Bocio nodular quístico recidivante. A propósito de un caso / Recurrent Nodular Cystic Goiter. In Regards with a Case

RESUMEN Los nódulos tiroideos quísticos en la gran mayoría de los casos son benignos, especialmente si son quistes puros. Los pequeños no necesitan tratamiento supresivo con levotiroxina. A los de gran tamaño, se puede realizar punción para extraer su contenido. Su reproducción es muy frecuente, lo que puede implicar punciones repetidas y el peligro de infección. Los quistes grandes se reproducen con facilidad, y es necesaria la cirugía, dado que rara vez responden al tratamiento médico. Se presenta el caso de un paciente del sexo masculino, de 78 años de edad, con antecedentes de ser fumador inveterado e hipertenso con tratamiento, que refirió haber presentado desde hacía unos meses aumento de volumen del cuello, acompañado de disfonía y disfagia a los alimentos sólidos. Al examen físico se constató tumoración en la región antero-lateral derecha del cuello y parte de la región izquierda de 5 a 6 cm de diámetro, movible con la deglución y de consistencia suave y blanda, sin adenopatías palpables. Se le realizó biopsia por aspiración con aguja fina en 3 ocasiones, presentó recidiva, se le realizó lobectomía derecha. El estudio anatomopatológico informó bocio nodular con degeneración quística. A pesar de ser frecuente esta patología, se considera importante su comunicación con fines docentes.

ABSTRACT Cystic thyroid nodules in the vast majority of cases are benign, especially if they are pure cysts. Children do not need suppressive treatment with levothyroxine. Puncture may be performed to large cysts to extract its contents. Their reproduction is very frequent, which may involve repeated punctures and the danger of infection. Large cysts reproduce easily, and surgery is necessary, since they rarely respond to medical treatment. We present the case of a 78 year-old male patient, with a history of being an inveterate smoker and hypertensive with treatment, who reported having presented a few months increase in neck volume accompanied by dysphonia and dysphagia to solid foods. Physical examination showed a 5 to 6 cm in diameter tumor in the right antero-lateral region of the neck and part of the left region. It was movable with swallowing and of soft in consistency, without palpable adenopathies. A fine needle aspiration biopsy was performed 3 times, with recurrence and a right lobectomy was performed. The anatomic-pathological study reported nodular goiter with cystic degeneration. In spite of its frequency, communication with teaching purposes is considered important.

High-intensity focused ultrasound ablation as a treatment for benign thyroid diseases: the present and future

High-intensity focused ultrasound (HIFU) is a promising ablation technique for benign thyroid nodules. Current evidence has found good short- to medium-term outcomes, similar to those of better-established ablation techniques such as radiofrequency and laser ablation. The fact that it does not require insertion of a needle into the target makes HIFU a truly non-invasive treatment. Although it is not without risks, its low risk profile makes it an attractive alternative to surgery. There is much room for future development, starting from expanding the current indications to enhancing energy delivery. Relapsed Graves disease and papillary microcarcinoma are diseases that can benefit from HIFU treatment. Its role in the mediation of immune responses and synergistic effects with immunotherapy are promising in the fight against metastatic cancers.

Predictive value of CT signs in the diagnosis of benign and malignant thyroid nodules / 中华全科医师杂志

Objective To investigate the predictive value of multiple CT signs in the diagnosis of benign and malignant thyroid nodules.Methods The CT data of 1 009 nodules with diameter >1.0 cm confirmed by histology from 931 patients was retrospectively analyzed, including 548 benign nodules from 484 patients and 461 malignant nodules from 447 patients.According to the inspection time, all nodules were divided into model group(2009—2014)and test group(2015—2016).The distribution of nodules with irregular shape, bite cake syndrome, micro calcification, enhanced range reduction/blur, cystic and high enhancement were evaluated in two groups.Univariate and multivariate logistic regression analysis were performed to evaluate the predicting value of multiple CT sighs for benign and malignant thyroid nodules in two groups.Results The numbers of benign and malignant nodules were 252 and 233 in model group,and were 296 and 228 in test group.The univariate logistic analysis of the model group and the test group showed that irregular shape, bite cake syndrome, micro calcification, enhanced range reduction/blur were more common in malignant nodules.OR values were 4.172 and 6.327,3.927 and 3.493,5.354 and 6.674, 11.814 and 5.082,8.680 and 14.562,respectively.The areas under the predicted probability curve were 0.946 and 0.936, respectively.The micro calcification was an independent predictive factor in the multivariate logistic regression analysis in the model group but not in the test group.Conclusion Irregular shape,bite cake syndrome and enhanced blur/range reduction are the CT signs of the stable malignant nodules,cystic and high enhancement are the CT signs of stable and benign nodules.Combination of multiple CT signs could improve the accuracy of diagnosis for Benign and Malignant Thyroid Nodules.

