255 research outputs found
Follicular proliferation TIR3B. The role of total thyroidectomy vs lobectomy
No full textBackground: TIR3B thyroid nodules are considered to be at risk of malignancy (15-30%) but guidelines recommend conservative surgery with lobectomy with primary diagnostic porpoise. Risk stratification mainly based on ultrasound, elastography and genetic mutations usually may influences the surgical approach. Methods: We retrospectively analyzed 52 cases of TIR3B underwent between 2015 and 2017 total thyroidectomy (TT) and lobectomy (L), focusing mainly on the observed rate of malignancy. Chi-squared test and Fisher's exact probability test were used for analysis, considering a P values less than 0.05 as significant. Results: Out of 52 patients 49 underwent TT and 3 L. In TT group a multinodular goiter was associated in 67.3% of patients. Malignancy rate was 81.6 and 33.3% respectively after TT and L (P 0.003). Multicentric and contralateral tumors were detected respectively in 36.7% and in 32.6% of patients underwent TT. No main post-operative complications were registered. Conclusions: Ultrasound and elastography are useful to define within the TIR3B group those lesions at higher risk and therefore requiring a more radical approach. TT seems an appropriate approach to TIR3B lesions, especially in multinodular goiter, considering the incidence of malignancy with probably higher rate than previously reported
Correct information to patients undergoing breast-conserving surgery. The medicolegal significance
No full textMany of the women newly diagnosed with breast cancer not have
access to all the information they need to make the surgical and treatment
choices that are most appropriate for them. Research clearly shows
that lumpectomy and other breast-conserving surgeries are just as safe
as mastectomy for most women with early stage disease, and yet approximately
half will undergo the more disfiguring procedures, but
many healthy women who have strong family histories of breast cancer
consider prophylactic mastectomies, and their decisions are also based
on very limited information, because there are few studies showing the
effectiveness of that procedure. This paper delineates how to avoid limited
information and biased recommendations is important for a
conscious and informed choice by the patients
Health technology assessment and thyroid surgery.
No full textThe growth of technological innovation, the request for assistance, the rising patient's expectations and the interest of the industry have led to a rise in the cost of health care systems. In this context the role of the National Health System is not to delay the development or adoption of new technologies, but rather to drive the development selecting priorities and promoting its use. Health Technology Assessment (HTA) is a multidisciplinary and multidimensional approach for analyzing the medical-clinical, social, organizational, economic, ethical and legal implications of a technology (devices, drugs, procedures) through the assessment of multiple parameters such as effectiveness, safety, costs of the social and organizational impact. A health technology assessment is a comprehensive, systematic evaluation of the prerequisites for estimating the consequences of using health technology. Main characteristic of HTA is that the problem is tackled using an approach focused on four main elements: - technology; - patient; - organization; - economy. The authors have applied the HTA method for the analysis of the ultrasonic focus dissector on thyroid surgery. They compared the cost of the surgical procedure using the ultrasonic dissector and without it in a case study of 440 patients who underwent thyroidectomy
Surgical margins in breast-conserving therapy Current trends and future prospects.
