Wound complications and clinical results of electrocautery versus a scalpel to create a cutaneous flap in thyroidectomy: a prospective randomized trial.

PURPOSE: The use of electrocautery for tissue dissection is becoming increasingly popular, despite the associated risk of poor wound healing and excessive scarring. We conducted this study to compare the wound complications and early and late clinical results resulting from electrocautery versus the scalpel to create a cutaneous flap during thyroidectomy. METHODS: The subjects of this study were 100 patients, randomized prospectively to either a scalpel group (group S, n = 50) or an electrocautery group (group E, n = 50). RESULTS: Thickness of tissue damage, postoperative thickness of the flap, discomfort in the neck 7 days after surgery, and hypoesthesia and paresthesia in the neck 3 months after surgery were significantly higher in group E than in group S. There were no significant differences in overall postoperative wound complications, postoperative pain, satisfaction with the cosmetic result, or overall outcome of the operation between the groups. Although the incidence of seroma was higher in group E (20%) than in group S (8%), the difference was not significant. CONCLUSION: Although electrocautery was associated with increased histological tissue damage, postoperative flap edema, discomfort, and other complications in the early stage, the clinical and cosmetic results of flaps made using electrocautery or a scalpel were similar and satisfactory 6 months after surgery.

Immunohistochemical study of E-cadherin and ß-catenin expression in colorectal carcinomas.

Parameters of histological type, differentiation, lymph node metastasis and stage have been observed to indicate the prognosis of colorectal carcinomas. Immunohistochemically E-cadherin and ß -catenin expression of tumour cells have been evaluated to define life expectancy, response to the treatment, metastatic disease and recurrence of tumour in correlation with these prognostic parameters. 60 cases diagnosed as colorectal adenocarcinoma were selected to be studied retrospectively. Immunohistochemistry was performed using E-cadherin and ß -catenin primary antibodies and avidin-biotin-peroxidase. 53 of 60 adenocarcinoma tissues were evaluated as classical type adenocarcinoma and 7 of them as mucinous carcinoma. 48 classical type adenocarcinoma tissues showed membranous staining for E-cadherin, 13 tissues showed cytoplasmic staining. All 53 adenocarcinoma tissues expressed nuclear or membranous type ß -catenin in different intensities. Reduced E-cadherin expression significantly correlated with lymph nodes metastasis (p = 0.01). E-cadherin expression significantly correlated with increasing histological differentiation (p = 0.04). When E-cadherin and ß -catenin expressions were compared, there was a significant difference between the tumour stage, histological differentiation and the existence of lymph node metastasis. When both E-cadherin and ß -catenin expressions were reduced, there was a significant unfavourable prognosis.

Giant true cyst of the spleen with elevated serum markers, carbohydrate antigen 19-9 and cancer antigen 125.

A 19-year-old woman presented with a left upper abdominal mass. Computed tomography of the abdomen showed a solitary cystic lesion in the splenic hilum, approximately 20×16 cm in size, demonstrating almost total displacement of the remaining splenic parenchyma. She had high serum concentrations of carbohydrate antigen 19-9 and cancer antigen 125. A splenectomy was performed. Immunohistochemical study confirmed the existence of an epithelial cyst. Following surgery, the serum concentrations of the tumour markers decreased gradually. True splenic cysts are rare and their origin is controversial. In splenic cysts with high serum concentrations of tumour markers, such as occurred in our patient, cystectomy or splenectomy were preferred to remove tumour marker-producing epithelium and to prevent recurrence after treatment. If the epithelial lining of the cyst cannot be detected under light microscopy, immunohistochemical study should be performed.