Campana Fp

High Rate of Recurrence After Lobectomy for Solitary Thyroid Nodule

OBJECTIVE To evaluate the long-term outcome of patients treated by lobectomy for solitary thyroid nodule. DESIGN Retrospective study. SETTING University hospital. PATIENTS 83 patients admitted with a clinical diagnosis of solitary thyroid nodule. INTERVENTIONS Preoperative ultrasonography showed a solitary nodule in 32 patients and this finding was confirmed intraoperatively in 24 cases (77%). 59 patients with multinodular goitres were treated by total thyroidectomy and 24 with solitary nodule by lobectomy. MAIN OUTCOME MEASURES Postoperative complications and freedom from nodule recurrence and/or parenchymal irregularity. RESULTS One patient after lobectomy and 3 after total thyroidectomy developed temporary recurrent laryngeal nerve injury. Postoperative temporary hypoparathyroidism occurred in 13 patients (22%) after total thyroidectomy and in no patient after lobectomy (p = 0.02). Neither permanent recurrent laryngeal nerve injury nor permanent hypoparathyroidism occurred after either procedure. Among patients who underwent lobectomy, 6 had an adenoma and 18 had a nodular hyperplasia. At 4-year follow-up, the freedom rate from any thyroid nodule recurrence or parenchymal irregularity was 44.7%, and the freedom rate from nodular recurrence was 74%. Men tended to have a 4-year freedom rate from nodular relapse poorer than women (48% vs. 87%. p = 0.07). Nodular recurrence occurred in one patient operated on for an adenoma, and all the other recurrences occurred in patients with nodular hyperplasia. CONCLUSIONS The mid-term freedom rate from thyroid nodule recurrence or parenchymal irregularity after lobectomy for solitary nodule of the thyroid is unsatisfactory. This observation calls for a better evaluation of long-term results after lobectomy for this condition and identification of risk factors predictive of recurrence. This would enable a more appropriate preoperative selection of patients undergoing lobectomy, indicating total thyroidectomy for those patients with solitary nodule at high risk of recurrence.

Unsaturated polyester-styrene resins: effect of the catalyst concentration on the kinetic rate and activation energy of the radical crosslinking reactions

Abstract The T1 spin lattice relaxation time, measured by pulsed n.m.r., has been used to monitor the effect of the catalyst concentration on the kinetics of the radical crosslinking reaction of unsaturated polyester-styrene resins. The measurements were performed primarily in the intermediate-final part of the reaction under isothermal conditions. The loss of mobility of the protons of the sample has been correlated with the degree of cure and the kinetic constant as well as with the activation energy, and has been evaluated using the semiempirical kinetic expression proposed by Kamal et al. In the concentration range investigated (from 0.05 to 0.3% w/w) for the catalyst cobalt octanoate the decrease of the activation energy for the process was found to be 2.3 kcal mol−1 of double bonds for each 0.1% w/w of cobalt octanoate.

Facial nerve function after parotidectomy for neoplasms with deep localization.

PurposeTo determine whether the deep location of a parotid gland neoplasm is specific risk factor for facial nerve paralysis after parotidectomy.MethodsWe retrospectively reviewed 88 patients, including 59 with a benign superficial neoplasm of the parotid treated by superficial parotidectomy (group 1); 5 with a benign deep neoplasm treated by total parotidectomy (group 2); 20 with a malignant superficial neoplasm treated by total parotidectomy (group 3); and 4 with a malignant deep neoplasm treated by total parotidectomy (group 4).ResultsTemporary facial nerve paralysis developed in 10.3%, 20%, 10%, and 50% of groups, 1, 2, 3, and 4, respectively. Permanent facial nerve paralysis developed in 0%, 0%, 10% and 50% of groups 1, 2, 3, and 4, respectively.ConclusionThe risk factor associated with nerve damage resulting from surgery for parotid neoplasms were malignancy and deep localization. However, the deep location of a benign tumor was not a major risk factor for permanent paralysis.

