No abstract

Abstract. Central lymph node metastasis (CLNM) is common in papillary thyroid microcarcinoma (PTMC). The aim of the present study was to investigate the risk factors associated with CLNM in clinical lateral cervical lymph node-negative (cN0) PTMC in Eastern China. A total of 392 patients with confirmed PTMC by histological examination who underwent thyroidectomy and central neck lymph node dissection (CND) between May 2011 and October 2012 at the First Affiliated Hospital of Wenzhou Medical University (Wenzhou, China) were enrolled. The clinicopathological and ultrasonographic data from the patients were analyzed retrospectively. A scoring system was developed on the basis of independent predictive factors for CLNM. Male gender, age <45 years, maximum tumor diameter >5 mm, lower lobe location, multifocal carcinoma with total tumor diameter >10 mm and extracapsular spread were independent predictive factors for CLNM according to logistic regression analysis. The clinicopathological score was statistically significant, with an index point ≥2 indicating CLNM with 86.2% sensitivity and 70.4% specificity. The findings of the present study indicate that CND may be recommended to be routinely performed when the clinicopathological index point ≥2.

Ultrasound-guided fine needle aspiration biopsy (FNAB) is a costly diagnostic item with a low yield in identifying the tiny proportion of nodules that actually represent malignant disease. Our aim through this study was to obtain an ultrasound (US) score for selecting subcentimeter-sized thyroid nodules requiring FNAB in eastern China. Some 248 patients for a total of 270 thyroid nodules less than 1 cm in diameter underwent FNAB and subsequent surgery from January 2006 to March 2012 at our hospital. The clinicopathological and US data from all the nodules were analyzed retrospectively. An US score was developed on the basis of independent predictive factors for malignancy. Irregular shape, hypoechogenicity, no well-defined margin, presence of calcifications and ratio between antero-posterior and transversal diameters (AP/TR) ≥1 were independent predictive factors for malignancy on logistic regression analysis. US score were statistically significant, with ≤2 favoring benignancy with an 80.3% sensitivity and a 72.7% specificity. US score is useful for differentiating between malignant and benign subcentimeter-sized thyroid nodules. We suggest FNAB for nodules when the US score is higher than 2.

It has been reported that hypereosinophilic syndrome may be induced by antituberculosis drugs. We herein report the case of a 43-year-old man who had been on antituberculosis drugs for two months to treat tuberculous meningitis. During therapy, he suffered from drug rash with eosinophilia and systemic symptoms (DRESS) presenting as acute eosinophilic myocarditis, as confirmed on a histopathologic examination. According to the patient's medication history, clinical features and accessory examination findings, the eosinophilic myocarditis was thought to be possibly induced by isoniazid. Although further investigations are needed to confirm causality, isoniazid may be added to the list of drugs with the potential to cause DRESS syndrome.

To investigate the efficacy of Taxanes- and Oxaliplatin-based chemotherapies (TC and OC) in the treatment of gastric cancer patients after D2 gastrectomy with different Lauren types. In this study, 299 patients of gastric adenocarcinoma with D2 lymph node dissection were reviewed between 2007 and 2014. Chemotherapies were classified as Oxaliplatin-based and Taxanes-based regimen. Treatment outcomes were analyzed according to different Lauren types, such as the intestinal type, diffuse type, and mixed type groups, respectively. The disease-free survival (DFS) and overall survival (OS) were estimated using the Kaplan–Meier method. The log-rank test was used for univariate analysis, and Cox regression was used for multivariate analysis. In diffuse type gastric cancer, the Oxaliplatin-based arm had a longer median DFS and OS compared with Taxanes-based arm (DFS: 47.0 vs 28.6 months, P = 0.04; OS: 51.9 vs 34.5 months, P = 0.048). The chemotherapy regimen was an independent prognostic factor for DFS and OS of diffuse type gastric cancer patients by multivariate analysis (P = 0.01). In the intestinal type, although the DFS and OS of intestinal type patients in TC group were higher than those in OC group (DFS: 53.4 vs 42.4 months; OS: 69.7 vs 57.8 months), there was no statistical significance observed (both P > 0.05). For the mixed type, the 2 different chemotherapy regimens achieved similar median DFS and OS. In a conclusion, the patients of diffuse type were more sensitive to OC, and the intestinal type patients may be benefit from TC. Therefore, it will be of benefit for gastric patients by introducing Lauren classification clinically and to help the choice of chemotherapy regimen for gastric patients after D2 gastrectomy.