Course of the recurrent laryngeal nerve relative to the inferior thyroid artery and the suspensory ligament of Berry.

An awareness of the surgical anatomy and the possible dispositions of the recurrent laryngeal nerve (RLN) is very helpful in avoiding its injury during thyroidectomy. The relationship of the RLN to the inferior thyroid artery (ITA) and the suspensory ligament of Berry were studied in 172 patients undergoing thyroidectomy. One hundred and ninety one nerves were identified, 109 on the right and 82 on the left. Most nerves, both on the right (82.6%) as well as on the left (85.4%) ran either posterior or between the branches of the inferior thyroid artery. The majority of nerves were found within 3 mm from Berry's ligament. The relationship of the recurrent laryngeal nerve to the inferior artery and to the ligament of Berry does not follow a constant anatomical pattern. Nevertheless these structures have a quite close relationship to the nerve in the majority of cases.

Pancreas transplant pathology. A morphologic, immunohistochemical, and electron microscopic comparison of allogeneic grafts with rejection, syngeneic grafts, and chronic pancreatitis.

In an effort to establish diagnostic criteria for rejection and recurrent disease in transplanted pancreas, a comparative study was performed based on clinical diagnosis. Clinical rejection was diagnosed in patients who had decreased urinary amylase or increased blood glucose; they were treated for rejection and improved. A clinical diagnosis of recurrent diabetes was made in syngeneic transplant recipients with islet dysfunction. In addition, two control groups were used--nontransplant, nondiabetic pancreatitis patients and pretransplant normal biopsies from patients in the study. Morphologically, tissues were assessed for acinar inflammation, ductal changes, islet and nerve inflammation, and vascular changes. Immunohistochemical staining for insulin and glucagon was also performed to quantitate differences between the groups. Vascular changes (endothelialitis, vasculitis, obliterative endarteritis) were specific for rejection. Also, rejection was characterized by a lymphocytic or mixed infiltrate that involved the ducts. Recurrent diabetes was characterized by selective loss of beta cells with isletitis. Leukocyte common antigen and UCHL1 staining was helpful in identifying islet inflammation. An insulin/glucagon ratio of less than 1.0 appears to be specific for recurrent disease and in the absence of isletitis is a reasonable method for detecting recurrent disease at an early stage.

Long-term follow-up of renal transplantation for Wegener's disease.

Eight patients with end-stage renal failure due to Wegener's granulomatosis underwent renal transplantation at the University of Minnesota. Seven patients were alive with a functioning graft 40 to 128 months posttransplant (mean follow-up: 91 months). One patient died 126 months posttransplant with a well-functioning graft. Posttransplant immunosuppression controlled primary disease in all but 1 patient, who presented with perisinusitis. Recurrent disease was not noted in any of the transplanted organs. We conclude that transplantation is an excellent treatment for renal failure secondary to Wegener's disease.

Unusual primary locations of hydatid disease. Case report.

Two unusual cases of primary hydatid disease are described. In one of them a retroperitoneal cyst, presenting as a palpable abdominal mass, was strongly adherent to the inferior vena cava and dislocated the right kidney. Partial cystectomy and drainage were performed. The other cyst, of the right ischiorectal fossa, was initially misinterpreted as a perineal of sciatic hernia. It was completely removed. No other site of hydatid disease was found and the patients remain well 3 and 4 years postoperatively.

Site distribution of carcinoma of the large intestine. Retrospective study of 600 cases.

The site distribution of large-bowel adenocarcinomas was studied in a retrospective study compromising 600 patients. These patients were divided into two groups according to the year of their operation; group A included patients operated upon between 1978 and 1982, and group B patients were operated upon between 1983 and 1987. Comparing these two five-year periods, a statistically significant increase in the incidence of right colon tumors was noted (P less than 0.05). There was no difference in the distribution pattern of the carcinomas according to sex or age between the two groups (P less than 0.1). The shift to the right of large-bowel neoplasms may indicate the need for an alteration of the diagnostic procedures concerning this disease, with more emphasis given to total colonoscopy and or double-contrast barium enema.