Robot-assisted transaxillary thyroidectomy: Surgical technique

AbstractRobot-assisted transaxillary thyroid surgery avoids the need for a neck incision. It consists of thyroid lobectomy and isthmectomy for moderately large unilateral benign nodules. The surgical imperatives are the same as for conventional surgery, but with differences in terms of patient positioning, surgical incision, equipment, surgical technique and indications. The purpose of this article is to describe the equipment, patient positioning and surgical technique of exclusive robot-assisted transaxillary total thyroid lobectomy and isthmectomy

SN 2019ehk: A Double-peaked Ca-rich Transient with Luminous X-Ray Emission and Shock-ionized Spectral Features

We present panchromatic observations and modeling of the Calcium-rich supernova (SN) 2019ehk in the star-forming galaxy M100 (d ≈ 16.2 Mpc) starting 10 hr after explosion and continuing for ~300 days. SN 2019ehk shows a double-peaked optical light curve peaking at t = 3 and 15 days. The first peak is coincident with luminous, rapidly decaying Swift-XRT–discovered X-ray emission (L_x ≈ 10⁴¹ erg s⁻¹ at 3 days; L_x ∝ t⁻³), and a Shane/Kast spectral detection of narrow Hα and He II emission lines (v ≈ 500 km s⁻¹) originating from pre-existent circumstellar material (CSM). We attribute this phenomenology to radiation from shock interaction with extended, dense material surrounding the progenitor star at r (0.1–1) × 10¹⁷ cm. The photometric and spectroscopic properties during the second light-curve peak are consistent with those of Ca-rich transients (rise-time of t_r = 13.4 ± 0.210 days and a peak B-band magnitude of M_B = −15.1 ± 0.200 mag). We find that SN 2019ehk synthesized (3.1 ± 0.11) × 10⁻² M_⊙ of ⁵⁶Ni and ejected M_(ej) = (0.72 ± 0.040) M⊙ total with a kinetic energy E_k = (1.8 ± 0.10) × 10⁵⁰ erg. Finally, deep HST pre-explosion imaging at the SN site constrains the parameter space of viable stellar progenitors to massive stars in the lowest mass bin (~10 M_⊙) in binaries that lost most of their He envelope or white dwarfs (WDs). The explosion and environment properties of SN 2019ehk further restrict the potential WD progenitor systems to low-mass hybrid HeCO WD+CO WD binaries

Cancer papillaire de la thyroïde (facteurs de pronostic, traitement et surveillance)

MONTPELLIER-BU Médecine UPM (341722108) / SudocPARIS-BIUM (751062103) / SudocMONTPELLIER-BU Médecine (341722104) / SudocSudocFranceF

Atypical Presentations of Sinonasal Inverted Papilloma: Surgical Management and Influence on the Recurrence Rate

International audienceBACKGROUND:Sinonasal inverted papilloma (SNIP), classically, is a unilateral benign tumor of the nasal lateral wall. Numerous variations have been observed, depending on location, bilateral presentation, or association with nasal polyposis.OBJECTIVE:The aim of this work was to describe atypical presentations of SNIPs with their management specificities and to assess their influence on the recurrence rate in a large case series.METHODS:A retrospective single center study of 110 patients treated for SNIP. Atypical inverted papillomas were identified according to the following criteria: (1) unusual location (frontal, posterior, anterior), (2) bilateral involvement, and (3) association with nasal polyposis. Surgical management was detailed, and the influence of each atypical group on recurrence was assessed by using Kaplan-Meier survival curves and the log-rank test.RESULTS:Distribution of atypical presentations was as follows: frontal sinus localization (10.9%); posterior localization, including sphenoid sinus (9%); nasal anterior localization (3.6%); bilateral involvement (3.6%); and nasal polyposis association (10%). The surgical approach was endoscopic (74.5%), external (5.5%), or combined endoscopic and external (20%). Except for nasal anterior localization, all the groups were associated with a higher recurrence rate, without reaching statistical significance.CONCLUSION:Recurrence rates for these atypical presentations arise from their specific surgical challenges. The choice of the surgical technique is guided by tumor location and extension, and by the surgeon's experience; the main objective is a complete resection. The endoscopic endonasal approach is the most frequent procedure

SN 2019ehk: A Double-peaked Ca-rich Transient with Luminous X-Ray Emission and Shock-ionized Spectral Features

We present panchromatic observations and modeling of the Calcium-rich supernova 2019ehk in the star-forming galaxy M100 (d$\approx$16.2 Mpc) starting 10 hours after explosion and continuing for ~300 days. SN 2019ehk shows a double-peaked optical light curve peaking at $t = 3$ and $15$ days. The first peak is coincident with luminous, rapidly decaying $\textit{Swift}$-XRT discovered X-ray emission ($L_x\approx10^{41}~\rm{erg~s^{-1}}$ at 3 days; $L_x \propto t^{-3}$), and a Shane/Kast spectral detection of narrow H$\alpha$ and He II emission lines ($v \approx 500$ km/s) originating from pre-existent circumstellar material. We attribute this phenomenology to radiation from shock interaction with extended, dense material surrounding the progenitor star at $r<10^{15}$ cm and the resulting cooling emission. We calculate a total CSM mass of $\sim$ $7\times10^{-3}$ $\rm{M_{\odot}}$ with particle density $n\approx10^{9}\,\rm{cm^{-3}}$. Radio observations indicate a significantly lower density $n < 10^{4}\,\rm{cm^{-3}}$ at larger radii. The photometric and spectroscopic properties during the second light curve peak are consistent with those of Ca-rich transients (rise-time of $t_r =13.4\pm0.210$ days and a peak B-band magnitude of $M_B =-15.1\pm0.200$ mag). We find that SN 2019ehk synthesized $(3.1\pm0.11)\times10^{-2} ~ \rm{M_{\odot}}$ of ${}^{56}\textrm{Ni}$ and ejected $M_{\rm ej} = (0.72\pm 0.040)~\rm{M_{\odot}}$ total with a kinetic energy $E_{\rm k}=(1.8\pm0.10)\times10^{50}~\rm{erg}$. Finally, deep $\textit{HST}$ pre-explosion imaging at the SN site constrains the parameter space of viable stellar progenitors to massive stars in the lowest mass bin (~10 $\rm{M_{\odot}}$) in binaries that lost most of their He envelope or white dwarfs. The explosion and environment properties of SN 2019ehk further restrict the potential WD progenitor systems to low-mass hybrid HeCO WD + CO WD binaries.Comment: 51 pages, 27 figures. Accepted for publication in Ap