Reoperative thyroid surgery is an uncommon operation associated with a high complication rate. We retrospectively reviewed the data of 115 patients to study the incidence of complications after reoperative thyroid surgery. There were 107 women and 8 men (13.4:1.0) with an average age of 42.8 years (range 18-80 years). The most frequent indication for reoperation was completion thyroidectomy for a carcinoma identified by permanent sections (50 patients, 43.5%). Reoperative surgery was performed on 13 (11.3%) patients with recurrent thyroid cancer. The remaining 52 patients underwent reoperation for recurrent thyrotoxicosis (12 patients, 10.4%), recurrent nodular goiter (28 patients, 24.3%) or recurrent multinodular goiter (12 patients, 10.4%). Seven patients with recurrent nodular goiter and one patient with recurrent thyrotoxicosis underwent total thyroidectomy for the presence of malignancies that were identified by frozen sections. Overall, the interval between the initial and reoperative procedures ranged from 1 day to 33 years (2335 +/- 272 days). The length of hospital stay was 5.8 +/- 0.5 days. The length of time needed for reoperative thyroid surgery was 122.0 +/- 6.2 minutes. There was no 30-day perioperative mortality. The postoperative complications consisted of transient hypoparathyroidism in six patients (5.2%), permanent hypoparathyroidism in two patients (1.7%), transient RLN palsy in 3 patients (2.6%), and permanent recurrent laryngeal nerve palsy in two patients (1.7%). Reoperative thyroid surgery can be performed safely with little morbidity to the patient.

Adolescent↗

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Mass poisoning in Perak, Malaysia or the Tale of the Nine Emperor Gods and rat tail noodles.

Explore the source record for details and available documents.

Adolescent↗

PubMedDate not supplied

Angiolipoma of the breast with microcalcification. Mammographic, sonographic, and histologic appearances.

Angiolipoma of the breast is a rare benign fatty tumor that can be mammographically confused with breast carcinoma. We herein report such a case presenting as a partial obscured mass with microcalcification on mammogram. Sonogram revealed an encapsulated hyperechoic nodule with homogeneous internal echo. Microscopic evaluation revealed abundant adipose tissues with evidence of proliferating vessels and intravascular hyaline thrombi. To our knowledge, angiolipomas of the breast containing microcalcification secondary to intravascular thrombi had not been previously reported.

Angiolipoma↗

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Thyroid follicular neoplasms diagnosed by high-resolution ultrasonography with fine needle aspiration cytology.

OBJECTIVE: To investigate the final results of cases with preoperative diagnoses of thyroid follicular neoplasms by fine needle aspiration cytology (FNAC). STUDY DESIGN: A retrospective review of 6,499 patients who received thyroid ultrasonography with FNAC at Chang Gung Memorial Hospital. Among 6,499 patients, 209 (3.2%) were diagnosed by FNAC as having follicular neoplasms, of which 84 received surgical treatment. Eighty-two of the 84 cases had a frozen section prepared during the operation. RESULTS: Thyroid malignancy was confirmed histopathologically in 164 cases. Among 84 thyroid follicular neoplasm patients, 21 cases were diagnosed as malignant tumors, including papillary thyroid carcinoma, follicular thyroid carcinoma, medullary thyroid carcinoma and Hürthle's cell carcinoma. Ultrasonography on these 21 patients revealed that 16 cases (76.2%) had low echo density in the thyroid nodule. The percentage was statistically significantly different from that in benign cases, 23.8% (P < .05). A higher incidence of malignancy was found in males, but the data did not reach statistical significance (P = .0586). CONCLUSION: Most of the follicular neoplasms revealed by FNAC were benign lesions. Low echo density on ultrasonography and male sex carried a higher risk of malignancy.

Adenocarcinoma, Follicular↗

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Diagnosis of occult thyroid carcinoma by thyroid ultrasonography with fine needle aspiration cytology.

