The use of ultrasound elastography in the assessment of malignancy risk in thyroid nodules and multinodular goitres.

OBJECTIVE: The objective of our work is to use a surgical series to analyse the validity of elastography in evaluating the malignancy of thyroid nodules and multinodular goitres. PATIENTS AND METHODS: The study examined 156 patients, 134 women (85·9%) and 22 men (14·1%), who underwent surgery for nodular thyroid disease between October 2008, and November 2010. The average age of the patients was 52 years (±14·42). Thirty-six patients (23·1%) presented with a single nodule, and 120 (76·9%) exhibited multinodular goitres. Prior to surgical intervention, all patients underwent colour eco-elastography using a qualitative five-point ordinal scale for nodule classifications. Test results were analysed using a receiver operating characteristic (ROC) curve, and an anatomical pathologic examination of surgical specimens was used as a gold standard diagnostic tool for comparison. RESULTS: Of the 192 nodules analysed, 28 (14·6%) were malignant. Using elastography data, an ROC curve was obtained with an area under the curve of 0·662 (±0·060) and a 95% confidence interval (CI 95%) between 0·545 and 0·779 (P = 0·006). By establishing a cut-off point that classified thyroid nodules with an elastographic value greater than or equal to 3 as malignant, we achieved a sensitivity of 75%, specificity of 45·73%, positive predictive value of 19·1% and negative predictive value of 91%. The positive and negative likelihood ratios were 1·38 and 0·55, respectively. CONCLUSIONS: Ultrasound elastography can provide information regarding malignancy risk in thyroid nodules and multinodular goitres. However, the sensitivity and specificity values obtained in our study are below those reported by other groups, a finding that calls into question the current clinical utility of ultrasound elastography.

Vacuum assisted closure: utilidad en el abdomen abierto y cierre diferido. Experiencia en 23 pacientes / Vacuum assisted closure in open abdomen and deferred closure: experience in 23 patients

Introducción: Analizamos nuestra experiencia y los resultados obtenidos con el uso del vacuum assisted closure (VAC®, KCI Clinic Spain SL) en el manejo del abdomen abierto. Material y métodos Revisamos de forma retrospectiva las laparostomías realizadas entre junio de 2006 y marzo de 2011 usando la terapia VAC® en el Hospital Xeral-Cíes de Vigo. Resultados Incluimos a 23 pacientes consecutivos (18 varones y 5 mujeres) en los que se usó el VAC® en un abdomen abierto por distintas indicaciones (traumatismo abdominal, peritonitis, pancreatitis, patología isquémica o síndrome compartimental abdominal). El VAC® precisó recambio una media de 3,1 veces por paciente (1-7), con una duración total media de la terapia de 14,8 días (2-43) hasta el cierre, lográndose el cierre primario en 18 de 21 pacientes (86%). La estancia media hospitalaria fue de 110,1 días (8-163) y 6 pacientes (26%) fallecieron durante el ingreso por problemas relacionados con su proceso de base. Siete casos (30%) presentaron complicaciones durante la terapia VAC®: 3 abscesos intraabdominales (13%), 4 fístulas o dehiscencias de suturas (17%) y 1 evisceración (4%).Conclusiones La terapia VAC® es de manejo sencillo con una aceptable tasa de complicaciones, particularmente la de fístulas intestinales, y una mortalidad reducida. De los diversos sistemas disponibles para el cierre diferido de un abdomen, el VAC® supone un progreso considerable en estos últimos años gracias a su material adaptable y sus numerosas ventajas. Posiblemente su uso aumentará en el futuro (AU)

