Paul Lo Gerfo

Local/regional anesthesia for thyroidectomy: Evaluation as an outpatient procedure ☆

Abstract Background: The purpose of this paper was to review my evolving experience with local/regional anesthesia in an outpatient setting. Methods: Two hundred three consecutive patients during a 9-year period who chose to undergo thyroid operation under regional/local anesthesia were reviewed. Early discharge was offered to patients who were observed for 6 hours without neck swelling and who had no surgical reasons for delaying discharge. Results: In group A there were 2 patients who were given inhalation anesthesia during operation compared with none in groups B and C. The average length of stay in group A was 0.49 days, 0.55 days in group B, and 0.24 days in group C. Eighty-five percent of the patients whose operation began before 1300 hours were discharged within 6 hours versus only 50% of those operated on later in the day. Forty-seven percent of patients in group A, 65% of group B, and 77% of patients in group C were discharged within 6 hours of operation. On the basis of previous experience with general anesthesia, discharge time is not significantly influenced by the type of anesthesia chosen. There were no readmissions to the hospital, but 2 episodes of postoperative bleeding required reoperation. Survey showed that 95% of patients rated the level of pain equivalent or less severe than dental procedures under local anesthesia, and all patients would choose local again. Conclusions: These data suggest that thyroidectomy can be performed with the patient under local/regional anesthesia, with low morbidity and high patient satisfaction. Most patients can be discharged within 6 to 8 hours, and these discharges were not associated with readmissions. (Surgery 1998;124:975-9.)

Detection of circulating thyroid cells in peripheral blood

BACKGROUND Detection of circulating malignant thyroid cells may provide a method to identify postoperative patients at risk for metastatic thyroid cancer. METHODS On the basis of tissue specificity of thyroglobulin gene expression and the sensitivity of the reverse transcriptase-polymerase chain reaction (RT-PCR) analysis, we performed RT-PCR using primers for thyroglobulin on blood samples from patients with thyroid disease to detect thyroglobulin RNA transcripts. Postoperative peripheral blood samples from 100 patients, including patients with known metastatic thyroid cancer (six papillary and three follicular), thyroid cancer and no evidence of current metastases (63 papillary, 10 follicular, and five patients with both papillary and follicular), benign thyroid disease (six nontoxic nodular goiters), and normal volunteers (seven). RESULTS Thyroglobulin transcripts were detected in nine of nine patients with metastatic thyroid cancer, seven of 78 patients with thyroid cancer and no current metastases (although of these seven patients, five had a history of metastatic disease that had been previously treated by surgery, one had a coexisting parathyroid cancer, and one had both papillary and follicular thyroid cancers), zero of six patients with benign thyroid disease, and zero of seven normal volunteers. Identity of amplicons was confirmed by restriction enzyme digestion and by cloning and sequencing of RT-PCR amplified thyroglobulin fragment (the latter in a limited number of cases). CONCLUSIONS These data indicate that RT-PCR can be used to detect thyroglobulin mRNA in peripheral blood. The presence of these transcripts correlates with the existence of extrathyroidal disease.

Thyroidectomy Using Local Anesthesia in Critically Ill Patients with Amiodarone-Induced Thyrotoxicosis: A Review and Description of the Technique

Hyperthyroidism caused by amiodarone is a well-known and accepted side effect of therapy. This problem can frequently be treated by medical means if patients are stable. In some patients, particularly those who are critically ill with cardiac disease the addition of hyperthyroidism can be particularly detrimental. These patients present with an interesting paradox because they are frequently on amiodarone because of life-threatening arrhythmias not responsive to other regimens, yet the amiodarone can precipitate hyperthyroidism that can acutely worsen the progression of their disease and prevalence of arrhythmias. In these patients, prompt treatment of their hyperthyroidism by total thyroidectomy may be the best option. Unfortunately, this also raises another treatment paradox in that these patients are at particularly high risk for complications from general anesthesia. In this subset of patients, total thyroidectomy under local anesthesia may be the best treatment option. Herein, we present a review of amiodarone-induced hyperthyroidism and our technique and review of our experience in its management with total thyroidectomy performed under local anesthesia.

Studies on tumor-associated antigen: TAA

Abstract A method for the preparation of tumor-associated antigen (TAA) is described. We have been able to demonstrate two antigens with common antigenic determinants that are separable by ion-exchange chromatography and electrophoresis. These antigens appear identical by Ouchterlony immuno-diffusion analysis and by Sephadex chromatography. The differences in electrophoretic mobility of these antigens appear related to a sialic acid moiety, although we have demonstrated that the antigenic specificity does not reside in this portion of the molecule. These antigens share at least one common determinant with a low-molecular-weight substance found in perchloric acid extracts of normal lung and colon. This and previous studies would suggest that this antigen is identical to carcinoembryonic antigen (CEA).

Recent Advances in the Immunodiagnosis of Cancer

Neoplasms are known to produce specific hormones, enzymes, and antigens which, if identified, can aid in the diagnosis and treatment of patients with cancer. Some of the more commonly used tumor markers are discussed in this article and the clinical applicability of each is evaluated according to specific criteria.