Video-assisted thyroidectomy performed in a one-day surgery setting

AbstractBackground and aimEvidence base data have demonstrated that video-assisted thyroidectomy (VAT) has good results regarding safety, morbidity, patient cure rate, pain and cosmesis. Aim of this study was to evaluate the performance of VAT in an ambulatory setting (i.e. one-day surgery, <24-h stay).Materials and methodsBetween September 2007 and July 2008, 43 patients underwent VAT in a one-day surgery division. Patient selection criteria for VAT were: thyroid nodules <30mm, gland volume <20ml, no history of thyroiditis or neck surgery or irradiation, “low risk” papillary carcinoma and absence of enlarged lymph nodes. One-day surgery patient selection criteria were medical and social logistic (Materazzi G, et al. Eur Surg Res 2007;39:182–8). Intraoperative neuromonitoring (IONM) was used for RLN identification. Intact parathyroid hormone (iPTH) levels were determined early postoperatively at +6-h. Postoperative complications, conversion rate were analyzed.ResultsNo cases required conversion to open surgery or ordinary recovery (i.e. >24h). Incidence of temporary hypoparathyroidism was 11.6% (5/43) with no case of symptomatic hypocalcemia. Incidence of temporary RLN injury was 2.3% (1 patient) with no case of permanent or bilateral RLN injury. All patients were satisfied with the type of recovery.ConclusionsThis preliminary report is an example of the safe incorporation between new technologies (IONM, early iPTH measurement) with improvement of the quality and safety of VAT performed in a one-day surgery setting

Postoperative laryngoscopy in thyroid surgery: proper timing to detect recurrent laryngeal nerve injury

BACKGROUND: There is currently a lack of consensus to support the proper timing for postoperative laryngoscopy that is reliable to diagnose recurrent laryngeal nerve palsy (RLNP) after thyroid surgery. The purpose of this study was to investigate the impact of different time intervals of fiber-optic nasolaryngoscopy (FNL) on the diagnosis of RLNP. METHOD: FNL was performed postoperatively at day 0 (T1), at second day post-op (T2), and +2 weeks (T3). For patients with RLNP, repeated examinations were performed at +2 (T4), +6 (T5), and +12 months (T6). RESULTS: Four hundred thirty-four patients appear for postoperative FNL, providing 825 nerves at risk. Permanent RLNP occurred in 0.7%, temporary RLNP in 6.7%. RLNP rate was 6.4% at T1, 6.7% at T2, 4.8% at T3, 2.5% at T4, 0.8% at T5, and 0.7% at T6. Full recovery of vocal cord function was confirmed after rehabilitation in 87.5% of cases at T5 and 89% in T6. T2 was significantly superior to T3 in terms of diagnosis of RLNP (P < 0.05). Of patients at T2, 10.7% did not see any reason to FNL because of their normal voice register. CONCLUSION: FNL is essential for the detection of vocal cord paralysis after thyroidectomy. We report different time evaluation criteria of vocal cord motility with great and significant variability of results. Second day post-op inspection of the larynx (T2) is suggested. Symptomatic voice assessment is insufficient

Neuroendocrine carcinomas of the breast

INTRODUCTION: Neuroendocrine (NE) breast cancers encompass a heterogeneous group of tumours showing morphological features similar to those of NE neoplasms of the gut and lung and expressing one or more neuroendocrine markers (neuron specific enolase, chromogranins synaptophysin) in at least 50% of tumour cells. They are rare lesions representing about 2-3% of all breast cancers and affecting more frequently elderly patients. AIM: Prospective observational study is to analyse the clinico-pathological aspects of NE carcinomas of the breast undergone surgical resection compared to breast carcinomas with a minor neuroendocrine component and to conventional invasive ductal or lobular cancers. MATERIAL AND METHOD: Thirty-five consecutive breast carcinomas showing morphological features suggestive of an endocrine differentiation were selected among breast cancers undergone surgical treatment during the period of January 1979-December 2004. RESULTS: The 35 patients were divided into two categories: 13 neuroendocrine carcinomas (NECs) and 22 ductal carcinomas with a minor neuroendocrine component (DC-NE). The average follow-up was 60 months. The patients with CNE developed breast cancer in an advanced age compared to the patients with infiltrating ductal carcinoma NAS or infiltrating lobular carcinoma. We did not find recurrent disease in the NEC group, while it was observed in 2 patients (9%) with DC-NE, in 6 cases (17%) with infiltrating ductal carcinoma NAS and in 7 cases (20%) with infiltrating lobular carcinoma. DISCUSSION: The CNE compared with the infiltrating ductal and lobular carcinoma are statistically different in relation to the expression of the receptor of c-erb-B2, p53, progesterone, for the lymph node state at diagnosis and the risk of reappearance of breast tumour. Our study confirms the choice to consider the neuroendocrine carcinoma of the breast as a separate histological group and seems to suggest a less aggressiveness of this type of tumou

Quantum Information Processing and Relativistic Quantum Fields

It is shown that an ideal measurement of a one-particle wave packet state of a relativistic quantum field in Minkowski spacetime enables superluminal signalling. The result holds for a measurement that takes place over an intervention region in spacetime whose extent in time in some frame is longer than the light-crossing time of the packet in that frame. Moreover, these results are shown to apply not only to ideal measurements but also to unitary transformations that rotate two orthogonal one-particle states into each other. In light of these observations, possible restrictions on the allowed types of intervention are considered. A more physical approach to such questions is to construct explicit models of the interventions as interactions between the field and other quantum systems such as detectors. The prototypical Unruh-DeWitt detector couples to the field operator itself and so most likely respects relativistic causality. On the other hand, detector models which couple to a finite set of frequencies of field modes are shown to lead to superluminal signalling. Such detectors do, however, provide successful phenomenological models of atom-qubits interacting with quantum fields in a cavity but are valid only on time scales many orders of magnitude larger than the light-crossing time of the cavity.Comment: 16 pages, 2 figures. Improved abstract and discussion of 'ideal' measurements. References to previous work adde

Total orthotopic small bowel transplantation in swine under FK 506

Previous experimental studies in rodents and in dogs have established the efficacy of FK 506 in controlling the immunologic events following small bowel or multivisceral transplantation.1–5 To complete the assessment of FK 506 in experimental small bowel transplantation, we present here our experience with the frequently used swine model