The efficacy and safety of high-intensity focused ultrasound ablation of benign thyroid nodules

High-intensity focused ultrasound (HIFU) is a promising form of thermal ablation of benign thyroid nodules, but evidence supporting its use is scarce. The present review evaluated the efficacy and safety of single-session HIFU treatment of benign thyroid nodules. As reported in the literature, the extent of nodule shrinkage following treatment ranged from 48.8% to 68.8%. Like other forms of ablation, the shrinkage rate was greatest in the first 3-6 months, and the best responders were patients with small (≤10 mL) nodules. Complications were uncommon, but temporary vocal cord palsy occurred in 3%-4% of patients, and was related to the distance between the HIFU beam and the recurrent laryngeal nerve. Despite being safe and efficacious, a larger-scale prospective trial is required.

Clinicopathological analysis of thyroid nodules with preoperative recurrent laryngeal nerve palsy / 中国耳鼻咽喉头颈外科

OBJECTIVE To investigate the clinical significance of preoperative recurrent laryngeal nerve palsy (RLNP) for thyroid nodules with regard to the incidence of malignancy,recurrent laryngeal nerve involvement and histopathological character.METHODS Eighty patients with preoperative RLNP treated in Zhejiang Cancer Hospital between Jan 2007 to Dec 2014 were enrolled,their clinicopathological data were recorded and retrospectively analyzed.RESULTS Of 80 patients,16 patients had benign thyroid disease,while the other 64 had malignancies (80.0％).The preoperative RLNP incidence of benign and malignant lesions was 0.3％ and 0.9％ respectively.Poorly differentiated and anaplastic thyroid cancer had the higher incidence of preoperative RLNP comparing with other pathology types (25.93％,P＜0.05).The RLN did not preserved intraoperatively in 2 patients with benign lesions (2/16,12.5％) and in 42 patients with malignancy lesions (42/48,87.50％).All nerves were sacrificed in poorly differentiated and anaplastic thyroid cancer patients.The RLN could be isolated from 14 benign lesions and 6 malignancies,with or without adhesion,and the nerve function was recovered postoperatively.CONCLUSION The probability of preoperative RLNP is significantly higher in malignant lesions than benign lesions.Thyroid tumors with RLNP are strongly suggested of malignancy,with higher rate of intraoperative nerve sacrifice.The RLN should be preserved if it has not been invaded by the tumor,which offers a chance of functional recovery postoperatively.

Expression of micro RNA-125b in female patients with nodular goiter and Hashimoto's thyroiditis / 中华全科医师杂志

Twenty four female patients underwent thyroidectomy between June 2015 and August 2016,among whom 11 cases were pathologically diagnosed as nodular goiter (NG group),and 13 cases were diagnosed as nodular goiter complicated with Hashimoto's thyroiditis (NG + HT group);meanwhile,17 female patients with Hashimoto's thyroiditis (HT group) and 20 healthy females (control group) were also recruited in the study.The expression of micro RNA(miR)-125b was evaluated by quantitative real-time PCR(qRT-PCR),the expression level of tumor necrosis factor α (TNF-α) was analyzed by Western blotting in thyroid nodules and adjacent thyroid tissue in NG and NG + HT groups.Serum expression of miR123b was detected in all 4 groups.qRT-PCR results showed that the expression of miR-125b was down regulated by 0.55 fold in thyroid nodules of NG + HT group compared to NG group (t =2.873,P ＜ 0.01).The serum expression levels of miR-125b in control group,NG group,HT group and NG + HT group were 1.00,1.06,0.92 and 0.79,respectively,the expression level in NG + HT group was significantly lower than that of control group (q =4.717,P ＜ 0.01).Western blot showed that the expression of TNF-α in thyroid nodules of NG + HT group was significantly higher than those in nodules of NG group and adjacent thyroid tissues of both groups.The results suggest that miR-125b might serve as a promising diagnostic biomarker of Hashimoto's thyroiditis in patients with nodular goiter.

