2. Aktuelles zur Schilddrüsenchirurgie: Hyperthyreose — Struma maligna

Zusammenfassung Es gilt den Stellenwert der Chirurgie in der Behandlung verschiedener Hyperthyreoseformen: Morbus Basedow bzw. thyreoidale Autonomie — zu definieren. Angesichts 60–80%iger Rezidivraten der rein medikamentösen Therapie soll alternativ zur Radiojodtherapie die Indikation zur Operation, erforderliche Vorbereitung, Behandlungsrisiko bzw. -erfolg abgehandelt werden. — Histomorphologische und Stadien-Klassifizierung entscheiden über chirurgische Radikalitätsprinzipien in der Therapie der Struma maligna. — Die Einführung gilt einer multidisziplinären Behandlung des Leitthemas.     

Zervikale Ösophagusresektion bei Struma maligna

Zusammenfassung Bei 2 F?llen von maligner Struma wurden ?sophagusresektionen durchgeführt, da die Speiser?hre bereits karzinomat?s infiltriert war. In beiden F?llen komplikationsloser Verlauf. Herrn Univ.-Prof. Dr. R.H?fer zum 60. Geburtstag gewidmet.     

116. Auswirkungen verschiedener Therapiekonzepte auf die Lebenserwartung maligner Strumen — Eine retrospektive Studie über 1128 Fälle

Zusammenfassung 1128 maligne Strumen, die in den Jahren 1949–1981 an der Chirurgischen Abteilung des Kaiserin Elisabeth Spitales der Stadt Wien unter 4 Vorständen (P. Huber, P. Fuchsig, G. Hienert, K. Keminger) mit sehr unterschiedlichen Therapiekonzepten behandelt wurden, wurden computermäßig erfaßt und in einer retrospektiven, klinischen Studie statistisch ausgewertet. Analysiert wurden: Tumorhistologie, Tumorstadium, Alter, Operationsart und Nachbehandlung.Die totale Thyreoidektomie mit Radiojod- und Hormontherapie hat beim differenzierten Ca. bei einer Langzeitbeobachtung von 25 Jahren die beste Lebenserwartung. Undifferenzierte Ca. sollten so radikal als möglich operiert und einer Hochvolttherapie zugeführt werden.     

Treatment of 153 Japanese patients with Q-switched alexandrite laser

We have recently used Q-switched alexandrite laser for the treatment of various kinds of pigmented skin lesions. We retrospectively compared therapeutic outcomes of 153 Japanese patients who consulted our department. This approach was not very efficient for nevus spilus/café-au-lait spots, which seemed laser-resistant, especially when the pigmentation had appeared after 1 year of age, was treated after 5 years of age, was located on the face, was oval with a smooth border, and the patient was male. This approach was equally effective for senile lentigo, nevus of Ota, and Mongolian spots, but less effective for acquired bilateral nevus of Ota-like macules. Some patients with sacral Mongolian spots or those with light-colored, senile lentigo developed severe post-inflammatory hyperpigmentation after treatment. As a whole, good therapeutic outcome was achieved after multiple treatment sessions. However, the use of other lasers or other treatment modalities should be considered to treat nevus spilus/café-au-lait spots.     

Lentigines, laser, and melanoma: a case series and discussion

Solar lentigines are considered one of the earliest signs of photoaging and are an extremely common cosmetic complaint. Successful removal of these lesions can be achieved with laser and non-laser light sources, and is one of the most frequently performed cosmetic procedures in laser centers. Distinguishing a benign lentigo from other pigmented lesions can sometimes be challenging, even for a trained dermatologist. We report a series of three patients who presented to our laser center within 2 months of one another for cosmetic removal of pigmented lesions that were found to be melanoma. One patient was referred by another dermatologist, one by a physician family member, and the other presented on his own. These cases highlight the need for careful evaluation of pigmented lesions prior to laser treatment, regardless of the source of the referral. In this article, we will review the diagnostic and treatment differences between lentigines and their malignant counterparts, and examine the role of laser in both.     

