Recurrent disease in differentiated thyroid carcinoma is more common in patients treated with low-activity radioactive iodine in patients with lymph node metastases and extrathyroidal extension. These recurrences typically occur within four years of initial treatment. Patients lacking both of these risk factors treated with low radioactive iodine activity (<1850 MBq) have excellent outcomes, even after 10 years.

Background: Integration of neoadjuvant chemotherapy (NCT) in early 70s resulted that many LABC tumors become resectable but with total mastectomy especially those with partial response, oncoplastic techniques give better oncological outcome with better cosmetic results. Objective: We evaluate the oncological safety of oncoplastic breast surgery (OS) in LABC showing partial response to NCT. Methods: We prospectively analyzed the data of 32 out of 58 patients with LABC who showed partial response to NCT and could have conservative surgery with advanced oncoplastic techniques rather than total mastectomy. Results: Out of 58 patients with LABC, received neoadjuvant chemotherapy, complete response was observed in 8 patients (13%), partial response reported in 32 (55.1%) cases, 12 patients (20%) had stable disease and 6 patients (10%) showed progressive disease. Data of 32 cases were studied (mean age 44.84 ± 9.10 years; range 26 -59 years). Inferior pedicle was performed in 9 cases, mini LD flap in 3 patients, 5 had Grissotti technique, 6 with superomedial pedicle, 4 had V mammoplasty and 3 with J mammoplasty and 2 had vertical mammoplasty. Margins were positive in 5 cases (15.6%) with mean margin width 9.63 ± 5.72 (range 0 -22 mm), and the local recurrence was reported in 2 cases (6.2%). Complications were reported in 3 cases (9.3%). The follow up was 1.67 ± 1.03 (range 0 -3.3 years). Conclusions: Integration of neoadjuvant chemotherapy together with advanced oncoplastic techniques opens a new way for management of LABC especially those showing partial response with avoidance of total mastectomy, and comparable oncological safety in addition to better aesthetic and psychological outcome.

BackgroundNeuropsychiatric abnormalities are common in multiple sclerosis (MS) patients. Cognitive dysfunction affects B40% of MS patients. Advances in neuroimaging are increasing our understanding of the pathogenesis of these disorders. Aim This study aimed to assess the possible neurological and psychiatric complications and cognitive impairment in MS patients and to correlate the psychiatric symptoms with clinical types, severity, and MRI findings in MS patients. Participants and methods This is a cross-sectional descriptive study that was carried out on 25 patients diagnosed with definite MS according to McDonald's criteria. All patients were subjected to a semi-structured interview that included demographic data and full neurological and psychiatric examination, Expanded Disability Status Scale (EDSS) evaluation, Mini-Mental State Examination (MMSE), and MRI brain with assessment of the lesions number, site, and brain atrophy. ResultsThis study included 25 adults, 19 women and six men. They ranged in age from 22 to 55 years, mean age 33 ± 9 years. The mean disease duration was 6.4 ± 3 years. Sixty-four percent of the patients were married. Sixty-four percent of the patients had the relapsing remitting type of MS. Fatigue was the most prevalent symptom (96%), followed by sphincter troubles, (80%) visual symptoms (76%), dizziness (64%), sexual dysfunction (60%), and pain (56%). EDSS showed that 44% of the patients had moderate disability, 32% of the patients needed intermittent or constant unilateral assistance, and 24% of the patients needed constant bilateral support. On applying the Structural Clinical Interview for DSM-IV Axis I (SCID-I), it was found that depression (60%), dysthymia (60%), and generalized anxiety disorder (68%) were the most prevalent psychiatric presentations. For the MMSE, 24% of the patients showed an MMSE score between 17 and 25 and 4% the patients showed scores less than 17. Assessment of MRI brain showed that atrophic brain changes were present in 72% of the patients. All the patients studied had supratentorial plaques and 44% had frontal plaques. Infratentorial lesions were present in 72% of MS patients. Conclusion and recommendationsAttention should be focused on the other important presentations of the disease such as psychiatric disorders and cognitive impairments, and a comprehensive biopsychosocial neuropsychiatric approach should be adopted, which is essential for optimal care of patients with MS.

No abstract