Solitary fibrous tumor arising in the mesentery: a case report

<p>Abstract</p> <p>Background</p> <p>Solitary fibrous tumor (SFT) is a rare mesenchymal neoplasm usually found in the pleura, soft tissues and visceral organs. We describe one case arising in the mesentery, which is an exceptional localization.</p> <p>Case presentation</p> <p>A 71-year-old man was referred to our establishment for a painless hypogastric mass. Further investigation revealed a vascular tumor, which was resected <it>en bloc</it>. Pathological findings confirmed solitary fibrous tumor of the mesentery.</p> <p>Conclusion</p> <p>This is the second case of solitary fibrous tumor of the small intestine mesentery ever reported. It was managed by <it>en bloc </it>resection and close follow up considering the high risk of recurrence. Investigation should be made regarding the use of adjuvant systemic therapy to improve long-term survival for these patients.</p

Medical Management for the Treatment of Nontuberculous Mycobacteria Infection of the Parotid Gland: Avoiding Surgery May Be Possible

Infection with nontuberculous mycobacteria (NTM) is uncommon in the head and neck; therefore there is no clear consensus on treating these infections. Our objective was to report our experience with a unique case of NTM infection of the parotid in an immunocompetent patient, in order to determine appropriate management through our experience with this pathology. A 57-year-old man, known for numerous comorbid diseases, presented to our institution complaining of right parotid swelling and pain. A computed tomography (CT) of the neck showed a multiloculated collection in the inferior portion of the right parotid gland, compatible with abscess formation. This abscess was drained by interventional radiology (IR) but required repeat drainage twice due to lack of initial improvement. He was treated with several antibiotics as culture results initially indicated Gram-positive bacilli and then Mycobacterium species, with final identification by a reference laboratory as Mycobacterium abscessus. Imipenem was initiated with amikacin and clarithromycin. His infection clinically and radiologically resolved after 5 months of antibiotherapy. In our case, the patient improved following intravenous antibiotic therapy. Our experience demonstrates that appropriate antibiotherapy can lead to resolution of Mycobacterium abscessus infection in the parotid without the risks associated with surgical intervention

Functional outcomes of injectable substances on surgically injured rabbit vocal folds: a comparative study

Objectives: The objective of this study was to evaluate the phonatory function of rabbit larynges 42 days after surgical injury of the vocal folds and immediate injection treatment of dexamethasone, hyaluronic acid/gelatin hydrogel, glycol-chitosan solution or saline as a control. Methods: A modified microflap procedure was performed on the left vocal fold of 12 rabbits to induce an acute injury. Animals were randomized into one of four treatment groups with 0.1 mL injections of dexamethasone, hyaluronic acid/gelatin hydrogel, glycol-chitosan or saline as control. The injection was performed at the level of the lamina propria of the left mid vocal folds, immediately following the injury. Right vocal folds served as uninjured controls. Larynges were harvested at Day 42 after injection, and were subjected to airflow-bench evaluation. Acoustic, aerodynamic and laryngeal high-speed videoendoscopy (HSV) analyses were performed. In addition, HSV segments of the vibrating vocal folds were rated by three expert laryngologists on six parameters related to vocal fold vibratory characteristics on a Likert scale.Results: The fundamental frequency, one possible surrogate of vocal fold stiffness and scarring, appeared to be lower in all treatment groups compared to that of the saline control (411.52 11.63 Hz). The lowest fundamental frequency value was observed in the dexamethasone group (348.79 14.99 Hz). Expert visual ratings of the HSV segments indicated an overall positive outcome in the Dexamethasone treatment group. Conclusion: Dexamethasone injections might be a useful intraoperative adjunct to guide the vocal fold healing process after surgical injury. An increased sample size and a histological correlate would be helpful to confirm this finding.Objectif: L'objectif de la présente étude était d'évaluer la fonction vocale de larynx de lapins excisés 42 jours suivant une chirurgie laryngée et une injection de Dexamethasone, d'Hydrogel d'acide hyaluronique/gélatine, de solution de Glycol-chitosan ou de solution Saline en contrôle. Méthodes: Une microchirurgie a été effectuée sur les cordes vocales gauches de 12 lapins afin de provoquer une inflammation aigue. Les animaux furent assignés à l'un des 4 groupes de traitement de façon aléatoire. Des injections de 0.1 mL de dexamethasone, d'hydrogel d'acide hyaluronique/gélatine, de solution de glycol-chitosane ou de solution saline en contrôle ont été faites. Le matériel fut injecté au niveau de la lamina propria du milieu de la corde vocale, immédiatement après l'incision. Les cordes vocales droites ont été préservées comme contrôle. Les larynx furent recueillis 42 jours après l'injection, et furent soumis à des évaluations fonctionnelles avec phonation induite par un ventilateur externe. Des analyses acoustiques, aérodynamiques et d'images à haute définition ont été faites. Les segments vidéos ont été évalués par trois experts laryngologistes examinant six paramètres de la vibration des cordes vocales sur une échelle de Likert. Résultats: La fréquence fondamentale, présumément représentative de la raideur et de la présence d'une cicatrice, semble plus basse dans tous les groupes de traitements que celle dans le groupe de contrôle salin (411.52 11.63 Hz). La valeur la plus basse est dans le groupe dexamethasone (348.79 14.99 Hz). Les évaluations d'experts basés sur la revue des segments vidéos semblent aussi indiquer un effet d'adoucissement de la cicatrice dans le groupe dexamethasone. Conclusion: Les injections de dexamethasone pourraient avoir un effet bénéfique positif sur la guérison des cordes vocales après chirurgie. Des études de plus grande envergure ainsi qu'une analyse histologique sont nécessaires pour confirmer ce résultat

