The overall prognosis in pediatric differentiated thyroid carcinoma (DTC) is excellent. Recurrent disease is frequent, however, and requires additional treatment. We analyzed the probability of recurrence, prognostic factors, treatment, and outcome of juvenile DTC. Methods: Fifty-one DTC patients (32 girls and 19 boys; ≤20 y old; mean age, 16.5 y) were treated with 131 I (radioiodine, or radioactive iodine [RAI]); the median follow-up was 10 y. Patients underwent different initial treatments: 46 patients received total thyroidectomy and RAI, 3 patients received total thyroidectomy, and 3 patients received subtotal thyroidectomy. The probability of recurrence and prognostic factors were tested with the Kaplan-Meier method. Results: Initially, 36 of 51 patients achieved complete remission, 14 of 51 achieved partial remission, and 1 of 51 had progressive disease. By the follow-up, 11 of 51 patients (21.6%) had developed recurrent disease; the median appearance time was 4 y (range, 1-15 y). The probabilities of recurrence were 16.7% at 5 y, 22.3% at 10 y, and 33.3% at 15 and 23 y after the initial treatments. Factors that were strongly predictive of recurrence were age (P 5 0.001), initial treatment (P 5 0.0001), and tumor multifocality (P 5 0.011). Sex, nodal metastases at presentation, distal metastases at presentation, histologic type of the tumor, T stage, and clinical stage had no influence on relapse (P 5 0.180, P 5 0.786, P 5 0.796, P 5 0.944, P 5 0.352, and P 5 0.729, respectively). Patients with recurrent disease, partial remission, and progressive disease were retreated, with either surgery or surgery and RAI, receiving cumulative activities of up to 40 GBq. The overall outcome in our patients was excellent: 90.2% complete remission, 3.92% partial remission, 1.96% stable disease, 1.96% disease-related death, and 1.96% another cause of death. Conclusion: Younger age at diagnosis, less radical primary surgery without subsequent RAI, and tumor multifocality are factors that are strongly prognostic for recurrence. For reducing the rate of relapse and improving surveillance for recurrent disease, total thyroidectomy followed by RAI appears to be the most beneficial initial treatment for patients with juvenile DTC. The use of RAI seems to be safe, with no adverse effects on subsequent fertility and pregnancy or secondary malignancy.

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Most of today available non-invasive procedures cannot clearly determinate between benign and malignant solitary pulmonary nodules (SPN). The purpose of the study was to assess the possibility of using 99mTc labeled hexakis-2-methoxyisobutylisonitrile (99mTc-MIBI) to differentiate benign from malignant SPN. Sixty patients were included in the study if the CT scan showed indeterminate SPN. Prior to definitive diagnosis 99mTc-MIBI single photon emission computerized tomography (SPECT) was performed: early scan 10 minutes and delayed 60-120 minutes after the intravenous injection of 740 MBq 99mTc-MIBI using dual-headed Gamma camera. The results were considered positive if there was an increased accumulation of the radiopharmaceutical in the area of the lung corresponding to the location of the lesion. The mean nodule size ± SD measured on CT scan was 2.96 cm. Lung cancer was diagnosed in 30/60 patients (14 squamocellular, 10 adenocarcinoma, 3 large-cell and 3 microcellular lung carcinomas). Of the 30 patients with malignant lesions, 27 patients (90%) had positive 99mTc-MIBI scan results by qualitative assessment. Among benign lesions, 23/30 (76.7%) were negative on 99mTc-MIBI scan. The size and PH report of SPN is statistically significantly influencing on 99mTc-MIBI accumulation in the SPN (p<0.01). The sensitivity, specificity, accuracy, positive and negative predictive value were 90%, 76.6%, 79.4%, 88.5% and 83.3% respectively. 99mTc-MIBI SPECT is an inexpensive non-invasive diagnostic procedure which might be useful diagnostic modality in the evaluation of SPN. Easy availability and low cost makes 99mTc-MIBI SPECT an attractive method in evaluating SPN.

Background/Aim. Infection is the major cause of acute exacerbation of chronic obstructive pulmonary disease (AECOPD). The aim of the study was to establish the most common bacterial agents of AE-COPD in patients hospitalized in a tertiary medical care institution. Methods. This retrospective study included the patients hospitalized due to infective AE-COPD in the Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica in a 12-month period. We evaluated clinical data, spirometry, pathogen etiology in the patients with positive sputum findings and disease outcome. Results. The study included a total of 81 patients, 47 (58.02%) males and 34 (41.97%) females of the mean age of 65.7 years. The mean history of the disease was 14.5 years. The median forced expiratory volume in one second (FEV1) was 30.12%. The most common isolated pathogens was Pseudomonas aeruginosa (n = 36; 38.29%), followed by Haemophilus influenzae (n = 25; 26.59%) and Streptococcus pneumoniae (n = 16; 17.02%). Coinfections were present in 9 (9.57%) of the patients. The median FEV1 values of 28.67%, 37.23%, and 42.26% were registered in the patients with Pseudomonas aeruginosa, Haemophilus influenza, and Streptococcus pneumonia induced infection, respectively. The case fatality rate (CFR) was 6.2%. Of the deceased, 100% had Pseudomonas aeruginosa- induced infection. A statistically significant difference in FEV1 values was registered between the patients with and without Pseudomonas aeruginosa in their sputum finding (p = 0.016). Conclusion. The most common pathogens in patients with AE-COPD were Pseudomonas aeruginosa, Haemophilus influenzae, and Streptococcus pneumonia. The CFR was 6.2%. All (100%) deceased patients had the infection induced by Pseudomonas aeruginosa.