Guidelines of Polish National Societies Diagnostics and Treatment of Thyroid Carcinoma. 2018 Update.

Significant advances have been made in thyroid can-cer research in recent years, therefore relevant clinical guidelines need to be updated. The current Polish guidelines "Diagnostics and Treatment of Thyroid Carcinoma" have been formulated at the "Thyroid Cancer and Other Malignancies of Endocrine Glands" conference held in Wisla in November 2015 [1].

Neuroendocrine tumours of rare location.

Neuroendocrine tumours (NETs) arising from dispersed endocrine system may originate from almost every location, although they are most commonly found in the gastrointestinal tract and respiratory system. NETs are considered as particularly rare if they constitute less than 1% of all neuroendocrine tumours. The aim of the paper is to present ten rare NETs from the database of the Endocrinology Department of the Jagiellonian University, Medical College: 4 NETs of the ampulla of Vater, 2 of the gallbladder, and 1 of the ovary, sphenoid sinus, Meckel's diverticulum, and epiglottis. The clinical presentation of such tumours and their management are discussed.

An evaluation of the utility of additional tests in the preoperative diagnostics of acute appendicitis.

BACKGROUND: Determining the optimum algorithm for diagnostic procedure in suspected acute appendicitis (AA) may not only reduce the number of unnecessary operations, but also the frequency of complications, and may contribute measurably to reducing the costs of treating patients with acute abdominal conditions. OBJECTIVE: The aim of the study was to assess the value of standard diagnostic methods and measurement of selected biochemical and hematological parameters (C-reactive protein, CRP; interleukin-6, IL-6; procalcitonin, PCT; total count of white blood cell, WBC) in the accuracy of preoperative AA diagnosis. MATERIAL AND METHODS: The prospective study included 132 patients (female: 52.3%, male: 47.7%) emergency admitted to the Surgical Department, aged 15 to 74 years (mean 36 years), with a suspicion of appendicitis. Measurement of PCT concentration was carried out by immunoluminometric assay, IL-6 concentration by micro enzyme-linked immunosorbent assay and CRP concentration by immunonephelometric assay. Statistical analysis was done by the chi-square test and Fisher's exact test for categorized discrete variables, and the Mann-Whitney U and Kruskal-Wallis tests for continuous variables. In order to assay the diagnostic utility of tests, the receiver operating characteristic model of curve analysis was used. RESULTS: AA was confirmed in 89 (67.5%) of the patients operated on (group A). Twenty-six (19.7%) of the patients were not operated on and did not require surgery (group C); in 13 patients (9.8%) operated with a preliminary diagnosis of AA, no changes in the appendix were found during the course of the operation (group B). Four (3%) of the patients treated conservatively for periappendicular infiltration were excluded from the following analysis (group D). The mean count of WBC in AA was 13.22 ± 4.45 × 103/µL, with no statistical significance between groups, which does not allow the patients requiring surgery to be distinguished. The highest elevation of IL-6 concentration was observed in the group with the AA and the periappendicular infiltration: 101.5 ± 355.9 vs. 173.6 ± 228.33 pg/mL, respectively; p < 0.05. No surgery patients of group C showed considerably lower CRP concentrations than those of group D: CRP: 2.05 ± 3.6 vs. 6.36 ± 4.74 mg/L; p < 0.05. In cases of advanced forms of AA, the gangrenous with perforation, higher marker values are obtained than those in the phlegmonose form (186.60 ± 541.2 vs. 40.08 ± 48.3 pg/mL; (p < 0.05) for IL-6 and 8.88 ± 7.45 vs. 2.84 ± 3.83 mg/L; (p < 0.001) for CRP, respectively). CONCLUSIONS: 1. AA diagnosis based only on an assessment of clinical status may lead to an increase in the number of people operated with false-positive diagnoses of AA. 2. Applying additional diagnostic methods such as IL-6 determination seems to be useful in reducing the numbers of false-positive diagnoses of AA. 3. Laboratory tests, i.e., CRP, IL-6, and PCT are much more useful in assessing the risk of complications during the course of AA.

Surgical management of mediastinal goiter: risk factors for sternotomy.

BACKGROUND AND AIMS: Mediastinal goiter constitutes an indication for surgical management. The procedure can most commonly be performed using the cervical access, but at times, a sternotomy or thoracotomy is necessary. The objective of the investigation was to analyze the prevalence and therapeutic results in patients with mediastinal goiter and to assess factors that affect the need of performing sternotomy in the course of mediastinal goiter surgery. MATERIAL AND METHODS: In the years 1984-2004, i.e., over 21 years, 11,849 patients with various types of goiter were operated on in the department. Mediastinal goiter was detected in 88 (0.76%) individuals. The analyzed material included 64 (72.7%) females and 24 (27.3%) males. The age of the patients ranged between 19 to 81 years, with the mean age of 61 +/- 13 years of life. The material was statistically analyzed. Risk factors for sternotomy were assessed using the multidimensional logistic regression method. RESULTS: The highest percentage of mediastinal goiter was noted in patients operated on due to recurrent goiter (3.86%). Goiter situated in the anterior mediastinum was noted in 61 (69.3%) individuals, while 27 (30.7%) patients demonstrated goiter located in the posterior mediastinum; of the latter, nine were previsceral and 18 retrovisceral. In the majority of cases, these were primarily cervical goiters, which descended from the neck to the mediastinum (53 patients). Aberrant adenomas were diagnosed in 32 (36.4%) individuals. Four patients presented with the superior cava vein syndrome. Primary goiters evaluated intraoperatively with blood supply originating from the mediastinal vessels were observed in 12 (13.6%) cases. In 27 (30.7%) patients, sternotomies were necessary. In the majority of cases, these were individuals with goiters showing additional blood supply originating from the mediastinal vessels, patients with aberrant adenomas in the mediastinum, especially in recurrent goiters, or else subjects with goiters situated in the posterior mediastinum as compared to anterior mediastinal goiters. No postoperative mortality during stay in a hospital was noted. CONCLUSIONS: Surgical management of patients with mediastinal goiter is the therapeutic modality that requires considerable experience of the surgical team, performed in specialized centers, and appropriate preoperative diagnostic management. Statistically significant risk factors for sternotomy are as follows: recurrent goiter, primary mediastinal goiter, posterior mediastinal location of goiter, and the presence of an aberrant adenoma situated in the mediastinum.

