Pediatric differentiated thyroid carcinoma in stage I: risk factor analysis for disease free survival

<p>Abstract</p> <p>Background</p> <p>To examine the outcomes and risk factors in pediatric differentiated thyroid carcinoma (DTC) patients who were defined as TNM stage I because some patients develop disease recurrence but treatment strategy for such stage I pediatric patients is still controversial.</p> <p>Methods</p> <p>We reviewed 57 consecutive TNM stage I patients (15 years or less) with DTC (46 papillary and 11 follicular) who underwent initial treatment at Ito Hospital between 1962 and 2004 (7 males and 50 females; mean age: 13.1 years; mean follow-up: 17.4 years). Clinicopathological results were evaluated in all patients. Multivariate analysis was performed to reveal the risk factors for disease-free survival (DFS) in these 57 patients.</p> <p>Results</p> <p>Extrathyroid extension and clinical lymphadenopathy at diagnosis were found in 7 and 12 patients, respectively. Subtotal/total thyroidectomy was performed in 23 patients, modified neck dissection in 38, and radioactive iodine therapy in 10. Pathological node metastasis was confirmed in 37 patients (64.9%). Fifteen patients (26.3%) exhibited local recurrence and 3 of them also developed metachronous lung metastasis. Ten of these 15 achieved disease-free after further treatments and no patients died of disease. In multivariate analysis, male gender (p = 0.017), advanced tumor (T3, 4a) stage (p = 0.029), and clinical lymphadenopathy (p = 0.006) were risk factors for DFS in stage I pediatric patients.</p> <p>Conclusion</p> <p>Male gender, tumor stage, and lymphadenopathy are risk factors for DFS in stage I pediatric DTC patients. Aggressive treatment (total thyroidectomy, node dissection, and RI therapy) is considered appropriate for patients with risk factors, whereas conservative or stepwise approach may be acceptable for other patients.</p

Theoretical aspects of the Cauchy problem for non-Lipschitz semi-linear parabolic partial differential equations

The aim of this thesis is to provide a generic approach to the study of semi-linear parabolic partial differential equations when the nonlinearity fails to be Lipschitz continuous, but is in the class of Hӧlder continuous functions or the class of upper Lipschitz continuous functions. New results are obtained concerning the well-posedness (in the sense of Hadamard) of the initial value problem, namely, uniqueness and conditional continuous dependence results for upper Lipschitz continuous nonlinearities, and an existence result for Hӧlder continuous nonlinearities. To obtain these results, two new maximum principles have been obtained, for which examples have been provided to exhibit their applications and limitations. Additionally, new derivative estimates of Schauder-type have been obtained. Once the general theory has been established, specific problems are studied in detail. These show how one can apply the general theory, as well as problem specific approaches, to obtain well-posedness results