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

Study of intratumoral and intravenous administration of recombinant of human TNF in patients with advanced cancers

Twenty-eight patients with advanced cancers resistant to standard cytoreductive therapy were enrolled in this study [eight cases of lymphoma, four cases of melanoma, four cases of renal cell carcinoma, four cases of ovarian carcinoma, cases of pancreatic malignancies and four cases of breast cancer]. The study found that the mean TNF level in cancer patients = 57.09 +/- 11 pgm/ml [0.120 U/ml]. The study also found that the maximal plasma level of TNF is higher [60 U/ml] after intratumoral injection than after 24 hours infusion [5 U/ml]. The necrotizing effects of TNF on the tumor were observed in twelve patients after intratumoral administration and only in eight patients after continuous infusion. The side effects after 24 hours infusion were fever, chills, tachycardia, severe hypotension, nausea, vomiting diarrhea, fluid retention due to capillary leak syndrome, general prostration and CNS affection. These side effects after 24 hours infusion were more severe and took more time for resolution than after intratumoral injection in which the only side effects were fever, chill, tachycardia and change in blood pressure. So, it was concluded that intratumoral application of rHuTNF is better tolerated and more efficient than continuous 24 hours infusion