Five-Year Follow-up of a Randomized Clinical Trial of Unilateral Thyroid Lobectomy with or Without Postoperative Levothyroxine Treatment

Background  

The aim of this study was to compare the prevalence of recurrent nodular goiter in the contralateral thyroid lobe among patients after unilateral thyroid lobectomy for unilateral multinodular goiter (MNG) receiving versus not receiving postoperative prophylactic levothyroxine (LT4) treatment.     

Quality of life is not influenced by the extent of surgery in patients with benign goiter

Introduction  

The surgical approach to benign goiter is becoming increasingly radical due to the risk of recurrent goiter. The aim of this prospective study was to evaluate the impact of surgery on health-related quality of life (HRQoL) of patients with benign goiter.     

Indications for Surgery and Significance of Unrecognized Cancer in Endemic Multinodular Goiter

Background  

The exclusion of cancer in endemic goiter is often difficult mainly because of the high number of nodules and the as-yet unclear natural history of diagnosed cancer in endemic goiter patients. In a large number of consecutive patients who were to undergo total thyroidectomy for endemic multinodular goiter, we assessed indications for surgery and thyroid cancer outcome.     

Papillary Thyroid Microcarcinoma: Extrathyroidal Extension, Lymph Node Metastases, and Risk Factors for Recurrence in a High Prevalence of Goiter Area

Background  

Although papillary thyroid microcarcinoma (PTMC) is diagnosed with increasing frequency, the best therapeutic option and follow-up protocol have not been established yet, especially in the case of incidental diagnosis. We reviewed our series of patients with PTMC to determine risk factors for recurrence in an area where there is a high prevalence of goiter.     

Heavy and Trace Metals in Carcinoma of the Gallbladder

Background

Carcinoma of the gallbladder is the commonest malignancy of the biliary tract in northern India The etiologic relation of specific metals (heavy and trace) and their compounds to neoplasia has been a topic of investigation for some time but not adequately described for carcinoma of the gallbladder. The aim of the present study was to evaluate the relation of heavy and trace metals to this malignancy.

Methods

The levels of selenium, zinc, copper, manganese, cadmium, chromium, lead, and nickel were estimated in serum, bile, gallstones, and gallbladder tissue using atomic absorption spectrophotometry. The tests were carried out in 30 patients with gallbladder cancer and 30 sex-matched patients with cholelithiasis.

Results

Selenium and zinc levels were significantly reduced (p < 0.001) and copper concentration was found to be significantly higher (p < 0.001) in serum, bile, and gallbladder tissue from patients with carcinoma of the gallbladder. Lead, cadmium, chromium, and nickel levels were elevated in serum and bile in patients with carcinoma of the gallbladder.

Conclusions

The present study demonstrated a significant decrease in serum, biliary, and tissue levels of selenium and zinc but increased copper, lead, cadmium, chromium, and nickel levels in patients with carcinoma of the gallbladder, indicating a strong relation between the concentrations of these metals and gallbladder cancer.     

Five-year Follow-up of a Randomized Clinical Trial of Total Thyroidectomy versus Dunhill Operation versus Bilateral Subtotal Thyroidectomy for Multinodular Nontoxic Goiter

Background  

The extent of thyroid resection in multinodular nontoxic goiter (MNG) is controversial. The aim of the present study was to evaluate results of various thyroid resection modes, with special emphasis put on the recurrence rate and morbidity rate, in a 5-year follow-up.     

Correlations of SELENOF and SELENOP genotypes with serum selenium levels and prostate cancer

Background

Selenium status is inversely associated with the incidence of prostate cancer. However, supplementation trials have not indicated a benefit of selenium supplementation in reducing cancer risk. Polymorphisms in the gene encoding selenoprotein 15 (SELENOF) are associated with cancer incidence/mortality and present disproportionately in African Americans. Relationships among the genotype of selenoproteins implicated in increased cancer risk, selenium status, and race with prostate cancer were investigated.

