Surgical management and prognosis of thyroid carcinomas invading adjacent structures

Objectives: To evaluate the surgical approaches and prognosis of thyroid carcinomas invading the adjacent structures

Methods: The medical records of 197 patients with a pathology diagnosis of thyroid cancer were retrospectively reviewed

Results: Seventeen patients [9%] with thyroid carcinoma invading surrounding structures were included. Patients were initially divided into two groups on the basis of tumor histology: papillary [Group A] and nonpapillary [Group B]. Then patients were divided into three groups Group 1: patients who underwent total thyroidectomy Group 2: patients who underwent total thyroidectomy with shaving resection Group 3: patients who underwent total thyroidectomy with extensive surgery. All patients who didn't survive were more than 45 years old. The survival rate was statistically better in group A compared to group B [92% versus 20%]. The survival rate decreased from Group 1 through Group 3, without reaching statistical significance

Conclusions: Age and histologic type are important in determining the prognosis of locally invading thyroid cancer

[Management of complicated appendicitis at the Hotel-Dieu de France hospital in Beirut]

Objective : To study the effectiveness and evaluate the rate of success of the conservative treatment adopted at the Hôtel-Dieu de France [HDF] university hospital, in the case of complicated appendicitis with an abscess or inflammatory mass and to compare this management with the one described in the literature

Material and Methods: This retrospective observational and descriptive study is based on data from patients treated at the hospital Hôtel- Dieu de France between 2009 and 2013, for complicated appendicitis with an initial non-surgical management. Forty patients were included in this study. Data were collected from medical records of the patients

Results: The average age of patients was 47.93 years and 65% were male. Conservative treatment was effective in 90% of patients with early failure in 7.5% of cases and late failure [relapse after antibiotherapy discontinuation] in 2.5% of cases. Drainage was performed in 32.5 % of patients, and resulted in a significant extension of the average duration of the first hospitalization [10.92 days] compared to patients treated without drainage [5.81 days]. The total duration of antibiotic therapy in our study was 4.5 weeks on average. Twenty-nine patients [72.5%] were operated by laparatomy and 11 [27.5%] laparoscopically, with an average hospital stay shortened from 4.04 to 2.5 days with the laparoscopic technique. As for the pathological examination, 10% of patients presented a mucinous neoplasm. No intra-operative complications were noted. Similarly, none of the patients had postoperative intraabdominal complications

Conclusion : At Hôtel-Dieu de France [HDF] university hospital, the conservative treatment of complicated appendicitis with an abscess or an inflammatory mass, followed by an appendectomy a few weeks later, shows a high success rate [90%]

[Medium-term functional results of surgical lacura of Gastro-Esophageal Reflux]

Introduction: The evaluation of the quality of life [QoL] has now become an established parameter in clinical research, including analysis of the effectiveness of medical or surgical treatment. Therefore, the treatment of gastroesophageal reflux disease [GERD] not only aims to relieve symptoms, prevent complications, minimize undesirable side effects of treatment but also improve the QoL of patients

Material and Methods: Our series includes 51 patients [23 men and 28 women] whose average age was 37 years [range 17-62], treated surgically for GERD at University Hospital Hotel-Dieu de France between 2005 and 2012. Their QoL was evaluated before and after surgery [mean follow-up 4.5 years], retrospectively, using the GIQLI Questionnaire [gastrointestinal quality of life index], which comprises 36 items covering five dimensions: symptoms, physical condition, emotions, social integration and medical treatment

Results: Before the intervention, the GIQLI score was 89 +/- 9; after antireflux surgery, GIQLI score was 113 +/- 9 [p < 0.001]. The unit-variable statistical analysis revealed that the highest GIQLI scores were correlated with the lowest BMI [body mass index]. No statistically significant difference was recorded for the age, sex, and duration of medical treatment before surgery, the surgical indication, surgical technique and the surgical approach. Statistically significant improvement was noted in the following dimensions: symptoms, physical condition, medical treatment and social integration. A non-statistically significant improvement was observed at the level of the emotional dimension. 12% of operated patients resumed a regular medical treatment against reflux, 37% have resumed medical treatment on demand and 51% of patients have never taken medical treatment after the operation. Six patients were reoperated with an overall reoperation rate of 12%

