Is the technetium 99M scan useful in screening for nontoxic solitary thyroid nodules?

The proposed benefits of the technetium [99[m] Tc] scan in the screening of patients with clinically solitary thyroid nodules were assessed. One hundred seventy-eight patients with such lesions underwent 99[m]Tc scanning followed by surgical resection. The solitary nature of the lesion was confirmed by Tc scanning in 153 [86%] patients. In the remaining 25 [14%], the scan showed patchy uptake by the thyroid gland, suggesting subclinical multinodularity. Of these 25 patients with conflicting clinical and scan findings, the lesion was confirmed to be sol-these 25 patients with conflicting clinical and scan findings, the lesion was confirmed to be solitary by operative and pathological findings in ten [40%] patients, of whom two patients had thyroid malignancies that might have been misdiagnosed as multinodular goiter. In the other 15 [60%] patients, the scan was accurate in detecting subclinical multinodularity, but again, two patients in this group had thyroid malignancies that might have been misdiagnosed as multinodular gointer. These findings indicate that the 99[m]Tc scan is useless in screening patients with nontoxic solitary thyroid nodules, and even more so in patients from geographical areas where there is a high incidence of malignancy in multinodular thyroid disorders

Intramuscular AV fistula of the sternomastoid muscle

The first reported case of arteriovenous fistula of the sternomastoid muscle is presented. Excision of the fistula resulted in complete recovery with no evidence of a recurrence after one year of follow-up

Significant prognostic factors in differentiated thyroid carcinoma: a literature review of single factor and multivariate analysis studies

The surgical management of differentiated thyroid carcinoma remains controversial and comparisons of the efficiency of various methods of treatment depend on analysis of retrospective studies. The majority of these relate prognosis to various clinical and pathological factors. The conclusions however differ when single or multivariate analysis is used to predict the most discriminative factors. Single factor analysis has regarded age as a major discriminant. When, however, all factors are considered- with multifactorial analysis -age alone loses its prognostic importance. In general the presence of distant metastases and/or infiltration of the primary lesion through the thyroid capsule are considered the two most adverse prognostic features in differentiated thyroid carcinoma and in their absence the outcome of treatment in patients with early and localized intraglandular lesions is favourable at all ages

Lobectomy for solitary thyroid nodules

Published reports show that the incidence of malignancy in the solitary thyroid nodule ranges between 2.7 and 33% and that the majority of these malignancies are differentiated thyroid carcinomas. The implied benefits of excision of the grossly normal opposite lobe when a differentiated thyroid carcinoma is found in the excised solitary nodule are removal of multifocal disease and thyroid ablation if an angioinvasive follicular carcinoma is present, to facilitate later management of metastases with radioactive iodine. However, follow-up studies demonstrate that despite the high incidence of multifocal disease the recurrence and mortality rates after single lobectomy for differentiated thyroid carcinoma presenting as a solitary nodule remain very low, and no advantage in these respects is conferred by total thyroidectomy with its attendant high incidence of complications. Single lobectomy is therefore justifiable as the treatment of choice for primary lesions of differentiated thyroid carcinoma Presenting as a single nodule. The very low incidence of angio-invasive follicular carcinoma in the solitary nodule does not justify the practice of routine frozen section examination of the excised nodule; with its incurring additional anaesthetic and operative time and the cost of the histological service itself. In the rare instance of angio-invasion being shown in the definitive paraffin section, the remaining thyroid tissue can still be ablated by radioactive iodine or surgery

Diagnosis and management of hydatid disease of the liver at King University Hospital

34 patients with hydatid disease of the liver were surgically treated at King Khalid University Hospital, Riyadh, from 1983 to 1986. Diagnosis was made on clinical examination, Casoni's test, serology and imaging technique. 26 patients [76.4%] had a cyst in the right lobe, two had a cyst confined to the left lobe of liver, and the remaining six patients had cysts in both lobes. A communication of the cyst with the biliary tree was observed in one patient. The surgical procedures used were endocystectomy with tube drainage [22/34], endocystectomy with primary obliteration of the cavity [4/34], endocystectomy with omentoplasty [4/34], and total pericystectomy with partial resection of liver [4/34]. In our experience, endocystectomy with drainage is a safe procedure and can be applied in any position of the cyst in the liver. Morbidity and complication rates can be minimized to a great extent by early removal of the tube. There was no mortality in our series and the average hospital stay was 15 days

pattern of surgically treated thyroid disease in two general hospitals in Riyadh

Of 380 patients with surgically treated thyroid disease in Riyadh, thyroid malignancy was observed in 21%, thyroid adenoma in 31%, non-toxic nodular goiter in 28%, toxic nodular goiter and Graves' disease in 11%, Hashimoto's disease in 7% and tuberculous thyroiditis in 0.8%. the incidence of malignancy in resected thyroid specimens was high in the Saudi nationals [25%] as compared to the non- Saudi residents studied [11%]. Hashimoto 's disease was observed in 4% of the Saudi males in this study

Thyroid malignancy in two general hospitals in Riyadh

An analysis of 380 patients from Riyadh treated surgically for goiter showed thyroid malignancy in 81 patients [21%]. Of these malignancies 92.6% were differentiated in type with a predominance of the papillary variety. The occurrence of thyroid malignancy was equal in Saudi females with single or multi-nodular goiter [22%] but seems to be high in the male Saudi presenting clinically as multi-nodular goiter [50%]. The high frequency of unsuspected carcinoma in goiters may warrant early thyroidectomy in the Saudi population

Observations relating to the pattern of acute appendicitis in Saudi Arabia

This prospective study examines clinical and operative findings in two population groups of patients who underwent acute appendicectomy at the King Khalid University Hospital in Riyadh. Of the group of 100 Saudi patients, 77% presented with colicky pain, vomiting being an associated symptom in 59%, and 86% showed retrocaecal appendicitis. 80% of the group of 100 non-Saudi patients complained of colicky pain, with vomiting a feature in 61% but the appendix was shown to be retrocaecal in only 47%. Raised leucocyte counts were consistent with the diagnosis of acute appendicitis. Peritonitis was a finding in 5% of all patients, and the postoperative wound infection rate was 7.5%. The overall 'white' appendicectomy rate was 4.5%