1,721,004 research outputs found
Parathyroid Cancer
No full textParathyroid carcinoma is a rare endocrine malignancy derived from the parenchymal cells of the parathyroid glands. It is usually associated with more severe and profound clinical and laboratory manifestations than its more common benign counterparts. Its course is usually indolent but progressive; unlike other malignancies, most patients die because of metabolic complications of parathormone (PTH)-related hypercalcemia rather than tumor invasion and spread.
The definitive diagnosis of parathyroid carcinoma may be particularly challenging, since the histology of parathyroid tumors may be equivocal or frankly misleading; for this reason, malignancy is often confirmed on a clinical basis only when local or distant metastases occur. Recent advances in the molecular pathogenesis of the disease will lead to the development of more reliable diagnostic markers
Indications, results of video parathyroidectomy by lateral approach in patients with primary hyperparathyroidism
No full textResults of surgical treatment of sporadic medullary thyroid carcinoma following routine measurement of serum calcitonin.
No full textAIM: The aim of this study was to evaluate the results of the surgical management of medullary thyroid carcinoma (MTC), following the introduction of systematic calcitonin measurement in patients referred for thyroid diseases.
METHOD: We included all the patients with elevated calcitonin and MTC from January 1993 to March 2001.
RESULTS: Among 8497 patients, MTC was diagnosed in 52 with a mean age of 56.1 years. Thirty-two fine needle biopsies led to diagnose MTC in 19 cases. The median basal pre-operative calcitonin level was 245 pg/ml. Elevated calcitonin serum was the only indicator of MTC in 31 patients. Fifty-one patients underwent total thyroidectomies, with lymphadenectomy in 45. Thirteen patients had lymph node involvement. Post-operatively, 40 (77%) had normal basal and pentagastrin (Pg) stimulated calcitonin serum levels, and remained normal at a mean follow-up of 5.16 years (1.8-8).
CONCLUSION: Routine pre-operative measurement of calcitonin should be performed because it is often the only indicator of MTC at an early stage. This could lead to an improved MTC cure rate
VIDEOASSISTED PARATHYROIDECTOMY VIA LATERAL APPROACH VS CONVENTIONAL SURGERY IN THE TREATMENT OF SPORADIC PRIMARY HYPERPARATHYROIDISM: RESULTS OF A CASE CONTROL STUDY
No full textThe "false" nonrecurrent inferior laryngeal nerve
No full textBACKGROUND: Communicating branches between the cervical sympathetic system and
the inferior laryngeal nerve (ILN) have been described. They usually originate
from the middle cervical sympathetic ganglion (MCSG). These branches
(sympathetic-inferior laryngeal anastomotic branch [SILAB]), usually thin,
sometimes have the same diameter as the ILN. In this study we prospectively
evaluated the frequency of this condition and its implications during surgical
neck exploration.
METHODS: From November 1998 to October 1999, 791 patients underwent surgical neck
exploration, and 1253 ILNs were dissected: 656 on the right side (52.3%) and 597
on the left side (47.7%).
RESULTS: On the right side, a nonrecurrent ILN was found in 3 cases (0.46%), and
a large SILAB was found in 10 cases (1.5%). The SILAB originated from the
superior cervical sympathetic ganglion in 2 cases and directly from the
sympathetic trunk above the MCSG in 8 cases. No anomalous branch was found on the
left side.
CONCLUSIONS: The SILAB may originate not only from the MCSG but also from the
superior cervical sympathetic ganglion or directly from the sympathetic trunk.
When the SILAB is as large as the ILN, it could be mistaken for a nonrecurrent
ILN. The awareness of this anatomic condition during neck dissection may help to
avoid injuries of the genuine ILN running in the usual pathway
Thyrotoxic hypokalemic periodic paralysis. Report of three cases
No full textHypokaliemic thyrotoxic periodic paralysis (HTPP) is an uncommon complication of hypothyroidism. Mostly described among Asian patients, it is rare in the other ethnic groups, in particular in caucasians people. Among the possible mechanisms, modification of potassic flows in relation to anomalies of the sodium-potassium pump were evoked.
PATIENTS AND METHOD:
We present the cases of three caucasians patients operated on for HTPP. These patients had all previous history of several paretic episodes. The flask paralytic attacks occurred in a brutal way or were preceded by diffuse myalgias. They reached the proximal muscles, especially in inferior limbs. No patient had any respiratory complications. These three patients underwent total thyroidectomy to treat the symptoms of HTPP.
RESULTS:
In the three cases, a total thyroidectomy allowed the recovery of the symptoms. After a four years average period of post-operative follow-up, no patient presented any repetition of HTPP. The hyperthyroidism is the cause of decompensation of the molecular anomaly.
CONCLUSION:
In our opinion, surgical treatment (total thyroidectomy) is needed in order to reduce the potential gravity of this pathology
Laparoscopic adrenalectomy: Lessons learned from 274 laparoscopic adrenalectomies.
No full textAIMS: To define the role of minimally invasive video-assisted surgery in the surgical management of adrenal disease and discuss the respective indications of the trans and retroperitoneal video assisted approaches. MATERIALS AND METHODS: During the last 8 years (1994-2001), 330 adrenalectomies were performed in 305 patients: 274 (83%) laparoscopic approaches and 56 (17%) open approach. Open surgery was reserved for patients presenting with large or malignant tumours (29 cases), multiple and/or extraadrenal phaeochromocytomas (13 cases), previous intraabdominal intestinal surgery (10 cases), and in those requiring concomitant intraabdominal surgery (4 cases). Laparoscopic adrenalectomy was performed using the lateral transperitoneal approach for 89 Conn's syndrome, 67 Cushing's syndrome, 2 virilizing tumours, 51 phaeochromocytomas and 65 non secretory tumours greater than 4 cm in diameter. Nineteen patients underwent bilateral adrenalectomy RESULTS: There were no deaths. Twenty patients (7.3%) had a complication. Eleven cases required open conversion (4%) because of difficulties with dissection (8 cases), preoperative suspicion of malignancy (2 cases), and one pneumothorax. The average size of tumours was 34 mm (7-110 mm). There were 18 malignant tumours (6.5%): 8 adrenocortical carcinomas, 1 leiomyosarcoma, and 9 metastases. All patients with hormonally secreting tumours were cured of their endocrinopathy. There was 1 death secondary to hepatic metastases in a patient with an adrenocortical carcinoma. CONCLUSION: Most adrenal tumours are suitable for video assisted excision. The only absolute contraindication is an invasive carcinoma requiring an extended excision. The lateral, transperitoneal approach is the most suitable for tumours greater than 5-6 cm in diameter. Both the transperitoneal or retroperitoneal approaches are suitable for smaller tumours depending on operator choice and experience. However in the presence of a large right lobe of liver or previous intraabdominal surgery the retroperitoneal approach may be preferable
Carcinoma midollare tiroideo sporadico ed iperplasia delle cellule C: possibilità di differenziazione preoperatoria tramite il dosaggio della calcitonina basale e dopo stimolo pentagastrinico
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