1,720,971 research outputs found
Treatment and 35 year-outcome of papillary thyroid carcinoma: monoinstitutional experience.
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PAPILLARY THYROID CARCINOMA: 35-YEAR OUTCOME AND PROGNOSIC FACTORS IN A GROUP OF 1858 PATIENTS
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Diagnosis treatment, prognostic factors and long-term outcome in papillary thyroid carcinoma
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Cervical lymphorrea after nodal dissection: role of fasting based on clinical evidence.
No full textThe management of chylous fistula, subsequent to neck nodal dissection, includes either unstandardized conservative procedures and reoperation. The main reason of controversy in literature is probably due to the rarity (1-2.5%) of such troublesome complication due to inadvertent disruption of the thoracic duct itself or of its tributary branches. We report one case of severe cervical chylous fistula, occurred after left lateral dissection for advanced papillary thyroid carcinoma, and successfully restored by a conservative approach. None of the following treatment modalities was effective: pressure dressing, low-fat diet, octreotide, etilefrine, and local tetracycline sclerotherapy. Instead, fasting combined with total venous nutritional replacement was successful in curing the leak. It may be hypothesized that the beneficial effect on chyle production observed in the present patient in fasting condition, could be explained by a decrease of splancnic blood flow consequent to intestinal feeding rest. The other treatment procedures can be adjunctive methods with impredictable effect. As a standard approach with the aim to prevent and treat cervical lymphorrea, we suggest preoperatory fat meal, intraoperative search for milky leak by positive respiratory pressure, ligation of the thoracic duct (a mesh coverage when necessary) if inadvertently damaged, but not a systematic search for it. Moreover, according to the amount and the duration of the leakage, fasting combined with venous supplement by central or peripheral access, in combination with local treatment by sclerosing agents appears to be efficacious. In our opinion, neck reoperation or intrathoracic ligation of the thoracic duct represent the last therapeutic option of unresponsive or untractable cases
Long-Term Outcomes of Parathyroidectomy in Hyperparathyroidism-Jaw Tumor Syndrome: Analysis of Five Families with CDC73 Mutations
No full textBackground: Hyperparathyroidism-jaw tumor syndrome (HPT-JT) is a rare disease caused by CDC73 germline mutations, with familial primary hyperparathyroidism (pHPT), ossifying jaw tumors, genito-urinary neoplasms. The present study was aimed at determining the long-term postoperative outcome of parathyroidectomy in HPT-JT. Methods: A retrospective analysis of a single-center series of 20 patients from five unrelated HPT-JT families undergoing parathyroid surgery was performed. Results: Pathology confirmed a single-gland involvement in 95% of cases at onset. Parathyroid carcinoma occurred in three patients undergoing en-bloc parathyroidectomy and thyroid lobectomy: parathyroid benign lesions in 17 patients undergoing subtotal parathyroidectomy for evident multiglandular involvement (n = 1) or selective parathyroidectomy for single-gland involvement (n = 16), during bilateral (n = 13) or targeted unilateral neck exploration (n = 7). At a median overall follow-up of 16 years (range 2.5–42), patients with parathyroid carcinoma had a persistent/recurrent disease in 66.6%; patients with benign lesions had recurrent pHPT in 23.5% after a prolonged disease-free period; recurrent benign pHPT occurred slightly more often in cases of discordant preoperative localization (60% vs 9%; p = 0.06). Conclusion: pHPT in HPT-JT is generally characterized by a benign and single-gland involvement, with a relatively increased risk of malignancy (15%). Parathyroid carcinoma needs extensive surgery because of high risk of permanent/recurrent disease (66.6%). In benign involvement, targeted unilateral exploration with selective parathyroidectomy may be effective in cases of concordant single-gland localization at preoperative localization imaging techniques. Bilateral neck exploration with subtotal parathyroidectomy might be preferred in cases of negative or discordant preoperative localization, because of the increased risk of multiglandular involvement and long-term recurrences (23.5%). © 2019, Société Internationale de Chirurgie
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