Measures prior to diagnosis and treatment already installed were assessed retrospectively in 8501 patients with suspect thyroid disease between the years 1976 and 1979. In 10.5% of these patients there were 11.2% misdiagnosis or wrong treatment. The most common misdiagnoses were hyperthyroidism in euthyroid patients (1.9%), hypothyroidism in euthyroidism (0.8%), non-recognition or non-aspiration of cold nodules (0.9%), missing a goitre (0.6%). Among diagnostic methods the radio-iodine test was reason for a wrong diagnosis most commonly (66%). The TRH-test proved to be least erroneous, technical reasons being the cause of the 9.6% of misdiagnoses. The most common mismanagements were due to lack of prophylaxis of recurrence after goitre operation (1.5%), external irradiation of the thyroid gland with radium or Roentgen rays (0.7%), and during thyroid hormone treatment of goitre (1.3%). Iatrogenic disease existed mainly as factitious hyperthyroidism (0.7%), non-treated hypothyroidism after treatment with radio-iodine of hyperthyroidism (0.1%), and as goitre recurrence due to lack of prophylaxis of recurrence (0.8% of all patients). As every 10th patient was subjected to misdiagnosis or mismanagement, shifting to endocrinological advisory centers may prevent future mismanagement of thyroid disorders.

Background: Medulloblastoma (MB) is the commonest malignant brain tumour of childhood. Accurate clinical data on paediatric MB in the low-and-middle-income countries (LMIC) setting are lacking. Sequential improvements in outcomes seen in high-income countries are yet to be reflected in LMICs.Aim: The aim of this study was quantification of paediatric MB outcomes in the LMIC setting over three decades of advances in multidisciplinary intervention.Setting: Cape Town, South Africa.Methods: This was a retrospective study of 136 children with MB diagnosed between 1985 and 2015. The modified Chang criteria were used for risk stratification. The primary objective of this study was overall survival (OS), quantified by analysis of epidemiological, clinical and pathological data.Results: OS improved significantly during the most recent decade (2005–2015) when compared with the preceding two decades (1985–1995 and 1995–2005). Despite reduced-dose craniospinal irradiation (CSI) for standard risk cases, OS was significantly greater than during the preceding two decades. High-risk disease was identified in 71.4% of cases and was associated with significantly inferior OS compared with standard-risk cases. Improved OS was positively correlated with the therapeutic era, three-dimensional (3D) conformal radiotherapy technique, older age at diagnosis, classic and desmoplastic histology, extent of resection and absence of leptomeningeal spread on imaging.Conclusion: Advances in multidisciplinary management of MB in our combined service are associated with improved survival. Access to improved imaging modalities, advances in surgical techniques, increased number of patients receiving risk-adapted combination chemotherapy or radiotherapy, as well as CSI using a linear accelerator with 3D planning, are considered as contributing factors.