Analysis of misdiagnosis with contrast-enhanced ultrasound in nodules goiter / 中华超声影像学杂志

Objective To analyze the misdiagnosed cases of the nodular goiter (NG)in real-time contrast-enhanced ultrasound(CEUS),in order to improve the diagnostic accuracy of NG.Methods Two-hundred and sixty-five cases of NG CEUS images,especially the 48 nodules in 44 misdiagnosis cases,were retrospectively analyzed to find out the main reasons of the misdiagnosis.In addition,the factors which effected the results of CEUS such as size,number and calcification of NG nodules were summarized.Results There were 42 nodules misdiagnosed as thyroid cancer,5 nodules misdiagnosed as thyroid adenoma and 1 nodular goiter misdiagnosed as subacute thyroiditis in 874 nodular goiter cases.The misdiagnosis rate of nodular goiter was 5.49% (48/874)by the diagnostic criterion of homogeneous enhancement in CEUS.The differences size and calcification of nodules had a significant impact on CEUS.The misdiagnosis rate of the NG nodules with major diameter less than 10 mm was much higher than that of more than 10 mm,the misdiagnosis rate of NG nodules with coarse calcification was much higher than the situation of microcalcification(P <0.05).Conclusions Major diameter less than 10mm and coarse calcifications of NG nodular are the main factors which influence the results of CEUS.

Relationship between Thyroid Hormones and the Nature of Thyroid Nodules / 天津医药

Objective To detect serum levels of thyroid hormones in patients with thyroid nodules (TN), and investi-gate their relationship with the nature of TN. Methods A total of 245 patients with TN were recruited in the study. Accord-ing to levels of thyroid antibodies and postoperative pathological results, all patients were divided into nodular goiter (NG) group, thyroid adenoma (TA) group and thyroid cancer (TC) group. TC group was further classified as the TC with increased level of thyroid antibodies (TC-AB+group) and the TC with normal level of thyroid antibodies (TC-AB-group). The serum levels of free T3 (FT3), free T4 (FT4) and thyroid stimulating hormone (TSH) were detected for all patients before operation, and differences of thyroid hormones were analyzed between different groups. Results The serum level of TSH was signifi-cantly higher in TC group than that of NG group and TA group (P<0.05). The serum level of FT3 was significantly lower in TC-AB+group than that of NG group and TC-AB-group. The serum level of FT4 was significantly lower in TC-AB+group than that of NG group, and the serum TSH level was significantly higher than that of other groups (P<0.05). Conclusion The increased serum levels of TSH were found in some patients with TC, which may partly attribute to their coexistence with autoimmune thyroiditis and subsequent hypothyroidism. The increased serum TSH level may not be the inherent characteris-tics of TC.

Analysis of the effect of ultrasound knife assisted low small incision thyroid operation / 中国基层医药

Objective To discuss the clinical curative effect of ultrasound knife assisted low small incision thyroid operation.Methods According to the digital table ,100 patients with nodular goiter who were treated with operation were divided into the small incision group and control group ,50 cases in each group .The patients in small incision group were given the ultrasound knife assisted low small incision thyroid operation , while the patients in control group were given the traditional thyroid operation .The operation time , incision length , operative blood loss , postoperative visual analog scale (VAS) of pain scores,length of stay(LOS) and postoperative complications were observed and compared in the two groups .Results The operations in two groups were both successful .The operation time,incision length,operative blood loss,LOS,VAS of pain scores 12 h and 24 h after the operation in the small inci-sion group were much better than those in the control group (t=2.91,2.93,2.17,2.22,2.24,2.87,all P<0.05). The incidence rate of postoperative complication in the small incision group was lower than that in the control group (χ2 =4.33,P<0.05).Conclusion Compared with traditional thyroid operation ,ultrasound knife assisted low small incision thyroid operation has the following advantages to treat nodular goiter :shorter operation time ,smaller operation wound,lighter postoperative pain,better cosmetic effect,less postoperative complication and etc .