Introduction: We analyse our experience and the results obtained with the use of vacuumassisted closure (VAC1, KCI Clinic Spain SL) in the management of open abdomen.Material and methods: We retrospectively reviewed the la parostomies performed between June 2006 and March 2011 using VAC1treatment in the Hospital Xeral-Cíes, Vigo. Results: We included 23 consecutive patients (18 males and 5 females) on whom the VAC1was used in the open abdomen due to different indications (abdominal trauma, peritonitis, pancreatitis, ischemic disease or abdominal compartmental syndrome). The VAC1neededchanging a mean of 3.1 times per patient (range 1-7), with total mean treatment duration of14.8 days (2-43) until closure, primary closure being achieved in 18 out of 21 patients (86%).The mean hospital stay was 110.1 days (8-163) and 6 patients (26%) died during their hospital stay due to problems related to their underlying disease. Seven cases (30%) had complications during the VAC1 therapy: 3 intra-abdominal abscesses (13%), 4 fistulas or suture dehiscence (17%), and 1 evisceration (4%).Conclusions: VAC1therapy is simple to manage, with an acceptable rate of complication, particularly of intestinal fistulas, and a reduced mortality. Of the various systems available for the deferred closure of the abdomen, the VAC1has made considerable progress in the past few years, mainly due to its adaptable material, and its numerous advantages. Its use will possibly increase in the future (AU)

[Vacuum assisted closure in open abdomen and deferred closure: experience in 23 patients]. / Vacuum assisted closure: utilidad en el abdomen abierto y cierre diferido. Experiencia en 23 pacientes.

INTRODUCTION: We analyse our experience and the results obtained with the use of vacuum assisted closure (VAC(®), KCI Clinic Spain SL) in the management of open abdomen. MATERIAL AND METHODS: We retrospectively reviewed the laparostomies performed between June 2006 and March 2011 using VAC(®) treatment in the Hospital Xeral-Cíes, Vigo. RESULTS: We included 23 consecutive patients (18 males and 5 females) on whom the VAC(®) was used in the open abdomen due to different indications (abdominal trauma, peritonitis, pancreatitis, ischaemic disease or abdominal compartmental syndrome). The VAC(®) needed changing a mean of 3.1 times per patient (range 1-7), with total mean treatment duration of 14.8 days (2-43) until closure, primary closure being achieved in 18 out of 21 patients (86%). The mean hospital stay was 110.1 days (8-163) and 6 patients (26%) died during their hospital stay due to problems related to their underlying disease. Seven cases (30%) had complications during the VAC® therapy: 3 intra-abdominal abscesses (13%), 4 fistulas or suture dehiscence (17%), and 1 evisceration (4%). CONCLUSIONS: VAC(®) therapy is simple to manage, with an acceptable rate of complication, particularly of intestinal fistulas, and a reduced mortality. Of the various systems available for the deferred closure of the abdomen, the VAC(®) has made considerable progress in the past few years, mainly due to its adaptable material, and its numerous advantages. Its use will possibly increase in the future.

Hiperparatiroidismo, bocio y carcinoma tiroideo bien diferenciado: una relación frecuente con implicaciones diagnósticas / Hyperparathyroidism, goiter and well-differentiated thyroid carcinoma. A common association with diagnostic implications

Objetivo. Estudiar la enfermedad tiroidea encontrada en pacientes intervenidos por hiperparatiroidismo (HPT) comparando la frecuencia de carcinomas tiroideos bien diferenciados entre los distintos tipos de HPT. Pacientes y método. Revisión retrospectiva de las historias clínicas de 124 pacientes intervenidos de HPT de manera consecutiva en nuestro servicio por un mismo cirujano entre enero de 1998 y junio de 2006. Resultados. Se trata de 105 (84,7%) mujeres y 19 (15,3%) varones, con una media de edad de 59,7 ± 15,66 años. De ellos, 115 (92,7%) presentan HPT primario (HPTP) y 9 (7,3%), HPT renal (HPTR). En 3 (2,6%) HPTP y en ninguno de los HPTR hay antecedente de radioterapia cervical. En 43 (34,7%) pacientes se realizó simultáneamente algún tipo de cirugía del tiroides, 40 (34,8%) de los HPTP y 3 (33,3%) de los HPTR (p = 1,00). Entre los 115 pacientes intervenidos por HPTP, encontramos 6 (5,2%) carcinomas papilares y entre los 9 afectos de HPTR, 2 (22,2%), sin diferencias estadísticamente significativas entre ambos grupos (p = 0,105). Conclusiones. La afección tiroidea es frecuente en pacientes intervenidos por HPT, pero no más que en series de autopsias. No se encuentran diferencias significativas en la prevalencia de carcinoma papilar de tiroides entre los HPT primario y renal. La radioterapia cervical no parece ser en la actualidad un factor clínicamente relevante en el desarrollo de carcinoma papilar de tiroides en los pacientes afectos de HPTP. La prevalencia de enfermedad tiroidea en la población general justifica la realización de una ecografía preoperatoria de forma sistemática (AU)

