1,721,009 research outputs found
Il carcinoma cortico-surrenalico secernente in stadio avanzato: problematiche del work up diagnostico e del trattamento correlate alla prognosi
No full textCurage ganglionnaire radical modifié dans le traitement du carcinome papillare de la thyroïde à travers une mini-cervicotomie.
No full textRisk factors for nodal metastasis and recurrence among patients with papillary thyroid microcarcinoma: differences in clinical relevance between nonincidental and incidental tumors
No full textBACKGROUND:
Papillary microcarcinoma (PMC) is a subgroup of papillary thyroid carcinoma (PTC) measuring 1.0 cm or less in diameter. Herein we focused on the search for risk factors predicting nodal metastasis and recurrence in PMCs, analyzing differences in presentation, treatment, and prognosis between nonincidental and incidental tumors.
METHODS:
From January 1998 to May 2007, 149 patients had a diagnosis of PMC in our department. A cross-sectional study of 76 patients with nonincidental and 73 patients with incidental PMC was carried out. Demographic data, diagnostic results, tumor characteristics, risk assessment, surgical treatment, and postoperative and follow up results were evaluated.
RESULTS:
Cytology detected thyroid cancer and nodal involvement in nonincidental PMC. Mean tumor size was significantly larger in nonincidental PMC (7.5 vs. 4.2 mm), which was commonly found within a normal thyroid gland or Hashimoto's thyroiditis, while incidental PMC was associated with a multinodular goiter. TNM staging system showed a higher cancer stage (IVA) in nonincidental. At multivariate analysis, capsular invasion and a nonincidental diagnosis were the two independent factors significantly affecting nodal metastasis. All patients with nonincidental PMC underwent iodine-131 ablation therapy after surgery compared with 49 patients with incidental. Nodal metastasis at diagnosis was the only factor influencing recurrence which was found in three nonincidental cases: two in the lateral and one in the central neck compartments.
CONCLUSIONS:
Several PMCs presented with risk-free clinical courses. Some nonincidental tumors had a more aggressive behavior and a tendency to recurrence. In these cases, early detection and aggressive treatment are mandatory as for conventional PTC according to risk stratification and cancer stage
Meta-analysis of Prospective Randomized Studies Comparing Single-Incision Laparoscopic Cholecystectomy (SILC) and Conventional Multiport Laparoscopic Cholecystectomy (CMLC)
No full textBackground Single-incision laparoscopic cholecystectomy (SILC) has gained acceptance among surgeons as there is a trend
to minimize the invasiveness of laparoscopy. The aim of this meta-analysis has been to assess the feasibility and safety of
SILC when compared to conventional multiport laparoscopic cholecystectomy (CMLC).
Methods A literature search for trials comparing SILC and CMLC was performed. Studies were reviewed for the outcomes
of interest: patient characteristics; operative time and conversion rate; postoperative pain; length of hospital stay; postoperative
complications; and patient satisfactory score (0–10). Standardized mean difference (SMD) was calculated for continuous
variables and odds ratio for qualitative variables.
Results Twelve prospective randomized trials comparing SILC and CMLC were analyzed. Overall, 892 patients were
randomized to either SILC (465) or CMLC (427). Operative time was significantly longer in SILC (63.0 vs. 45.8 min,
SMD01.004, 95% CI00.434–1.573). Patient satisfactory score significantly favored SILC (8.2 vs. 7.2, SMD0−0.759, 95%
CI0−1.064 to −0.455). No other difference was found.
Conclusions SILC is a safe and effective procedure for the treatment of uncomplicated benign gallbladder disease with a
significant patient satisfaction. New multicenter randomized trials are expected to evaluate SILC in more complex circumstances
such as acute cholecystitis, previous abdominal surgery, and severe obesity
Nodal metastasis and recurrence in papillary thyroid microcarcinoma
No full textDespite the majority of papillary thyroid microcarcinoma (PTMC) patients has benign clinical courses, some PTMCs have a clinical presentation similar to conventional papillary thyroid carcinoma (PTC). The aim of this study was to identify risk factors for lymph node metastasis at presentation and prognostic parameters
influencing nodal recurrence in PTMC. From January 1998 to October 2013, 556 consecutive patients had a diagnosis of differentiated thyroid carcinoma in our surgical department.
A total of 219 (39.4 %) patients who had a pathological diagnosis of PTMC represented the cohort for the current study. We carried out a retrospective cohort study
to compare 24 PTMC patients with lymph node metastasis at diagnosis (N1) and 195 PTMC patients without lymph node involvement (N0). The comparison between groups involved evaluation of patients and tumor characteristics. A diameter [8 mm, the presence of multifocality, and extrathyroid invasion (T3) were independent risk factors for nodal involvement at presentation. The presence of T3 was the only independent prognostic parameter influencing nodal recurrence. Prognostic factors for N1 at presentation and for recurrence are pathological parameters, thus it is not possible before surgery to detect PTMC patients who are at risk. However, we believe that a full treatment protocol should be also indicated in the case of PTMC according to risk stratification and cancer stage as for the conventional counterpart of PTC
Le carcinome papillare encapsulé de la thyroide: une entite clinique avec un bas degree de melignité.
No full textA Mini-incisional, Less Invasive, Modified Radical Neck Dissection in the Treatment of Metastatic Papillary Thyroid Carcinoma.
No full textLarger tumor size predicts nodal involvement among patients with follicular thyroid carcinoma.
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