To evaluate the association of either propylthiouracil or methimazole treatment for hyperthyroidism during pregnancy with congenital malformations, relevant studies were identified by searching Medline, PubMed, the Cochrane Library and EMBASE. We intended to include randomized controlled trials, but no such trials were identified. Thus, we included cohort studies and case-control studies in this meta-analysis. A total of 7 studies were included in the meta-analyses. The results revealed an increased risk of birth defects among the group of pregnant women with hyperthyroidism treated with methimazole compared with the control group (odds ratio 1.76, 95% confidence interval 1.47-2.10) or the non-exposed group (odds ratio 1.71, 95% confidence interval 1.39-2.10). A maternal shift between methimazole and propylthiouracil was associated with an increased odds ratio of birth defects (odds ratio 1.88, 95% confidence interval 1.27-2.77). An equal risk of birth defects was observed between the group of pregnant women with hyperthyroidism treated with propylthiouracil and the non-exposed group (odds ratio 1.18, 95% confidence interval 0.97-1.42). There was only a slight trend towards an increased risk of congenital malformations in infants whose mothers were treated with propylthiouracil compared with in infants whose mothers were healthy controls (odds ratio 1.29, 95% confidence interval 1.07-1.55). The children of women receiving methimazole treatment showed an increased risk of adverse fetal outcomes relative to those of mothers receiving propylthiouracil treatment. We found that propylthiouracil was a safer choice for treating pregnant women with hyperthyroidism according to the risk of birth defects but that a shift between methimazole and propylthiouracil failed to provide protection against birth defects.

Tumores da região da pineal (TRP) são pouco frequentes e as propostas de tratamento são bastante variadas. Os autores relatam sua experiência em cirurgias com uso gamma knife (CGK) como tratamento experimental inicial em séries de TRP que não têm diagnóstico anatomopatológico ou nos quais o diagnóstico não ficou claro. Foram estudados retrospectivamente 17 pacientes com TRP nestas condições e que foram submetidos a CGK. Destes, 9 pacientes foram submetidos posteriormente a radioterapia de todo o encéfalo e medula espinhal entre 6 e 9 meses depois da CGK. Dezesseis dos 17 pacientes foram acompanhados por um período médio de 33,3 meses. A taxa total de resposta nos pacientes foi de 75% e a taxa dos controles, 81,3%. Não houve nenhum déficit neurológico evidente que pudesse ser atribuído à CGK. A CGK como tratamento experimental pode ser uma estratégia alternativa no grupo específico de pacientes com TRP em que não há diagnóstico anatomopatológico, podendo ser obtida uma boa qualidade de vida com poucas complicações para esse grupo de pacientes.

Objective : Pineal region tumors (PRTs) are uncommon, and treatments vary among neoplasm types. The authors report their experience with gamma knife surgery (GKS) as an initial treatment in a series of PRT patients with unclear pathological diagnoses. Method : Seventeen PRT patients with negative pathology who underwent GKS were retrospectively studied. Nine patients had further whole-brain and spinal cord radiotherapy and chemotherapy 6–9 months after GKS. Results : Sixteen of 17 cases were followed up over a mean of 33.3 months. The total response rate was 75%, and the control rate was 81.3%. No obvious neurological deficits or complications were attributable to GKS. Conclusion : The findings indicate that GKS may be an alternative strategy in selected PRT patients who have negative pathological diagnoses, and that good outcomes and quality of life can be obtained with few complications.

OBJECTIVE: To evaluate the psychometric properties of the WHO Quality of Life questionnaire (WHOQOL-100), a multi-dimensional, conceptualized, 100-item quality-of-life instrument. METHODS: A total of 460 patients in China with chronic diseases (including hypertension, schizophrenia, stroke, end-stage renal disease, head and neck cancer and breast cancer) and 418 family members who were their caregivers were assessed at baseline and one year later. FINDINGS: The WHOQOL-100 had acceptable internal consistency (a = 0.76-0.90 across domains). There were strong correlations between the domains of WHOQOL-100 and the dimensions of the General Quality of Life Inventory (a = 0.72-0.82 across related domains). Within domains most facet correlations were satisfactory, although some facets correlated more strongly with a domain other than that to which they had been assigned. Principal component analysis produced four factors accounting for 61% of the total variance. CONCLUSION: The WHOQOL-100 was able to discriminate between the different groups of patients and was sensitive to clinical change in patients' conditions. It proved to be a reliable and valid instrument for assessing the quality of life of patients with chronic diseases and their caregivers in China.

OBJETIVO: Evaluar las propiedades psicométricas del Cuestionario sobre Calidad de Vida de la OMS (WHOQOL-100), un instrumento multidimensional y conceptualizado de medición de la calidad de vida que abarca 100 elementos. MÉTODOS: Al inicio del estudio y un año más tarde se evaluó a un total de 460 pacientes de China afectados por enfermedades crónicas (como hipertensión, esquizofrenia, accidente cerebrovascular, nefropatía terminal, cáncer de cabeza y cuello y cáncer de mama) y a 418 miembros de sus familias que los atendían como cuidadores. RESULTADOS: El cuestionario WHOQOL-100 mostró una coherencia interna aceptable (a = 0,76-0,90 entre dominios). Se observaron estrechas correlaciones entre los dominios del WHOQOL-100 y las dimensiones del Inventario de la Calidad General de Vida (a = 0,72-0,82 entre dominios relacionados). Dentro de los dominios, la mayoría de las correlaciones de facetas fueron satisfactorias, aunque algunas facetas estaban más correlacionadas con un dominio distinto de aquel al que habían sido asignadas. El análisis de componentes principales permitió aislar cuatro factores que explicaban un 61% de la variación total. CONCLUSIÓN: El cuestionario WHOQOL-100 permitió discriminar entre los diferentes grupos de pacientes y fue sensible a los cambios de su estado clínico, lo que hace de él un instrumento fiable y válido para evaluar la calidad de vida de los pacientes con enfermedades crónicas y de sus cuidadores en China.

OBJECTIF: Evaluer les propriétés psychométriques du questionnaire OMS sur la qualité de vie (WHOQOL-100), un outil multidimensionnel et structuré de 100 items pour la mesure de la qualité de vie. MÉTHODES: L'évaluation a été réalisée en Chine sur 460 patients atteints de maladies chroniques (hypertension, schizophrénie, accident vasculaire cérébral, maladie rénale en phase terminale, cancers de la tête et du cou et cancer du sein) et 418 soignants membres de leur famille, interrogés à la date de référence et un an plus tard. RÉSULTATS: Le WHOQOL-100 avait une cohérence interne acceptable (a = 0,76-0,90 entre domaines). Il existait une forte corrélation entre les domaines du WHOQOL-100 et les dimensions de l'inventaire général de la qualité de vie (a = 0,72-0,82 entre domaines connexes). A l'intérieur des domaines, la plupart des corrélations entre facettes étaient satisfaisantes, même si certaines facettes présentaient une corrélation plus forte avec un domaine autre que celui auquel elles appartenaient. L'analyse des principales composantes a donné 4 facteurs expliquant 61 % de la variance totale. CONCLUSION: Le WHOQOL-100 était capable de distinguer les différents groupes de patients et était sensible aux modifications de l'état clinique. Il s'est montré fiable et utile pour évaluer la qualité de vie des patients atteints de maladies chroniques et celle de leurs soignants en Chine.