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A biztonságra törekvő radikalitás helye, szerepe és dilemmái a pajzsmirigysebészet mindennapjaiban
Safety-driven radical approaches in routine thyroid surgery: roles and challenges
Introduction: In thyroid surgery, the primary objectives are to facilitate effective hormone replacement therapy and to prevent recurrent diseases. Thyroid lobectomy is often the optimal approach to achieve these goals. Objective: This study aims to establish the criteria for safety-driven radicality and identify the appropriate surgical approaches. Methods: A total of 2215 thyroid surgeries were performed between 2001 and 2003. Among these, 86.1% were uni- or bilateral lobectomies, and 12.3% were near-total resections. Substernal extension was observed in 28.9% of cases, and recurrent disease was found in 5.3%. Partial sternotomy was required in 1.8% of cases. Results: Of the 2215 thyroid specimens analyzed, 27.9% were tumors, 19.6% showed hyperplasia, and 18.1% exhibited inflammation. Among the 216 cases of papillary carcinoma, the occult form was present in 42.1%, encapsulated form in 30.1%, multinodular form in 26.4%, bilateral involvement in 12.5%, and mixed appearance in 8.3%. Lymph node involvement in the central region was detected in 41% of cases. Co-occurrence of tumors with Hashimoto’s thyroiditis was significantly more common than with hyperplasia. Transient laryngeal nerve paresis occurred in 3.3% of cases, while permanent paresis was observed in 0.49%. Discussion: Radicality in thyroid surgery aims to minimize residual tissue while ensuring the functional integrity of nerves and parathyroid glands. These objectives are challenged by tissue inflammation, cancer, substernal extension, recurrent disease, and undetected metastases in the central paratracheal lymph nodes. Our analysis of routine lobectomies with meticulous nerve preparation revealed a significantly higher incidence of recurrent laryngeal nerve paresis in cases involving recurrent disease. Conclusion: Maintaining blood-free surgical conditions, cooling the nerves during preparation, meticulous dissection of nerves at the superior pole of the thyroid, and experience in excising non-inflammatory thyroid tissue are crucial for achieving safety-driven radicality. These practices are effective not only in cancer cases but also in the presence of hyperplasia, inflammation, and recurrent disease. Orv Hetil. 2024; 165(39): 1548–1557.
Nontyphoid salmonella (NTS) serotypes can cause gastroenteritis, bacteriemia, and focal infections. However, these focal infections, including urinary tract infections (UTI), are occasionally observed; in particular, the presence of several predisposing factors, such as immunodeficiency and structural abnormality in the urinary tract, increase the possibility of the occurrence of infection. We present a case of UTI caused by Salmonella enterica serovar Virchow in an elderly and debilitated patient with benign prostatic hyperplasia (BPH). Administration of appropriate antibiotic treatment resulted in recovery of the patient’s clinical course.
Experimental infection of specific-pathogen-free (SPF) Leghorn chickens with a highly pathogenic H5N2 avian influenza virus produced cellular hyperplasia in the bone marrow at 36 hours post infection (hpi) and haematological evidence of monocytosis, thrombocytopenia and heterophilia was also detected. An early, significant and progressive haematological change was thrombocytopenia starting at 24 hpi without an increase of prothrombin time. The findings suggest that highly pathogenic avian influenza virus interferes only with the primary haemostatic mechanisms by consumption of thrombocytes, while the secondary haemostatic mechanisms remain intact.
Absztrakt
Az eosinophil oesophagitis a nyelőcső krónikus, antigénmediált gyulladása. A nyelőcsőben orális és/vagy aeroantigének által indukált eosinophilgranulocyta-infiltráció, nyálkahártya-hyperplasia és a subepithelialis rétegek fibrosisa szűkülethez, dysphagiához és falatelakadáshoz vezethet. A betegség gyakran társul más allergiás kórképekkel, mint az asthma vagy az atopiás dermatitis. Az eosinophil oesophagitis kezelésének sarokkövei az elkerülő diéta és a helyileg alkalmazott, gyulladáscsökkentő szteroidkezelés. A szerzők áttekintik a jelenleg rendelkezésre álló kezelési stratégiákat. Orv. Hetil., 2015, 156(23), 927–932.
The mechanisms leading to the development of eosinophilia were investigated in 65 patients with immunodermatological disorders, including the role of eosinophilotactic cytokines and the possible involvement of human T-cell leukemia virus, HTLV. HTLV-1 gag proviral sequences were revealed in two cases of lymphoproliferative disorders such as angiolymphoid hyperplasia with eosinophilia (ALHE) and CD4+ cutaneous lymphoma, respectively. Increased level of GM-CSF was detected in 33% of disorders studied. Elevated level of IL-5 and eotaxin was detected in 27% and 30%, respectively, of patients with bullous diseases. Elevated level of GM-CSF and eotaxin was found in 33% and 46%, respectively, of patients with inflammatory diseases. Neither of the four cytokines, however proved to be responsible alone or together for the induction of eosinophilia. The possible indirect role of human retroviruses through induction of eosinophilic chemotactic cytokines is hypothesized.
