Risk factors for anaplastic thyroid cancer.

Background. Anaplastic thyroid cancer (ATC) is a form of thyroid cancer with very poor prognosis, but is fortunately quite rare. Its aetiology is unknown and not well researched. Aim. The aim of this study was to identify potential risk factors for ATC. Material and Method. Case-control study of 126 ATC patients (77 females and 49 males) and 252 controls individually matched by gender, age, and place of abode. In statistical analysis we used a Cox regression model. Results. Univariate logistic regression showed that the risk factors for ATC are low education level, type B blood group, goitre, other nonthyroid malignancies, diabetes, late menarche, and an early first pregnancy. Multivariate logistic regression analysis showed that independent risk factors for ATC are low education level (OR = 1.42, 95% CI = 1.09-1.86), type B blood group (OR = 2.41, 95% CI = 1.03-5.66), and goitre (OR = 25-33, 95% CI = 5.66-126.65). Conclusion. Independent risk factors for ATC are: low education level, type B blood group, and goitre.

Surgical anatomy of the pyramidal lobe and its significance in thyroid surgery.

AIM: The purpose of this prospective study was to highlight some new findings about anatomical and morphological variations of the thyroid pyramidal lobe and to emphasise the necessity and importance of exploration of the visceral compartment of the neck and resection of this structure in primary thyroid operations. METHOD: We analysed 100 consecutive primary thyroid operations with additional pathological examination of the specimens. RESULTS: A pyramidal lobe was found in 61% of the cases. The lobe of Lalouette was found more often in women (61.96%) than in men (50%) and more often (67.3%) in patients less than 50 years old than in those older than 50 (54.2%). The lobe branched off more frequently from the midline (49.18%) than from other parts of the isthmus; its length ranged from 8 - 40 mm, with a median length of 20.13 mm. In diffuse thyroid diseases, the lobes were always pathologically involved and significantly longer. CONCLUSION: Since the pyramidal lobe is a normal component of the thyroid gland, of varying position and size, with pathological changes in benign and malignant diseases, it should always be examined during thyroid surgery and mandatorily removed in total and subtotal thyroidectomies.

[Solitary hyperfunctioning thyroid gland carcinomas]. / Unifokale hyperfunktionelle Karzinome der Schilddrüse.

BACKGROUND: Thyroid gland carcinomas usually appear as afunctional and hypofunctional lesions on thyroid scintigrams, but some rare cases of thyroid carcinoma with scintigraphic hyperfunctional lesions have also been reported. The aim of our retrospective study was to elucidate the frequency of carcinomas in patients operated for solitary hyperfunctional thyroid nodules and to represent their demographic and clinical features. PATIENTS AND METHODS: During one decade (1997/2006), 308 patients were operated for solitary hyperfunctional thyroid nodules in the Centre for Endocrine Surgery in Belgrade. RESULTS: Malignancy was revealed in 9 cases (about 3 %) by histopathological examination. In 6 cases papillary microcarcinomas were found adjacent to dominant hyperfunctional adenomas, while in 3 cases (about 1 %) real hyperfunctional carcinomas were confirmed. Follicular carcinoma was diagnosed in 2 cases and papillary carcinoma in one. All 3 patients were preoperatively hyperthyroid. In both patients with follicular carcinoma we performed lobectomies. In the third case we carried out a total thyroidectomy considering the intraoperative frozen section finding of a papillary carcinoma. CONCLUSIONS: According to our results the frequency of solitary hyperfunctioning thyroid carcinomas is about 1 %, so that the possibility that a hyperfunctional nodule is malignant should be considered in the treatment of such lesions.

[The incidence rate of thyroid microcarcinoma during surgery benign disease].

Thyroid microcarcinoma are well-differentiated tumors less than 1 cm in diameter. A retrospective analysis was performed on patients operated of benign thyroid disease at the Center for endocrine surgery, Institute of endocrinology, Clical Center of Serbia in Belgrade, from January 1st to December 31st 2004, in order to establish the incidence of microcarcinoma. Indications for surgery were euthyroid multinodular goiter in 201 patients, thyroiditis in 31, thyroid adenoma in 178, Graves disease in 89 and Plummers disease in 79 patients. The results of this study, demonstrate that in 13.4% of the patients operated for goiter, 6.4% operated for thyroiditis, 5.6% for thyroid adenomas, 9.0% for Graves disease and 7.0% of the patients operated for Plumers disease, the presence of a microcarcinoma was noticed in the definitive histopathologic examination. The results obtained are in line with the current knowledge of high incidence of thyroid microcarcinoma.

[Classification, staging, prognostic factors and risk factors in thyroid carcinoma]. / Klasifikacija, stepenovanje, prognosticki faktori i faktori rizika kod karcinoma stitaste zlezde.