Methods

Tissue microarrays were used to assess SELENOF levels and cellular location in prostatic tissue. Sera and DNA from participants of the Chicago‐based Adiposity Study Cohort were used to quantify selenium levels and genotype frequencies of the genes for SELENOF and the selenium‐carrier protein selenoprotein P (SELENOP). Logistic regression models for dichotomous patient outcomes and regression models for continuous outcome were employed to identify both clinical, genetic, and biochemical characteristics that are associated with these outcomes.

Results

SELENOF is dramatically reduced in prostate cancer and lower in tumors derived from African American men as compared to tumors obtained from Caucasians. Differing frequency of SELENOF polymorphisms and lower selenium levels were observed in African Americans as compared to Caucasians. SELENOF genotypes were associated with higher histological tumor grade. A polymorphism in SELENOP was associated with recurrence and higher serum PSA.

Conclusions

These results indicate an interaction between selenium status and selenoprotein genotypes that may contribute to the disparity in prostate cancer incidence and outcome experienced by African Americans.

     

Survival in anaplastic thyroid cancer in relation to pre-existing goiter: a population-based study

Background

We investigated whether pre-existent goiter and well-differentiated thyroid cancer (WDTC) are associated with survival in anaplastic thyroid carcinoma (ATC).

Methods

We analyzed medical records from 94 ATC patients, drawn from the Netherlands Cancer Registry, diagnosed in 17 hospitals between 1989 and 2009.

Results

The 29 patients (31%) with pre-existent goiter, including 8 with WDTC, were younger than those without (median, 69 vs 76 years; P = .02). One-year overall survival was 9% (95% confidence interval [CI], 3% to 14%) with no difference between pre-existent goiter or not (overall survival, 14%; 95% CI, 1% to 26% vs overall survival, 6%; 95% CI, 0% to 13%]). Higher age was associated with a worse survival (hazard rate, 1.03; 95% CI, 1.01 to 1.06]), whereas the hazard to die was lower after surgery and/or radiotherapy (hazard rate, .37; 95% CI, .21 to .67 and hazard rate, .22; 95% CI, .12 to .41, respectively).

Conclusions

ATC patients with pre-existent goiter were younger, yet survival was not significantly different between those with or without pre-existent goiter or WDTC.     

Colorectal Liver Metastasis in the Setting of Lymph Node Metastasis: Defining the Benefit of Surgical Resection

Background  

For patients with colorectal liver metastasis (CLM), the presence of concomitant perihepatic/para-aortic lymph node metastasis (LNM) is considered a contraindication to liver resection. We sought to determine the benefits of liver resection among patients with CLM + LNM by examining long-term outcomes among a large cohort of patients.     

Complications in primary and completed thyroidectomy

Purpose  

To compare the rates of postsurgical complications following a primary and completed thyroidectomy for multinodular goiter (MNG).     

Assessment of Selenium in Roux-en-Y Gastric Bypass and Gastric Banding Surgery

Background

Until recently, there was limited documented data on both dietary and serum selenium deficiency in bariatric surgery. We performed an evaluation of selenium intake and both serum selenium and glutathione peroxidase (GTP; as a functional measurement of selenium) before and after roux-en-Y (RNY) gastric bypass and gastric banding surgery.

Methods

The endpoints obtained from the subjects included dietary intake of selenium and vitamins E and C, as well as serum levels of selenium, GTP and vitamins E. These were analyzed at pre-surgery (baseline) and 3 and 12?months post surgery.

Results

Dietary deficiencies in selenium intake (38.2?% recommended daily allowance) were noted at 3?months, but not baseline or 12?months, in the gastric bypass group. No dietary deficiencies were noted in the lap band group. For both surgeries, there was a significant reduction from baseline to 3?months in both serum selenium and GTP levels (p?=?0.033 and 0.0033 respectively). The serum selenium levels and GTP levels both trended back toward baseline values by 12?months without concomitant selenium supplementation. Mean GTP levels were below normal at all three time points while mean serum selenium levels were all at or above normal.

Conclusions

This study shows that RNY gastric bypass and laparoscopic adjustable gastric banding procedures, and accompanying dietary restrictions, increases the risk for disturbances of selenium and GTP homeostasis. Consideration for selenium supplementation at higher levels than the current RDA of 55?mcg daily during the first 3?months and perhaps longer should be studied further.     