OBJECTIVE: To assess the role of ultrasonography and fine needle aspiration cytology (FNAC) in preoperative diagnosis of patients with occult thyroid carcinoma (OTC). STUDY DESIGN: Data on 768 thyroid carcinoma patients receiving primary treatment at Chang Gung Medical Center were retrospectively reviewed. Of these patients, 97 had OTC. To detect small thyroid nodules early and define the characteristics of clinically palpable nodules, thyroid ultrasonography with FNAC were performed on 67 histopathologically proven OTC patients. Analysis for diagnostic value was done for ultrasonography and FNAC. RESULTS: In the 67 patients receiving ultrasonography with FNAC, 23 were preoperatively diagnosed as having papillary thyroid carcinoma and 1 as having follicular carcinoma. The tumor size of these 24 preoperative FNAC-proven OTC was 0.81 +/- 0.23 cm (mean +/- SD). In the remaining patients, 10 presented pictures suspicious for malignancy, with a mean tumor size 0.63 +/- 0.24 cm, and 33 (49.3%) were diagnosed as having benign thyroid lesions in preoperative FNAC. The tumor size in these 33 lesions was 0.58 +/- 0.24 cm. Fifty-seven of the 67 OTC patients received frozen sections. Thirty-eight papillary thyroid carcinomas and four follicular carcinomas were correctly diagnosed on frozen sections. CONCLUSION: Although the rate is not high, high-resolution ultrasonography and FNAC is the best approach to preoperative diagnosis for OTC patients today.

Adenoma↗

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Gastroduodenal perforation in cancer patients.

BACKGROUND/AIMS: Patients with advanced or metastatic cancer have compromised nutritional, metabolic, and immune conditions. Little is known about gastroduodenal perforation in cancer patients. METHODOLOGY: Data of 11 cancer patients with gastroduodenal perforation were retrospectively reviewed. RESULTS: There were 2 females and 9 males with a mean (+/- s.e.) age of 56.7+/-4.7 years and a median of 55. The primary malignancies included lung cancers (3 cases), hepatocellular carcinomas (2 cases), squamous cell carcinomas of the tongue (2 cases), malignant lymphoma of the small bowel (1 case), adenocarcinoma of the pancreas (1 case), adenocarcinoma of the stomach (1 case), and acute lymphoblastic leukemia (1 case). The average duration of symptoms was 36.5+/-10.1 hours (median: 24 hours). Methods of surgical treatment included simple closure of the perforation (6 cases), truncal vagotomy and pyloroplasty (3 cases), pyloroplasty (1 case), and subtotal gastrectomy (1 case). Four patients (36.4%) had post-operative complications. The post-operative hospital mortality rate was 18.2%. One patient died of sepsis with gastrointestinal hemorrhage and 1 died of hepatic failure and respiratory failure. Pre-operative shock is the only significant factor in predicting operative mortality. CONCLUSIONS: Gastroduodenal perforation occurring in cancer patients without chemotherapy had favorable short-term operative results.

Adult↗

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Surgical treatment of papillary and follicular thyroid carcinoma.

There is limited clinical information about the prognostic factors in survival and distant metastasis for well differentiated thyroid cancer in Chinese patients. Pitfalls were noted when applying the results of published studies to another population. In order to realize the differences of these factors between different areas, we retrospectively analyzed the data of 569 papillary or follicular thyroid carcinoma patients who received their primary treatment at the Chang Gung Memorial Hospital during the period from January 1979 to June 1994. Actuarial survival rates were calculated by the Kaplan-Meier method. For the analysis of prognostic variables, 14 clinical parameters were coded into the computer for the univariate and multivariate analyses. Multivariate analysis was performed to assess the independent effect of these variables using the Cox model. Among these cases, there were 466 papillary thyroid carcinoma (81.9%), 103 cases of follicular thyroid carcinoma (18.1%). The subjects included 440 female patients with mean age of 38.8 +/- 14.4 years and 129 male patients with the mean age of 44.7 +/- 14.4 years (p = 0.0001). Most of the cases received total thyroidectomy treatment after the diagnosis was confirmed by a frozen section during the operation. In the follow-up period, 30 (5.3%) patients died of metastatic thyroid cancer. The one year Greenwood survival probability after the disease diagnosed in papillary and follicular thyroid carcinomas was 0.986 and 0.909 respectively. Using a log-rank univariate analysis, survival was significantly associated with the histological type of primary tumors, age, clinical staging, post-operative 131I pattern, tumor size, postoperative serum thyroglobulin (Tg) level and post-operative X-ray findings. Tumor size larger than 2.5 centimeters could influence both the survival and distant metastases of these well differentiated thyroid cancer patients. In the Cox multivariate regression analysis, the combination factors that gave the best prognostic values were the association of distant metastasis (0.005), age (p = 0.027), and one month postoperative serum Tg level (p = 0.042). Well differentiated thyroid cancer is not an unusual disease in Taiwan. In this limited period of follow-up study, distant metastasis at the time of surgery, the patients' age and one month post-operative serum Tg level may serve as the prognostic factors for the well differentiated thyroid cancer patients.

Adenocarcinoma, Follicular↗