Tireoidectomia total nas doenças benignas da tireóide / Total thyroidectomy for benign thyroid diseases

OBJETIVO: discutir as indicações da tireoidectomia total como opção preferencial em determinadas doenças benignas da tireóide, com a finalidade de evitar recidivas ou futuras reoperações. MÉTODOS: estudo retrospectivo de pacientes portadores de doenças benignas da tireóide, realizado no período de janeiro de 1997 a dezembro de 2009, analisando os dados relativos à idade, tratamento cirúrgico, evolução pós operatória. RESULTADOS: A idade média foi de 51,8 anos (21/77), sendo a maior incidência na quinta e sexta décadas de vida, com 34 (51,5 por cento) pacientes. O diagnóstico mais comum no pré operatório foi de bócio multinodular atóxico, onde sete tinham características de mergulhantes, seguido da tireoidite autoimune; os bócios recidivados foram 11. O bócio multinodular foi encontrado em 37 (56,1 por cento)pacientes, a tireoidite autoimune em 22 (33,3 por cento), o adenoma folicular isolado em cinco (7,6 por cento), o adenoma de células de Hürthle em dois (3,0 por cento). Dezesseis pacientes (24,2 por cento) tiveram mais de um diagnóstico histopatológico. A lesão permanente de nervo recorrente foi observada em um paciente (1,5 por cento). Não foi registrado nenhum caso de hipoparatireoidismo definitivo. Não houve mortalidade operatória. CONCLUSÃO: a tireoidectomia total é uma operação que pode ser realizada com segurança e baixa incidência de complicações permanentes, o que permite ampliar suas indicações nas diversas doenças benignas da tireóide evitando, assim, futuras recidivas e reoperações.

OBJECTIVE: To review the indications for total thyroidectomy as the preferred option in certain benign diseases of the thyroid in order to prevent recurrence or future reoperations. METHODS: A retrospective study of patients with benign thyroid diseases, carried out from January 1997 to December 2009, analyzing the data relating to age, surgical treatment and postoperative evolution. RESULTS: The mean age was 51.8 years (21/77), with the highest incidence in the fifth and sixth decades of life, with 34 (51.5 percent) patients. The most common preoperative diagnosis was nontoxic multinodular goiter, of which seven were also intrathoracic, followed by autoimmune thyroiditis; recurrent goiter occurred in 11 cases. Multinodular goiter was found in 37 (56.1 percent) patients, autoimmune thyroiditis in 22 (33.3 percent), follicular adenoma isolated in five (7.6 percent), Hurthle cell adenoma in two (3.0 percent). Sixteen patients (24.2 percent) had more than one histopathological diagnosis. Permanent injury of the recurrent nerve was observed in one patient (1.5 percent). There was no case of permanent hypoparathyroidism. There was no operative mortality. CONCLUSION: Total thyroidectomy is an operation that can be safely performed, with low incidence of permanent complications, which allows one to broaden its indications in various benign thyroid diseases, thus avoiding future recurrences and reoperations.

Clinical analysis of reoperation for patients suffering from rucurrent nodular goiter / 中国地方病学杂志

Objective To explore the causes of postoperative recurrence in patients of nodular goiter,the selection of method for reoperation and the postoperative complications. Methods The clinical data of 278 nodular goiter patients admitted in the first affiliated hospital of Harbin Medical University between 2001 and 2008 were analyzed retrospectively,including the methods and complications for first operation and reoperation. Results In the first operation,79 eases received simple eminectomy and 167 cases received partial lobectomy,accounted for 28.4% and 60.1%,respectively. Unilateral subtotal lobectomy plus contralateral eminectomy was performed in 23 cases and subtotal thyroideetomy was conducted in 9 cases,accounted for 8.3% and 3.2%,respectively. Postoperative complications occurred in one hundred and twenty-three cases,the incidence being 8.2% (23/278). Unilateral subtotal Iobectomy plus contralateral partial iobectomy was reperformed in 37 cases and bilateral subtotal thyroidectomy in 241 cases. Postoperative complications occurred in 12 cases,the incidence being 4.2%(12/278). No postoperative recurrence of nodular goiter was found. Conclusions Recurrence of nodular goiter is closely associated with the scope of previous surgical treatment,and correct operative manipulation may reduce the recurrent rate.