Metastases to the thyroid gland: seventeen cases operated on in a single clinical center.

BACKGROUND AND AIMS: In spite of its rich vasculature, the thyroid gland is rarely the site of metastatic disease. The incidence of such metastases differs depending on the type of the analyzed material. In clinical papers, the incidence is low and, according to various sources, amounts to 2-3% of all malignant tumors of the thyroid. Most commonly, the primary tumor is located in the breast, bronchi, gastrointestinal system, (the colon, esophagus, or stomach) and kidneys. Usually, metastatic thyroid disease is identified upon autopsy, and only sporadic cases are encountered in clinical material. The authors present their experience in treating metastatic disease involving the thyroid gland based on the analysis of their clinical material consisting of patients operated on in a single center. MATERIALS AND METHODS: Seventeen patients presented with metastatic tumors of the thyroid. The material was further analyzed retrospectively. The group included four men and 13 women, with the male to female ratio of 1:4.25. The age of the patients ranged from 46 to 76 years, with the mean age amounting to 62+/-9.78 years. Eleven patients were diagnosed based on fine needle aspiration biopsy (FNAB). RESULTS: In 13 patients, the primary lesion was a clear cell carcinoma of the kidney, in one breast cancer, in another one uterine carcinoma. In two patients, no primary focus location was established. All the patients were treated surgically. Twelve patients were consistently followed up after the surgery. Of this group, seven are still alive, including five individuals with metastases of renal carcinomas, but without recurrent disease. Five patients died due to disseminated neoplastic disease. No data are available on three patients. The mean follow-up time after thyroid surgery was 3.9 years. The longest followed-up survival time was 11 years. CONCLUSIONS: The most commonly clinically detected and treated surgically metastatic lesion of the thyroid gland is clear cell cancer of the kidney. In cases of renal cancer metastases to the thyroid gland, a total thyroidectomy seems to be warranted, although it does not affect the survival time.

[The role of prophylactic examinations in detecting thyroid disorders. Preliminary results]. / Rola badan profilaktycznych w wykrywaniu schorzen gruczolu tarczowego. Doniesienie wstepne.

PREFACE: Nonpalpable nodules in the thyroid are frequent and estimated to be found in 50% of people above 50 year of age when goiter in adult population is found in 4-10%. Thyroid nodules in 5% are of neoplastic character and their diligent investigation is necessary with USG, FNA and certain biochemical factors evaluation. Screening is an important part of diagnosing thyroid gland. MATERIAL AND METHODS: Prophylactic examination donated by Krakow's City Government was performed in 140 persons aged 18-71 among whom 93.3% were women. Clinical examination, USG, FNA (when it was necessary), and TSH serum level evaluation were conducted in these patients. RESULTS: In 42.2% (group I) no abnormalities were detected. In 28.5% (group II) USG revealed thyroid nodules when clinical examination was negative. In 29.3% (group III) the presence of palpable nodules was confirmed by USG. In consecutive groups I-III following factors were presented: mean age, frequency of performed FNA's and thyroids volume. CONCLUSION: USG is an efficient method in prophylaxis of thyroid disorders.

[Post-thyroidectomy hemorrhage]. / Krwotok po operacji wola.

The aim of the study was to estimate the prevalence and causes of haemorrhages, that required extemporaneous surgical treatment, after goiter operations, in our own material. Between 1984 and 2000, i.e. during 17 years, 7400 patients were operated in our Clinic due to different kinds of goiter. Haemorrhage during post operative period was presented in 46 (0.62%) patients. There were 37 women and 9 men in the analysed material. The age of patients was between 19 and 77 years, and the average age was 50.6 +/- 15.4. The lowest percentage of this complication was observed after operation of non-toxic goiter (0.39%) and the highest in a group of patients operated due to Graves-Basedow's disease (1.02%). Frequent local symptoms were observed, such as: enlargement of circumference of neck, supple haematoma with dyspnoea, and sometimes swallowing difficulties. A decrease in blood pressure was observed in 5 (10.9%) patients. Low molecular weight heparin prophylaxis was applied in 18 (39.1%) patients and in 2 cases disorders of blood coagulability were observed. The quantity of drainage from the wound was between 30 and 610 ml, with average 249.8 +/- 144.69 ml. Time from main operation termination to revision was 20 to 1440 minutes, with average time 346 +/- 285.66 minutes. The most common cause of post-thyroidectomy haemorrhage was bleeding from the thyroid lobe stump, which presented in 28 (60.9%) patients. The most dangerous haemorrhage, because of its intensity, was the bleeding from the upper thyroid artery (6 patients). During the postoperative period 16 patients (34.8%) required blood transfusions, however massive transfusions (4 and more blood units) were performed only in 4 patients. Early complications included: paralysis of recurrent laryngeal nerve in 6 patients and transient hypocalcaemia in one patient.