Outpatient hemithyroidectomy: A retrospective feasibility analysis.

BACKGROUND: Outpatient surgery is a major public health policy issue. It is controversial for total thyroidectomy, which raises the question of hemithyroidectomy. The present study assessed our experience in outpatient hemithyroidectomy. OBJECTIVES: To evaluate the rates of postoperative hematoma and unscheduled hospital admission. MATERIAL AND METHODS: A multicenter retrospective analysis was conducted in two hospital centers between January 2009 and December 2013. Exclusion criteria for outpatient hemithyroidectomy comprised: ASA score >2, anticoagulant therapy, risk of completion procedure, and associated procedure requiring >12 hours' surveillance. Data were collated for age, gender, weight, postoperative complications, and unscheduled hospital admission. RESULTS: During the study period, 294 hemithyroidectomies were performed, 130 of which on an outpatient basis (44%). There were no medical contraindications to outpatient surgery in 64% of patients operated on under conventional admission. In the outpatient group, mean age was 44 years. Eight completion thyroidectomies were performed in the outpatient group, and only two patients required admission for surveillance, with no revision surgeries. All patients were satisfied or very satisfied with outpatient management. CONCLUSION: In our experience, outpatient hemithyroidectomy was safe and reliable.

Calcitonin-secreting carcinomas of the prostate. An immunohistochemical and ultrastructural analysis.

Two cases of calcitonin-producing carcinomas of the prostate are reported. Light microscopical, immunohistochemical, and ultrastructural investigations have been performed. These tumors displayed a remarkable dual, endocrine and common epithelial (exocrine), differentiation. However, they presented two different architectural growth patterns. Of particular interest, numerous calcitonin cells were immunocharacterized. In addition, the endocrine component could harbour carcinoembryonic antigen, serotonin, human chorionic gonadotrophin, and prostate-specific acid phosphatase immunoreactive cells. Ultrastructural analysis confirmed the presence of numerous endocrine cells. These findings are not unexpected, since calcitonin, serotonin, and human chorionic gonadotrophin immunoreactive cells are normal and constitutive inhabitants of prostate gland. In the current cases, calcitonin cells showed a strong carcinoembryonic antigen immunoreactivity, as observed also in thyroidal C-cells. This peculiar kind of prostatic carcinoma might be compared to certain thyroidal tumors of intermediate type coupling parafollicular and follicular differentiation.

[Spontaneous rupture of the liver in pregnancy. Case study and review of the literature]. / La rupture "spontanée" du foie au cours de la grossesse. Etude d'un cas et revue de la littérature.

The authors report a case of "spontaneous" rupture of the liver in a woman of 35 years of age. This occurred immediately after post-partum eclampsia. It was not possible to obtain complete haemostasis using absorbable haemostatic compresses along the convexity of the liver. Complete cessation of bleeding only occurred after the operation when posterior pituitary abstracts had been transfused. The patient died 53 days after the initial procedure from a high gastro-intestinal haemorrhage. A study of the literature shows that this rare condition is most probably a complication of toxaemia of pregnancy but the physio-pathology of these liver lesions is ill-understood. The clinical picture is in two phases--the first corresponds to the formation of a sub-capsular haematoma and the second to the intra-peritoneal rupture of this haematoma. The prognosis for this condition is poor, the maternal mortality ranging from 56%-75%. The prognosis is linked to the speed with which the diagnosis is made and surgical intervention is carried out. This should be done before the capsule of the liver ruptures. Haemostasis is nearly always best obtained by using haemostatic compression with packs but haemostasis is not always adequate, particularly if there are several lesions in both lobes of the liver. This case history shows that using posterior pituitary abstracts in transfusion can be helpful.