Conclusions: Antireflux surgery significantly improves QoL of patients but does not guarantee the full exemption of medical treatment. In our series, patients with a normal BMI and patients with only the classic complaints of reflux [heartburn, regurgitation, belching] are the best candidates for antireflux surgery. Better patient selection could prove to be a way to improve the results in terms of QoL

Idiopathic omental ischemia treated by laparoscopy case report

Omental ischemia and infarction is a rare cause of acute abdomen. Clinical diagnosis is usually difficult because signs and symptoms are similar to other common causes of abdominal pain. The most common differential diagnosis is acute appendicitis. Diagnosis is mainly based on ultrasound and especially computed tomography scan analysis. There is at present no standard treatment modality. When diagnosed by radiological imaging, omental infarction can be managed conservatively. We hereby report the case of a 42-year-old male presented with primary idiopathic partial omental ischemia and treated by laparoscopy

Retroperitoneal cystic lymphangiomas in adults: four case reports and review of the literature

Retroperitoneal location of cystic lymphangiomas in adult patients is rare. Their clinical presentation is not specific. Magnetic resonance imaging is the best radiological exam for the diagnosis. These tumors must be distinguished from mesenteric cysts which are more frequent and can degenerate. The authors report four cases of retroperitoneal cystic lymphangioma with a literature review

Subtotal or total colectomy as surgical treatment of left-sided occlusive colon cancer

The treatment of acutely obstructed carcinoma of the left colon and sigmoid still represents a matter of controversy. The aim of this study was to assess retrospectively the results of its management by emergency subtotal or total colectomy with primary anastomosis. Sixty-seven patients were reviewed. There were 42 males and 25 females. The mean age was 70.5 years [range: 26-87 years]. Mean operative time was 210 minutes. There were five synchronous colon carcinomas [75%] and 23 [343%] synchronous tubulous and tubulovillous adenomas. No death was noted in the series. Ten postoperative complications [15%] occurred in nine patients including one postoperative peritonitis without evidence of anastomotic leak, one alithiasic cholecystitis, one evisceration and two intra-abdominal abscesses. The mean hospital stay was 11.4 days. Fifty-eight patients were assessed at three and twelve months for functional results. No fecal incontinence was encountered. The mean number of bowel movements per 24 hours was 3.2 at three months and 2 at twelve months. All patients were satisfied with their quality of life. Twelve patients [20.7%] occasionally needed anti-diarrheic medications. Urgent subtotal or total colectomy with primary anastomosis is a safe and efficient procedure in the management of acutely obstructed neoplasm of the left colon. It allows to treat in one stage the cancer and the obstruction, bearing no mortality, acceptable morbidity and satisfactory postoperative functional results

Colorectal cancer in young patients: Presentation, clinicopathological characteristics and outcome

Previous studies have emphasized the increasing incidence of colorectal cancer [CCR] among young adults and suggest that they may have more aggressive disease and worse five-year survivals than their older counterparts. Describe the profile of sporadic colorectal cancer in young patients focusing on its prevalence, clinicopathological characteristics, prognostic and survival factors. Three hundred and twenty-five CCR patients were divided in two groups: Gl < 45 years and G2 > 45 years. 13.2% of patients were less than 45 years old. A family history of a first-degree relative with colorectal cancer was more frequent in young patients: 44.1% vs 18.2% [p - 0.025]. A significant delay in seeking medical care was noted in Gl patients: 29.7 weeks vs 18.6 weeks [p = 0.01]. A trend to have more aggressive stages III and IV at presentation was observed among young patients: 55.8% vs 48.6% [p = 0.8]. Mucin-producing tumors were more frequently observed in Gl group: 41.9% vs 12% [p = 0.000]. Mean survival was 76.9 months in Gl group and 91.7 months in G2 group [p = NS]. Five-year survival was 52% in Gl group and 58% in G2 group [p - 0.6]. Stage for stage comparison was not significant in determining survival. The only independent factors were delay in consultation, right location of the tumor, peritoneal carcinomatosis, and the need for chemotherapy. This study confirms that colorectal cancer in young patients is frequent. Despite more frequent occurrence of mucin-producing tumors, age is not by itself a worse outcome predictor

