A retrospective analysis of prognostic factors predictive of lymph-node metastasis and recurrence in thyroid papillary microcarcinoma.

AIM: The literature is inconclusive concerning the prognostic factors and therapeutic management of papillary thyroid microcarcinoma (PTMC). Herein we report on our extensive experience with PTMC in relation to clinicopathological characteristics and prognostic factors. METHODS: In all, 248 patients that were diagnosed and treated for PTMC between 2007 and 2012 were retrospectively analyzed. Demographic and tumor characteristics at presentation, and recurrence during follow-up were noted. RESULTS: Total thyroidectomy and radioactive iodine (RAI) ablation treatment were performed in all patients. Bilateral involvement, vascular and capsular invasion, extra-thyroidal extension, and lymph node metastasis occurred significantly more frequently in patients with tumor size>5 mm (P<0.05). Multivariate statistical analysis showed that a clinically suspected diagnosis (OR:0.095; P=0.043) and elevated thyroglobulin (TG) level (OR: 1.083; P=0.011; cut-off value≥7.98 ngmL(-1)) were significant and independent risk factors for lymph node metastasis, with a sensitivity of 57% and specificity of 83%. After a median follow-up of 2 years (range:0.3-11 years), 10 (4%) of the 248 patients had recurrent disease. According to multivariate analysis, lymph node metastasis (OR: 51.4; P=0.003) was the only independent predictor of recurrence. CONCLUSION: Our findings revealed that serum TG level and a clinically suspected diagnosis were risk factors for lymph node metastasis, while nodal metastasis was a predictor of recurrence.

Hürthle cell presence alters the distribution and outcome of categories in the Bethesda system for reporting thyroid cytopathology.

OBJECTIVES: We aimed to determine whether the presence of Hürthle cells altered the distribution of categories in the Bethesda system for reporting thyroid cytopathology, or the expected neoplastic and malignant outcome. METHODS: Fine needle aspiration (FNA) cytology reports of Hürthle cells in a 2-year period were evaluated. The distribution of Bethesda system categories and the outcome at partial or complete thyroidectomy were compared for FNAs with and without Hürthle cells. RESULTS: Of 895 adequate FNAs with Hürthle cells, 764 (85.4%) were classified as benign, 86 (9.6%) as atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS), 32 (3.6%) as follicular neoplasm/suspicious for follicular neoplasm (FN/SFN), 12 (1.3%) as suspicious for malignancy (SFM) and one (0.1%) as malignant. Of 10 359 adequate FNAs without Hürthle cells, 9707 (93.7%) were classified as benign, 412 (4.0%) as AUS/FLUS, 77 (0.7%) as FN/SFN, 93 (0.9%) as SFM and 70 (0.7%) as malignant. The distribution of categories in FNAs with and without Hürthle cells was significantly different (P < 0.001) as a result of a decrease in benign and an increase in AUS/FLUS and FN/SFN categories. Among 128 patients with and 582 without Hürthle cells undergoing surgery, the overall neoplastic and malignancy rates were higher in the former than in the latter group (27.3% versus 14.9%, P < 0.001; 21.1% versus 11.7%, P = 0.003; respectively). Although neoplastic and malignant rates were higher in the group with than without Hürthle cells in all categories, the differences were only significant for a neoplastic outcome of benign cytology (15.1% versus 6.0%, P = 0.0013) and a malignant outcome of FN/SFN cytology (63.6% versus 21.9%, P = 0.0108). CONCLUSIONS: We found that the rates of AUS/FLUS and FN/SFN categories in the Bethesda system were higher when Hürthle cells were present. After surgery, neoplastic and malignant outcomes were significantly higher in the Hürthle cell group.

EFFECTS OF ETHYLENE OXIDE RESTERILISATION AND IN-VITRO DEGRADATION ON MECHANICAL PROPERTIES OF PARTIALLY ABSORBABLE COMPOSITE HERNIA MESHES.

