Candinas, D

Hagemann, M

Inglin, R

Schudel, H

Seifert, E

Seiler, C

Vorburger, S

Worni, M

Bern Open Repository and Information System (BORIS)

source: https://doi.org/10.48350/24241 | downloaded: 17.2.2023Background: Using immunohistochemical markers can facilitatethe diagnosis in thyroid carcinoma.Patients and methods: Since 2004 up to June 2007 we analysedmRNA-expression (Micro-array-analysis) in unfixed fresh thyroidtissue to uncover possible differences in different benign andmalignant thyroid diseases like follicular adenoma, Graves diseaseand all kinds of thyroid carcinomas (Group A). Results were usedfor Immunohistochemical analysis in paraffin embedded tissueprospectivly (Group B) and retrospectivly (Group C).Results: A] Fresh tissue-probes were drawn in 143 patients.Analysis of FTC tissue showed an up-regulation for quinolinate-phosphoribosyltransferase (QPRT) (n=12).B] Immunohistochemical analysis in paraffin embedded tissueshowed positive results for QPRT in follicular adenomas in 30%,in micro-invasive FTC in 60% and in grossly invasive FTC in90% (n=47).C] Theses results are about to be reproduced in 100 own historicalcases of FTC, investigation is in progress.Conclusion: QPRT is a possible new immunohistochemicalmarker in FTC. Possibly QPRT can be used as a presurgicalmarker in thyroid cytology in the future.9INTRATHYROIDAL HEMATOPOIESIS—A RAREHISTOLOGICAL FINDING IN AN OTHERWISE HEALTHYPATIENT AND REVIEW OF THE LITERATUREChristina C. Westhoff1, Carsten Dietz2, Elias Karakas21Institute of Pathology, University Hospital Giessen andMarburg, LocationMarburg, Medical Faculty of Philipps UniversityMarburg, Marburg, Germany2Department of Visceral-, Thoracic- andVascular Surgery, UniversityHospital Giessen and Marburg, Location Marburg, Medical Facultyof Philipps University Marburg, Marburg, GermanyBackground: Multinodular goiter represents the most commonthyroid disease in Europe. Regressive changes like hemorrhage,infarction or fibrosis are frequently observed, calcifications havealso been detected. Extramedullary hematopoiesis has beendescribed in almost every organ, especially in patients withhematologic diseases. However, true bone formation is uncommonand to date only two cases of metaplastic bone formation withextramedullary hematopoiesis in the thyroid have been reported inthe literature.Patients and methods: We present a case of total thyroidectomydue to multinodular goiter harboring an area of mature bone andhematopoiesis in an otherwise healthy female patient. Further-more we reviewed and summarized for the first time all availablecases from the literature.Results: We report the third case of metaplastic bone formationwith foci of hematopoietic tissue in the thyroid gland. All threepatients were young females without any obvious stimulus forextramedullary hematopoiesis.Conclusion: Isolated extramedullary hematopoiesis seems to bemore frequent in the thyroid gland than metaplastic bone withhematopoiesis, particularly in older people with underlyinghematologic disorders. It also represents an important differentialdiagnosis of anaplastic carcinoma of the thyroid, particularly inintra-operative frozen sections and needle biopsy.10TOTAL THYROIDECTOMY—A SURGICAL STANDARDPROCEDURE FOR THERAPY OF GRAVES,DISEASERalf Wilke, Bernhard J. Lammers, Hinrich Böhner,Peter E. GoretzkiKlinik für Allgemeine, Viszeral-, Thorax- und Gefässchirurgie,Lukaskrankenhaus, Neuss, DeutschlandBackground: Surgery is an important therapeutic option in thetreatment of Graves’ disease. Nevertheless it is still controversialwhether the extent of resection correlates with the number ofsurgical complications and the success of the therapy. This studyevaluates the preconditions that would justify total thyroidectomyas part of the primary therapy concept for Graves’ Disease.Patients and methods: The prospective study covered the periodfrom October 2001 to