One hundred liver resections: improved outcome in a tertiary care center in Lebanon

Recent reports highlight the reduced mortality and morbidity rates of liver resection in the last decades. The authors report on the surgical techniques and perioperative management that have yielded a low mortality and morbidity rates. One hundred consecutive liver resections carried out from 1997 to 2005 were reviewed. Data were collected retrospectively. The indications for liver resection were malignant tumors in 73%. Major liver resection was performed in 52%. Overall, 42.5% of liver resections were performed without vascular clamping and 57% of liver resections were performed without blood transfusions. There was no intraoperative death and the overall mortality rate was 1%. The major complications rate was 28% and was related to the extent of resection. The mean length of hospital stay was 12 days. The current series shows that with accurate preoperative evaluation, standardization of the surgical technique, appropriate use of vascular clamping method, and vigilant postoperative monitoring, an in-hospital mortality of 1% was achieved in a series where more than 50% of patients underwent a major hepatectomy

Preoperative diagnosis of right nonrecurrent inferior laryngeal nerve by CT scan. Report of a case and review of the literature

The nonrecurrent inferior laryngeal nerve [NRILN] is a nerve anomaly that is associated with the developmentally aberrant subclavian artery. Thus, it is possible to predict NRILN by preoperative diagnosis of an aberrant subclavian artery. The purpose of this study was to report a new case of this anomaly and to assess the possibility of diagnosis of an aberrant subclavian artery preoperatively by CT scan of the neck, underline how such recognition is crucial for the prevention of intraoperative nerve damage and review the literature. We report a case of thyroid surgery associated with a right NRILN diagnosed preoperatively by CT scan of the neck. The preoperative CT scan showed a retroesophageal aberrant right subclavian artery. The patient underwent total thyroidectomy for a multinodular goiter. She had identification of recurrent laryngeal nerve on the left side and NRILN on the right side. Post-operatively, the patient had normal vocal cord function on laryngoscopy. It was possible to predict preoperatively a right NRILN by identifying an aberrant right subclavian artery on the CT film of the neck, which likely enabled the prevention of vocal cord paralysis

Gastric pneumatosis as a manifestation of ischemic infraction of the stomach. Report of a case and review of the literature

Gastric pneumatosis is a very rare entity, and of the hollow viscera, the stomach is the least often reported site for intramural gas. To describe a patient with gas in the gastric wall associated with pneumoperitoneum and diffuse ischemic changes of the small and large bowels. Old man with past history of hemodialysis for renal failure and a diffuse vascular atherosclerosis presenting with an acute abdomen. The CT scan of the abdomen revealed a gastric pneumatosis with pneumoperitoneum and complete thrombosis of the coeliac trunk. Laparotomy showed gastric infarction with peritonitis and diffuse changes through the gastrointestinal tract. A therapeutical abstention was decided in agreement with the family. The patient developed septic shock under broad spectrum antibiotic coverage and died after 12 hours of multiple organs failure. Surgeons, internists and gastroenterologists should be aware of the possibility of gastric pneumatosis in some cases. Underlying disease are important to clarify in order to apply the adequate treatment

[Male breast cancer. Report of eight cases]

