Background: The question of how to manage patients with low-risk papillary thyroid microcarcinoma (PTMC; T1aN0M0) has recently become an important clinical issue. Two Japanese centers have conducted prospective clinical trials of active surveillance (AS) for low-risk PTMC since the 1990s, reporting favorable outcomes. This policy has thus seen gradual adoption worldwide to avoid overtreatment. Not all PTMCs are suitable for AS, however, and many physicians still hesitate to apply the management policy in daily clinical practice. A task force on management for PTMC created by the Japan Association of Endocrine Surgery collected and analyzed bibliographic evidence and has produced the present consensus statements regarding indications and concrete strategies for AS to facilitate the management of adult patients diagnosed with low-risk PTMC. Summary: These statements provide indications for AS in adult patients with T1aN0M0 low-risk PTMC. PTMCs with clinical lymph node metastasis, distant metastasis, recurrent laryngeal nerve (RLN) paralysis due to carcinoma invasion, or protrusion into the tracheal lumen warrant immediate surgery. Tumors suspected of aggressive subtypes on cytology are recommended for immediate surgery. Immediate surgery is also recommended for tumors adherent to the trachea or located along the course of the RLN. Practical strategies include diagnosis, decision-making, follow-up, and monitoring related to the implementation of AS. The rate of low-risk PTMC progression is lower in older patients. However, we recommend continuing AS as long as circumstances permit. Future tasks in optimizing management for low-risk PTMC are also described, including molecular markers and patient-reported outcomes. Conclusions: An appropriate multidisciplinary team is necessary to accurately evaluate primary tumors and lymph nodes at the beginning of and during AS, and to adequately reach a shared-decision with individual patients. If appropriately applied, AS of low-risk PTMC is a safe management strategy offering favorable outcomes and preserves quality of life at low cost.

awasaki disease (KD) is a systemic vasculitis that primarily affects small and medium-sized arteries. 1 Transient myocardial dysfunction in children with acute KD has been reported 2,3 and moreover, myocardial inflammation, including myocarditis and microvascular damage in the myocardium, has been shown to cause aberrations in cardiac function. 4 Several recent studies have discussed the usefulness of tissue Doppler imaging (TDI) to evaluate left ventricular (LV) function. [5][6][7][8][9][10][11][12][13][14] Tissue Doppler measurement of myocardial Doppler velocity can be used to measure long-axis functions, which seem to be both more sensitive to minor disturbances in LV function and relatively preload-independent. 11,[13][14] In the present study we used TDI to evaluate disturbance of myocardial function in acute KD patients. Circulation Journal Vol.71, March 2007The plasma brain natriuretic peptide (BNP) level is associated with cardiac function in adult patients with congestive heart failure. 15,16 Although elevation of BNP has been reported in acute KD patients,17 no relation between BNP and cardiac function has been found.Reports have suggested that increased systemic oxidative stress is associated with progression of cardiovascular disease, including ischemia -reperfusion injury, atherosclerosis, and heart failure. [18][19][20][21][22][23][24] The isoprostanes are a complex family of compounds produced from arachidonic acid via a free radical-catalyzed mechanism. 18,19 The level of 8-isoprostane is used as a pathophysiological marker of lipid peroxidation. We previously reported elevation of urinary 8-isoprostane levels in acute KD patients, 25 and although the exact pathological role of increased oxidative stress in acute KD is uncertain, we believe that it is associated with oxidative injury to systemic vessels. 25 We hypothesize that this combined with disturbance of myocardial microcirculation may contribute to myocardial dysfunction in acute KD. Therefore, the purpose of the present study was to investigate the relationship between abnormal myocardial performance and plasma BNP levels, and to investigate the association between abnormal myocardial performance and enhanced oxidative stress. Background The aims of this study were to evaluate myocardial mechanics using pulsed tissue Doppler imaging (TDI), and to determine the relationship between abnormal myocardial performance and plasma brain natriuretic peptide (BNP) levels and oxidative stress in acute Kawasaki disease (KD). Methods and ResultsConsecutive TDI parameters, including peak systolic velocity (Sw) and early (Ew) and late diastolic excursion of the mitral annuli were obtained in 42 patients with KD (mean age: 2.4±0.4 years) in weeks 1, 2, and 3, and during convalescence. Plasma BNP level and urinary 8-isoprostane were also examined during the acute phase. These data were then compared with TDI profiles from 62 healthy children, plasma BNP levels in 38 controls with other febrile illnesses, and urinary 8-isoprostane levels in 13 healthy chi...

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