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

Enzymatic Hydrolysis of Bacterial Cellulose for the Production of Nanocrystals for the Food Packaging Industry

Bacterial cellulose nanocrystals (BCNCs) obtained by enzymatic hydrolysis have been loaded in pullulan biopolymer for use as nanoparticles in the generation of high-oxygen barrier coatings intended for food packaging applications. Bacterial cellulose (BC) produced by Komagataeibacter sucrofermentans was hydrolyzed by two different enzymatic treatments, i.e., using endo-1,4-\u3b2-glucanases (EGs) from Thermobifida halotolerans and cellulase from Trichoderma reesei. The hydrolytic activity was compared by means of turbidity experiments over a period of 145 h, whereas BCNCs in their final state were compared, in terms of size and morphology, by atomic force microscopy (AFM) and dynamic light scattering (DLS). Though both treatments led to particles of similar size, a greater amount of nano-sized particles ( 48250 nm) were observed in the system that also included cellulase enzymes. Unexpectedly, transmission electron microscopy (TEM) revealed that cellulose nanoparticles were round-shaped and made of 4-5 short (150-180 nm) piled whiskers. Pullulan/BCNCs nanocomposite coatings allowed an increase in the overall oxygen barrier performance, of more than two and one orders of magnitude ( 480.7 mL\ub7m-2\ub724 h-1), of pure polyethylene terephthalate (PET) ( 48120 mL\ub7m-2\ub724 h-1) as well as pullulan/coated PET ( 486 mL\ub7m-2\ub724 h-1), with no significant difference between treatments (hydrolysis mediated by EGs or with the addition of cellulase). BCNCs obtained by enzymatic hydrolysis have the potential to generate high oxygen barrier coatings for the food packaging industry

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

Amyloid goiter.

AbstractBackground and aimAmyloidosis refers to a variety of conditions in which amyloid proteins are abnormally deposited in organs and/or tissues. Amyloidosis is a rare occurrence in thyroid gland.MethodsA systematic review of the published data on amyloid goiter was carried out by searching Medline and other online databases (such as Scopus and Endnote) for the period from 1951 to March 2008. A total of 127 publications (case series, single case reports and reviews) was found, of which 31 were case series published from February 1995 to March 2008. Six articles have been considered for our review because they regard amyloid goiter as a manifestation of both primary and secondary amyloidosis (a total of 30 cases have been analyzed). Exclusion criterion was the presence of primary thyroid cancer.ResultsThe preoperative diagnosis of amyloid goiter should be considered in patients with known systemic amyloidosis or with a long-standing predisposing disease who present a rapidly growing thyroid volume in association with a euthyroid state. Fine-needle aspiration biopsy can be performed to exclude primary malignant lesions of thyroid gland and immunohistochemical studies can identify and characterize the amyloid deposits.ConclusionAmyloid goiter has to be suspected in all patients with a progressive, rapidly growing, bilateral thyroid enlargement and a concomitant history of chronic inflammatory processes. Moreover, this should be suspected in patients who are known to have disease predisposing to amyloid deposition

Optical frequency measurement of the 1S-3S two-photon transition in hydrogen

This article reports the first optical frequency measurement of the $1\mathrm{S}-3\mathrm{S}$ transition in hydrogen. The excitation of this transition occurs at a wavelength of 205 nm which is obtained with two frequency doubling stages of a titanium sapphire laser at 820 nm. Its frequency is measured with an optical frequency comb. The second-order Doppler effect is evaluated from the observation of the motional Stark effect due to a transverse magnetic field perpendicular to the atomic beam. The measured value of the $1\mathrm{S}_{1/2}(F=1)-3\mathrm{S}_{1/2}(F=1)$ frequency splitting is $2 922 742 936.729 (13) \mathrm{MHz}$ with a relative uncertainty of $4.5\times10^{-12}$. After the measurement of the $1\mathrm{S}-2\mathrm{S}$ frequency, this result is the most precise of the optical frequencies in hydrogen

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