May 2007 and assessed 155 patients whounderwent partial (subtotal) or total thyroidectomy for Graves’Disease. Neuromonitoring and LigaSure® was adopted as part ofthe routine surgical treatment from April 2006.Results: One hundred twenty-nine patients (83.2%) underwenttotal thyroidectomy, 26 patients (16.8%) were treated with partial(subtotal) thyroidectomy (remnant 2–4 ml). Pathology findingsrevealed Struma basedowificata in 153 cases(98.7%) and occultpapillary thyroid cancer in two cases (1.3%). Forty patients (91%)underwent total thyroidectomy, only four patients (9%) weretreated with partial (subtotal) thyroidectomy with routine use ofNeuromonitoring and LigaSure®. 0.8% of cases showed perma-nent recurrent laryngeal nerve (RLN) palsy for total thyroidectomy(TT) and 0% for partial(subtotal) thyroidectomy (ST). 1.6% ofcases showed permanent hypoparathyroidism for TT, 0% for ST,20% of cases displayed temporary hypoparathyroidism for TT,23% for ST. Routine use Neuromonitoring and LigaSure® reducedthe risk of RLN palsy (0%) and hypoparathyroidism (temporary10%, permanent 0%) in TT, with an additional reduction in theduration of the operation.Conclusion: Total or near-total thyroidectomy is an effective andsafe treatment for Graves’ disease when performed by anexperienced surgeon. The use of Neuromonitoring and LigaSure®is still routinely recommended as the treatment for Graves’Disease.11SINGLE-DOSE STEROID BEFORE THYREOIDECTOMYIMPROVES NAUSEA, PAIN AND VOCAL FUNCTIONMathias Worni1, Hans Harold Schudel1, Stephan A.Vorburger1, Eberhard Seifert2, Roman Inglin1, Matthias Hagemann2,Christian A. Seiler1, Daniel Candinas11Department of Visceral and Transplantation Surgery, Inselspital,University of Berne, Switzerland2Department of Otolaryngology, Head and Neck Surgery, Inselspital,University of Berne, Switzerland842 Langenbecks Arch Surg (2007) 392:839–855Background: We evaluated, if preoperative, single-dose steroidapplication reduces nausea, pain and voice disturbances afterthyroid surgery.Patients and methods: Sixty patients (m=16, w=44) with medianage 55 years (range 18–80) entered a two-arm, randomized, double-blinded, controlled study receiving either dexamethasone 8mg (D)(n=30) or NaCl 0.9% (C) (n=30) i/v 30 min before anaesthesia. At6 timepoints (4–48 h) after the operation nausea (verbal responsescale (0–3), use of antiemetic medication), pain (visual analoguescale (VAS), analgesic use) and vocal function was registered.Results: Groups did not differ in demographics. Nausea andantiemetic use was significantly less in group D compared to C.Over 48 h the difference in nausea and vomiting was significant(p<0.001; ANOVA repeated measures). There was a significantreduction in antiemetic use, too (D=16.1%/C=28.1%) (p<0.009).Mean scores for pain during the first 48 h after operation were17.5/25.1 in group D and C, respectively (p<0.001) with areduction in total opioid requirement (p<0.001). Changes in voicemean frequency over a 48 h period after surgery was significantlyless in the dexamethasone group than in the placebo group (p<0.02). No potential steroid related complications occurred.Conclusion: Preoperative single-dose steroid not only reducespostoperative nausea/vomiting and pain within 48 h afterthyroid resection but decreases voice dysfunction, too.12IN VITRO EVALUATION OF PROTEASOME INHIBITONBY BORTEZOMIB AS A NEWOPTION OF ANTIPROLIFERATIVETHERAPY IN ANAPLASTIC THYROID CANCERSabine Zimmer1, Sabine Teichler2, Annette Wunderlich1,Susanne Lingelbach1, Andreas Neubauer2,Matthias Rothmund1, Sebastian Hoffmann11Department of Surgery, Philipps University of Marburg, Germany2Department of Medicine, Division of Haematology,Philipps University of Marburg, GermanyBackground: Anaplastic thyroid cancer (ATC) is characterized byuncontrolled tumor cell proliferation. Because of failure of usualtherapy, patients with undifferentiated thyroid cancer are