Completion thyroidectomy of well-differentiated thyroid cancer — a prospective, miserandomised study

Wstęp: Rozpoznanie po operacjach pierwotnie niedoszczętnych raka brodawkowatego lub pęcherzykowego tarczycy wymaga radykalizacjileczenia operacyjnego i usunięcia całego gruczołu tarczowego. W zmienionych przez tkankę bliznowatą warunkach anatomicznychradykalność tych zabiegów może być niezadowalająca i w konsekwencji wpływać na wyniki tarapii.Celem pracy była ocena korzyści wynikających z zastosowania ręcznego gamma nawigatora w zabiegach wtórnie całkowitych w przypadkachdobrze zróżnicowanych raków tarczycy.Materiał i metody: W pracy przedstawiono 75 przypadków chorych z dobrze zróżnicowanymi rakami tarczycy, zakwalifikowanych doradykalizacji leczenia operacyjnego. W 43 przypadkach (grupa I) śródoperacyjnie zastosowano ręczny gamma nawigator (NavigatorGPS), 32 chorych reoperowano bez użycia wyżej wymienionego urządzenia (grupa II). W celu oceny radykalności wtórnie całkowitegozabiegu w obu grupach chorych badano pooperacyjnie stężenie tyreoglobuliny (Tg) oraz oceniano wyniki badania scyntygrafii całegociała (I131) — jodochwytność. W obu grupach porównano również wystąpienie powikłań po zabiegach wtórnie radykalnych.Wyniki: Podczas radykalizacji we wszystkich przypadkach wykonano całkowite wycięcie gruczołu tarczowego wraz z wycięciem węzłówchłonnych przedziału centralnego. Pooperacyjne średnie stęzenie Tg oraz jodochwytność były niższe w grupie I w porównaniu z grupąII: (3,32 ± 2,09 v. 4,58 ± 2,5 ng/ml, [p = 0,021] jodochwytność: 6,9 ± 3,38 (grupa I) v. 7,31 ± 2,29 ng/ml (grupa II) [p = 0,187]). Użycienawigatora nie miało wpływu na częstość wystąpienia pooperacyjnych powikłań w obu grupach chorych (p = 0,109).Wnioski: Śródoperacyjne zastosowanie nawigatora może być pomocne w osiągnięciu lepszej radykalności pierwotnie nieradykalnychoperacji, chociaż obserwowane wyniki pozwalają na stwierdzenie, że zabieg ten wykonywany przez doświadczonego operatorapozwala na osiągnięcie porównywalnej radykalności niezależnie o d śródoperacyjnej detekcji izotopowej.(Endokrynol Pol 2013; 64 (5): 335–339)Introduction: Postoperatively diagnosed papillary or follicular thyroid cancer in subtotally thyroidectomised patients requires a completionthyroidectomy. Re-operation with a gamma probe can be particularly useful in these patients.The aim of this study was to evaluate the benefits of using an intraoperative hand-held gamma detector during completion thyroidectomyin patients with well-differentiated thyroid cancer (WTC).Material and methods: 75 patients with WTC qualified for total re-thyroidectomy. In 43 patients, Group I (Nav), a hand-held gammaprobe (Navigator GPS) was used intraoperatively. 32 patients were re-operated without the gamma probe (Group II). In Group I, thyroidremnants were removed based on counted gamma signals. To estimate the radicality of reoperation in both groups, thyroglobulin (Tg)levels were determined and total body scanning (TBS) — I131 uptake — was performed.Results: Total thyroidectomy with central lymphadenectomy was performed in 75 cases. The average level of Tg and iodine uptake afterradicalisation was lower in Group I (Nav) than in Group II (3.32 ± 2.09 v. 4.58 ± 2.5 ng/mL, respectively, for Tg [p = 0.021] and 6.29 ±3.38 v. 7.31 ± 2.29 ng/mL, respectively, for iodine uptake [p = 0.187]). Additionally, the frequency of postoperative complications wascomparable, the difference in both groups was not significant, despite the use of the gamma probe (p = 0.109).Conclusions: The intraoperative use of a hand-held gamma detector can help to improve the radicality of a completion thyroidectomyprocedure after an incomplete primary thyroid resection, but the results of this procedure in the hands of an experienced surgeon arecomparable whether or not the gamma detector is used. (Endokrynol Pol 2013; 64 (5): 335–339

