Background
Papillary thyroid carcinoma (PTC) has excellent survival, yet recurrence remains a challenge. We sought to determine the proportion of re-operations performed for persistent, rather than truly recurrent disease.
Methods
We conducted a retrospective review of a prospectively maintained database. Patients with PTC that had re-operation for disease from 2000–2016 were included. We defined recurrence as disease that developed after a patient had an undetectable thyroglobulin and negative ultrasound within one year of surgery.
Results
A total of 69 patients underwent 92 re-operations. On initial pathology: mean tumor size was 2.6cm; 50.7% were multifocal; and 42% had extra-thyroidal extension. Half (46%) of the patients underwent a central/lateral neck dissection at initial surgery and 76.8% were treated with post-operative radioactive iodine. The median time to first re-operation was 21 months (range, 1–292), and 41.8% occurred within 1 year. Only three operations met criteria for true “recurrence”, while 71 operations were categorized as persistence.
Conclusion
Many re-operations for PTC are for management of persistent disease. Over half of the patients required re-operation within the first two years, which strongly suggests that improvements in the pre-operative assessment and adequacy of initial surgery need to be made to improve the care of patients with thyroid cancer.
Objective The aim of this study was to assess long-term effects for women following the use of magnesium sulphate for pre-eclampsia.Design Assessment at 2-3 years after delivery for women recruited to the Magpie Trial (recruitment in 1998(recruitment in -2001, which compared magnesium sulphate with placebo for pre-eclampsia.Setting Follow up after discharge from hospital at 125 centres in 19 countries across five continents.Population A total of 7927 women were randomised at the followup centres. Of these women, 2544 were not included for logistic reasons and 601 excluded (109 at a centre where <20% of women were contacted, 466 discharged without a surviving child and 26 opted out). Therefore, 4782 women were selected for follow-up, of whom 3375 (71%) were traced.Methods Questionnaire assessment was administered largely by post or in a dedicated clinic. Interview assessment of selected women was performed.Main outcome measures Death or serious morbidity potentially related to pre-eclampsia at follow up, other morbidity and use of health service resources.Results Median time from delivery to follow up was 26 months (interquartile range 19-36). Fifty-eight of 1650 (3.5%) women allocated magnesium sulphate died or had serious morbidity potentially related to pre-eclampsia compared with 72 of 1725 (4.2%) women allocated placebo (relative risk 0.84, 95% CI 0.60-1.18).
ConclusionsThe reduction in the risk of eclampsia following prophylaxis with magnesium sulphate was not associated with an excess of death or disability for the women after 2 years.
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