BACKGROUND: Prosthetic mesh repair for abdominal wall hernias is widely used because of its technical simplicity and low hernia recurrence rates. The most commonly used material is pure polypropylene mesh, however newer composite materials are recommended by some centers because of their advantages. However, these meshes are more expensive than pure polypropylene meshes. Resterilisation of a pure polypropylene mesh has been shown to be quite safe, and many centers prefer slicing a large mesh into smaller pieces that suitable for hernia type or defect size. Nevertheless there is no data about the safety after resterilisation of the composite meshes. OBJECTIVE: To search the effects of resterilisation and In vitro degradation in phosphate buffered saline solution on the physical structure and the mechanical properties of partially absorbable lightweigth meshes. DESIGN: Laboratory-based research. SUBJECTS: Two composite meshes were used in the study: One mesh is consisted of monofilament polypropylene and monofilament polyglecaprone--a copolymer of glycolide and epsilon (ε)-caprolactone--(Ultrapro®, 28 g/m2, Ethicon, Hamburg, Germany),andthe otherone consisted of multifilamentpolypropyleneandmultifilament polyglactine (Vypro II®, 30 g/m2,Ethicon, Hamburg, Germany). Two large meshes were cut into rectangular specimens sized 50x20 mm for mechanical testing and 20x20 mm for In vitro degradation experiments. Meshes were divided into control group with no resterilisation and gas resterilisation. Ethylene oxide gas sterilisation was performed at 55°C for 4.5 hours. In vitro degradation in 0.01 M phosphate buffered saline (PBS, pH 7.4) solution at 37 ± 1°C for 8 weeks was applied to one subgroup in each mesh group. Tensiometric measurements and scanning electron microscopyic evaluations were completed for control and resterilisation specimens. RESULTS: Regardless of resterilisation, when meshes were exposed to In vitro degradation, all mechanical parameters decreased significantly. Highest reduction in mechanical properties was observed for Ultrapro due to the degradation of absorbable polyglecaprone and polyglactin parts of these meshes. It was observed that resterilisation by ethylene oxide did not have significant difference on the degradation characteristics and almost similar physical structures were observed for resterilised and non-resterilised meshes. For Vypro II meshes, no significant mechanical difference was observedbetweenresterilised andnon-resterilised meshes after degradationwhile resterilised Ultrapro meshes exhibited stronger characteristics than non-resterilised counterparts, after degradation. CONCLUSION: Resterilisation with ethylene oxide did not affect the mechanical properties of partially absorbable composite meshes. No important surface changeswere observed in scanning electron microscopy after resterilisation.

Correlation of thyroid fine-needle aspiration with final histopathology: a case series.

AIM: The aim of this study was to evaluate the correlation between preoperative thyroid fine-needle aspiration result and final histopathology in patients with thyroid nodules. METHODS: The medical records of 298 patients (mean age, 47.7±12.3 years; 79.5% females) who underwent fine-needle aspiration for thyroid nodules and who were operated and have final pathological diagnosis were retrospectively reviewed. For reporting fine-needle aspiration specimen pathology, the Bethesda thyroid fine-needle aspiration classification was used. Tyroglobulin (Tg) and anti-Tg and anti-thyroid peroxidase (anti-TPO) antibody levels were determined preoperatively. RESULTS: Thyroid nodules were non-diagnostic, benign or atypia (Bethesda groups 1-3) in 76.8% of patients; and follicular neoplasm, suspicious for malignancy or malignant (Bethesda groups 4-6) in 23.1% of patients. Final pathology of surgery specimen was most commonly nodular goiter (36.6%) and papillary carcinoma (35.6%). Nodular goiter was significantly more prevalent in Bethesda 1 group while papillary carcinoma was more common in Bethesda 3 group (P<0.05). Tg level is significantly higher in the nodular goiter group (90.49±126.93 ng/mL), while anti-Tg and anti-TPO levels are significantly higher in the lymphocytic thyroiditis goiter group (229.77±494.42 U/mL and 282.86±360.77 U/mL, respectively) than the other pathology groups (P<0.05 for all). CONCLUSION: Papillary carcinoma is more common in Bethesda thyroid fine-needle aspiration classification 3 group. Therefore, preoperative fine-needle aspiration for thyroid nodules is predictive of final pathology and should be applied for diagnosis and follow-up.

Effects of ethylene oxide resterilization and in-vitro degradation on mechanical properties of partially absorbable composite hernia meshes.

BACKGROUND AND AIM: Prosthetic mesh repair for abdominal wall hernias is widely used because of its technical simplicity and low hernia recurrence rates. The most commonly used material is pure polypropylene mesh, although newer composite materials are recommended by some centers due to their advantages.However, these meshes are more expensive than pure polypropylene meshes. Resterilization of a pure polypropylene mesh has been shown to be quite safe, and many centers prefer slicing a large mesh into smaller pieces, suitable for any hernia type or defect size. Nevertheless there is no data about the safety after resterilization of the composite meshes. The present study was carried out to investigate the effects of resterilization and in vitro degradation in phosphate buffered saline solution on the physical structure and the mechanical properties of partially absorbable lightweight meshes. METHODS: Two composite meshes were used in the study: One mesh consists of monofilament polypropylene and monofilament polyglecaprone -a copolymer of glycolide and epsilon(ε)- caprolactone - (Ultrapro®, 28 g m2, Ethicon, Hamburg,Germany), and the other one consisted of multifilament polypropylene and multifilament polyglactine (Vypro II®, 30g m2, Ethicon, Hamburg, Germany). Two large meshes were cut into rectangular specimens sized 50 x 20 mm for mechanical testing and 20 x 20 mm for in vitro degradation experiments.Meshes were divided into control group with no resterilization and gas resterilization. Ethylene oxide gas sterilization was performed at 55°C for 4.5 hours. In vitro degradation in 0.01M phosphate buffered saline (PBS, pH 7.4) solution at 37 ± 1°C for 8 weeks was applied to one subgroup in each mesh group. Tensiometric measurements and scanning electronmicroscopic evaluations were completed for control and resterilization specimens. RESULTS: Regardless of resterilization, when the meshes were exposed to in vitro degradation, all mechanical parameters decreased significantly. Highest reduction in mechanical properties was observed for Ultrapro due to the degradation of absorbable polyglecaprone and polyglactin parts of these meshes. It was observed that resterilization by ethylene oxide did not determine significant difference on the degradation characteristics and almost similar physical structures were observed for resterilized and non-resterilized meshes. For VyproII meshes, no significant mechanical difference was observed between resterilized and non-resterilized meshes after degradation while resterilized Ultrapro meshes exhibited stronger characteristics than non-resterilized counterparts, after degradation. CONCLUSION: Resterilization with ethylene oxide did not affect the mechanical properties of partially absorbable compositemeshes. No important surface changes were observed inscanning electron microscopy after resterilization.