Male breast cancer is relatively rare. We report herein 8 cases with clinical, biological and therapeutic characteristics. A retrospective study included all male breast cancers in our institution between 1998 and 2004. Mean age of the 8 patients was 67 years [52 to 81 years]. Patients presented with a breast lump [n=4], nipple discharge [n=2], Paget disease's [n=1], and on physical exam in patient with colon cancer [n=1]. The cancer localized in the right side [n=7] or the left side [n=1]. The tumor localized in subareolar region [n=7] or in the right lower outer quadrant [n=1]. The tumor size was between 1 and 2 cm [n=2], or between 2 and 5 cm [n=6]. One patient had pleuro-pulmonary metastases. The surgical treatment consisted of modified radical mastectomy [n=6], total simple mastectomy [n=1], and lumpectomy [n=1]. The final pathology showed infiltrating ductal carcinoma [n=6], infiltrating papillary carcinoma [n=1], and ductal carcinoma in situ with mini-invasion [n=1]. The lymph nodes were positive in 83.3% of cases. The estrogen and progesterone receptors were positive in 100% and 83.3% of cases respectively. Adjuvant chemotherapy, hormonal therapy or both was given in 2 cases, 1 case, and 5 cases respectively. The follow-up ranged from 6 to 72 months. The patient with metastases died 7 months after the diagnosis. The other patients [n=7] remained free of disease. Male breast cancer is relatively rare with predominance of infiltrating ductal carcinoma. Modified radical mastectomy remains the optimal surgical treatment. Hormone receptors were positive in all our patients and hormonal therapy with Tamoxifen remains the cornerstone of adjuvant therapy

[Endosonography-guided drainage of a pancreatic pseudocyst. Case report and review of the literature]

Surgery for pancreatic pseudocyst [PP] is becoming an infrequent-therapeutic option with advances in non-surgical drainage procedures. Actually, endoscopic drainage of PPs has become the preferable treatment for symptomatic PPs. It is indicated when a mature pseudocyst is bulging into the wall of the stomach or the duodenum. The risk of perforation and bleeding is increased when no obvious bulge is visible at endoscopy and when no diagnostic method is used to detect the presence of vascular structures. It seems clear that diagnostic endoscopic ultrasound [EUS] is mandatory before attempted endoscopic drainage because it is the most accurate technique to detect interposed vessels, the distance between pseudocyst and gut lumen [<1 cm] and to distinguish cystic neoplasms from PPs. Now EUS may be used alone for cyst decompression. EUS-directed pseudocyst aspiration and drainage is ideal because of advances in EUS endoscope design with new interventional linear echoendoscope with Doppler and large channel. This technique will completely replace the current standard approach of diagnostic EUS with a radial scan endoscope followed by endoscopic drainage with a side-viewing endoscope. We report a case of pancreatic pseudocyst drainage completely guided by endoscopic ultrasound and perform a literature review

Perforation of the rectum and colon during barium enema examination. Report of four cases

Background The barium enema examination [BEE] is an important diagnostic study and considered to be safe without adverse effects. Perforation of the bowel is rare but is the most frequent complication of BEE and can be life-threatening. We report four cases of barium extravasation due to BEE treated at our institution, three rectal perforations and one perforation in the descending colon. The four patients underwent surgery because signs of peritonitis developed. Two of them recovered and two died from multiple organ failure. Perforation of the colon and rectum during BEE constitutes a surgical emergency in most cases. Prompt recognition and management are vital in decreasing morbidity and mortality

Carcinome metaplasique de sein. A propos d'un cas de type sarcomatoide et revue de la literature

Metaplastic changes are a rare entity that occurs in fewer than 5% of breast carcinomas. Their sarcomatoid variant is the rarest primary malignancy of the breast. We report a case of sarcomatoid breast cancer and insist on the diagnosis and treatment of this rare tumor. case report: A 71-year-old female patient presented for a right breast mass above the nipple, between the upper inner and upper outer quadrants, of 20 mm of diameter, highly dense on mammography with cystic and solid components on ultrasound core biopsy showed a probable sarcoma whereas the partial mastectomy revealed the sarcomatoid metaplastic breast carcinoma. The workout for distant metastasis was negative and the treatment was completed by a modified radical mastectomy and adjuvant CMF chemotherapy. Six months after treatment there was no evidence of locoregional recurrence nor distant metastases. Although metaplastic carcinoma is a rare breast malignancy, with no specific clinical or radiologic features, it should be considered as an independent entity and included in the differential diagnosis of breast tumors