Detection and its clinical significance of CD+4 CDHi25 CDLo127 regulatory T cells in peripheral blood of patients with thyroid neoplasm / 肿瘤研究与临床

Objective To analyze CD+4 CDHi25 CDLo127 regulatory T cells (Treg) in peripheral blood of patients with thyroid nodules and differentiated thyroid cancer and their change regularity, and to investigate the immunosuppression mechanism. Methods The peripheral blood was collected from 175 patients with thyroid nodules, including 43 patients with differentiated thyroid cancer and 132 patients with nodular goiter.By using monoclonal antibodies, the blood samples were evaluated with the flow cytomertry for lymphocyte subsets and Treg cells. Results The results showed the prevalence of the CD+4 CDHi25 CDLo127 Treg in differentiated thyroid cancer group [(6.48±1.49) %] and nodular goiter group [(6.23+1.67) %] was higher than those in the healthy group [(5.62±1.48) %], and the difference was significant(P < 0.005), but there was no significant difference between the nodular goiter group and differentiated thyroid cancer group (P >0.005).Conclusion It is concluded that the relative increase of CD+4 CDHi25 CDLo127 Treg in peripheral blood of patients with nodular goiter and differentiated thyroid cancer may be related to immunosuppression and tumor progression.

Expressão citofotométrica do fator de proliferação celular ki-67 no bócio colóide e no carcinoma papilífero da tireóide / Citophotometric expression of the factor of cellular proliferation ki-67 in the goiter colloid and in the papillary carcinoma of the thyroid

Objetivo: Comparar a expressão citofotométrica quantitativa do fator de proliferação celular Ki-67 no bócio colóide com o do carcinoma papilífero da tireóide. Métodos: Foram estudadas a expressão da proteína Ki-67, em 12 casos de bócio colóide da tireóide e 20 casos de carcinoma papilífero da tireóide. Os núcleos celulares imunomarcados foram quantificados através do software SAMBA 4000 ® e do software IMMUNO®, analisando o índice de marcagem e densidade óptica. Foi estimado o coeficiente de correlação de Spearmane e o teste não- paramétrico de Mann-Whitney. Resultados: Foi rejeitada a hipótese nulapara o índice de marcagem. confirmando que existe diferença significativa entre o bócio colóide e o carcinoma papilífero da tireóide, quanto ao índice de marcagem do Ki-67, que são maiores nos carcinomas papilíferos da tireóide. Não foi encontrada diferença quanto à densidade óptica. Quanto ao bócio colóide, o coeficiente de correlação estimado entre o índice de marcagem e adensidade óptica do Ki-67 foi igual a 0,78. No bócio colóide, houve associação positiva e significativa entre o índice de marcagem e a densidade ótica do Ki-67. Para o carcinoma papilífero da tireóide o coeficiente de correlação estimado entre o índice de marcagem e a densidade ótica do Ki-67 foi igual a 0,18. Não houve no carcinoma papilífero de tireóide, associação entre o índice de marcageme a densidade ótica do Ki-67. Conclusão: A expressão citofotométrica do Ki67 no bócio colóide teve índice médio de marcação de 13,92% e densidade óptica média de 36,43; a expressão citofotométrica do Ki-67 no carcinoma papilífero teve índice médio de marcação de 38,29% e densidade óptica média de 48,07%; há maior proliferação celular no carcinoma papilífero em comparação com o bócio colóide na expressão do Ki-67.

Objective: To compare the cytophotometric quantitative expression of Ki-67 cellular proliferation factor in the colloid goiter with papillary carcinoma of the thyroid. Methods: The protein Ki-67 was studied with immunohistochemistry in 20 cases of papillary carcinoma of the thyroid and 12 cases of colloid goiter. The immunomarked cell nuclei were quantified through the software SAMBA4000 ® and analyzed by software IMMUNO ®, considering variables index marker and optical density. The coefficient of the Spearman rank correlation and the non-parametric test of Mann-Whitney wre estimated. Results: There is significant difference between the goiter colloid and the papillary carcinoma of the thyroid in Ki-67 measurements, being bigger in papillary carcinomas. No difference wasfound in optical density. The correlation coefficient between the index marker and the optic density was 0,78. In colloid goiter, there was positive and significant association between the index marker and the optic density. For the papillary carcinoma of the thyroid thecorrelation between index marker and optic density was 0,18 (p = 0,572). There was no association between the index marker and the optic density in the carcinoma papillary of the thyroid. Conclusion: The cytophotometric expression of the Ki-67 showed higher cellular proliferation in the papillary carcinoma of the thyroid in comparison with in the colloid goiter.