Thyroid carcinomas arise from follicular cells (papillary, follicular, Hurthle, anaplastic), parafollicular cells (medullary) and stroma (lymphoma, sarcoma). Gradation and prognostic factors are different for every one of histological type. Most patients with papillary and follicular thyroid cancer have an excellent prognosis. At the other extreme is anaplastic thyroid cancer whose usual mean survival can be measured in months. Exposure to external radiation and living in endemic goiter area increase the frequency of thyroid cancer. Medullary thyroid carcinoma is often familial and may occur in associations with the multiple endocrine neoplasia syndromes.

[Specifics of preoperative care, intraoperative monitoring and postoperative evaluation of patients with thyroid carcinoma]. / Specificnosti preoperativne pripreme, intraoperativnog monitoringa i postoperativne evaluacije bolesnika sa karcinomom stitaste zlezde.

The aim of the study was to show the standards of preoperative management, intraoperative monitoring and postoperative evaluation of patients with thyroid gland carcinoma. It was point out the importance of the preoperative diagnosis of the tumor, and the concurrent diseases. The special attention was paid to difficult airway recognition and resolving this situation. Both, anesthetist's and surgeon's point of view of perioperative and postoperative complications were discussed with special interest on early surgical complications and the need for urgent anesthetic treatment. Criteria for minimal and desirable monitoring of vital functions were suggested in order to prevent, recognize and cure complications. Our conclusions were based on recent references from the world literature and on our own experience in Center for endocrine surgery KCS, Belgrade.

[Anaplastic carcinoma of the thyroid gland]. / Anaplasticni karcinom stitaste zlezde.

The aim of the present paper was to study some characteristics and possibility of surgery of anaplastic thyroid cancer. During five years period in Center for endocrine surgery, we found anaplastic thyroid cancer in 65 patient (44 female and 21 male), median age 63 years (from 37 to 88 years). Surgical treatment was peerformed in one half (32) anaplastic thyroid cancer patients, at majority of them operative biopsy or tumor reduction only. Radical surgery was performed in about 10% patients. Possibility of surgery in anaplastic thyroid cancer are very limited. In one third patients there were long standing goiter or thyroid nodule or histological verified dedifferentiation of papillary thyroid cancer. This patient should be operated formerly, before anaplastic transformation.

[Lymphoma and other rare malignant tumors of the thyroid]. / Limfomi i drugi retki maligni tumori stitaste zlezde.

UNLABELLED: Primary thyroid lymphomas are rare. Surgery is seldom indicated. The aim of the study is to find out the main characteristics of primary thyroid lymphomas in our patients, indications for surgery and the possibility of treatment. frequency and characteristics of rare thyroid tumors. METHOD: Retrospective study of 1044 patient operated for malignant thyroid tumor. RESULTS: From 1995 to may 2003. We operated upon 15 patients with primary thyroid lymphomas. 2 men and 13 women mean age of 50.12 years (from 22 to 74 years), also one patient of age 69 with insular thyroid cancer. Reason for surgery was thyroid tumor in all, compressive disturbances in 9, among them 4 with asphyxia. Radical total thyroidectomy was performed in 4 (26.7%), whole in others some residual tumor tissue was could not be removed in spite of thyroidectomy in 3, hemithyroidectomy in 2, tumor debulking in 5 and only open biopsy was performed in one patient. There was no operative mortality. no postoperative hypocalcaemia and no recurrent nerve palsy. Histological type of tumor was Non-Hodgkin lymphoma in 13 patients, Hodgkin disease in 2 female patients of age 22 and 24. Hashimoto thyroiditis was present in 3 patients. After surgery, 13 patients were treated with chemotherapy, one patient died one month after the operation and one patient refused chemotherapy. Follow-up data are available for 9 patients and the mean follow-up period was 20 months (1-48 months). Three patients died after a month, 2 and 3 years after surgery. Six patients are without local relapse. In one patient who refused chemotherapy, a year after thyroid surgery, resection of large intestine was performed because of lymphoma of the colon. CONCLUSION: Malignant thyroid lymphomas are rare. They present with rapidly growing thyroid tumor, compression and asphyxia. Surgery is only temporarily effective and it is necessary to start with chemo-radiotherapy as soon as possible. Rare forms of thyroid cancer have to be histologically recognised in order to choose the best way of treatment.

[Surgical treatment of recurrent thyroid carcinoma]. / Hirursko lecenje recidiva karcinoma stitaste zlezde.

UNLABELLED: Recurrent thyroid tumors are much less frequent but more aggressive than primary tumors. The aim is to find out their characteristics, aggressiveness and the possibility of radical surgical excision as well as the frequency of complications. METHOD AND MATERIAL: Retrospective study on 69 patients operated for recurrent thyroid tumors. RESULTS: Recurrent tumors were found in 42 patients with papillary, 11 with follicular (8 with Hurthle), 9 with medullary and 7 with anaplastic thyroid tumors. Relapse in thyroid bed on dominant side had 41 patients (59.4%), relapse on the opposite side we found in 19 patients (27.5%) and relapse in lymph nodes outside of thyroid bed in 37 patients (53.6%). In 33/69 patients, the first procedure was incomplete (reduction in 5, partial resection in 19, hemithyroidectomy in 9). The second procedure was incomplete in 14, near total thyroidectomy in 2, total thyroidectomy in 33 and dissection of lymph nodes in 33, among them in 20 with the operation in thyroid bed. Pre-operative recurrent nerve palsy had 2 patients and transitional recurrent nerve palsy occurred after second procedure in 2 patients. Among 33 patients after thyroidectomy for recurrent tumor, postoperative hypoparathyroidism occurred in 8 (24.2%), of whom in 2 permanent (6%). In the group of 54 patients with recurrent differentiated thyroid cancer, radioiodine therapy after first operation had received only 7 patients (13%). CONCLUSION: The main causes of thyroid cancer relapse are incomplete first procedure and aggressiveness of cancer. It is not always possible to excise the complete recurrent tumor. After surgery for papillary cancer, radioiodine therapy is seldom used.