Surrenalectomie coelioscopique. Experience de 10 cas

Aim of the study: To report our experience in laparoscopic adrenalectomy and to evaluate the effectiveness of this technique for a variety of endocrine disorders. methods: Ten patients were operated for laparoscopic adrenalectomy between January 1998 and January 2001. eight females and two men, of 45 years mean age [range, 16-71 years], were operated for laparoscopic adrenalectomy. There were 8 tumours in right adrenal gland and two in the left adrenal gland. Indications were pheochromocylomas [n = 5], aldosterone-producing adenoma [n = 2], cortisol producing adenoma [n = 2] and cyst [n = 1]. All patients had a CT. Scan or RMI preoperatively. the patients with pheochromocytoma were prepared preoperatively. Mean operative time was 133 minutes [range, 110-190 minutes]. There was no mortality and morbidity was encountered in one patient [bleeding in a trocart site peroperatively]. During pheochromocytoma operation, hypertension occurred in two patients. There was one conversion secondary to bleeding. The average length of stay was 3.6 days [range, 2-7 days]. During follow-up [range, 6-36 months], the patients were satisfied and none had recurrence of hormonal excess. Laparoscopic adrenalectomy is safe, effective and decreases hospital stay and convalescence. The laparoscopic approach is the procedure of choice for adrenalectomy except in the case of carcinoma

Maladie de Castelman. A propos de deux cas et revue de la literature

Castelman's disease, an unusual condition of unknown cause, consisting of a massive proliferation of lymphoid tissue. Three histologic variants [hyaline vascular, plasma-cell, and mixed] and two clinical types [localized and multicentric] of Castelman's disease have been described.Localized disease can be cured with surgery or radiotherapy, but complete remission in patients with multicentric disease have been achieved only with prednisone or chemotherapy given at the time of diagnosis.The aim of this study is to report two cases of retroperitoneal Castelman's disease with review of the literature.the first patient, of 36 years old, presented for abdominal pain with anorexia and weight loss. The abdomino-pelvic CT scan showed a 6 cm retroperitoneal mass. The biopsy of this lesion suspected a lymphoproliferative disease. At laparotomy total excision of mass was made and the final histology revealed a hyaline-vascular type of Castelman's disease.The second patient, of 26 years old, presented for left lumbar pain with weight loss. The abdominopelvic CT. Scan showed a 6.5 cm retroperitoneal mass.The biopsy of this lesion showed a Castelman's disease. At laparotomy total excision of mass was made and the final histology confirmed a hyalinovascular type of Castelman's disease

Manifestation rare de l'hypothyroid': l'occler sion intestinale rapport de deux cas et revue de la litte'rature

Gastrointestinal manifestation of hypothyroidism are unfrequent. They consist particularly in hypomotility, intestinal atony, and pseudoobstruction. A high index of suspicion must exist, especially in elder subjects, in order to avoid unnecessary and even harmful investigation and intervention. We are reporting two cases of intestinal occlusion due to hypothyroidism with review of the literature

Laparoscopic Surrenalectomy for Pheochromocytoma. Case report and review of the literature

Laparoscopic surgery has a wide application in general surgery. Since the first laparoscopic adrenalectomy, this approach has quickly been adopted and increasing numbers are being reported. The small size of the adrenal gland the benign nature of most adrenal tumors and the difficulty in reaching the organ via open means make resection of this gland, particularly amenable to the laparoscopic approach. The potential benefits of this mini-invasive surgery include decreased operation blood loss, reduced narcotics requirements, shorter hospital stay and recovery time and minimize the parietal trauma. We report herein the Lebanese case of laparoscopic adrenalectomy for pheochromocytoma with review of the literature