Amal Alhefdhi

Infrared Thermographic Profiles Of Vessel Sealing Devices On Thyroid Parenchyma

BACKGROUND During thyroid lobectomy, division of the thyroid parenchyma has traditionally been accomplished using suture ligation. Development of hemostatic techniques in the forms of ultrasonic dissection (UD) and electronic vessel sealing (EVS) have increased the usage of these devices during thyroid operations. We sought to characterize the thermal profile of each of these devices when used to divide the parenchyma of the thyroid gland. METHODS Using a porcine model, the parenchyma of the gland was sealed by alternating application of the UD and EVS devices. In each case, the thermal activity was recorded using infrared thermal imaging. We performed multiple seals with each instrument and then compared the thermal profiles. RESULTS There was no significant difference in lateral thermal spread of EVS and UD above 39, 40 or 60°C (2.30 ± 0.31 mm versus 2.53 ± 0.47 mm, P = 0.26; 2.22 ± 0.27 mm versus 2.47 ± 0.47 mm, P = 0.22, and 1.37 ± 0.27 mm versus 1.54 ± 0.26 mm, P = 0.22). There was no significant difference in mean time above 39 or 40°C (35.1 ± 8.7 s versus 31.7 ± 9.3 s, P = 0.47 and 29.9 ± 8.1 s versus 27.3 ± 6.7 s, P = 0.50). UD reached a greater maximum temperature (179.12 ± 0.0008C versus 96.52 ± 5.6C, P ≤ 0.001) and stayed over 60°C for longer than EVS (9.5 ± 1.8 s versus 5.3 ± 0.97 , P ≤ 0.001). CONCLUSIONS The amount of lateral spread of thermal energy was not significantly different between the UD and EVS devices. However, the use of UD produced a higher maximum temperature during thyroid parenchyma sealing and remained above 60°C longer than EVS. This may translate into greater thermal injury to thyroid and surrounding tissues during division.

Recurrent and persistence primary hyperparathyroidism occurs more frequently in patients with double adenomas

INTRODUCTION The incidence of recurrent primary hyperparathyroidism (PHPT) had been reported to be between 1% and 10%. The purpose of this study was to examine if patients with multigland disease have a different recurrence rate. METHODOLOGY A retrospective analysis of a prospectively collected database was performed on patients with PHPT who underwent parathyroidectomy at one institution between 2001 and 2013. Patients who underwent initial parathyroidectomy with at least 6 mo of follow-up were included and were divided into three groups according to operative notes: single adenoma (SA), double adenoma (DA), and hyperplasia (HP). An elevated postoperative serum calcium level within 6 mo of surgery was defined as a persistent disease, whereas an elevated calcium after 6 mo was defined as a recurrence. RESULTS In total, 1402 patients met inclusion criteria, and the success rate of parathyroidectomy was 98.4%. The mean age was 60±14 y and 78.5% were female. Among them, 1097 patients (78%) had SA, 124 patients (9%) had DA, and 181 patients had HP (13%). The rate of persistent PHPT was higher among patients with DA (4%) versus SA (1.3%) and HP (2.2%) (P=0.0049). Moreover, the recurrence rate was higher among patients with DA (7.3%) versus SA (1.7%) and HP (4.4%) (P=0.0005) with identical median follow-up time. The median of the follow-up was 11 mo for patients with SA, 12.5 for patients with DA, and 12 for patients with HP (P=0.1603). CONCLUSIONS Recurrent and persistent PHPT occur more frequently in patients with DA. These data suggest that DA in some cases could represent asymmetric or asynchronous hyperplasia. Therefore, patients with DA may warrant more rigorous intraoperative scrutiny and more vigilant monitoring after parathyroidectomy.

Leflunomide suppresses growth in human medullary thyroid cancer cells

BACKGROUND Medullary thyroid cancer (MTC) is a neuroendocrine tumor that arises from the calcitonin-secreting parafollicular cells of the thyroid gland. Leflunomide (LFN) is a disease-modifying antirheumatic drug approved for the treatment of rheumatoid arthritis, and its active metabolite teriflunomide has been identified as a potential anticancer drug. In this study we investigated the ability of LFN to similarly act as an anticancer drug by examining the effects of LFN treatment on MTC cells. METHODS Human MTC-TT cells were treated with LFN (25-150 μmol/L) and Western blotting was performed to measure levels of neuroendocrine markers. MTT assays were used to assess the effect of LFN treatment on cellular proliferation. RESULTS LFN treatment downregulated neuroendocrine markers ASCL1 and chromogranin A. Importantly, LFN significantly inhibited the growth of MTC cells in a dose-dependent manner. CONCLUSIONS Treatment with LFN decreased neuroendocrine tumor marker expression and reduced the cell proliferation in MTC cells. As the safety of LFN in human beings is well established, a clinical trial using this drug to treat patients with advanced MTC may be warranted.