No full textInadequate surgical margins represent a high risk for adverse clinical outcome in breast-conserving therapy (BCT) for early-stage breast cancer. The majority of studies report positive resection margins in 20% to 40% of the patients who underwent BCT. This may result in an increased local recurrence (LR) rate or additional surgery and, consequently, adverse effects on cosmesis, psychological distress, and health costs. In the literature, various risk factors are reported to be associated with positive margin status after lumpectomy, which may allow the surgeon to distinguish those patients with a higher “a priori” risk for re-excision. However, most risk factors are related to tumor biology and patient characteristics, which cannot be modified as such. Therefore, efforts to reduce the number of positive margins should focus on optimizing the surgical procedure itself, because the surgeon lacks real time intraoperative information on the presence of positive resection margins during breast-conserving surgery. This review presents the status of pre- and intraoperative modalities currently used in BCT. Furthermore, innovative intraoperative approaches, such as positron emission tomography, radio-guided occult lesion localization, and near-infrared fluorescence optical imaging, are addressed, which have to prove their potential value in improving surgical outcome and reducing the need for re-excision in BCT
Forgotten goiter. Our experience
No full textForgotten goiter is a rare disease that is defined as a mediastinal thyroid mass after total thyroidectomy. Massard, a French school author, was the first to us this term. According to literature the incidence is between 2-16%. The authors recorded their experience about four cases. Patients age is 46-56 years and three of them were female: case n. 1 was an incidental finding, case n. 2 had cervicobrachialgia, case n. 3 had persistent hyperthyroidism and case n. 4 had thyroid cancer metastases in laterocervical nodes. The time gap between thyroidectomy and reintervention was average 10 years. Diameter of masses is between 8-10 cm. Cervicotomy was enough to carry out in one case, cervicotomy and sternotomy were used in two patients. In one case it was necessary to carry out a cervicosternotomy and right posterolateral thoracotomy because the mass reached the Barety loggia and paraesofageal area. We used new devices for hemostasis and intraoperative nerve monitoring. Cases of permanent hypoparathyroidism, permanent recurrent laryngeal nerve paralysis or hemorrhage were not recognized. The surgery is mandatory after diagnosis. The choice of the type surgery way is conditioned by the relationships that the pathological tissue has with the mediastinal structures and exact location in that area. Surgical management for forgotten goiter in specialized centers is associated with low morbility
Metastasi polmonari da carcinoma tiroideo in gozzo tiroideo dimenticato: exeresi attraverso doppio accesso cervicosternotomico e toracotomico. Case report
No full textnon previst
Tracheal varices caused by mediastinal compression of a large intrathoracic goiter: report of a case
No full textIntroduction. Tracheal varices are a rare condition but they can be an important source of massive or recurrent haemoptysis. Usually they are related to increased pressure in the pulmonary veins. Mediastinal goiter is often associated to compressive effects on the surrounding structures, including mediastinal vessels with potential superior vena cava syndrome. Case report. We describe a case, not previously reported in literature, of mediastinal goiter with hemoptysis as first clinical manifestation. Bleeding was attributed to a superior vena cava syndrome associated to a tracheal fragile mucosa with an easily bleeding intramural nodule which was diagnosed as tracheal varices after total thyroidectomy. The nodule in fact disappeared together with the venous hypertensive signs after venous decompression of the mediastinum. Conclusions. Compressive symptoms including tracheal varices, related to mediastinal goiter, can be treated surgically by total thyroidectomy via cervicotomy and when required with associated median sternotom
Cervical thoracic duct injury. Our experience
No full textCervical lymphatic fistula is a severe but rare complication after thyroid surgery. It appears to be more common during radical or functional lymphatic dissection of the posterior triangle and V level. In the period from January 1989 to December 2013, 16 cervical chylous fistulas have been treated in our Department. Seven fistulas happened in our clinical practice while 9 were referred to our service from other hospitals. Five/19 followed total thyroidectomy, 1/19 was related to bilateral neck lymphectomy while monolateral lymphnode dissection was performed before the onset of the remaining 10 fistulas. The finding of an active lymphatic leak allowed a prompt surgical repair in 2 cases. Among the 5 cases of "low-flow" fistula, 4 healed after conservative therapy but 1 required surgery. Out of the 9 cases of "high-flow" fistula, 5 were submitted to surgery during the first post-operative week, 1 between the first and the second week, and 3 between the 15th and 30th postoperative day. Right supra-diaphragmatic lymphatic duct ligation was performed once by videothoracoscopic approach
Tracheal varices caused by mediastinal compression of a large intrathoracic goiter. Report of a case
No full textINTRODUCTION:
Tracheal varices are a rare condition but they can be an important source of massive or recurrent haemoptysis. Usually they are related to increased pressure in the pulmonary veins. Mediastinal goiter is often associated to compressive effects on the surrounding structures, including mediastinal vessels with potential superior vena cava syndrome.
CASE REPORT:
We describe a case, not previously reported in literature, of mediastinal goiter with hemoptysis as first clinical manifestation. Bleeding was attributed to a superior vena cava syndrome associated to a tracheal fragile mucosa with an easily bleeding intramural nodule which was diagnosed as tracheal varices after total thyroidectomy. The nodule in fact disappeared together with the venous hypertensive signs after venous decompression of the mediastinum.
CONCLUSIONS:
Compressive symptoms including tracheal varices, related to mediastinal goiter, can be treated surgically by total thyroidectomy via cervicotomy and when required with associated median sternotomy
Por el Brço Eclesiastico. Sobre la eleccion de personados, que debe nombrar ... Por el dotor Martin de Avenia ...
No full textCopia digital. Zaragoza, 200
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