Thyroid screening program; follow-up evaluation.
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Biomedical subjects
Publications and source records attributed to M Razack.
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From the thyroid screening program at the Roswell Park Memorial Institute in Buffalo, New York, 85 patients with thyroid nodules who had received previous irradiation to the head and neck were identified. The diagnosis was confirmed microscopically by needle aspiration cytology and the patients were treated with thyroid replacement therapy. In 24 patients, the nodules disappeared completely; a partial response (more than 50% reduction in size) was seen in 26; 11 patients were improved (20% to 50% reduction in size); 14 had stable disease (less than 20% reduction in nodule size) and in 10 the condition progressed (an increase of more than 20% in nodule size). Six of 21 patients who underwent operation had well differentiated tumours. The number of cases of Hashimoto's thyroiditis (14) was high. Suppressive therapy will separate those patients whose nodules will disappear completely and who will thus be spared operation. Continued follow-up of such patients is essential. All other patients should be offered operation since thyroid nodules are malignant in 30% of cases.
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Hemipelvectomy was performed in 50 patients with malignant neoplasms of the upper part of the thigh and pelvis. Although not technically difficult, the operation is associated with considerable blood loss. Postoperative complications are frequent, the greatest morbidity resulting from skin flap necrosis. Symptomatic phantom limb is as occasional late problem. Of 37 patients resected for cure prior to 1969, 14 were alive five or more years postoperatively. Five of these long-term survivors subsequently died of metastases. Patients with fibrosarcoma and chondrosarcoma had the best survival. Six other patients underwent palliative hemipelvectomy for intractable pain, with gratifying results. Hemipelvectomy is an important, useful operative procedure in selected patients.