Minimally invasive video assisted thyroidectomy for small follicular thyroid nodules

Minimal access surgery in the thyroid compartment has evolved considerably over the past 10 years and now takes many forms. This study examined the feasibility and reliability of minimally invasive thyroid surgery in the management of small benign thyroid lesions. Sixty eight patients with small thyroid nodules admitted in Oncology Center, Mansoura University, Egypt, were enrolled in this prospective randomized trial. Patients were allotted in one of these procedures, minimally invasive video assisted thyroidectomy [MIVAT], or minimally invasive open thyroidectomy using the Sofferman technique of strap muscle transection. Exclusion criteria were nodules greater than 4 cm, presence of thyroiditis, and thyroid gland volume greater than 20 ml Preoperative diagnosis, operative time, blood loss, postoperative pain, complications and cosmetic outcome were all evaluated. MIVAT group included 35 patients and the Sofferman group included 33 patients. The main preoperative pathology was benign follicular lesion [70.5%] and the main postoperative final pathology was follicular adenoma [54.4]. Both groups were comparable regarding age, sex and extent of thyroid surgery. Operative time was significantly longer in MIVAT group [115.4 +/- 33.5 min] compared to the Sofferman group [65.6 +/- 23.7 min]. Postoperative course was significantly less painful in MIVAT group [P< 0.05]. Although patients in MIVAT group had smaller incisions [P <0.05], the cosmetic outcome in both groups was comparable. No long term complication was encountered in both groups. Two distinct approaches of minimally invasive thyroidectomy are now available and can be performed safely in selected patients. Despite some MIVAT advantages of less postoperative pain and slightly better cosmesis, minimally invasive open thyroidectomy offers an advantage of less operative time with comparable cosmetic results

Transerectal ultrasonography [TRUS] in evaluation of prostatic lesions

TRUS is the preferred ultrasonic investigation of BPH and other prostatic diseases providing a safe, non-invasive technique for imaging of the prostate. The size of the prostate can be measured, also staging and screening of prostatic cancer. TRUS is an ideal imaging modality for follow-up of patients treated for cancer prostate and infection permitting sequential objective assessments of the gland texture and capsular integrity. In combination with PSA measurements and DRE it may be useful for detecting prostatic cancer and screening programs based on TRUS. PSA. and DRE, that combination can be used in clinical trials of different treatment regimens for prostatic cancer. However microscopic invasion the prostatic capsule and cancers less than 4.4 mm, also false positive results as a result of similar echogenicity of normal structure and some lesions, and lastly isoechoic cancers are main limitation of TRUS evaluation of prostatic lesions

Computed tomography versus fiberoptic bronchoscopy in the evaluation of bronchial disease

CT was compared to fiberoptic bronchoscopy [FOB] in 41 cases in which local airway disease was identified with FOB and in 30 patients in whom the airway appeared normal at bronchoscopy. CT was positive in 38 of 41 cases in which lesions were detected at FOB and in 60 [90%] of 67 lesions in the results are analyzed according to the extent of the involvement of the individual bronchi. CT excluded disease if 27 [90%] of 30 cases that were verified to be normal by FOB. The diagnosis of malignancy was not missed in any case by CT. While extremely accurate in detecting focal lesions CT was inaccurate in predicting whether a given abnormality was endobronchial, submucosal or peribronchial. In conclusion CT is helpful when bronchoscopy is contraindicated or refused. CT may also be used in cases with low clinical suspicion of endobronchial disease and as an adjuvant procedure to FOB for outlining the exact location of major mediastinal and hilar vessels, lymph nodes and tumour in relation to adjacent airways

Value of computed tomography in the evaluation of pleural diseases

48 cases of localised and diffuse pleural diseases were evaluated with computerized tomography [CT] after perforimg plain X-ray chest [both P.A. and Lat. Views]. History of asbestos exposure was obtained in 12% of the cases, while past history of radiotherapy was found in 27% of the cases. Plain X-ray chest revealed unilateral opacification in 41 cases and bilateral opacification in 7 cases. The opacity was homogenous in 20 cases, heterogenous in 27 cases and nodular in 5 cases. Ipsilateral mediastinal shift was seen in 41 cases. CT revealed 25 cases with solid masses [17 cases associated with pleural effusion] and 23 cases with pleural effusion [free effusion in 20 cases and encysted in 3 cases]. Mediastinal lymphadenopathy was found in 5 cases [3 cases of proven lymphoma and 2 cases of pleural metastasis from cancer breast]. Diaphragmatic invasion and retroperitoneal extension of mesothelioma were found in 2 cases. Liver metastasis was detected in 2 cases. CT guided fine-needle aspiration biopsy [FNAB] was done in 25 cases, thoracotomy and wide resection of pleural mass was performed in 4 cases. CT could differentiate solid lesion from pleural effusion, clearly demonstrate extension of the lesion, associated lymphadenopathy, rib destruction, distant liver metastasis in addition to taking CT guided FNAB

Transrectal ultrasonography in the evaluation of rectal and extrarectal diseases

Transrectal ultrasound was used to evaluate known on suspected rectal and extra-rectal masses. 32 patients were examined, 25 patients with rectal carcinoma and 7 patients with extra-rectal masses. All patients underwent surgical exploration. They include, rectal cancers, recurrent cancer bladder, posterior uterine wall leiomyoma, perirectal abscesses and presacral endometriosis. Pathological staging of rectal cancer cases after surgery, had shown that transrectal ultrasound was accurate in detecting the site of rectal cancer, defining perirectal fat infiltration and perirectal lymph node involvement. The results suggest that, transrectal ultrasound is a cost effective, reliable adjunct for staging rectal cancers