Laparoscopic treatment of perforated duodenal ulcer -- a multicenter study.

AIM: The aim of this study is to evaluate the results of the laparoscopic treatment of perforated duodenal ulcer performed in 6 Romanian surgical centres with experience in the field of laparoscopic surgery. MATERIAL AND METHOD: Between 1996 and 2005, 186 patients with perforated duodenal ulcer were operated on in the centers participating in this retrospective study, all patients being ASA I-II. Thirty-nine patients (20.0%) presented mild peritonitis, 120 (64.5%) medium peritonitis and 27 (15.5%) severe (20.0%) simple suture was performed, in 110 (59.1%) suture with epiplonoplasty, for 1 (0.5%) only epiplonoplasty and 1 (0.5%) underwent excision of the perforation and suture. RESULTS: The operative time was between 30-120 minutes, with an average of 75 minutes. No death was noted. Average hospitalization time was 6 days, with periods varying between 3 and 18 days. Postoperative complications included: 5 patients (2,6%) presented infections of the abdominal walls, 1 patient (0.5%) duodenal fistula, 1 patient (0.5%) intra-abdominal abscess, 1 patient (0.5%) a superior digestive hemorrhage by "mirrored ulcer" and 1 patient (0.5%) duodenal stenosis 6 months after operation. The patients were administered 50% less analgesics, used 70% less dressings, 30% less antibiotics and had 60% less complications in comparison with those operated by the classical approach. CONCLUSION: The laparoscopic approach of perforated duodenal ulcer constitutes the first choice for patients without important co-morbidities, allowing a quick recovery and a significant reduction in the consumption of analgesics, antibiotics and dressing materials.

Evaluation of proliferation potential in thyroid normo-/hypofunctioning and hyperfunctioning nodules.

INTRODUCTION: Thyroid follicular adenomas (FA) and adenomatous thyroid nodules (AN) - lesions that are frequently found in areas with iodine deficiency, can be normo-/hypofunctioning (scintigraphically cold - SCN) or hyperfunctioning (scintigraphically hot - SHN) nodules. AIM: Evaluation of proliferation potential in thyroid nodules on tissue samples obtained at surgery from euthyroid patients clinically diagnosed with SCN and from patients with thyroid hyperfunction and SHN. MATERIALS AND METHODS: We investigated the proliferation activity estimated by assessing PCNA and Ki-67 proliferation markers in 20 SCN (eight FA and 12 AN) and 16 toxic nodules (six hyperfunctioning FA and 10 toxic multinodular goiters), on formalin-fixed and paraffin-embedded tissue samples, 4-5 µm thick; we used the immunohistochemical technique in LSAB system (DAB visualization) with anti-PCNA (PC10) and anti-Ki-67 (MIB-1) monoclonal antibodies. For each case, we calculated the proliferation index PI-PCNA and PI-Ki-67. The dates were statistically evaluated using the t-unpaired test. RESULTS: We observed a higher PI-PCNA in thyroid nodules than in the normal surrounding thyroid tissue, with statistically significant values for FA (14.3% vs. 3.8%; p<0.029) and also for AN (8.36% vs. 1.24%; p<0.001). The mean PI-Ki-67 in nodules vs. surrounding thyroid tissue was 1.64% vs. 1.10% in FA (p<0.35) and 1.07% vs. 0.51% in AN (p>0.05). We also noted: (1) significantly higher PI-PCNA values (p < 0.01) in FA (14.03%) than in AN (8.36%), as compared to statistically insignificant values for Ki-67 (1.64% vs. 1.07%; p>0.05); (2) increased proliferation rate (p<0.01) in thyroid nodules with aspects of lymphocytic thyroiditis (LT) (PI-Ki-67 was 1.21%) as compared to nodules without LT (PI-Ki-67 was 0.12%); (3) a mean PI-PCNA of 8.5% and PI-Ki-67 of 4.61% in toxic thyroid nodules (TTN) vs. 3.01% and 1.5% in normal surrounding thyroid, respectively. CONCLUSIONS: The clinical expression of SCN is the consequence of increased thyrocyte proliferation in the nodules; the increased proliferative potential of TTN thyrocytes is a common feature of nodules, independent of their histopathological characteristics.

[Thyroid cancer--the malignant lesions in the contralateral lobe]. / Cancerul tiroidian--leziunile maligne din lobul contralateral.

AIM: This study analysed the frequency of the malignant lesions in contralateral thyroidian lobe after completion thyroidectomy for malignant lesions in the ipsilateral lobe, in order to establish which patients have indication of total thyroidectomy. MATERIAL AND METHOD: There were studied retrospectively 228 patients which had completion thyroidectomy after histological confirmation of the thyroid cancer in the ipsilateral lobe. RESULTS: Thyroid cancer in contralateral lobe was found in 94(41.2%) patients. One (4.7%) of patients with cancer < 1 cm in ipsilateral lob had malignant lesions in the contralateral lobe. In patients with ipsilateral lobe cancer > 1 cm, the frequency of malignant lesions was between 42.8% and 47.6%. CONCLUSION: The very high frequency of malignant lesions in the patients with ipsilateral thyroid cancer > 1 cm impose total thyroidectomy in these cases.