Objective. To analyze thyroid gland disease incidentally found in patients undergoing surgery for hyperparathyroidism and to compare the frequency of nonmedullary thyroid carcinoma among different hyperparathyroidism varieties. Patients and method. We retrospectively reviewed 124 clinical records of patients who underwent surgery for hyperparathyroidism by a single surgeon from January 1998 to June 2006. Results. There were 105 women (84.7%) and 19 men (15.3%). The mean age was 59.7 ± 15.66 years old. Of these, 115 (92.7%) were diagnosed with primary hyperparathyroidism and 9 (7.3%) with renal hyperparathyroidism. In the primary hyperparathyroidism group, 3 patients (2.6%) had received neck irradiation compared with none in the renal hyperparathyroidism group. Thyroid gland surgery was performed simultaneously in 43 patients (34.7%), 40 (34.8%) of them belonging to the first group and three (33.3%) to the second group (p = 1.00). Among the 115 patients operated on for primary hyperparathyroidism, 6 papillary thyroid carcinomas (5.2%) were found and 2 (22.2%) were found among the 9 patients with renal hyperparathyroidism, but this difference was not statistically significant (p = 0.105). Conclusions. An incidental finding of thyroid disease in patients undergoing surgery for hyperparathyroidism is fairly frequent but no more so than that found in autopsy series. No statistically significant differences were found between primary and renal hyperparathyroidism in the prevalence of papillary thyroid carcinoma. Currently, neck irradiation does not seem to be a clinically significant factor in this issue. The high prevalence of thyroid disease in the general population warrants systematic neck ultrasound before hyperparathyroidism surgery (AU)

[Hyperparathyroidism, goiter and well-differentiated thyroid carcinoma. A common association with diagnostic implications]. / Hiperparatiroidismo, bocio y carcinoma tiroideo bien diferenciado: una relación frecuente con implicaciones diagnósticas.

OBJECTIVE: To analyze thyroid gland disease incidentally found in patients undergoing surgery for hyperparathyroidism and to compare the frequency of nonmedullary thyroid carcinoma among different hyperparathyroidism varieties. PATIENTS AND METHOD: We retrospectively reviewed 124 clinical records of patients who underwent surgery for hyperparathyroidism by a single surgeon from January 1998 to June 2006. RESULTS: There were 105 women (84.7%) and 19 men (15.3%). The mean age was 59.7 +/- 15.66 years old. Of these, 115 (92.7%) were diagnosed with primary hyperparathyroidism and 9 (7.3%) with renal hyperparathyroidism. In the primary hyperparathyroidism group, 3 patients (2.6%) had received neck irradiation compared with none in the renal hyperparathyroidism group. Thyroid gland surgery was performed simultaneously in 43 patients (34.7%), 40 (34.8%) of them belonging to the first group and three (33.3%) to the second group (p = 1.00). Among the 115 patients operated on for primary hyperparathyroidism, 6 papillary thyroid carcinomas (5.2%) were found and 2 (22.2%) were found among the 9 patients with renal hyperparathyroidism, but this difference was not statistically significant (p = 0.105). CONCLUSIONS: An incidental finding of thyroid disease in patients undergoing surgery for hyperparathyroidism is fairly frequent but no more so than that found in autopsy series. No statistically significant differences were found between primary and renal hyperparathyroidism in the prevalence of papillary thyroid carcinoma. Currently, neck irradiation does not seem to be a clinically significant factor in this issue. The high prevalence of thyroid disease in the general population warrants systematic neck ultrasound before hyperparathyroidism surgery.