Current surgical status of thyroid diseases

Thyroid nodules are a common clinical problem for surgeons. The clinical importance of nodules is the need to exclude thyroid cancer, which occurs in 5%–15% of patients. If fine needle aspiration cytology is positive, or suspicious for malignancy, surgery is recommended. During the past decade, with the tendency to develop smaller incisions, an endoscopic approach has been applied to thyroid surgery, called minimally invasive video-assisted thyroidectomy. This approach was immediately followed by other minimally invasive or scarless neck techniques, such as the breast approach, axillary-breast approach, and robot-assisted method. All these techniques follow the same principles of surgery and oncology. This review presents the current surgical management of the thyroid gland, including the surgical techniques and compares them by describing benefits and drawbacks of each one

The influence of tourniquet on primary total knee arthroplasty: study of cement mantle thickness and systematic release of gentamicin

Aim: Is to investigate the effect of tourniquet on the cement mantle thickness below the tibial prosthesis and on the systemic serum concentration of gentamicin in patients undergoing primary total knee arthoplasty. Methods: 100 patients who underwent total knee arthroplasty with or without tourniquet were studied retrospectively and evaluated radiologically for the thickness of the cement mantle and the radiolucency under the tibial implant. Also, 40 patients were studied prospectively and randomly regarding the systemic serum concentration of gentamicin in relation to the use of tourniquet after primary total knee arthroplasty. Results: The cumulated thickness of the cement mantle below the tibial prosthesis was statistically higher in tourniquet group (10.49 ± 2.31mm vs. 9.27 ± 1.85mm, p <0.01). The cumulated width of the radiolucent lines in the anteroposterior view was statistically greater in non-tourniquet group (7.74 ± 6.68mm vs. 3.48 ± 4.69mm, p <0.001). There was no statistically significant difference in the postoperative systemic concentration of gentamicin between groups. Conclusions: The use of tourniquet during total knee arthroplasty, although it appears to increase the thickness of the cement mantle below the tibial prosthesis and possibly the survival of the arthroplasty, does not appear to affect the postoperative serum concentration of gentamicin.Σκοπός: Είναι ο έλεγχος της επίδρασης της ίσχαιμου περίδεσης στο μανδύα τσιμέντου κάτω από την κνημιαία πρόθεση και στην συστηματική συγκέντρωση γενταμυκίνης στον ορό των ασθενών που υποβλήθηκαν σε ολική αρθροπλαστική του γόνατος. Μέθοδος – Υλικό: Μελετήθηκαν αναδρομικά 100 ασθενείς που υποβλήθηκαν σε ολική αρθροπλαστική του γόνατος με ή χωρίς ίσχαιμο περίδεση και αξιολογήθηκαν ακτινολογικά για το πάχος του μανδύα τσιμέντου και τον έλεγχο ακτινοδιαύγειας. Επίσης, μελετήθηκαν προοπτικά και τυχαιοποιημένα 40 ασθενείς ως προς τη συστηματική συγκέντρωση γενταμυκίνης στον ορό σε σχέση με τη χρήση ίσχαιμου περίδεσης μετά από πρωτογενή ολική αρθροπλαστική γόνατος. Αποτελέσματα: Το άθροισμα του πάχους του μανδύα τσιμέντου κάτω από την κνημιαία πρόθεση ήταν στατιστικά μεγαλύτερο στους ασθενείς που χρησιμοποιήθηκε ίσχαιμος (10.49 ± 2.31mm έναντι 9.27 ± 1.85mm, p<0.01). Το άθροισμα του πλάτους των ακτινοδιαυγαστικών γραμμών στην προσθιοπίσθια λήψη ήταν στατιστικά μεγαλύτερο στους ασθενείς που δεν χρησιμοποιήθηκε ίσχαιμος (7.74 ± 6.68mm έναντι 3.48 ± 4.69mm, p<0.001). Δεν υπήρχε στατιστικά σημαντική διαφορά στην μετεγχειρητική συστηματική συγκέντρωση της γενταμυκίνης μεταξύ των ασθενών των ομάδων. Συμπεράσματα: Η χρήση ίσχαιμου περίδεσης στην ολική αρθροπλαστική του γόνατος, αν και φαίνεται να αυξάνει το πάχος του μανδύα τσιμέντου κάτω από τη κνημιαία πρόθεση και πιθανόν την επιβίωση της αρθροπλαστικής, δεν φαίνεται να επηρεάζει την συγκέντρωση της γενταμυκίνης στον ορό των ασθενών μετεγχειρητικά

Tuberculosis in the Peritoneum: Not Too Rare After All

Peritoneal tuberculosis is rare with increased incidence rates in recent years. The absence of characteristic clinical features of the disease often makes its diagnosis difficult and elusive. We present the case of 61-year-old female with peritoneal tuberculosis. The patient suffered from abdominal pain for a period of 5 months prior to admission. The diagnosis was established on the basis of findings from an abdominal computed tomography scan, a chest radiograph and histopathological analysis of the laparoscopic resection of the two masses. The patient was discharged from hospital receiving a fourfold antituberculous treatment with isoniazid, rifampicin, pyrazinamide and ethambutol. A high index of suspicion and a combination of radiologic, endoscopic, microbiologic and histopathological examination achieves diagnostic accuracy and prevents clinical mismanagement

Benign Post-Radiation Rectal Stricture Treated with Endoscopic Balloon Dilation and Intralesional Triamcinolone Injection

Post-radiation stricture is a rare complication after pelvis irradiation, but must be in the mind of the clinician evaluating a lower gastrointestinal obstruction. Endoscopy has gained an important role in chronic radiation proctitis with several therapeutic options for management of intestinal strictures. The treatment of rectal strictures has been limited to surgery with high morbidity and mortality. Therefore, a less invasive therapeutic approach for benign rectal strictures, endoscopic balloon dilation with or without intralesional steroid injection, has become a common treatment modality. We present a case of benign post-radiation rectal stricture treated successfully with balloon dilation and adjuvant intralesional triamcinolone injection. A 70-year-old woman presented to the emergency room complaining for 2 weeks of diarrhea and meteorism, 11 years after radiation of the pelvis due to adenocarcinoma of the uterus. Colonoscopy revealed a stricture at the rectum and multiple endoscopic biopsies were obtained from the stricture. The stricture was treated with endoscopic balloon dilation and intralesional triamcinolone injection. The procedure appears to have a high success rate and a very low complication rate. Histologic examination of the biopsies revealed non-specific inflammatory changes of the rectal mucosa and no specific changes of the mucosa due to radiation. All biopsies were negative for malignancy. The patient is stricture-free 12 months post-treatment