Adenopathie cervicale revelatrice de microcancer papillaire de la thyroide

Aim of the study to report retrospectively 5 cases of papillary M inicrocarcinoma of the thyroid revealed by cervical adenopathy with the clinic and histologic characteristics. material and method: Total thyroidectomy and bilateral cervical lymphadenectomy was realized in 5 patients From 1996 to 2002, 4 females and one man of 33 years old mean age presented for cervical adenopathy. Biopsy confirmed thyroid metastatic nature. The final pathology showed: a papillary microcarcinoma, bilateral and multifocal in 4 patients [80%], bilateral adenopathy in 3 patients [60%]. All patients had a radioactive iodine and hormonotherapy postoperatively. The follow-up varied from 12 to 30 months. No metastasis or local recurrence were noted Total thyroidectomy and bilateral cervical lymphadenectomy is the treatment of choice for papillary microcarcinoma of the thyroid presenting as a cervical metastatic adenopathy because it was bilateral and multifocal in 80% of cases with bilateral positive adenopathy in 60% of cases. Radioactive iodine and hormonotherapy postoperatively are recommended

Tertiary hyperparathyroidism in patients on hemodialysis for chronic renal failure: subtotal parathyroidectomy or conservative treatment?

To report our experience in novel surgical strategy in the treatment of tertiary hayperparathyroidism in hemodialysis patients for chronic renal failure and to assess the impact of this type of surgery on postoperative clinical and laboratory variables in this population. methods: Fifteen hemodialysis [12 female and 3 male] patients with chronic renal failure were operated on for tertiary hyperparathyroidism. Cervical ultrasound was performed in all patients [n = 15]. Preoperative cervical ultrasound showed one enlarged parathyroid gland [n = 4] or few enlarged parathyroid glands [n = 11]. Group I consisted of four patients with single parathyroid gland enlargement on ultrasound. These patients underwent resection of only the enlarged gland; three by unilateral approach under local anesthesia and one by cervicotomy under general anesthesia. Group II consisted of 11 patients with enlargement of all parathyroid glands on ultrasound. These patients were assumed to have hyperplasia and underwent subtotal parathyroidectomy [3.5 glands] and thymectomy by cervicotomy under general anesthesia. Postoperatively, patients in group I were normocalcemic [n = 4] and patients in group II were normocalcemic [n = 4] or had transient hypocalcemia [n = 7]. The pathology showed an adenoma in patient of group I [n = 4] and hyperplasia in patients of group II [n = 11]. postoperatively, both patients in Group I and II had a similar resolution of their symptoms. Tertiary hyperparathyroidism secondary to chronic renal failure may be treated by parathyroidectomy of one or few enlarged parathyroid gland[s]. Parathyroidectomy by unilateral approach under local anesthesia may be of value when preoperative localization studies show a single parathyroid gland enlargement