Medical Management for the Treatment of Nontuberculous Mycobacteria Infection of the Parotid Gland: Avoiding Surgery May Be Possible

Infection with nontuberculous mycobacteria (NTM) is uncommon in the head and neck; therefore there is no clear consensus on treating these infections. Our objective was to report our experience with a unique case of NTM infection of the parotid in an immunocompetent patient, in order to determine appropriate management through our experience with this pathology. A 57-year-old man, known for numerous comorbid diseases, presented to our institution complaining of right parotid swelling and pain. A computed tomography (CT) of the neck showed a multiloculated collection in the inferior portion of the right parotid gland, compatible with abscess formation. This abscess was drained by interventional radiology (IR) but required repeat drainage twice due to lack of initial improvement. He was treated with several antibiotics as culture results initially indicated Gram-positive bacilli and then Mycobacterium species, with final identification by a reference laboratory as Mycobacterium abscessus. Imipenem was initiated with amikacin and clarithromycin. His infection clinically and radiologically resolved after 5 months of antibiotherapy. In our case, the patient improved following intravenous antibiotic therapy. Our experience demonstrates that appropriate antibiotherapy can lead to resolution of Mycobacterium abscessus infection in the parotid without the risks associated with surgical intervention

A retrospective cohort study: do patients with graves’ disease need to be euthyroid prior to surgery?

Abstract Background The 2016 American Thyroid Association guidelines indicate that patients with Graves’ disease who undergo a thyroidectomy should be rendered euthyroid through the use of antithyroid drugs (ATD) prior to surgery to avoid complications such as a thyroid storm. At times, the use of ATDs can have limited efficacy and therefore some patients will inevitably remain biochemically hyperthyroid at the time of surgery. The aim of this study is to assess if hyperthyroid patients undergoing a thyroidectomy are at an increased risk of developing a thyroid storm in comparison to euthyroid patients. Furthermore, this study seeks to establish a correlation between thyroid storm identified by the levels of thyroid hormones (T3 and T4) and the level of thyroid stimulating hormone (TSH). Methods A retrospective cohort study was conducted at two Canadian centers, one in Montreal and the other in Nova Scotia. Sixty-seven patients undergoing thyroidectomy for Graves’ disease from January 2006 to December 2016 were evaluated. Results The study comprised 67 participants with a mean age of 46 years (range16–78 years). A total of 78% of patients were on methimazole, 34% on beta-blockers, 27% on potassium iodine solution, 10% on propylthiouracil and 7% on steroids. At the time of surgery 21% were in an overt hyperthyroid state and 33% were in a subclinical hyperthyroid state. The average TSH level of 0.03 mIUL/L (range 0.01–0.23 mIUL/L). Sixteen percent of patients had a TSH level less than 0.01 mIUL/L. The average free T4 level was 29.58 pmol/L (range 11.5–95.2 pmol/L). The average total T3 level was 11.52 nmol/L (range 4.5–29.1 nmol/L) and free T3 level was 6.35 pmol/L (range 6.1–6.6 pmol/L). No patient developed thyroid storm. Conclusions In our study, biochemically hyperthyroid patients undergoing thyroidectomy did not develop thyroid storm. Additional studies with larger sample sizes are needed to better understand the risk of thyroid storm in hyperthyroid patients

The first Canadian experience with the Afirma® gene expression classifier test

Abstract Background Thyroid nodules are common and often benign, although prove to be malignant upon surgical pathology in 5–15% of cases. When assessed with ultrasound-guided fine-needle aspiration (USFNA), 15–30% of the nodules yield an indeterminate result. The Afirma® gene expression classifier (AGEC) was developed to improve management of indeterminate thyroid nodules (ITNs) by classifying them as “benign” or “suspicious.” Objectives were (1) to assess the performance of the AGEC in two Canadian academic medical centres (2), to search for inter-institutional variation and (3) to compare AGEC performance in Canadian versus American institutions. Methods We undertook a retrospective cohort study of patients with indeterminate cytopathology (Bethesda Class III or IV) as per USFNA who underwent AGEC testing. We reviewed patient demographics, cytopathological results, AGEC data and, if the patient underwent surgery, results from their final pathology. Results In total, we included 172 patients with Bethesda Class III or IV thyroid nodules underwent AGEC testing, 109 in Montreal, Quebec and 63 in St. John’s, Newfoundland, in this study. Among the nodules sent for testing, 55% (60/109) in Montreal and 46% (29/63) in St. John’s returned as “benign.” None of these patients underwent surgery. On the other hand, 45% (49/109) nodules in Montreal and 54% (34/63) in St. John’s were found to be “suspicious,” for a total of 83 specimens. Seventy seven of these patients underwent surgery. Both in Montreal and St. John’s, the final pathology yielded malignant thyroid disease in approximately 50% of the specimens categorized as “suspicious.” Since 2013, no patient diagnosed with a benign nodule as per AGEC testing was found to harbor a malignant thyroid nodule on follow-up. Conclusions Molecular analysis is increasingly used in the management of indeterminate thyroid nodules. This study highlights the experience of two Canadian centres with AGEC testing. We found inter-institutional variability in the rate of nodules returning as “benign,” however we found similar rates of confirmed malignancy in nodules returning as “suspicious.” According the literature, results for AGEC testing in two Canadian institutions align with results reported in American centres