Blue-dye sentinel node mapping in thyroid carcinoma : Debatable results of feasibility

Abstract The present study aims to investigate the feasibility and influence of the lymphatic mapping and sentinel node biopsy on determination of the nodal status in thyroid carcinoma using blue-dye method. Nine consecutive patients with cytological diagnosis of papillary carcinoma were included in this study. To detect the sentinel lymphnode, intra-or perinodular injection of an average quantity of 0.5 ml (range: 0.1-1.2) of Bleu Patenté V was performed intraoperatively in 8 cases only, as in one case a solitary cystic nodule occupied the entire lobe and thus any injection was impossible. After an average time of 16 minutes (range: 5–25) before dissection of the thyroid, no lymphnodes and no lymphatic afferent thereto visibly coloured were evidenced, except for spread of the vital dye into adjacent tissue and disrupted blood and lymphatic vessels at the injection site. Our results evidence that: intranodular injection, does not allow proper diffusion of the dye in the adjacent parenchyma, and in nodules smaller than 1 cm it may be difficult; and that it is hazardous in cystic nodule because of the rupture risk; perinodular injection, at the four cardinal points, is impossible when the nodule occupies the entire lobe or the isthmus; multinodular goiter complicates the identification by palpation of the neoplastic nodule in which the dye should be injected or, if perinodular injection is given, to detect the parenchyma surrounding the nodule.

Incidental Parathyroid Adenomas with Normocalcemia Discovered During Thyroid Operations: Report of Three Cases

Abstract We report three cases of parathyroid adenoma incidentally discovered during a total thyroidectomy. No patients showed any clinical or chemical features that led us to suspect a hyperparathyroidism condition before operation, but a macroscopically enlarged parathyroid was discovered during the dissection and it was removed in all three cases. All patients had a single adenoma confirmed by a histological analysis. Calcemia decreased after operation in every case but only one patient needed temporary adjunctive therapy. No permanent hypoparathyroidism or recurrent hyperparathyroidism was observed. We recommend that any enlarged parathyroid discovered during neck surgery should thus be removed in order to avoid the risks of future surgical procedures due to successive bouts of clinical hyperparathyroidism.

Unsaturated polyester resin: kinetics of the cross-linking reaction by pulsed NMR

SummaryPulsed NMR at 20 MHz has been used to monitor the time course of the intermediate-final stage of the radical crosslinking reaction (cure of unsaturated polyester-styrene resins.) The measurement of Spin lattice relaxation time T1 allowed us to follow the hardening process having as a parameter the loss of general mobility of the system at the molecular level.The degree of cure as a function of time, the kinetic constant as well as the activation energy for the crosslinking reaction in isothermal conditions has been evaluated using the semiempirical kinetic equation proposed by Kamal and coworkers. The activation energy was estimated to be 13.6 Kcal per mole of double bonds in the components.

Unusual metastasis of gastrointestinal stromal tumor misdiagnosed as anaplastic thyroid carcinoma

Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumorsof thedigestive tract. Almost allGISTs express theKIT protein (CD 117), the product of the c-KIT protoncogene that is a transmembrane receptor for the stem cell factor (SCF or KIT ligand) with a tyrosine kinase domain. The tumorigenesis of GISTs involves mutations in the cKIT protoncogene, resulting in ligand-independent

Magic Angle Spinning-Cross Polarization 13C NMR of crosslinked unsaturated polyester resins

SummaryMagic Angle Spinning-Cross Polarization (MAS-CP) 13C NMR spectra of four different unsatured resins reticulated with styrene have been measured.Styrene crosslinks may be constituted essentially by dyads or may consist in (styrene) microdomains (n⩾2), depending mainly upon the molar ratio of maleic acid residues in the original unsaturated polyester to styrene.Also in the case of solid unsaturated resins the MAS-CP 13CNMR technique promises to allow structural insights only very difficultly obtainable by more classical indirect means.