Review of Heterotopic Thyroid Autotransplantation

Total thyroidectomy is increasingly accepted for the management of bilateral benign thyroid disorders. Postoperatively, patients require lifelong levothyroxine replacement therapy to avoid postoperative hypothyroidism, which besides the burden of compliance, has been proven to be associated with several long-term side effects. Heterotopic thyroid autotransplantation was proposed several decades ago to avoid the need for life-long postoperative replacement therapy with maintaining the autoregulatory mechanism of thyroxin production inside the body according to its needs. Available data regarding this topic in literature is relatively poor. Before applying thyroid autotransplantation on humans, several studies have been done on animals, where the autologous transplantations were found to be successful in almost all the cases, proved by follow up postoperative 8-week measurements of thyroid hormones and histopathological examination of the removed autografts. Regarding the clinical application, few trials have been done using cryopreserved in vivo, in vitro or immediately autotransplanted thyroid autografts. Satisfactory results were obtained, however, the number of these studies and the number of patients per each study was very low. Besides the study methodologies were not so consistent.

Assessment of moist exposed burn ointment [MEBO] in the healing of chronic pressure ulcers: a prospective comparative clinical study

Pressure ulcers are a serious health issue causing clinical, financial, and emotional challenges. Treatment modalities that promote wound healing are therefore warranted. To assess the efficacy and safety of MEBO [Julphar Gulf Phannaceutical Industries, UAE] as compared to topical antibiotic ointment [Fucidin, Leo Pharmaceutical, Denmark] in the healing of chronic pressure ulcers. During a 4-year period [Jan 2003-Jan 2007], 45 patients of both sexes with 87 pressure ulcers seen at the Ahmadi Hospital [Kuwait] were categorized into 2 groups, those in group 1 [n=22] received MEBO while those in group 2 [n=23] received Fucidin. Age of the patients ranged between 14 and 102 years with a mean of 69, +/- 7.4 years. Patients had their ulcers prior to study entry for a mean of 10.55 months [range 2-26 months]. Data collected included demographics, nutritional status, underlying predisposing disease and co-morbidities. Ulcer surface area [SA] and healing index [HI] were calculated and compared at two-week intervals for 12 weeks. Patients in both groups had similar demographic and clinical features regarding their age, gender, underlying predisposing factor and comorbidities. Ulcer characteristics were also similar with respect to their number, site, size, duration, depth and presence or absence of sepsis. There was a significant [P<0.05] increase in HI and reduction in ulcer SA on weeks two and four respectively, that was main- tamed through 12 weeks in patients receiving MEBO as compared to those receiving Fucidin. Cumulative patient sample percentage showed that 55.8% of ulcers treated with MEBO had complete healing [HI = 1] by 12 weeks, as opposed to only 20.5% of those treated with Fucidin [P<0.001]. Moreover, none of the patients receiving MEBO had a HI of <50% by 12 weeks as compared to 27.3% of those receiving Fucidin [P<0.001]. Linear regression analysis showed that the change in ulcer size and HI can be attributed to ointment application [r2> 0.4]. No adverse effects of ointment were encountered in either group. Based on the data presented, it may be concluded that in addition to its safety, application of MEBO significantly promotes the healing of chronic pressure ulcers with significant increase in HI of any given ulcer to be expected as early as two weeks following initiation of treatment

Thyroiditis: a disease with many faces

Background: Diagnosis of thymiditis is rather difficult since it can simulate any other thyroid disease. This study was conducted to determine the clinico-pathological features of thyroiditis and to evaluate the efficacy of the various modalities utilizedfor diagnosis of the disease

Patients and Methods: The study included 59 patients with the clinical diagnosis of thyroiditis. Ten patients had subacute thyroiditis SAT and 49 had chronic thyroiditis [CHT]. Investigations included serum levels of T3, T4 and TSH, anti-chromosomal antibodies [AMA], anti-thyroglobulin antibodies [ATGA], Ultrasonography for the thyroid gland and FNAC. Twenty-four patients improved by conservative treatment while 35 needed thyroidectomy where histopathology for the excised glands confirmed the diagnosis of thyroiditis

Result: The mean age of patients with SAT was significantly lower than that of those with CHT [2813 +/- 5.82 years vs. 44.1 +/- 8.36 years, respectively] [t: 5.62, p=0.002]. Seventy one percent of patients with CHT had concomitant autoimmune disease, and nine of the 10 patients with SAT had history of recent upper respiratory tract infection. There was an obvious tendon; towards hyperthyroidism associated with CHT and towards hyperthyroidism associated with SAT. Both AMA and ATGA were significantly higher in patients with CHT as compared to those with SAT [P<0.05]. Hypoechoic sonographic pattern of the goiters formed the majority in both groups [33/49 and 8/10 for CHT and SAT respectively] [X2=26.612, P<0.001] fNAC could diagnose 30 out of 49 cases of CHT with a sensitivity of 59.2% a specificity of 90%, a positive predictive value of 96.7% and a negative predictive value of 31%. It did not diagnose any of the ten SAT

Conclusions: Diagnosis of thyroiditis requires a high index of suspicion. A history of concomitant autoimmune disease could associate CHT. An upper respiratory tract infection nay well precede a SAT. CHT is associated with a significant rise of AMA and ATGA. Hypoechoic sonographic petten is found in a significant number of patients with thyroiditis. FNAC is specific yet insensitive test for the diagnosis of thyroiditis

