Infiltrating papillary thyroid carcinoma: review of 134 cases of papillary carcinoma.

BACKGROUND: Papillary thyroid carcinomas (PTCs) are diagnosed mainly by the features of nuclei of the neoplastic cells. Theoretically, by similarity to other types of carcinoma, infiltrative tumor growth likely distinguishes the thyroid neoplastic lesions with potential of metastasis from those without this capability. METHODS: One hundred thirty-four cases of PTC, consisting of 41 encapsulated tumors and 93 nonencapsulated tumors, were examined for the presence of infiltrating PTC (IPTC), defined by tumor cells infiltrating a desmoplastic or sclerotic stroma. RESULTS: Encapsulated tumors with focal or extensive IPTC and nonencapsulated tumors with focal or extensive IPTC were associated with rates of lymph node metastases of 28%, 42%, 36%, and 65%, respectively. The tall cell variant of PTC was associated with a higher rate of metastasis. There was a small group of tumors without identifiable IPTC, designated as PTC without identifiable infiltrating carcinoma, which included six encapsulated tumors with areas of sclerosis in the capsule and three nonencapsulated tumors consisting of neoplastic cells with optically clear nuclei, nuclear grooves, and intranuclear inclusions in over two thirds of the cell population. Of these lesions, one case developed lymph node metastases. Papillary thyroid tumors without areas of IPTC and exhibiting the nuclear changes described, but in less than two thirds of the tumor cells, did not develop lymph node metastases. CONCLUSIONS: Infiltrating tumor growth is an indicator of malignant behavior in most thyroid papillary neoplastic lesions. The extent of IPTC is likely proportional to the rate of lymph node metastases.

Expanded polytetrafluoroethylene patch in hernia repair: a review of clinical experience.

The use of an implantable prosthetic material is often needed to repair inguinal and incisional hernias, especially when the local tissue is of poor quality or there is a large defect that would cause excessive tension if closed without patching with prosthetic material. An expanded polytetrafluoroethylene (ePTFE) patch was used in 37 patients between May 1986 and May 1990 to repair 25 direct inguinal and 12 incisional hernias. There was one recurrence in the group of patients with incisional hernia but none in those with a direct inguinal hernia. The recurrence was due to poor collagen ingrowth into the patch and subsequent herniation between two sutures. There were no complications due to infection, adhesions, erosion or fistulization. On the basis of this clinical experience, the authors conclude that the ePTFE patch is almost an ideal abdominal wall substitute, but that because of poor anchorage with tissue reaction alone, the success of the repair depends on the technique of suture placement.

Percutaneous catheter drainage of abdominal abscesses.

This paper presents a study of 45 patients who had percutaneous catheter drainage of 52 intra-abdominal abscesses. In 37 patients this was the only treatment necessary; the other 8 needed further surgery to correct the cause of the abscess or treat concurrent surgical disease. The catheter complication rate was 3.8%.

Dysphagia following vagotomy.

Dysphagia is a fairly common complication of vagotomy but has received little attention in the literature. The authors reviewed the hospital records of 79 patients who underwent highly selective vagotomy or truncal vagotomy with various types of drainage. Overall, 11 patients (13.9%) suffered from dysphagia, which was generally of short duration. The incidence of dysphagia was significantly (p less than 0.001) higher after highly selective vagotomy than after truncal vagotomy (60% versus 7.2%). There was no significant difference between the occurrence of dysphagia after elective compared with emergency truncal vagotomy. The dysphagia usually resolves spontaneously and requires no specific therapy.

Familial polyposis coli: an unusual family.

Familial polyposis is an autosomal, dominantly inherited disorder. Usually less than 50% of siblings are affected because of incomplete penetrance by the responsible gene. The family described in this paper was unusual in that all seven siblings of one son had the disorder. The chances of this occurring, assuming complete penetrance, is 1 in 128. Moreover, several members of his family had Gardner's syndrome with associated extracolonic manifestations, including a rarely associated papillary carcinoma of the thyroid. There was no evidence of a cosanguineous marriage. Patients with familial polyposis are advised to adopt children, otherwise surveillance of their children must be lifelong, beginning at puberty.

Outpatient treatment of pilonidal disease.

In pilonidal disease there are recurrent painful draining intergluteal abscesses that require surgical treatment. Many types of treatment have been suggested for this condition. On the basis of our experience, as described below, we propose that pilonidal disease can be successfully treated on an outpatient basis with local anesthesia, minimal excision, marsupialization and packing.

Anaerobic liver abscess complicating radiation enteritis.

Multifocal liver abscess developed in a 68-year-old woman with radiation enteritis. Two strains of Bacteroides fragilis were cultured from the liver and blood. Surgical drainage was not possible, and in spite of appropriate antibiotic therapy the patient died.