Rationality in prophylactic central neck dissection in clinically node-negative (cN0) papillary thyroid carcinoma: Is there anything more to say? A decade experience in a single-center

10noAim: Papillary thyroid carcinoma (PTC) is the most common thyroid malignancy. Despite its extremely favorable prognosis, cervical lymph node metastases are a common feature of PTC and a known independent risk factor for local recurrence. However, the role of prophylactic central neck dissection (PCND) remains a matter of debate in patients with clinically node-negative (cN0) PTC. To better clarify the current role of PCND in the surgical treatment of PTC, evaluating advantages and disadvantages of PCND and outcome of cN0 PTC patients who have been treated with either total thyroidectomy alone or in combination with PCND. A review of recent literature data is performed. Methods: Between January 2000 and December 2015, 186 consecutive patients with cN0 PTC were identified to be included in the present study. 74 of these underwent total thyroidectomy associated with PCND, while 112 patients underwent total thyroidectomy alone. The epidemiological and clinicalpathological data of all patients included were collected at diagnosis and during follow-up. Results: Overall complication rate was significantly higher in the group of patients undergoing PCND (39.2% vs. 17.8%, p ¼ 0.0006). To be specific, they presented a considerably increased risk of temporary recurrent laryngeal nerve injury (p ¼ 0.009) and of permanent hypothyroidism (p ¼ 0.016). Overall survival and recurrence rates did not differ between those undergoing PCND and those undergoing total thyroidectomy alone (p ¼ 1.000 and p ¼ 0.715, respectively). Conclusions: The results of the present study do not support the routine use of PCND in the treatment of cN0 PTC patients.partially_openopenDobrinja, C; Troian, M.; Cipolat Mis, T.; Rebez, G.; Bernardi, S.; Fabris, B.; Piscopello, L.; Makovac, P.; Di Gregorio, F.; de Manzini, N.Dobrinja, Chiara; Troian, Marina; CIPOLAT MIS, Tommaso; Rebez, Giacomo; Bernardi, Stella; Fabris, Bruno; Piscopello, L.; Makovac, Petra; Di Gregorio, F.; de Manzini, Nicolo

Comparison between thyroidectomy and hemithyroidectomy in treatment of single thyroid nodules identified as indeterminate follicular lesions by fine-needle aspiration cytology.

Abstract Aim: The objective of this study is to determine the optimal surgical approach for patients undergoing thyroid operation for indeterminate follicular lesions diagnosed by cytology and to evaluate the long-term outcome of patients treated by hemi or total thyroidectomy for these lesions. Material of study: From January 2000 to January 2010, 98 patients having a solitary thyroid nodule with a cytological diagnosis of "indeterminate follicular lesion" were selected retrospectively. Results: There were 81 women and 17 men with a mean age of 56 years (range: 28-83). Hemithyroidectomy (HT) was performed in 57 patients (58%) and a Total thyroidectomy (TT) in 41 (42%). Postoperative morbidity was 3.50% in patients who underwent HT and 9.75% in those who underwent TT At the histological analysis 16 (16.32%) patients had a malignant lesion. Discussion: HT was considered adequate treatment for 51 patients (89.48%) while in 6 patients (10.52%) has been necessary a completion thyroidectomy. Total thyroidectomy was not associated with clinically significant additive morbidity No permanent hypoparathyroidism and no definitive recurrent nerve palsies were observed in either group. Postoperative thyroid hormone replacement was required in 40.35% of lobectomy patients. Overall, in the indeterminate follicular lesions patient population, 57 hemithyroidectomies were performed and no further operation was required in about 90% of patients. Conclusions: Considering the high rate in which HT represents the adequate treatment, and the low rate of re-operation morbidity, HT seems to be the preferable initial surgical approach for indeterminate follicular lesions. Long-term ultrasonographic follow-up seems advisable

Coexistence of chronic lymphocytic thyroiditis and papillary thyroid carcinoma. Impact on presentation, management, and outcome

Background: The association between chronic lymphocytic thyroiditis (CLT) and papillary thyroid car- cinoma (PTC) has been investigated for several years from different perspectives. In spite of that, there were only few attempts to design a common frame of references to understand the complex mutual interactions between the various pathways of inflammatory response and of thyroid tumor induction and progression. This study compares two independent groups of patients aiming to determine the frequency and the prognostic significance of CLT in patients with PTC. Material and methods: From January 2005 to September 2013, we conducted a retrospective study on 160 patients with PTC who underwent thyroidectomy. CLT was diagnosed histopathologically. Age, sex, tu- mor features (dimensions, angioinvasion, capsular infiltration, mono/multifocality and lymph node metastases) pathologic findings and outcome were considered. Mean follow-up (metastasis, completeness-of-resection, serum thyroglobulin levels, tumor recurrence) period was 61 months (ranged from 18 to 132 months). A p < 0.05 was considered statistically significant. Results: Patients were divided in 2 groups. In group A there were 90 patients affected by PTC alone, and in group B there were 70 patients affected with PTC associated with CLT. Our data showed that the presence of CLT correlate with a lower grade of PTC (p < 0.05). Considering the sex of the patients there were a statistically significant correlation (p < 0.02) and the presence of CLT associated with PTC was most representative in female patients. Conclusions: The presence of CLT in patients with PTC correlated with a lower grade of PTC, but it does not affect the overall survival of papillary thyroid cancers

Assessment of the awareness and management of sleep apnea syndrome in acromegaly. The COM.E.TA (Comorbidities Evaluation and Treatment in Acromegaly) Italian Study Group.

In 2007 the Italian COM.E.T.A. (COMorbidities Evaluation and Treatment in Acromegaly) study group started to assess the application in a clinical setting of the Versailles criteria for management of acromegaly complications by a first questionnaire focusing on cardiovascular co-morbidities. A further questionnaire on sleep apnea syndrome (SAS) was delivered by the COM.E.T.A. study group to 107 endocrine centers in Italy. The results of our survey suggest that SAS is a well-known comorbidity even if its estimated prevalence is lower than in the literature. Polysomnography is the preferred tool for diagnosis. Control of SAS is considered relevant both for quality of life and co-morbidities. Continuous positive airway pressure is the cornerstone of therapy, but patients' acceptance may be critical. Control of GH/IGF-I secretion is important to improve SAS. Management of SAS requires cooperation between specialists. ©2011, Editrice Kurtis

Assessment of the awareness and management of sleep apnea syndrome in acromegaly. The COM.E.TA (Comorbidities Evaluation and Treatment in Acromegaly) Italian Study Group

In 2007 the Italian COM.E.T.A. (COMorbidities Evaluation and Treatment in Acromegaly) study group started to assess the application in a clinical setting of the Versailles criteria for management of acromegaly complications by a first questionnaire focusing on cardiovascular co-morbidities. A further questionnaire on sleep apnea syndrome (SAS) was delivered by the COM.E.T.A. study group to 107 endocrine centers in Italy. The results of our survey suggest that SAS is a well-known comorbidity even if its estimated prevalence is lower than in the literature. Polysomnography is the preferred tool for diagnosis. Control of SAS is considered relevant both for quality of life and co-morbidities. Continuous positive airway pressure is the cornerstone of therapy, but patients' acceptance may be critical. Control of GH/IGF-I secretion is important to improve SAS. Management of SAS requires cooperation between specialists. \ua92011, Editrice Kurtis