[Arginase activity in plasma and erythrocytes in children with hematologic diseases]. / Aktivnost arginaze u plazmi i eritrocitima kod dece s hematoloskim oboljenjem.

INTRODUCTION: Arginase (EC 3.5.3.1) is one of the essential enzymes in the terminal stages of the urea cycle in the liver which participates in the elimination of ammonia from the human body [1, 7]. Except in liver tissue arginase is also present in many human tissues and in the circulating blood cells, especially in erythrocytes and leukocytes. Arginase splits arginase to urea and ornithine that serve for biosynthesis of amino acid proline, glutamic acid and biosynthesis of polyamines-spermine, spermidine and putrescine. Arginase activity is high during the mitotic cycle, with the function in phase S of the cell cycle. The aim of our study was to assess the arginase activity in the blood of children with some haematologic diseases. METHODS: We examined the arginase activity in blood plasma and erythrocytes of children who suffer from some haematological disorders (27 patients) and in healthy children (control group-15 subjects). The enzyme activity was measured with spectrophotometric method on the basis of the determination of the amount of liberated ornithine from substrate-arginine [3]. RESULTS: The obtained results suggest that arginase activity was much higher in the blood of ill children (Table 1 and Figure 1). In the control group of children (total 15) plasma arginase activity was in the range of 0 to 20 U/L x = 0.86 U/L), and enzyme activity in erythrocytes was 1.62-3.98 U/g Hb (x = 2.81 U/g Hb). Erythrocytes enzyme activity and plasma enzyme activity were in ranges of 4.03-5.26 U/L with the mean value of x = 4.56 U/L, and arginase activity in erythrocytes was in ranges of 9.38-14.16 U/g Hb, with mean value x = 11.34 U/g Hb, respectively. Arginase activity in erythrocytes was also significantly higher in children with non-spherocytic haemolytic anaemia (9 children) and was in ranges of 5.33-9.58 U/g Hb (x = 7.29 U/g Hb), with the relatively low values in plasma, 0-4.14 U/L (x = 1.75 U/L). In children with sideropenic anaemia (total number-11) arginase activity in erythrocytes was also very significantly increased with the range between 2.86 and 14.16 U/g Hb (x = 5.54 U/g Hb) while the plasma enzyme activity was relatively low, with the values in range of 0-4.98 U/L (x = 1.41 U/L); in myelodysplastic syndrome (4 pts) arginase activity in plasma was very low (0-0.71 U/L; x = 0.26 U/L) with higher values of arginase activity in erythrocytes (4.22-5.89 U/g Hb; x = 4.94 U/g Hb). DISCUSSION: We have concluded that the enzyme activity was the highest in erythrocyte haemolysates of patients with spherocytosis, non-sherocytic haemolytic anaemia; it was also high, but in a smaller degree, in erythrocytes of children with sideropenic anaemia and myelodysplastic syndrome; arginase activity in plasma of these children was higher in comparison with enzyme activity in plasma and erythrocytes of healthy children. Our results are in agreement with data from literature where it is stated that the younger erythrocytes have the highest arginase activity than the mature erythrocytes [4]. CONCLUSION: The measurement of arginase activity in plasma and erythrocytes is a good diagnostic indicator for the presence of young erythrocytes and reticulocytes in the circulating blood as is the good sign for the detection of haemolytic processes.

[Pharmacotherapy of nutritive anaemia in pediatrics]. / Farmakoterapija nutricionih anemija u pedijatriji.

The therapeutical problem of nutritive anaemia is discussed. The incidence of sideropenic anaemia is particularly stressed. All the drugs used in the pharmacotherapy of sideropenic and megaloblastic anaemia are also described. The doses, indications and adverse effects of these drugs are described in detail.

Cerumen-impaction management for clients of all ages.

A cerumen plug in the external auditory canal can cause dizziness, pain, itching, ringing or decreased hearing. These symptoms are particularly distressing to elderly clients who may already have compromised hearing or be experiencing changes in functional ability. A cerumen plug that causes hearing impairments can retard children's educational and psychosocial development. This article focuses on the physiology of cerumen, the risk factors of cerumen plugs and the best way to remove cerumen in clients of all ages. The contraindications and complications of aural lavaging and instrument removal of cerumen are discussed. An ear-irrigation flow sheet is also included for ambulatory clinical use.