Michael S. Barakate

Total thyroidectomy is now the preferred option for the surgical management of Graves’ disease

Purpose:  Subtotal thyroidectomy has been advocated as the standard treatment for Graves’ disease because of the possibility of avoiding thyroxine therapy as well as the assumed lower risk of complications compared to total thyroidectomy. However, the long‐term results of subtotal thyroidectomy are not as good as they were previously believed to be, as evidenced by the increasing incidence of hypothyroidism. If the risk of complications from total thyroidectomy is no higher, then that procedure offers significant advantages in the surgical management of Graves’ disease. The aim of this study therefore was to compare the complication rate of the two procedures in patients with Graves’ disease.

Ludwig's Angina: Report of a Case and Review of Management Issues

Ludwigs angina, although uncommon, remains a potentially life-threatening condition because of the risk of impending airway obstruction. Effective treatment is based on early recognition of the clinical process, with the appropriate use of parenteral antibiotics, airway protection techniques, and formal surgical drainage of the infection. We present a case of Ludwigs angina together with a brief review of the relevant literature.

Angioplasty and Stenting in the Posterior Cerebral Circulation

Purpose: To report initial experience with intracranial vertebral artery (VA) and basilar artery (BA) percutaneous transluminal angioplasty (PTA) and stenting. Methods: Eleven patients (10 men; mean age 66 years, range 56–75) with intracranial 14 VA and 3 BA stenoses were managed from December 1997 through November 1999. All patients presented with vertebrobasilar ischemia (VBI) despite antiplatelet and anticoagulant therapy. Clinical presentations included visual disturbance (n = 8), dysarthria/dysphasia (n = 5), and vertigo (n = 5). Results: Five patients underwent PTA only of 7 lesions with a mean preprocedural stenosis of 80% (range 50%–90%) that was reduced to 54% (range 30%–70%) after dilation. Six patients received 9 stents, 2 for VA dissections, 3 for tandem lesions, and 1 for a BA lesion. There were no embolic strokes. Patients were followed by clinical evaluation and personal or telephone interviews. Over a mean 18-month follow-up (range 12–35), 8 (73%) patients remained asymptomatic, while 3 (27%) had permanent deficits, 2 related to the procedure and 1 owing to distal disease Conclusions: Intracranial VA or BA angioplasty and stenting alleviated symptoms in patients with vertebrobasilar ischemia despite best medical management and may prevent stroke.

Papillary carcinoma of the thyroid arising in struma ovarii – report of a case and review of management guidelines

Struma ovarii, a cystic teratoma of the ovary predominantly composed of thyroid tissue, is an infrequently encountered clinical entity. Malignant transformation of these tumors is even more uncommon. We report a case of malignant struma ovarii containing foci of papillary carcinoma of the thyroid, which was incidentally found at laparotomy undertaken for repair of an infrarenal abdominal aortic aneurysm.

INTUSSUSCEPTION OF THE VERMIFORM APPENDIX DUE TO ENDOMETRIOSIS PRESENTING AS ACUTE APPENDICITIS

Intussusception of the appendix, as first described by McKidd in 1858, is an uncommon event.1 Sampson first described endometriosis involving the appendix, in 1921, with the documented frequency of appendiceal involvement in patients with endometriosis ranging from less than 1 to 5.3%2 and the frequency of endometriosis of appendicectomy specimens ranging from 0.05 to 0.80%.3 We report a case of intussusception of the appendix mimicking acute appendicitis, with a review of the relevant published work and management guidelines.

Combined Endovascular and Open Surgery for Four-Vessel Cerebrovascular Occlusive Disease

Purpose: To report a case of bilateral simultaneous percutaneous transluminal angioplasty and stenting of the intracranial vertebral arteries prior to staged bilateral carotid endarterectomy. Case Report : A 68-year-old man presented with a 3-month history of recurrent, intermittent left-sided weakness and diplopia. Imaging defined bilateral 80% to 99% internal carotid artery stenoses and >90% stenoses of both distal vertebral arteries at the level of the foramen magnum. Bilateral intracranial vertebral artery stenting was performed, followed by staged carotid endarterectomies. No complications occurred, and the patient recovered uneventfully from all 3 procedures. He remains symptom- and event-free 20 months later. Conclusions: Our initial success in this case indicates a role for percutaneous transluminal angioplasty and stenting as an alternative to open surgery for intracranial vertebral artery stenosis.

Short‐term resolution of psoriasis after total thyroidectomy for euthyroid multinodular goitre

A 36‐year‐old Chinese female with an 8‐year history of chronic, generalized plaque psoriasis demonstrated a marked improvement of the disease after removal of an intercurrent euthyroid multinodular goitre. Thyroxine was commenced immediately postoperatively. No thyroid antibodies were detected and thyroid function and calcium levels remained within normal limits both pre‐ and postoperatively. Four weeks following surgery, narrow‐band ultraviolet B (nbUVB) therapy was recommenced for recurrent psoriasis. The manifestations of psoriasis at this stage were less severe than before thyroidectomy and responded well to treatment, whereas before surgery the response to therapy had been poor. One year following total thyroidectomy, the patient received very effective psoriasis control with nbUVB therapy. The possible role of surgery and thyroid hormones in altering the pathogenesis of psoriasis in the acute setting is clearly of interest and warrants further research consideration.

Parapharyngeal malignant peripheral nerve sheath tumour in conjunction with ganglioneuroblastoma involving the mandible

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