Od preparowania czterogruczołowego do technik małoinwazyjnych. Małoinwazyjna paratyroidektomia jako obecny standard chirurgii pierwotnej nadczynności przytarczyc

Complete surgical resection of hyperfunctioning parathyriod tissue is essential for the treatment of primary hyperparathyroidism. During recent years, minimally invasive surgery has been successfully applied in neck exploration, because of significant developments of guidance by intraoperative scans, the use of quick, intraoperative PTH assay, and also preoperative imaging procedures such as high resolution ultrasonography and sestamibi scintigraphy. The results of operations which are performed with minimally invasive techniques are comparable to those of conventional surgery, and provide advantages with regard to cosmetic result, length of hospitalisation, and reduced post-operative pain.Całkowite chirurgiczne usunięcie nadczynnej tkanki gruczołowej jest kluczowe dla leczenia pierwotnej nadczynności przytarczyc. Podczas ostatnich lat, techniki chirurgii małoinwazyjnej były z sukcesem wprowadzane do preparowania tkanek szyi. Było to możliwe dzięki opracowaniu śródoperacyjnych metod lokalizowania zmienionej tkanki, szybkim testom oznaczającym stężenie PTH w surowicy ,jak również doskonaleniu technik obrazowania przedoperacyjnego, takich jak ultrasonografia wysokiej rozdzielczości czy scyntygrafia z wykorzystaniem sestamibi. Wyniki operacji z wykorzystaniem technik małoinwazyjnych są porównywalne z wynikami technik konwencjonalnych oraz wiążą się z zaletami, takimi jak skrócony okres hospitalizacji, zmniejszenie bólu pooperacyjnego czy lepszy efekt kosmetyczny

The correlation of protein peroxidation with morphological changes in experimental oestradiol-induced carcinogenesis

Oestradiol-induced male Syrian hamster carcinogenesis is a well-known experimental model of human cancer of the breast, ovary and uterus. The pathomechanism postulated in this model is 4-hydroxylation of oestradiol and further free radical formation. The same process is suspected in human breast cancer. Dynamic changes in protein peroxidation were reported during the tumour induction. In this paper we try to correlate the protein peroxidation markers with the histopathological progression of the changes. The biochemical and histopathological evaluations were performed after 1, 3, 6 and 9 months of the hormone exposition. Significant protein peroxidation was observed as soon as after 1 month and increased further until the 6th month. After 9 months however, it was not significantly different from the control. The discrete histopathological changes after 1 month, progressed into tubular and interstitial hyperplasias after 3 and 6 months. After 9 months several dysplastic areas, sometimes with features of carcinoma in situ, were observed. The severe 9-month histopathological changes did not correlate with the protein peroxidation

Od preparowania czterogruczołowego do technik małoinwazyjnych. Małoinwazyjna paratyroidektomia jako obecny standard chirurgii pierwotnej nadczynności przytarczyc

Podczas ostatnich lat, techniki chirurgii małoinwazyjnej były z sukcesem wprowadzane do preparowania tkanek szyi. Było to możliwe dzięki opracowaniu śródoperacyjnych metod lokalizowania zmienionej tkanki, szybkim testom oznaczającym stężenie PTH w surowiczy, jak również doskonaleniu technik obrazowania przedoperacyjnego, takich jak ultrasonografia wysokiej rozdzielczości czy scyntygrafia z wykorzystaniem sestamibi. Wyniki operacji z wykorzystaniem technik małoinwazyjnych są porównywalne z wynikami technik konwencjonalnych oraz wiążą się z zaletami, takimi jak skrócony okres hospitalizacji, zmniejszenie bólu pooperacyjnego czy lepszy efekt kosmetyczny

Introduction of new technique of single-port transgastric access for repeated debridement of infected pancreatic necrosis

In this article we introduce a novel technique of repeated single-port transgastric debritment of walledoff pancreatic necrosis using TriPort ™ Access System. The presented technique seems an appealing and innovative approach to the treatment of walled-off pancreatic necrosis in acute pancreatitis patients. Studies proving feasibility, safety and efficiency are necessary to elucidate real value of the techniqu

Bariatric surgery in morbidly obese patients with chronic renal failure, prepared for kidney transplantation – case reports