indesperate need of new therapeutic strategies. Bortezomib is aninhibitor of the proteasome that has been approved for thetreatment of multiple myeloma. The aim of this study was toevaluate the effect of Bortezomib alone and in combinations onanaplastic thyroid cancer cell lines as a possible new therapeuticoption for ATC.Patients and methods: Three anaplastic thyroid cancer cell lines(Hth74,C643,KAT4) were evaluated in vitro. The antiproliferativeeffect of Bortezomib (0.1–100 nM) alone, or in combination withvalproic acid (0.125–4 mM) or AEE788, a dual tyrosine kinaseinhibitor (TKI) of EGF-R/VEGF-R, (AEE788 4 μM) on thyroidcancer cell lines was quantified by MTT assay. The proapoptoticeffect was asessed by flowcytometric analysis (FACS) after PIstaining and cell cycle analysis. Single and combination therapy ofcompounds were analyzed.Results: Administration of Bortezomib (B) and valproic acid (V)inhibited tumor cell numbers as follows: 92% inhibition in Hth74(B) 87,5%(V), 98% in C643(B) 44%(V) and 98% in KAT4(B)50%(V). The IC50 of Bortezomib was 8 nM in Hth74, 10 nM inC643 and 10 nM in Hth74. Combinations of IC50 concentrationsof Bortezomib with valproic acid or AEE788 displayed relevantsynergistic effects with an increased antiproliferative activity of upto 100% compared to the single agents. An increase of apoptoticcells of some 10–15% occurred by AEE788 and not byBortezomib or valproic acid administration.Conclusion: Proteasome inhibiton leads to significant decreasedtumor cell proliferation of anaplastic thyroid cancer cell lines invitro. Combination of Bortezomib with TKI of EGF-R/VEGF-Ror with valproic acid seems to be more effective than single agentstrategies. It is suggested that proteasome inhibiton may havetherapeutic potential in some anaplastic thyroid cancers.13MORBIDITY OF SECONDARY COMPLETE THYROIDRESECTION IN PATIENTS WITH DIFFERENTIATEDTHYROID CARCINOMA DEPENDSON THE TIME OF SURGERYAyman Agha, Gabriel Glockzin, Nabil Ghali, Hans J. SchlittDepartment of Surgery, University of Regensburg Medical Center,Regensburg, GermanyBackground: Secondary complete thyroidectomy (and lymph nodedissection) in patients with differentiated thyroid carcinoma areassociated with high morbidity and complication rates. However,the optimal time of surgery is discussed controversially. In thepresent study we evaluated patient outcome depending on the timeof secondary surgery.Patients and methods: Between 1996 and 2004 87 patients withdifferentiated thyroid carcinomas (PTC:58, FTC: 29) underwentsecondary completion of surgery at the University of RegensburgMedical Center. These patients were divided in three groupsdepending on the time between initial and secondary surgery: groupA: 0–3 days and >3 months, group B: 3–7 days and 7 weeks—3 months, group C: 1–7 weeks. The median follow-up time was60.5 months.Results: Operation procedures were comparable in all groups.There was a significant lower number of persistent hypocalcemiain group A compared with group B and C (p<0.042). Moreover,recurrent laryngeal nerve paresis was significantly decreased ingroup A (p<0.003). Five patients developed local recurrence(5.7%). Overall mortality rate was 5.7%.Conclusion: Our data suggest that completion of surgery inpatients with differentiated thyroid carcinoma within 3 days ormore than 3 months after initial surgery reduces morbidity andimproves patient outcome.14RECURRENT GOITER—THE BOOMERANG OF INITIALSURGERYUta Herden, Stefan W. Schmid, Daniel Candinas,Christian A. SeilerClinic of Visceral and Transplant Surgery, University Hospital,Berne, SwitzerlandLangenbecks Arch Surg (2007) 392:839–855 843

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Single-dose steroid before thyreoidectomy improves nausea, pain and vocal function

Single-dose steroid before thyreoidectomy improves nausea, pain and vocal function

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