Clinical features and outcome of retinoblastoma at the Vietnam National Cancer Hospital

OBJECTIVES

To characterize the clinical features, treatment, and outcome of children diagnosed with retinoblastoma (RB) at Vietnam National Cancer Hospital.

METHODS

The study enrolled all RB patients newly diagnosed at Vietnam National Cancer Hospital from January 2018 to December 2022. The primary endpoint was overall survival (OS) and the eye salvage rate.

RESULTS

In total, 139 patients were enrolled, 51.8% patients were male. Median age was 18.9 months. Most patients presented with leukocoria (63.3%), followed by strabismus (14.4%), and 43.9% had bilateral disease. Of 200 eyes, 129 (64.5%) were classified as group E. Extraocular extension was noted in 10 of 139 patients (7.2%). About one-third of the patients lived more than 300 kilometers (km) away from these hospitals, and 17.3% of the patients belonged to minority groups, both of which were dominated by group E and extraocular or high-risk eyes at the time of consultation. Primary enucleation was done for 57 eyes (28.5%), and 51 of 61 patients (83.6%) received eye salvage therapy in bilateral RB group. At study closure, 127 children were alive at the last follow-up, 12 cases were confirmed dead. The 5-year OS and progression-free survival (PFS) rates were 90.3% and 85.9%, respectively. In particular, ethnic minority, distance to hospital more than 150 km, and extraocular disease were significantly associated with higher mortality among children with RB treated in Vietnam National Cancer Hospital.

CONCLUSIONS

There is a need to support for screening RB with early symptoms in grassroots medical facilities and raise awareness among patients' families through health education programs. Besides, caring and supporting treatment for patients from the ethnic minority and who live far from hospitals are also extremely necessary.

Screening Patients With Cancer Admitted to Hanoi Medical University Hospital for Palliative Care Needs

PURPOSE

To evaluate a screening tool for identifying which patients admitted to the oncology ward of a Vietnamese hospital should be referred to specialist palliative care (PC).

METHODS

We performed a cross-sectional survey of consecutive patients hospitalized in the Department of Oncology and Palliative Care at Hanoi Medical University Hospital between June 2019 and September 2019. We translated a validated 11-item screening tool into Vietnamese and used a total score of ≥ 5 as a positive screen.

RESULTS

One hundred participants were recruited. Forty-four patients (44%) screened positive. Of these, 37 (84%) had locally advanced or metastatic disease, 31 (70%) had uncontrolled symptoms, and 43 (98%) requested a PC consultation. A score ≥ 5 was significantly more common in patients with stage IV disease versus earlier stage, performance status of Eastern Cooperative Oncology Group (ECOG) 2 versus ECOG 0, and when life-limiting complications of cancer were present. Screening identified four patients overlooked by oncologists as needing referral, and 34% of patients requesting a referral had scores < 5.

CONCLUSION

This screening tool provided oncologists with easy-to-use criteria for referring patients for PC. At the same time, it relieved the work load for under-resourced PC physicians by screening out requests with low-level need. This tool should be part of routine assessment on admission in all oncology units in Vietnam.

Multiple brown tumors with primary hyperparathyroidism mimicking bone metastases []

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Brown tumor is the differential diagnosis with bone metastasis.

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Brown tumor is a rare benign lesions in skeletal system, which caused by uncontrolled primary or secondary hyperparathyroidism.

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Serum phosphate, serum calcium and PTH level measurements are helpful diagnostic tools.

Multiple osteolytic lesions are usually associated with bone metastasis. However, brown tumor should also be included in the differential diagnosis. Brown tumor is a rare benign lesions in skeletal system, encountered in patients with uncontrolled primary or secondary hyperparathyroidism. In our case report, we present a 35-year-old female with multifocal brown tumor that difficultiy in differential diagnosis of metastasis of malignant parathyroid. Additionally, the treatment and follow up after parathyroidectomy are also emphasized.

Methods

The SCARE 2020 Guideline [1].

Case Report: Transoral Endoscopic Thyroidectomy via Vestibular Approach in Pediatric Thyroid Cancer

Background: Transoral endoscopic thyroidectomy via vestibular approach (TOETVA) is a new technique that has become more popular worldwide because of its many advantages. However, this novel approach for thyroid cancer treatment in children is highly challenging, even for high-volume surgeons. In our study, we report our experiences with TOETVA for pediatric patients with thyroid cancer. Patients and Methods: This study included four pediatric patients who underwent TOETVA performed by a single surgeon between June and December 2020. Patient demographics and surgical outcomes including operative time, incidence of complications, and length of hospital stay were evaluated. Results: Four patients successfully underwent TOETVA with no complications. All patients were girls, aged from 13 to 18. Three patients underwent lobectomy and isthmusectomy, plus prophylactic unilateral central neck dissection. One patient had a total thyroidectomy, plus prophylactic bilateral central neck dissection. The mean operative time was 85 min for the lobectomy and 120 min for total thyroidectomy plus central neck dissection. The median hospital stay was 4.1 days. No drains were used. The histological examination showed four cases of malignant disease (papillary thyroid carcinoma). The mean number of harvested lymph nodes was 4.2 (ranged 3 to 8). Conclusion: In the hands of a high-volume surgeon, TOETVA is a novel, feasible, and safe approach for treating selected pediatric patients with thyroid cancer.