Recent years, obesity is a growing health problem also in patients with chronic renal failure and end it’s end stage. This situation has a negative impact both on the extension of the waiting period for transplantation, and the survival rate of the transplanted organ and the recipient. Weight loss through lifestyle modification before transplantation is ambiguous. Its well known fact of rapid body mass gain after transplantation, and finnaly the results of transplantation are not better than those of patients who have not reduced body weight. The paper presents preliminary experience associated with bariatric operations of three chronic dialysed patients with morbid obesity BMI> 35 kg/m2, all patients had been treated by Roux-en-Y gastric by-pass (RYGB). All operated patients were classified as potential recipients were listed by Poltransplant. One of them three months after RYGB surgery underwent without complications a renal transplantation. Preliminary experiences based on operating these three caese confirmed the complete safety of this type of approach in patients with end-stage chronic kidney disease (CKD)

Sources of medical information of patients referred to colorectal surgery outpatient clinic for hemorrhoidal disease

Background: We surveyed patients with hemorrhoids about their behavior regarding searching for information about that disease and confronted it with data obtained from Google Trends website and Google searches. We aimed to determine sources of information on hemorrhoids used by patients. Secondary aim was to assess the quality of information provided by Internet in particular. Material and methods: We collected 78 surveys from patients of the outpatient surgical clinic at Medical University of Gdańsk, in which we asked about sources of information about hemorrhoids. We used Google Trends to analyze most often used search queries associated with that topic. In result, we analyzed the content of top 10 Google search results of that queries in order to verify reliability. Results: Over 80% of surveyed patients looked for information about that disease online, 50% of whom were satisfied with the quality of information obtained. Our Google Trends analysis showed that term hemorrhoids has overwhelming prevalence in comparison to remaining terms. Analysis of top 10 Google search results showed that 7 in 10 organic links lead to websites with professional information about hemorrhoids. Conclusions: Patients use the Internet as a source of knowledge about hemorrhoids and find it satisfactory. Moreover, our research indicates that this information is reliable

Totally videoscopic bilateral, simultaneous lumbar sympathectomy: original modification – preliminary report

Introduction: Lumbar sympathectomy seems to be technically a much more demanding procedure than thoracic sympathectomy.Nevertheless, some patients require this particular procedure. In our centre, the operation is performed nosooner than 12 months after initial thoracic sympathectomy as a simultaneous bilateral retro-peritoneoscopic procedure.Aim: To evaluate early effectiveness of totally videoretroperitoneoscopic lumbar sympathectomy from a posteriorapproach.Material and methods: Between June 2008 and June 2009, there were 12 patients operated on for primary plantarhyperhidrosis in the Department of General, Endocrine and Transplant Surgery, Medical University of Gdansk, Poland.A bilateral procedure was performed in 6 patients, and in 6 other cases (initial ones) the procedure had to be split dueto too slow progress of the procedure (learning curve).Results: Mean operation time was 92.5 ±27.16 min (for 6 bilateral procedures) and 84 ±20.17 min (for the initial12 unilateral procedures). There was no postoperative mortality. Morbidity involved post-sympathectomy syndromepresenting as moderate burning pain in the buttocks and thighs up to 4 weeks postoperatively. Postoperative stay was1 day in 7 cases and 2 days in 3 cases (due to long train travel awaiting the patient on his/her way home). In themajority of patients, early postoperative results were very good, expressed by both the subjective opinion of thepatient and gravimetric results. In one case dryness of the feet was so severe that the patient had to consult a dermatologist.Conclusions: We believe that videoretroperitoneoscopic lumbar sympathectomy from a posterior approach is a goodmethod of treatment for primary hyperhidrosis with plantar symptoms, but should be reserved for surgeonsexperienced in laparoscopic and retroperitoneoscopic surgery

Kidney Re-Transplantation after Simultaneous Heart and Kidney Transplant: Case Study and Literature Review

The kidney is one of most frequent transplants to be performed in multi-organ transplantation. A simultaneous heart and kidney transplant (SHKT) is the best-known treatment method in patients with severe heart failure and end-stage renal disease (ESRD). Here, the authors describe the case of a kidney re-transplantation after SHKT, which is in accordance with the majority of studies, and proves the safety of simultaneous procedures. The article highlights the complex care required after the transplant, followed by the multi-factor qualification for re-transplantation. In conclusion, the case shows that SHKT provides long-term favorable outcomes and enables a repeated kidney transplantation with satisfactory one-year follow-up results