Study on the correlation of serum insulin-like growth factor-1 and radioactive iodine uptake rate in patients with nodular goiter / 中国医师进修杂志

Objective To study the correlation of the serum insulin-like growth factor-1(IGF-1) level and the radioactive iodine uptake rate in patients with nodular goiter,to explore a simple and saftymethods of identifying different kinds of thyroid nodule.Methods Sixty diagnosed cases was selected intohot nodule group(30 cases)and cool nodule group(30 cases),and 30 healthy people were selected into thehealthy control group.Measured the IGF-1,FT3,FT4,TSH level of each group by radioimmunoassay,and measured the radioactive iodine uptake rate by radionuclear technique.Results To compare with healthy control group,the levels of serum IGF-1,FT3,FT4 and the radioactive iodine uptake rate of hot nodule group were increased obviously,but the serum TSH was decreased significantly,and the level of IGF-1 had positive correhtion with the radioactive iodine uptake rate(r=0.835)in the same group.Meanwhile,the 1 evel of IGF-1 had negative correlation with the level of TSH(r=-0.326).In cool nodule group,the levels of serum IGF-1,FT3,FT4,TSH had no significant difference oompared with healthy control group(P>0.05).Conclusion The level of IGF-1 and radioactive iodine uptake rate in patients with nodular goiter has certain correlation.

Introduction to Quick and Surround Needling Method for Nodular Goiter / 针灸推拿医学（英文版）

Clinically guided by the holistic concept of traditional Chinese medicine and in combination with four diagnostic methods and pattern identification, quick and surround puncture is used for treating nodular goiter, fully displaying the practical application value of the special acupuncture therapy.

Research on the correlation between serum insulin-like growth factor-1 level and the uII absorbance in patients with strunm nodosa / 中国地方病学杂志

Objective To investigate the correlation between serum insulin-like growth factor-1(IGF-1)level and the 131Ⅰahsorbante of thyroid nodule in patients with struma nadosa,to search for simpler and safer methods for differentiating thyroid nodule.Methods Detecting the 131Ⅰ absorbance of thyroid nodule by radioisotope scanning.then the patients were divided into warm and cold nodule groups,and the normal control group was also set up;the levels of IGF-1,FT3,FT4,sTSH were detected in serum of patients with struma nadosa by radio immunoassay,then the correlation between these data and the 131Ⅰabsorbance of thyroid nodule was analyzed.Results In the patients with warnl nodule,the level of serum IGF-1,FT3,FT4 and the 131Ⅰ absorbance of thyroid nodule[(315.86±22.74)μg/L,(9.95±5.62),(67.27±27.31)ng/L,0.64±0.17]were increased obviously when compared with the control group [(256.13±39.85)μg/L,(2.80±1.30),(13.51±5.50)ng/L,0.35±0.15],but the sTSH[(0.35±0.03)mU/L]went down significantly than the control group[(2.71±1.17)mU/L],the difference being statistically significant(P＜0.01).In the patients with cold nodule,the level of serum IGF-1,FT3,FT4,sTSH[(263.17±30.23)μg/L,(2.89±0.98),(14.23±2.84)ng/L,(2.81±0.42)mU/L] had no significant difference compared with the control group(P＞0.05).The level of serum IGF-1 was positively correlated with the 131Ⅰ absorbance of thyroid nodule(r＝0.835,P＜0.01),but negtively correlated with sTSH(r＝-0.326,P＜0.05)in the patients with warm nodule.Conclusion The level of sernm IGF-1 is closely correlated with the 131Ⅰ absorbance of thyroid nodule in patients with struma nadosa.

