Philipp Riss

Follicular thyroid carcinoma in an iodine-replete endemic goiter region: a prospectively collected, retrospectively analyzed clinical trial.

Objective:To determine risk factors for presence of lymph node or distant metastases in patients with follicular thyroid cancer (FTC) at the time of diagnosis and whether there is a relationship between the type of tumor invasion and metastases. Summary Background Data:FTC often presents distant metastases at the initial diagnosis. As distant metastases are independent prognostic factors in a patients survival, determination of clinicopathologic characteristics for patients who are at higher risk for developing metastases is of greater clinical importance. Methods:The prognostic significance of gender (male vs. female), age (≤40 years vs. <40 years), tumor size (≤40 mm vs. >40 mm), number of lesions (uni- vs. multifocality), type of invasion (minimally invasive vs. widely invasive), and oncocytic changes (with vs. without) were analyzed in 207 patients, according to presence of lymph node and distant metastases at the time of initial surgery. According to the type of invasion, the carcinoma-specific survival and the disease-free survival of minimally invasive (MI) and widely invasive (WI) FTC were estimated and compared. Results:None of the 127 patients with MI growth presented with lymph node metastases but 9.4% distant metastases. Overall risk factors for the presence of lymph node metastases at the initial diagnosis were multifocality (P = 0.02) and widely invasion (P = 0.0001) and for distant metastases age >45 years (P = 0.007), tumor size larger than 40 mm (P = 0.03) and widely invasion (P = 0.0001). WI-FTC patients show larger tumors (P = 0.0001), older age (P = 0.0001), and are presented more frequently in recurrent goiter disease (P = 0.0001). The estimated 10 years carcinoma-specific survival and disease-free survival for MI-tumors were significantly better than for WI-tumors (P = 0.0001). Conclusions:Total thyroidectomy is recommended in all patients with FTC because of early distant metastases. Patients with WI-FTC need a more aggressive surgical treatment because of higher tendency for lymph node metastases. MI-FTC has an excellent prognosis with no sign of lymph node metastases, which emphasizes a limited need for nodal surgery.

Is minimally invasive parathyroidectomy without QPTH monitoring justified

BackgroundIt is matter of discussion if quick parathyroid hormone (QPTH) monitoring is helpful in patients with primary hyperparathyroidism (PHPT) and “localized single-gland disease” (SGD; concordant sestamibi and ultrasound results) to further increase the rate of success (permanent normocalcemia) of performing selective parathyroidectomy by minimally invasive parathyroid exploration (MIP). The aim of this study was to evaluate if a randomized controlled trial was justified in order to clarify this discussion.Materials and methodsThe prospective database of patients with sporadic PHPT, SGD, MIP, and QPTH monitoring (1999–2005) was evaluated regarding the “conversion rate” to bilateral exploration and permanent normocalcemia (“QPTH” group). Retrospectively, the patients were analyzed a second time “without” applying QPTH monitoring (“non-QPTH” group). Statistical differences between both groups were calculated (McNemar’s test).ResultsBy definition, 338 patients with “localized SGD” underwent MIP. MIP was finished in 308 (91.1%) patients. Five of 308 patients (1.6%) showed persisting (n = 1) or recurrent disease (n = 4). In 30 of 338 patients (8.9%), a conversion to bilateral exploration was necessary (false preoperative localization 15 patients—one patient not cured; multiple-gland disease correctly indicated by QPTH monitoring 15 patients—one patient not cured). Analyzing the “non-QPTH” group, 14 additional patients showed persisting disease. Thus, without using QPTH monitoring, the rate of persisting PHPT would increase from 0.9% (three patients) to 5.0% (17 patients; p = 0.0005).ConclusionIntraoperative QPTH assay seems necessary even in patients with “localized SGD” by two techniques in an endemic goiter region. Abandoning QPTH monitoring would more than double the rate of persisting disease. A randomized trial seems not to be justified.

Impact of stapled haemorrhoidopexy on stool continence and anorectal function—long-term follow-up of 242 patients

Background and aimsSeveral studies have proved the feasibility and safety of stapled anopexy for treating haemorrhoidal prolapse. However, stool urgency and faecal incontinence as possible side effects are still debated. Therefore, the present study was designed to assess the impact of Longo’s procedure on stool continence and anorectal function.Materials and methodsFrom 1999 to 2005, 300 patients underwent stapled haemorrhoidopexy for symptomatic haemorrhoidal prolapse. Two hundred forty-two patients (100 women, 142 men) were available for follow-up and were retrospectively reviewed. All operations were performed by one single surgeon. To evaluate anorectal function, the results of a validated incontinence score (total incontinence score [IS]: 0 = best, 20 = worst) and evacuation score (total evacuation score [ES]: 0 = worst, 28 = best) were compared pre- and postoperatively.ResultsThe total IS showed no difference in means before and after operation (p = 0.875, CI 95%) retrospectively. Concerning the ES, paired sample t-test showed a weak positive correlation, indicating a significant difference in score means (p = 0.041, CI 95%). The group means changed from 26.24 before operation to 26.60 after the follow-up period.ConclusionThe present data revealed no significant negative impact of Longo’s technique on anorectal function. In contrast, according to the evacuation score, the results showed a significant improvement of evacuation.

