Drug-induced thyroiditis and papillary carcinoma in a minocycline-pigmented black thyroid gland.

We describe a 31-year-old woman who had ingested minocycline for 18 months prior to presenting with hyperthyroidism and a palpable thyroid nodule. There was no evidence of Graves' disease or autonomous nodule on thyroid scintigraphy, and a clinical diagnosis of thyroiditis was made. Fine-needle aspiration biopsy of the palpable lesion suggested papillary carcinoma, and the patient underwent a total thyroidectomy. Intraoperatively, the thyroid gland was found to have a striking black discoloration. Subsequent histological examination revealed the accumulation of pigment globules within the apical cytoplasm of the follicular cells, and associated findings of a drug-induced thyroiditis. The tumor nodule showed features of infarction and was felt to represent a necrotic papillary microcarcinoma. We postulate that in addition to causing black thyroid pigmentation, chronic minocycline use in our patient resulted in thyroiditis and subsequent hyperthyroidism. The papillary microcarcinoma was probably a coincidental finding.

Laparoscopic ventral hernia repair: defining the learning curve.

Between 2004 and June 2011, 181 patients underwent laparoscopic ventral hernia repair. Three main surgeons, all experienced in laparoscopic procedures, performed all the cases. After analyzing the operative time (OT) for 3 main surgeons, within the first 20 cases the overall performance plateaued. Data from 60 patients (50F, 10M), with a mean age of 42.3 years (range, 26 to 88 y) and a mean hernia defect size of 6.5 cm (range, 4 to 18 y), were evaluated. No significant differences were recorded among the 3 surgeons in OT and intraoperative or postoperative complications. But 3 (5%, P<0.03) patients had complications, and the recurrence rate was 6.6% with a mean follow-up of 54 months (range, 42 to 70 mo). One had prolonged postoperative ileus, the second had bowel serosal tear, and the last had port-site incarcerated hernia. Our results showed that the OT of 98.9 minutes (range, 48 to 205 min) stabilized in 12 cases.

"Scarless" (in the neck) endoscopic thyroidectomy (SET): an evidence-based review of published techniques.

BACKGROUND: Excision of the thyroid through a skin crease incision in the anterior neck provides good direct exposure to facilitate safe dissection and a quick operation with low morbidity and minimal mortality. However, these patients still have a scar in the neck. Technologic innovations have allowed surgeons to remove the thyroid gland from a remote site, providing a scarless outcome in the neck. This study was designed to assess the different techniques of scarless (in the neck) endoscopic thyroidectomy (SET) by reviewing the current literature. METHODS: A computer-assisted search of the Medline database through September 2007 was undertaken. The combination of terms used included the following: endoscopic thyroidectomy; minimally invasive thyroidectomy; minimally invasive endocrine surgery; thyroidectomy via the axillary approach; thyroidectomy via the anterior approach; and thyroidectomy via the breast approach. Additional data were provided based on previously unpublished experience from our own unit with SET. RESULTS: There were seven studies that involved 186 patients in whom the thyroid was excised via the axillary method and five published series that involved 169 patients who had thyroidectomies performed via the anterior approach. There were four published series of thyroidectomies performed via a hybrid approach, which is a combination of both the anterior and axillary approach, involving 180 patients. Four studies compared SET and another approach for a thyroidectomy. In our unpublished series of SET, we performed 20 cases during a 2-year period comprising 11 cases via the axillary approach and 9 cases via the anterior/breast approach. Nineteen cases were lobectomies and one case was an isthmusectomy. SET was associated with a longer operative time and increase postoperative pain. Patients who had SET were satisfied with the aesthetic outcome of the procedure. CONCLUSION: Scarless (in the neck) endoscopic thyroidectomy is not a minimally invasive technique but a maximally invasive one that involves a longer operative time and greater postoperative pain. What it does provide is a safe excision of the thyroid pathology with the absence of a scar in the neck. However, there is a steep learning curve. With experience and newer surgical instruments, the operative time and postoperative pain might decrease.