Cirugía ambulatoria en afecciones nodulares del tiroides / Ambulatory surgery in thyroid-nodular conditions

Se realizó un estudio comparativo, transversal y prospectivo de 104 pacientes afectados por patologías quirúrgicas del tiroides en el periodo comprendido de enero de 2001 hasta diciembre de 2002, los cuales fueron intervenidos quirúrgicamente 50 pacientes por el método de Cirugía Mayor no Ambulatoria en el Hospital Universitario "Abel Santamaría Cuadrado" de Pinar del Río. En la serie predominaron las patologías nodulares con respecto a los difusos, ya que estas últimas fueron excluidas de nuestro trabajo, intervenidos en su totalidad con anestesia general con intubación endotraqueal. Las enfermedades asociadas no constituyen limitaciones en la muestra escogida, en tanto la estadía hospitalaria en los pacientes con patologías nodulares benignas fue inferior a 24 horas postoperatorio, los cuales evolucionaron satisfactoriamente. Se demostró que las operaciones de nódulo de tiroides por cirugía ambulatoria son seguras y factibles para el paciente por el bajo número de complicaciones lo que reduce significativamente el costo hospitalario, ya que la mayoría de los pacientes fueron egresados entre 12 y 24 horas después. Se obtuvieron evidentes ventajas económicas con respecto al ahorro del recurso cama y la del costo hospitalario, así como un elevado grado de satisfacción por parte de los operados, lo que justifica que se recomiende incrementar la aplicación de este proceder y extenderlo al mayor número posible de afecciones quirúrgicas.

A comparative, cross-sectional and prospective study was carried out in 104 patients affected by surgical thyroid pathologies from January 2001 to December 2002. 50 patients underwent surgery through non ambulatory major surgery method and other 54 patients through ambulatory major surgery at Abel Santamaría Cuadrado Hospital in Pinar del Rio. In the sample nodose pathologies prevailed as for diffuses. Since the latter were excluded from our work, assisted totally with general anesthesia and endotraqueal intubations. Associated diseases constitute limitations in the chosen sample, as long as hospital stay in patients with nodose benign pathologies was lower than 24 hours post-operatively, whose progress was satisfactory. The study showed that surgeries of thyroid nodes with ambulatory surgery are safe and feasible for the patients because of low amounts of complications, which significantly reduces hospitalary cost, since most patients were discharged 12 and 24 hours later. Evident economical advantages were known as to saving bed resource and hospitalary cost, as well as a high degree of satisfaction by those patients undergoing surgery, which justifies the fact of recommending the increase of the application of this procedure and the spread of it to as many surgical diseases as possible.

Problems of operations for huge goitres / 中国普通外科杂志

Objective To sum up the problems should be taking care in operations for huge goitres. Methods Retrospectively analyzed the clinical data of 295 cases of huge goitres was made. Results All of the 295 cases had some degree of compress, replacement and bend of trachea by the goitre comfirmed by X ray examination .Among the 295 cases,162(54.9%) had trachea constriction.51(17.3%) had obvious dyspnea. Retrosternal goitres was found in 21 cases.12 complicated with secondary hyperthyroidism. All the 295 cases underwent subtotal or total thyroidectomy. Postoperative pathological diagnosis: nodular goitres was diagnosed in all the 259 cases (100%),including 11 cases(3.7%) with malignancy, 12 cases( 4.1% ) with secondary hyperthyroidism,and 39(15.1%) with adenomas. Conclusions Operation of huge goitres should choice appropriate anaesthetic method.For the main vessels of thyroid, very high position of the upper pole of thyroid, retrosternal goitres, malignancy of goitres etc,appropriate operative measures shoudd be adopted to prevent introoperative massive bleeding and damage of recurrent laryngeal nerve. If the indications of tracheostomy presents,a tracheostomy must be done.

p27 protein expression in nodular goiter / 中国普通外科杂志

ObjectiveTo measure p27 protein expression in nodular goiter and study the relationship between p27 protein expression and clinicpathologic factors.MethodsImmunohistochemical method-SP was used to detect expression of p27 protein in 42 cases of nodular goiter, 32 cases of normal thyroid tissues and 30 cases of thyroid cancer.ResultsThe positive expression rate of p27 protein was 52%?29% in nodular goiter, 87%?7 2% in normal thyroid tissue and 14%?12% in thyroid cancer. p27 protein expression in different thyroid tissues was significantly different (R 1,2=576, R 1,3=1?998, R 2,3=1?422, P