Does thyroid surgery for Graves' disease improve health-related quality of life?

Abstract PURPOSE: Graves' disease can induce alterations of the psychosocial well-being that negatively influence the overall well-being of patients. Among the current treatments, surgery has limited indications, and its impact on the health-related quality of life has not been well clarified. The aim of this study was to assess the impact of surgery on the quality of life. METHODS: Fifty-seven patients who underwent total thyroidectomy for Graves' disease in our surgical unit between April 2002 and December 2009 were administered a questionnaire concerning four issues: organic alterations and clinical manifestations, neurovegetative system disturbances, impairment of daily activities, psychosocial problems. Patients were retrospectively questioned after thyroidectomy about the presence of these symptoms in both the pre and postoperative periods. RESULTS: There was a significant improvement after surgery in all four areas. Organic manifestations and psychosocial problems had higher average improvements, as did some aspects of the neurovegetative system and difficulties in undertaking daily activities. There were no reports of a worsening of symptoms. CONCLUSIONS: Surgery resolved the hyperthyroidism in 100 % of cases, and was associated with a quality of life improvement of about 70 % in the patients. Surgery can therefore provide an immediate and effective resolution of Graves' disease, with benefits in health-related quality of life

Oligo-antigenic diet in the treatment of chronic anal fissures. Evidence for a relationship between food hypersensitivity and anal fissures.

Abstract OBJECTIVES: Patients with chronic constipation due to food hypersensitivity (FH) had an elevated anal sphincter resting pressure. No studies have investigated a possible role of FH in anal fissures (AFs). We aimed to evaluate (1) the effectiveness of diet in curing AFs and to evaluate (2) the clinical effects of a double-blind placebo-controlled (DBPC) challenge, using cow's milk protein or wheat. METHODS: One hundred and sixty-one patients with AFs were randomized to receive a "true-elimination diet" or a "sham-elimination diet" for 8 weeks; both groups also received topical nifedipine and lidocaine. Sixty patients who were cured with the "true-elimination diet" underwent DBPC challenge in which cow's milk and wheat were used. RESULTS: At the end of the study, 69% of the "true-diet group" and 45% of the "sham-diet group" showed complete healing of AFs (P<0.0002). Thirteen of the 60 patients had AF recurrence during the 2-week cow's milk DBPC challenge and 7 patients had AF recurrence on wheat challenge. At the end of the challenge, anal sphincter resting pressure significantly increased in the patients who showed AF reappearance (P<0.0001), compared with the baseline values. The patients who reacted to the challenges had a significantly higher number of eosinophils in the lamina propria and intraepithelial lymphocytes than those who did not react to the challenges. CONCLUSIONS: An oligo-antigenic diet combined with medical treatment improved the rate of chronic AF healing. In more than 20% of the patients receiving medical and dietary treatment, AFs recurred on DBPC food challenge

Short stay thyroid surgery: a personal experience

Introduction: In spite of a low incidence of complications during thyroidectomy, there is a widespread tendency to extend hospitalization at least until postoperative second day. The need of a rebalancing between costs and profits had led us to revise the hospitalization’s duration. Methods: We reviewed our early experience (129 patients candidated to total thyroidectomy as ordinary hospitalization from 2001 to 2002) identifying the causes of hospitalization’s delay both preoperatively and in discharge. We excluded from our analysis re-operations, substernal goitre requiring sternotomy, carcinomas needing a systematic lymphadenectomy and some cases of internal medical interest. Between June 2003 and June 2007, 708 patients meeting the same criteria were referred to a short hospitalization (one-day surgery) after their expressed consent; during surgical operation hemostasis was improved with special remedy in 545 cases; after thyroidectomy all patients were subjected to a empirical protocol to prevent hypocalcaemia. Results: Between 2003 and 2007 the average of postoperative hospitalization was 1.08 days; the causes of extension were: severe/symptomatic hypocalcaemia (45 patients), re-operation because of hematoma (1 case), one tracheotomy for transient bilateral paralysis of recurrent nerve; 2 patients were readmitted for local sepsis. This procedure has been successful in 92.8% of cases. 701 patients properly interrogated have declared to be satisfied. Conclusions: A rational management of patients to undergo a total thyroidectomy with a careful emphasis on prevention of hypocalcaemia makes sure the short stay. The advantages in terms of economics are obvious. Additional benefits seem to come from the introduction of “mini invasive” techniques

Galectin-3 immunodetection for improving the performance of conventional thyroid cytology: preliminay results

Introduction: Most of differentiated thyroid carcinomas should be easily revealed by fine-needle aspiration cytology but sometimes preoperative diagnosis is doubtful. Galactin-3 is a carbohydrate –binding protein with affinity for beta-galactosides that plays a significant role in cell-cell and cell matrix adhesion, growth, neoplastic transformation and metastasis. Moreover, galectin-3 immunodetection is related to follicular thyroid malignancies. Our aim is to test Galectin-3 as potential preoperative marker for follicular and papillary carcinomas. Methods: Expression of galectin -3 was tested by fluorescence staining on 40 fresh cytological thyroid samples obtained preoperatively; the samples were fixed, stained using gal-3-specific monoclonal antibodies and treated with Rhodamine Red-conjugated anti-mouse. Counterstaining was performed using Hoechst 33342. After thyroidectomy, we analyzed correlation between gal-3-expression in FNAB and histology. Results : In our series, definitive diagnoses were: 17 multinodular goiter (A), 13 benign follicular lesions (B), 9 papillary carcinomas (C), 1 follicular carcinoma (D). Group A had shown at the FNAB a gal-3-positivity of cells from 0% to 15% (median: 10%); group B from 2% to 95 (median: 15%); group C from 30% to 90% (median: 46%). D had a 100% positivity. Conclusions: Galectin-3 immunodetection could be an useful method to improve conventional cytology’s performance in pre-operative identification of thyroid differentiated carcinomas: one “suspected” FNAB case showing 3% of positive cells proved to be benign at histology ; one “indefinite” FNAB case with 40% of positive cells proved to be malign. Stronger data are needed to establish a cut-off for malignancy

COLONIC LOCALIZATION OF MYXOID LIPOSARCOMA: CASE REPORT

INTRODUCTION: myxoid liposarcoma approximately constitutes 20% of all mesenchymal malignancies preferably occurring in adults with prevalent localization in arts even if there are rare intra-abdominal locations: only 3 cases reported in the literature. We present a case of myxoid liposarcoma with colic localization outlining a diagnostic and therapeutic procedure through a literature’s review. CASE REPORT: We observed a 37 year-old man in January 2007 because of colic pain in the middle abdomen, dyspepsia and constipation. The CT with contrast agent showed a capsulated solid mass with net margins, lobules and adipose tissue component compressing and displacing small bowel. After incision we found a polypoid mass of 24 cm with extraluminal development arising from right colon. Total mass, terminal ileum and right colon were excised; an ileo-colic anastomosis was performed. According to the literature it was not practised any adjuvant treatment. After one year the patient presented a local peritoneal recurrences surgically excised. CONCLUSIONS: the diagnostic process is not yet well defined. Only surgery and histologic examination are able to clarify lesion’s nature. Also surgical treatment is not yet well established, although many authors suggest a total excision of lesion without reference to lymphadenectomy. As for the role of chemotherapy only one case was reported in the literature; myxoid liposarcoma is considered an histotype with intermediate degree of malignancy therefore it should be considered a potential malignant neoplasm and chemotherapy would be justified. Total surgical resection with or without adjuvant radio-chemiotherapy could have a strong impact on the prognosis and follow-up