Evaluation of Karydakis Technique for the management of chronic pilonidal sinus in obese patients

This study was conducted to evaluate Karydakis technique for the management of chronic pilonidal sinus in obese patients. The study included 40 patients divided according to their body mass index [BMI] into two groups: Group I included obese patients and Group II included non-obese patients. There was no significant difference between obese and non-obese patients regarding their clinical presentation in terms of symptoms, duration of the disease and number of sinus openings. It was concluded that Karydakis technique for management of chronic pilonidal sinus was easy to perform, had a fast healing time, short hospital stay and low recurrence rate. The results were similar between obese and non-obese patients with a BMI< 30.5 and no recurrence seen in these patients. Complications occurred in obese patients had a BMI > 30.5. In such patients, a dietary regimen before operation was advisable and inserting a suction drain during the operation was recommended to avoid seroma formation

Stimulation of hepatocyte regeneration by cyclosporine A [CyA]: an experimental, histopathologic and image analysis study

The effect of cyclosporine [CyA] upon liver regeneration was studied in rats after partial hepatectomy. In group I [controls], a standard two- thirds hepatectomy was performed. In group 2, CyA, at a dose of 10mg/kg body weight was given orally one day prior to, on the day of the operation and at 24 hours after the partial hepatectomy. Histologic findings and mitotic activities of remnant livers, as well as serum levels of ALT, AST, albumin and total bilirubin were examined from the day of the operation [day 0] to 10 days after hepatectomy. Treatment with CyA resulted in an increase of the mitotic activities of hepatocytes at days 2, 3 and 5 pstoperatively. This phenomenon coincided well with other histologic findings and biochemical pqarameters. Data obtained from image analysis studies demonstrated that CyA induced hepatocytes in the GO phase to enter the cell cycle and produce a reversible block at the G2 phase of the cycle. Based on these data, it may be concluded that CyA stimulates liver cell proliferation, reduces enzyme loss [ALT and AST] and improves albumin synthesis in rats after partial hepatectomy. Such actions would have important clinical implications in cases of hepatitis, hepatic resection and liver transplantation

Role of lymphogenous communications in the development of ascites in schistosomal hepatic fibrosis [SHF]

The present study included 20 patients. Ten patients had ascites [group 1] and 10 patients were ascites-free [group 2]. Ten healthy subjects served as controls [group 3]. All subjects were matched for age, sex and body weight. In addition, patients in groups 1 and 2 had comparable liver function tests and portal blood flow volume. Iodinated [125I] human serum albumin was injected intralymphatically in the first dorsal web space of the foot, and serial simultaneous blood samples were obtained from the inferior vena cava [IVC] and antecubital vein at 5, 10, 20, 30, 60, 90 and 120 minutes after injection and every 60 minutes thereafter for a total of 360 minutes. The radioactivity presented in each sample was determined with a scintillation counter. In the healthy subjects and in patients with ascites, negligible lymphovenous shunting of labeled albumin was noted. In non-ascitic patients, an increased quantity of iodinated albumin appeared in the circulation [P <0.001]

Correlation between serum levels of triiodothyronine [T[3]] and thyroxin [T[4]] and severity of clinical manifestations of uncontrolled thyrotoxicosis

The present study was carried out on 30 patients with uncontrolled thyrotoxicosis. Twenty seven patients [90%] were female and three [10%] were male. Their ages ranged between 17 and 56 years with a mean age of 36.6 years. Results revealed a significant correlation between the mean serum level of total triiodothyronine [TT3] and some, but not all, symptoms and signs of thyrotoxicosis. No significant correlation was found with respect to total thyroxin [TT4] level. A significant direct positive correlation was found between Wayne's score and the serum levels TT3 and TT4 [p<0,05]. An inverse relationship existed between serum levels of thyroid stimulating hormone [TSH] and those of TT3 and TT4 [p<0.05]. Fine needle aspiration cytology [FNAC] was not conclusive in pre-operative diagnosis of the disease as compared to post-operative paraffin section biopsies

Comparative study of hematological and immunological responses to splentectomy versus splenic autotransplantation in patients with traumatic rupture of the spleen

The present study was carried out on 20 male patients admitted to the Main Alexandria University Hospital with traumatic rupture of the spleen. Group 1 patients [n=10] were subjected to total splenectomy with intraperitoneal splenic tissue autotransplantation via an omental pouch, while group 2 patients [n=10] were subjected to total splenectomy alone and served as controls. Both groups were compared, utilizing hematological and immunological parameters measured preoperatively and 4 weeks and 8 weeks postoperatively, in order to assess function of the splenic implants. Results revealed partial restoration of splenic function as reflected by a statististically significant reduction [P<0.05] of the mean percentage of vaculated RBCs at 8 weeks postoperatively as compared to controls and significant increase of serum IgM levels at 8 weeks postoperatively as compared to their level at 4 weeks. Based on these data, it may be concluded that whenever total splenectomy is unavoidable following trauma, intraperitoneal autotransplantation of splenic tissue restores, at least partially, splenic function, particularly its role as a blood filter