We have analyzed the course of papillary thyroid carcinoma in 269 patients managed at the University of Chicago, with an average follow-up period of 12 yr from the time of diagnosis. Patients were ...categorized by clinical class; I, with intrathyroidal disease; II, with cervical nodal metastases; III, with extrathyroidal invasion; and IV, with distant metastases. Half of the patients had a history of thyroid enlargement known, on the average, for over 3 yr. In 15% of patients given thyroid hormone, the mass decreased in size. The peak incidence of cancer was when subjects were between 20-40 yr of age. Tumors averaged 2.4 cm in size; 21.6% had tumor capsule invasion, and 46% of patients had multifocal tumors. Sixty-six percent of the patients had near-total or total thyroidectomy. The overall incidence of postoperative hypoparathyroidism was 8.4%, but the incidence was zero in 83 near-total or total thyroidectomies carried out by 1 surgeon. Twenty-five percent of the patients had continuing or recurrent disease, and 8.2% died from cancer. Deaths occurred largely in patients with class III or IV disease. Cervical lymph nodes were associated with increased recurrences, but not increased deaths. Extrathyroidal invasion carried an increased risk of 5.8-fold for death, and distant metastases increased this risk 47-fold. Age over 45 yr at diagnosis increased the risk of death 32-fold. Tumor size over 3 cm increased the risk of death 5.8-fold. Surgical treatment combining lobectomy plus at least contralateral subtotal thyroidectomy was associated, by Cox proportional hazard analysis, with decreased risk of death in patients with tumors larger than 1 cm and decreased risk of recurrence among all patients, including patients in classes I and II, compared to patients who underwent unilateral thyroid surgery or bilateral subtotal resections. By chi 2 analysis, 131I ablation of residual thyroid tissue after operation was associated with decreased risk of recurrence in tumors larger than 1 cm and decreased risk of death in patients in classes I and II with tumors more than 1 cm in size. The data strongly support the use of more extensive initial surgery in class I and II patients with tumors more than 1 cm in size as well as postoperative radioactive 131I ablation of thyroid remnant tissue.
After the Waste Land Bowles, Samuel; Gordon, David M.; Weisskopf, Thomas E.
1990, 20150520, 2015-05-20
eBook
This critique of Reaganomics attempts to provide alternatives to both the supply experiments of the 1980s and neoliberal strategies of austerity. It presents arguments for economic democracy with a ...worker-oriented blueprint for improving productivity, growth, employment and economic justice.
The intensity interferometry technique, commonly referred to as the Hanbury-Brown/Twiss effect, has been applied to nuclear and elementary-particle collisions as a method of investigating their ...space-time evolution. In this review the theoretical framework of the technique is presented, describing the formulations in common use. A survey is made of its application to subatomic collisions, ranging from high-energy elementary-particle reactions to low-energy nuclear reactions. Results derived from experimental data analysis are compiled and discussed. A critique is made of the interpretational difficulties associated with the use of the technique in reaction studies.