A successful compartmental approach for the treatment of breast cancer brain metastases

BACKGROUND

Brain metastases are challenging daily practice in oncology and remain a compartmental problem since most anti-cancer drugs do not cross the blood-brain barrier at relevant pharmacological concentrations.

METHODS

In a young woman with HER2-overexpressing breast cancer resistant to standard treatments, at the time of brain metastases progression, a ventricular reservoir was implanted for intrathecal drug injections and detailed pharmacokinetic studies.

RESULTS

A first association of intrathecal trastuzumab with intravenous cisplatin was offered to the patient. For trastuzumab, the mean cerebrospinal fluid trough concentration of 53.4 mg/L reached relevant levels, enabling the stabilization of the metastases. Adding intravenous cisplatin was not beneficial, since the cerebrospinal fluid exposure was almost undetectable under 0.08 mg/L. We then offered the patient an intrathecal combination of trastuzumab and methotrexate, because of their in vitro synergic cytotoxicity. The cerebrospinal fluid peak of methotrexate was 1037 µmol/L at 2 h, and the concentrations remained above the theoretical therapeutic concentration. After 2 months of this drug combination, we obtained an excellent response on the brain metastases.

CONCLUSION

Our preliminary study supports the interest of a compartmental approach through a direct administration of drugs into the cerebrospinal fluid for the treatment of breast cancer brain metastases.

Transoral endoscopic thyroidectomy vestibular approach (TOETVA): A case report as new technique in thyroid surgery in Vietnam

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Endoscopic thyroidectomy is a favorable approach to treat patients with benign nodules and Grave’s disease.

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There are direct (cervical-anterior or lateral) and extracervical endoscopic procedures to have the thyroid exposed.

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TOETVA is an excellent choice for select patients requiring thyroid surgery who desire to avoid a neck incision.

Introduction

Transoral endoscopic thyroidectomy via vestibular approach (TOETVA) is a promising procedure with many advantages such as truly scar free healing, minimally invasive dissection, and accessible approach to both thyroid lobes.

Presentation of case

A female patient aged 19 presented with a benign thyroid nodule 2 cm in size for a year and the patient decided to proceed with surgery. The operation with a left subtotal thyroidectomy performed by the TOETVA technique was indicated. The surgery was implemented in 110 min, the patient was discharged after three days of postoperative care without any complication except for a mild seroma and swelling in the anterior neck which resolved completely within 10 days.

Discussion

Endoscopic thyroidectomy is a favorable approach to treat patients with benign nodules, Grave’s disease and thyroid cancer which has 1–2 cm cancer nodule without extrathyroid extension. There are direct (cervical-anterior or lateral) and extracervical endoscopic procedures to have the thyroid exposed but multiple small scars remain. However, TOETVA is an excellent choice for select patients requiring thyroid surgery who desire to avoid a neck incision.

Conclusion

TOETVA with the potential for scar-free surgery is a safe and effective procedure which provides good cosmetic outcome. The long operative time of this approach will be shortened with experience.

Mechanical properties of non-functionalized multiwall nanotube reinforced polycarbonate at 77 K

Mechanical properties of non-functionalized, multiwall carbon nanotube (CNT) reinforced polycarbonate composites are studied at room temperature and 77 K. Five sample groups are tested, ranging from 0 to 10.0 wt% CNT. The dispersion, interfacial bonding, bundling and CNT content, as well as the testing temperature, play a major role as regards mechanical properties. Mechanical testing shows increase in strength with increasing CNT content as well as an increase in Young's modulus and a decrease in ductility. The distribution of yield strength data for each sample group is analyzed using Weibull distributions. It is evident that interfacial debonding increases at low temperature. Higher CNT concentration samples are affected the most, which is reflected in a decrease in their impact on the mechanical properties at 77 K compared to RT. Scanning electron microscopy of fracture surfaces supports the interpretation of the measurement results.

User fees and health service utilization in Vietnam: how to protect the poor?

OBJECTIVES

Vietnam started its health reform process two decades ago, initiated by economic reform in 1986. Economic reform has rapidly changed the socio-economic environment with the transition from a centrally planned economy to a market-oriented economy. Health reform in Vietnam has been associated with the introduction of user fees, the legalization of private medical practices, and the commercialization of the pharmaceutical industry. This paper presents the user fees and health service utilization in Vietnam during a critical period of economic transition in the 1990s.

STUDY DESIGN

The study is based on two national household surveys: the Vietnam Living Standard Survey 1992-1993 and 1997-1998.

METHODS

The concentration index and related concentration curve were used to measure differences in health service utilization as indicators of health outcomes of income quintiles, ranking from the poorest to the richest.

RESULTS

User fees contribute to health resources and have helped to relieve the financial burden on the Government. However, comparisons of concentration indices for hospital stays and community health centre visits show that user fees can drive people deeper into poverty, widen the gap between the rich and the poor, and increase inequality in health outcomes.

CONCLUSIONS

An effective social protection and targeting system is proposed to protect the poor from the impact of user fees, to increase equity and improve the quality of healthcare services. This cannot be done without taking measures to improve the quality of care and promote ethical standards in health care, including the elimination of unofficial payments.