Do higher hospital-wide nurse staffing levels reduce in-hospital mortality in elderly patients with hip fractures: a pilot study

Background  

There is increasing recognition that lower nurse staffing levels are associated with higher morbidity and mortality among medical and surgical patients. The degree to which this applies to elderly patients with hip fractures is unclear.     

Surgical Treatment of Endemic Goiter in a Nonhospital Setting without General Anesthesia in Africa

Background

Endemic goiter remains a serious public health problem and 75 % of people affected live in underdeveloped countries where treatment is difficult for various reasons. The aim of this article is to report our experience in African countries with the management and surgical treatment of endemic goiter, performed in a nonhospital setting and without general anesthesia in the context of a collaborative development project by experienced endocrine surgeons.

Methods

Fifty-six black African patients with a goiter were studied. Those in poor general health, the elderly, patients with either small goiters or clinical hyperthyroidism, and those presenting with an acute episode of malaria were excluded from the study. Cervical epidural anesthesia with spontaneous ventilation was used and a partial thyroidectomy was performed. The technique used, its immediate complications, and early and late follow-up were analyzed.

Results

Surgery was performed on 31 patients with grades 3 and 4 goiter without mortality and a morbidity rate of 11.9 %, with 97 % of all complications being minor. There were no instances of dysphonia or symptomatic hypocalcemia and the mean stay was 1.57 days (range 1.25–1.93). Follow-up in the first year was 71 % and no case of severe or recurrent hypothyroidism was detected.

Conclusions

Surgery without general anesthesia performed in a nonhospital setting in underdeveloped countries in patients with goiter is a viable option with good results and low morbidity.     

A High Body Mass Index in Esophageal Cancer Patients Does Not Influence Postoperative Outcome or Long-Term Survival

Background  

The body mass index (BMI) in the general population has increased over the past decades. A high BMI is a known risk factor for the development of esophageal adenocarcinoma. Several studies on the influence of a high BMI on the postoperative course and survival after esophagectomy have shown contradictory results. The aim of the present study was to determine the influence of a high BMI on postoperative complications and survival among a large cohort of esophageal cancer patients.     

Reliability of videotaped observational gait analysis in patients with orthopedic impairments

Background  

In clinical practice, visual gait observation is often used to determine gait disorders and to evaluate treatment. Several reliability studies on observational gait analysis have been described in the literature and generally showed moderate reliability. However, patients with orthopedic disorders have received little attention. The objective of this study is to determine the reliability levels of visual observation of gait in patients with orthopedic disorders.     

Nonoperative management of pancreatic injuries in pediatric patients

Purpose  

Nonoperative management of minor pancreatic injury is the generally accepted approach. However, the management of major pancreatic injury remains controversial in pediatric patients. The aim of the present study was to determine the safety and efficacy of nonoperative management of pancreatic injury in pediatric patients.     

Fall incidence and risk factors in patients after total knee arthroplasty

Purpose  

To prospectively investigate the relationship between physical function and falls among elderly patients who underwent total knee arthroplasty (TKA) and to determine the incidence of falls as well as their risk factors.     

Diagnostic Utility of Fine-Needle Aspiration Cytology in Pediatric Differentiated Thyroid Cancer

Background  

Pediatric patients present with thyroid nodules less often than adults, but the rate of malignancy is much higher. This study was designed to determine the ability of fine-needle aspiration cytology (FNA) to diagnose accurately and facilitate management of thyroid neoplasms in pediatric patients.     

Clinicopathological study of infection-associated glomerulonephritis in adults

Objectives  

Infection-associated glomerulonephritis is uncommon in adults. In the present study, we have tried to determine the mode of presentation, the spectrum of morphology, and the prognostic factors for renal outcome in adult patients with infection-associated glomerulonephritis.     

Analysis of Factors Associated with Prognosis After Colorectal Cancer Resection in 174 Chinese Elderly Patients

Purpose  

The purpose of the present study was to investigate risk factors associated with prognosis in elderly patients with colorectal cancer (CRC) and to determine treatment and follow-up strategies.