Abstract
Selenium is an essential trace element and its levels in blood have been widely used for assessing Se status in humans. The aim of this present study is to develop a suitable method for the determination of Se in red blood cells (RBC) using ICP-MS after microwave digestion. The blood samples were obtained from patients with benign prostatic hyperplasia (BPH), who attended urology clinics at the Princess Alexandra hospital, Brisbane, Australia. No apparent polyatomic and matrix interferences were encountered when 82Se isotope was used for the analysis of Se levels in RBC. Whole Blood Seronorm Trace Elements (SERO, Norway) and dogfish muscle (DORM-1, NRCC) were used as reference materials for method validation. The method was rapid and accurate, and ideal for routine analysis of Se in RBC, and in particular for assessing of Se status in humans.
Abstract
The effects on vascular restenosis of intravascular radiation delivery from 188Rhenium (Re)-perrhenate liquid-filled balloon through beta-particle radiation are controversial. To determine the effect of beta-radiation on vascular injury in hypercholesterolemic rabbits, thirty rabbits fed with a high cholesterol diet were enrolled into this study. All the rabbits underwent percutaneous transluminal balloon overstretch over left iliac artery. After balloon overstretch, the catheter was withdrawn and immediately followed by irradiation using low dose 188Re solution (10 Gray) in the vascular wall 0.5 mm distal to intimal surface. After 2 and 6 weeks, arteries were harvested for histological and immunological analysis. This rabbit study suggest that endovascular 188Re low dose irradiation at the non-injury segment of iliac artery may enhance intima hyperplasia and smooth muscle cell proliferation.
The authors describe a case of unilateral adenocarcinoma emerging from the Harderian gland, filling the right orbital cavity of a Florida Red-bellied Turtle ( Pseudemys nelsoni ). The tumour did not produce any metastasis but presented an expansive growth and led to the dislocation and protrusion of the right eyeball. Histopathological analysis revealed the presence of numerous mitotic figures in the cellular population that made up the tumour. The tumour cells completely filled the alveoli of the gland and had a nest-like structure. The authors also emphasise the importance of the differential diagnosis of this rare pathological change in turtles. Epithelial hyperplasia of the Harderian gland’s duct, observed in animals suffering from vitamin A deficiency, can also lead to an enlargement of the eyelid, but in these cases the change usually involves both eyelids symmetrically. This is the first description of a Harderian gland adenocarcinoma in a Florida Red-bellied Turtle.
M Yokoyama 1999 Adenomyomatosus hyperplasia of the papilla of Vater: A sequela of chronic papillitis? Ann Diagn Pathol 3 174
Aktualitások az essentialis thrombocythaemia diagnosztikájában és terápiájában
Current management of essential thrombocythemia
Absztrakt:
Az essentialis thrombocythaemia Philadelphia-negatív krónikus myeloproliferatív neoplázia, amelyet emelkedett thrombocytaszám, megakaryocyta hyperplasia, fokozott thrombohaemorrhagiás és lassan progrediáló transzformációs hajlam jellemez. Ritka betegség, incidenciája 0,5–1,5/100 000 lakos/év, előfordulása női predominanciát és bimodalitást mutat: fiatal nőkben és az 50–70 évesekben gyakoribb. Az essentialis thrombocythaemia diagnózisa a 450·109/l feletti thrombocytaszámon, a normális erythroid sejttömegen és vasraktáron, valamint egyéb thrombocytosist okozó tényezők hiányán alapul, egyéb myeloproliferativ neoplasiák (a myelofibrosis, krónikus myeloid leukémia) kizárandóak. A Janus-2 pszeudokináz gén V617F-mutációja az essentialis thrombocythaemiás esetek közel 50%-ában fordul elő, a fennmaradókban a calreticulin gén (CALR) exon 9, néhányukban pedig thrombopoetin receptor gén (MPL) mutációja mutatható ki, de 10–15%-ban ezek egyike sincs jelen, ezeket tripla-negatív eseteknek nevezzük. A betegség tünetei a gyengeség, fejfájás, thrombohaemorrhagiás események mellett az erythromelalgia lehetnek. A splenomegalia általában mérsékelt fokú. A betegség prognózisa általában igen jó, a fő szövődményt a vascularis események jelentik. Az ET kezelésében elsődleges a thrombocyta aggregáció gátlás, de a 60 évnél idősebb és/vagy korábban már thromboembolián átesett betegek esetén cytoreduktív kezelés is javasolt. Az irodalmi adatok szerint a thrombosis kockázat nem függ össze a thrombocytosis mértékével.
