radioactive iodine treatment on the lives of thyroid cancer survivors: a qualitative study.

Background: Adjuvant treatment with radioactive iodine (RAI) is often considered in the treatment of well-differentiated thyroid carcinoma (WDTC). We explored the recollections of thyroid cancer survivors on the diagnosis of WDTC, adjuvant radioactive iodine (RAI) treatment, and decision-making related to RAI treatment. Participants provided recommendations for healthcare providers on counseling future patients on adjuvant RAI treatment.

Distinct hemodynamic patterns of septic shock at presentation to pediatric intensive care.

Objective: Early aggressive resuscitation is accepted best practice for severe pediatric sepsis. Targeting of therapy to individual hemodynamic patterns is recommended, but assessment of patterns is difficult early in the disease process. New technologies enabling earlier hemodynamic assessment in shock may inform choices for vasoactive drugs in fluid-resistant cases.