The influence of thiazide intake on calcium and parathyroid hormone levels in patients with primary hyperparathyroidism.

The effects of thiazide medication in patients with primary hyperparathyroidism (PHPT) have so far not been elucidated. The aim of this study was to analyse the extent to which the administration of thiazides may influence biochemical parameters and therefore the diagnosis of PHPT in a large cohort of patients.

Comment on "A rising ioPTH level immediately after parathyroid resection: are additional hyperfunctioning glands always present? An application of the Wisconsin Criteria".

our opinion, the role of sulfate reducing bacteria (SRB) in the pathogenesis of pouchitis remains unclear. The 2 studies that the authors refer to were unable to establish a clear role for SRB in the pathogenesis of pouchitis because neither study included patients with active pouchitis.1,2 Ohge and colleagues1 studied 50 restorative proctocolectomy (RPC) patients: 9 ulcerative colitis (UC) patients with previous pouchitis but no active disease for 1 year; 9 UC patients with pouchitis in the last year, but inactive for 6 weeks or more; 8 UC patients with no previous pouchitis; 11 UC pouchitis patients with ongoing antibiotic treatment; 8 UC patients with no history of pouchitis; and 5 patients with familial adenomatous polyposis. Stool samples were collected, and counts of sulfate reducing bacteria and output of hydrogen sulfide were measured. The authors found a 5 times greater release of hydrogen sulfide gas in all UC samples than the familial adenomatous polyposis (FAP) samples, except in the UC patients receiving antibiotic treatment where this was similar to the FAP group. Those who had recently had pouchitis had higher hydrogen sulfide gas production than those who had pouchitis more than 1 year previously, which was higher than those who had never had pouchitis. Bacterial counts of SRB were higher in samples from active pouchitis patients than all other groups. Duffy and colleagues2 studied 25 patients (10 UC RPC, 7 FAP RPC, 8 ileostomy) none of whom had a previous history of pouchitis. The differences between FAP and UC fecal microbiology were studied; 80% of the UC RPC samples contained SRB in contrast to none of the FAP samples or ileostomy samples. Rowan and colleagues correctly report that we failed to identify a disease-dependent alteration in the abundance of SRB. Unfor tunately, they incorrectly quote our data; in fact, we identified a median prevalence of 0% (with a mean of 1.6%) for the family Desulfobulbaceae in UC pouchitis patient samples (Desulfobulbaceae species were identified in only 1 patient sample). Rowan and colleagues also refer to our data and state that we failed to identify any bacteria from the family Desulfovibrionaceae in any patient sample. This is incorrect; in fact, 1 sequence was identified in a FAP nonpouchitis sample. Overall, data from our study do not support the role of sulfate reducing bacteria in the pathogenesis of pouchitis. It is acknowledged, however, that because of the sensitivity threshold of the clone library methodology we employed, it is possible that SRB were present in our cohort but not in high enough numbers to be detected by our analysis. A multifaceted approach is clearly the best way of investigating this hypothesis further, and we, therefore, agree with Rowan and colleagues that Quantitative Real Time Polymerase chain reaction (qPCR) analysis may provide worthwhile further insight.

Radiofrequenzablation von Schilddrüsenknoten: Good Clinical Practice Empfehlungen

J. Klin. Endokrinol. Stoffw. 2018 · 11:73–80 https://doi.org/10.1007/s41969-018-0043-6 Online publiziert: 21. September 2018

Primary hyperparathyroidism: Dynamic postoperative metabolic changes

Little is known about the natural changes in parathyroid function after successful parathyroid surgery for primary hyperparathyroidism. The association of intact parathyroid hormone (iPTH) and calcium (Ca) with “temporary hypoparathyroidism” and “hungry bone syndrome” (HBS) was evaluated.

Factors influencing pre-operative urinary calcium excretion in primary hyperparathyroidism.

Normal or elevated 24‐hour urinary calcium (Ca) excretion is a diagnostic marker in primary hyperparathyroidism (PHPT). It is used to distinguish familial hypocalciuric hypercalcaemia (FHH) from PHPT by calculating the Ca/creatinine clearance ratio (CCCR). The variance of CCCR in patients with PHPT is considerable. The aim of this study was to analyse the parameters affecting CCCR in patients with PHPT.