Importance of magnetic resonance imaging in patients with fibrocystic changes.

INTRODUCTION: A proper detection of atypical epithelial hyperplasia (component of FCC) without missing the coexistent malign disease is the main problem in evaluating the FCC-affected patients. For some patients, it is not enough to use only mammography and ultrasonography in pursuit or decision biopsy. Magnetic resonance imaging (MRI) may be important in these patients. Nevertheless, the MRI features of FCC are not clearly known because there are very few studies specifically focused on FCC. Studies reporting on MRI of breast fibrocystic changes are very scarce and their MRI findings are not clearly known. The aim of this study was to determine the MRI characteristics of fibrocystic changes. METHODS: Twenty-six patients with pathologically proven fibrocystic changes of the breast were retrospectively reviewed. The MRI study was performed using 1.5 T MR scanner with a phase array bilateral breast coil. The imaging protocol consisted of pre-contrast T1-weighted imaging and bilateral dynamic 3D contrast-enhanced imaging. The morphologic and kinetic features of fibrocystic changes on MRI were evaluated. RESULTS: Twenty-four patients showed benign enhancement kinetics (type 1), while 2 patients showed malignant enhancement kinetics (type 2). CONCLUSION: To our knowledge, the analysis of enhancement kinetics may be more useful in identifying atypical epithelial hyperplasia and cancer from other breast lesions provided that corrections are made for the true phase of menstrual cycle (Tab. 1, Fig. 1, Ref. 10).

In vivo confirmation of the reliability of the dorsal tangential view of the wrist.

The purpose of the study was to evaluate the reliability of the dorsal tangential view (DTV) of the wrist using direct visualization of the extensor compartments in vivo. Twelve patients with extensor tendon complications [nine patients with extensor synovitis, two patients with isolated extensor pollicis longus (EPL) rupture, one patient with EPL and extensor indicis proprius rupture] after volar plating of a distal radius fracture were enrolled in the study. We obtained DTVs in the operating room before implant removal and explored the extensor compartments during synovectomy or tendon reconstruction to confirm suspected screw penetration. We confirmed screw penetration on 10 patients during exploration of the extensor compartments. DTV was able to detect seven of these dorsal cortex breaches. There were no false positive results, which we had defined as a screw penetrating an extensor compartment preoperatively, but not visible on the DTV. Of these seven breaches, one was in the second compartment, four were in the third compartment, and the remaining two were in the fourth compartment. The DTV is sufficiently reliable to be used routinely to reduce postoperative extensor tendon complications during volar plating of the distal radius. LEVEL OF EVIDENCE: 4 (case series) diagnostic.

Primary hydatid disease of the soft tissue.

Human hydatid disease is caused by the larval form of the tapeworm genus Echinococcus. The ova hatch in the small intestine, penetrate the intestinal wall, pass through the portal vein into the liver, lungs, and other tissues, and develop into a hydatid cyst. Hydatid disease is endemic in many parts of the world; in the Mediterranean Countries, the Middle and Far East and South America. Soft tissue hydatid disease without the liver and the lung involvement occurs in 2.3% of patients reported from endemic areas. Hydatid disease should be considered in the differential diagnosis of all cystic masses in all anatomic locations especially in endemic areas.

Migration of an ingested needle to the mesentery, causing intestinal necrosis.

A case of an intra-abdominal sharp foreign body with migration to the mesentery vessels, causing intestinal necrosis in a 20-year-old patient is presented. Emergency surgery with 75 cm small bowel resection was performed.

Endometriosis of the groin hernia sac: report of a case and review of the literature.

Endometriosis is characterized by the presence of histological normal endometrial tissue outside the uterine cavity. It occurs in up to 15% of menstruating women and often goes undetected. Some cases of soft-tissue involvement have been reported, particularly in the skin and subjacent tissues of surgical scars. However, we came cross a 42-year-old female patient with millimetric focal lesions in a groin hernia sac. A case report and a review of the literature are presented. Although definitive diagnosis still requires biopsy, the patient's cyclic symptoms and history of previous uterine surgery should suggest the correct diagnosis.