SummaryObjective Some patients with papillary thyroid carcinoma (PTC) would suffer from locoregional recurrences or distant metastases. This study was aimed to elucidate the impacts of locoregional recurrences and distant metastases on these patients' survival. Design Retrospective hospital-based cohort study. Population Data were collected from 1636 subjects with PTC at National Taiwan University Hospital between 1985 and 2007. Measurements Overall and disease-specific survival curves were estimated by the Kaplan-Meier method. Time-independent and time-dependent prognostic factors were included simultaneously in multivariate analyses using Cox models. Results Overall survival (OS) rates at 10-and 20-years were 90% and 76%, respectively. The 10-and 20-year disease-specific survival (DSS) rates were 95% and 90%, respectively. Our multivariate analyses identified that older age, distant metastases (hazard ratio, HR: 6Á69, 95% CI: 4Á40-10Á18), locoregional recurrences (HR: 1Á88, 95% CI: 1Á22-2Á89), lymph node metastases, massive extrathyroid extension, male gender and larger tumour size (>4 cm) were significantly associated with poorer OS. Older age, distant metastases (HR: 15Á03, 95% CI: 8Á31-27Á21), locoregional recurrences (HR: 3Á63, 95% CI: 2Á03-6Á51), massive extrathyroid extension, male gender and larger tumour size (>4 cm) were independently related to worse DSS. The performance of highdose 131 I ablation had a protective effect on OS and DSS. Conclusion The locoregional recurrences had a moderately harmful impact on OS and DSS, but age and distant metastases were the major decisive factors for OS and DSS. High-dose 131
A 79-year-old woman with acute suppurative Salmonella thyroiditis is reported. She presented with fever and an enlarged, painful thyroid mass. Diagnosis was suspected by clinical symptoms and signs and confirmed by ultrasound, neck magnetic resonance imaging, aspiration cytology, and culture. The culture of fine-needle aspirate yielded Salmonella typhimurium. She was treated by parental antibiotics and surgical drainage. The source and route of infection remained unclear under a series of examinations. No piriform sinus fistula was evident on the imaging study. A hematogenous spread seems to be the most possible route.
BackgroundRhodiola crenulata (R. crenulata) is widely used to prevent acute mountain sickness in the Himalayan areas and in Tibet, but no scientific studies have previously examined its effectiveness. We conducted a randomized, double-blind, placebo-controlled crossover study to investigate its efficacy in acute mountain sickness prevention.MethodsHealthy adult volunteers were randomized to 2 treatment sequences, receiving either 800 mg R. crenulata extract or placebo daily for 7 days before ascent and 2 days during mountaineering, before crossing over to the alternate treatment after a 3-month wash-out period. Participants ascended rapidly from 250 m to 3421 m on two separate occasions: December 2010 and April 2011. The primary outcome measure was the incidence of acute mountain sickness, as defined by a Lake Louise score ≥ 3, with headache and at least one of the symptoms of nausea or vomiting, fatigue, dizziness, or difficulty sleeping.ResultsOne hundred and two participants completed the trial. There were no demographic differences between individuals taking Rhodiola-placebo and those taking placebo-Rhodiola. No significant differences in the incidence of acute mountain sickness were found between R. crenulata extract and placebo groups (all 60.8%; adjusted odds ratio (AOR) = 1.02, 95% confidence interval (CI) = 0.69–1.52). The incidence of severe acute mountain sickness in Rhodiola extract vs. placebo groups was 35.3% vs. 29.4% (AOR = 1.42, 95% CI = 0.90–2.25).ConclusionsR. crenulata extract was not effective in reducing the incidence or severity of acute mountain sickness as compared to placebo.Trial registrationClinicalTrials.gov
NCT01536288.
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