25. Indikation und operativer Eingriff bei den verschiedenen Formen und Stadien der malignen Struma

Zusammenfassung Das eigene Krankengut umfat bei 6502 benignen 173 maligne Strumen; die Malignitätsrate betrug in den letzten 5 Jahren 3,4 %. Die Operationsindikation ist beim kalten Knoten großzügig zu stellen. Trotz Selektion durch Punktionscytologie ist im Kindes- und Jugendalter, bei über 60jährigen und bei schnellem Wachstum und Konsistenzvermehrung die Entfernung des kalten Knotens angezeigt. Unabhängig von Histologie und TNM-Klassifizierung der Struma maligna steht die Thyreoidektomie an erster Stelle der Kombinationstherapie. Für die Indikation der neck dissection gibt es keine allgemein verbindlichen Richtlinien.     

A 71-Year-Old Woman with a Pigmented Nail Bed,which Persisted after Trauma

A 71-year-old woman presented in our out-patients department with pigmentation of the nail bed of her left large toe, which had persisted after a trauma two years earlier. An inconclusive biopsy showed melanoma in situ. The lesion was excised with amputation of the big toe at the IP-joint and closed primarily. The pathological diagnosis was melanoma in situ and lentigo maligna. The lesion had been radically excised.     

23. Reinterventionen beim Schilddrüsenmalignom

Zusammenfassung An der Chirurgischen Klinik der Universität München wurden von 1960–1975 217 operative Eingriffe, davon 82 Reinterventionen wegen Struma maligna durchgeführt. Histologie (differenzierte-entdifferenzierte, Carcinome), Tumorausbreitung, Alter und Geschlecht stellten auch für die Reintervention die Kriterien für operatives Vorgehen und Prognose dar. Je jünger der Patient, je begrenzter die Tumorausdehnung und je höher differenziert das Carcinom ist, um so frühzeitiger und radikaler sollte der Zweiteingriff erfolgen. Frühergebnisse wurden dargestellt, über die Spätprognose ist noch keine statistisch gesicherte Aussage möglich.     

122. Differenzierte Therapie der Schilddrüsencarcinome

Zusammenfassung Fernmetastasen anderer Tumoren in der Schilddrüse sind selten. Wir fanden bei 19 Patienten von 404 wegen Struma maligna operierter Patienten (1. 1. 1960–31. 12. 1984) eine Metastase (4,3%). Bei 14 Patienten war der Primärtumor vor der Operation bekannt, bei 5 Patienten wurde er erst später diagnostiziert. In unserem Krankengut überwog das Hypernephrom (n = 5), Bronchialund Mammacarcinom sowie gynäkologische Tumoren waren gleich häufig (n = 3). Die Prognose ist tumorabhängig, Monate bei Bronchial- und Mammacarcinom, z. T. Jahre bei den anderen. Operationsverfahren der Wahl ist die subtotale oder totale Resektion der metastasentragenden Schilddrüsenseite.     

124. Die kombinierte Behandlung der Struma maligna

Zusammenfassung Von 1969–1984 wurden 121 Schilddrüsenmalignom-Patienten 182mal operiert, nach der WHO-Klassifikation eingeteilt (82% differenziertes Carcinom; 40,4% papilläres) und einheitlich kombiniert behandelt: 74% Thyreoidektomie, 67% Radiojod, 6% Hormonsuppression allein, 14% Radiatio, 6% Cytostatica. Die Hospitalletalität der Operation betrug 4,9%. Die 5 Jahres-Überlebenswahrscheinlichkeit war für das papilläre Schilddrüsencarcinom 75%, das folliculäre 72% und das undifferenzierte 5%. Das geplante, eingeschränkt radikale Vorgehen des Tumorzentrums Heidelberg/ Mannheim für das occulte papilläre Schilddrüsencarcinom (ø < 1,5 cm) ohne Lymphknotenmetastasen wird vorgestellt.     