[Differentiated thyroid carcinoma in children and adolescents: therapeutic strategy according to clinic presentation]. / Cancers différenciés de la thyroïde chez l'infant et l'adolescent: stratégie thérapeutique adaptée à la présentation clinique.

AIM OF THE STUDY: The aim of this retrospective study was to propose a therapeutic strategy according to clinic and pathologic presentations, in differentiated thyroid carcinoma in patients less than 20 years of age. PATIENTS AND METHODS: From 1995 to 2002, 74 patients less than 20 years of age were operated on for a differentiated thyroid carcinoma. Patients were divided in two groups according to the presence of lymph node (LN) detected before operation (19 "with LN" and 55 "without LN"). RESULTS: Surgery consisted of total thyroidectomy and lymph node dissection in the group "with LN". In the second group "without LN", total thyroidectomy was performed in 19 patients (associated with lymph node dissection in seven) and loboisthmectomy in 29 patients. Post operative radio iodine ablation was performed in 25 patients (16 "with LN" and nine "without LN"). During the follow up (median 71 months), 9/19 patients "with LN" underwent surgery for lymph node recurrence. Four patients of the "without LN" group were reoperated for recurrence in the controlateral thyroid lobe after initial loboisthmectomy. Initial presence of lymph nodes was a risk factor for reoperation. Survival without reoperation at 5 and 10 years was 58% and 38% for the "with LN" group and 96% and 91% for the "without LN" group respectively (P < 0.001). At the time of analysis, all patients were alive. Ninety percent of patients were in remission (68% of "with LN" and 98% of "without LN" patients). CONCLUSION: The risk of reoperation for lymph node recurrence during first post operative year is important in the "with LN" group. Therapeutic strategy consists of total thyroidectomy, complete lymph node dissection, radio iodine administration and l-thyroxine treatment. In "without LN" patients risk of lymph node recurrence is low. Treatment consist of total thyroidectomy, lymph node dissection and radio iodine administration are not systematic.

[When to prescribe scintigraphy in the exploration of thyroid nodules?]. / Cand prescriem scintigrama tiroidiana în explorarea nodulilor tiroidieni?

Scintigraphy is employed almost systematically in current medical practice for initial thyroid nodules investigation. More and more authors observed that scintigraphy has lost importance confronted with others modern exam, but there are no statistical essay to demonstrate this fact. The aim of our work was to study, on 369 patients, the real contribution of scintigraphy to establish diagnosis and therapeutical strategy. Scintigraphy was truly useful only in 47 (12.7%) patients. We may conclude that thyroid scintigraphy ought to be indicated only in low TSH thyroid nodules, ectopic goiter and, eventually, in metastasis uptake radioactive iodine.

[Thyroid scintigraphy: its place in preoperative diagnosis of thyroid nodules?]. / La scintigraphie thyroïdienne: quelle place dans le bilan préopératoire des nodules thyroïdiens?

AIM OF THE STUDY: To evaluate the real contribution of the thyroid radionuclid scanning in the preoperative evaluation of the thyroid nodules. MATERIAL AND METHOD: The authors prospectively studied 369 patients who underwent surgical intervention: 160 (43.4%) for isolated nodules and 209 (56.6%) for multinodular goiters. RESULTS: The scintigraphy of the thyroid was performed in 281 (76.2%) patients: 39 (13.8%) patients with nodules less than 1.5 cm in diameter and 242 (86.2%) patients with nodules more than 1.5 cm in diameter. In 234 patients (83.3%) the scintigraphic evaluation did not bring any utile information for the therapeutic decision. The scintigraphy proved its utility only in 47 patients, which represents 16.7% from the scintigraphic exams performed, or 12.7% from the patients that underwent a surgical procedure. CONCLUSIONS: In the presence of thyroid nodule or multinodular goiter, the scintigraphy is indicated only in decreased TSH level, suspicion of ectopic thyroid or retrosternal goiter.

[Surgical treatment of thyroid nodules. The immediate results after different thyroidectomy methods]. / Tratamentul chirurgical al nodulilor tiroidieni. Rezultate imediate dupa diferite tipuri de tiroidectomie.

The extension of the resection for thyroid nodules depends both on nodules' nature and immediate or late postoperative complications risks. This clinical study analyzed the immediate complications appeared after partial thyroidectomy comparatively with those developed after total thyroidectomy. We studied 1411 patients operated in two clinics (from Romania and from France) which have two different attitudes concerning the width of the resection. Paralysis of recurrent laryngeal nerve occurred in 1.0% of patients with partial thyroidectomy and 3.0% of patients with total thyroidectomy, while only one patient (0.6%) developed permanent hypoparathyroidism after total thyroidectomy. In conclusion, total thyroidectomy can be performed by experimented surgeons with a recurrent or parathyroid injury risk similar to partial thyroidectomy. However, the surgeon should take into account the patient survey capacity and the discomfort produced by life substitutive treatment.