Perfil dos relatos de suscetibilidade à hipertermia maligna confirmados com teste de contratura muscular no Brasil

Background and objectives

Malignant hyperthermia is an autosomal dominant hypermetabolic pharmacogenetic syndrome, with a mortality rate of 10%‐20%, which is triggered by the use of halogenated inhaled anesthetics or muscle relaxant 10%‐20% succinylcholine. The gold standard for suspected susceptibility to malignant hyperthermia is the in vitro muscle contracture test in response to halothane and caffeine. The determination of susceptibility in suspected families allows the planning of safe anesthesia without triggering agents for patients with known susceptibility to malignant hyperthermia by positive in vitro muscle contracture test. Moreover, the patient whose suspicion of malignant hyperthermia was excluded by the in vitro negative muscle contracture test may undergo standard anesthesia. Susceptibility to malignant hyperthermia has a variable manifestation ranging from an asymptomatic subject presenting a crisis of malignant hyperthermia during anesthesia with triggering agents to a patient with atrophy and muscle weakness due to central core myopathy. The aim of this study is to analyze the profile of reports of susceptibility to malignant hyperthermia confirmed with in vitro muscle contracture test.

Resultados tras resección hepática laparoscópica: una opción adecuada en patología maligna

Introduction

The laparoscopic approach is not yet widely used in liver surgery, but has proven to be safe and feasible in selected patients even in malignant disease. The experience and results of a hepato-pancreato-biliary (HPB) surgery unit in the treatment of malignant liver disease by laparoscopic approach is presented.

Material and methods

Between February 2002 and May 2011, 71 laparoscopic liver resections were performed, 43 for malignant disease (only patients with more than one year of follow-up were included). Mean age was 63 years old and 58% of the patients were male. Forty-nine per cent of the lesions were located in segments ii-iii. Thirty segmentectomies were performed, 7 limited resections and 6 major hepatectomies.

Results

The median operative time was 163 min. There were 3 conversions. Five cases (11%) required blood transfusion. The oral intake began at 32 h and the median hospital stay was 6.7 days. There were no reoperations and there was one case of mortality. Nine patients (21%) had postoperative complications. The mean number of resected lesions was 1.2, with an average size of 3.5 cm. All resections were R0. The median survival after resection of colorectal liver metastases (CLM) was 69% and 43.5% at 36 and 60 months, respectively, and 89% and 68% at 36 and 60 months, respectively, in hepatocellular carcinoma (HCC).

Conclusion

The laparoscopic liver resection in malignant disease is feasible and safe in selected patients. The same oncological rules as for open surgery should be followed. In selected patients it offers similar long-term oncological results as open surgery.     

Reação atípica à anestesia em distrofia muscular de Duchenne/Becker

Background and objectives

Duchenne/Becker muscular dystrophy affects skeletal muscles and leads to progressive muscle weakness and risk of atypical anesthetic reactions following exposure to succinylcholine or halogenated agents. The aim of this report is to describe the investigation and diagnosis of a patient with Becker muscular dystrophy and review the care required in anesthesia.

Transformación maligna secundaria de teratomas testiculares: serie de casos y revisión de la literatura

BackgroundTeratomas are a spectrum of neoplasms that can undergo malignant transformation. In the World Health Organization (WHO) classification of tumors, this entity was classified as «teratoma with somatic-type malignancy», was defined as a malignant neoplasm of non-germinal phenotype that originates in a teratoma.Materials and methodsWe present a serie of nine cases of testicular teratomas with secondary malignant transformation. From January 1995 to December 2011, we found a total of 306 cases of testicular tumors. Mixed germ cell tumors were the most frequently diagnosed malignancy with 45.7%.ResultsTeratoma with secondary malignant transformation, represented 2.9% of all germinal tumors. Five cases originated within a mixed germ cell tumor, two cases from mature teratomas, and two from immature teratomas. The predominante malignant somatic component were sarcomas; two cases of chondrosarcoma, one rhabdomyosarcoma, and one case showing foci of chondrosarcoma and rhabdomyosarcoma. The case of osteosarcoma is notable for its rarity. Two cases showed epithelial malignancy in the form of an adenocarcinoma, and finally, two cases were primitive neuroectodermal tumors. At the time of diagnosis, five patients had metastases.ConclusionThe transformation of germ cell tumors to somatic type malignancies is rare. The malignant component can originate from any of the three germ lines. These tumors are resistant to standard chemotherapy for a germ cell tumor and the clinical stage is the most important prognostic factor. At our institution, the malignant component that appeared most frequently was chondrosarcoma.