Surgical management and prognosis of thyroid carcinomas invading adjacent structures

Objectives: To evaluate the surgical approaches and prognosis of thyroid carcinomas invading the adjacent structures

Methods: The medical records of 197 patients with a pathology diagnosis of thyroid cancer were retrospectively reviewed

Results: Seventeen patients [9%] with thyroid carcinoma invading surrounding structures were included. Patients were initially divided into two groups on the basis of tumor histology: papillary [Group A] and nonpapillary [Group B]. Then patients were divided into three groups Group 1: patients who underwent total thyroidectomy Group 2: patients who underwent total thyroidectomy with shaving resection Group 3: patients who underwent total thyroidectomy with extensive surgery. All patients who didn't survive were more than 45 years old. The survival rate was statistically better in group A compared to group B [92% versus 20%]. The survival rate decreased from Group 1 through Group 3, without reaching statistical significance

Conclusions: Age and histologic type are important in determining the prognosis of locally invading thyroid cancer

Intercostal nerve block versus bupivacaine pectoralis major infiltration in subpectoral breast augmentation A randomized controlled trial

Background: The purpose of our study is to evaluate the role of intercostal nerve block and pectoralis major muscle infiltration in postoperative pain management following subpectoral breast augmentation

Methods : This is a prospective randomized controlled study using patients as their own controls. Women undergoing primary bilateral subpectoral breast augmentation from July 2012 until July 2013 were enrolled and randomly allocated to two cohorts. Both cohorts received pectoralis major muscle infiltration using 20 mL of 0.25% bupivacaine with epinephrine on one breast. The contralateral breast was treated with intercostal nerve block in cohort 1, and with a placebo infiltration of the pectoralis major muscle in cohort 2. The 10-point Visual Analog Scale was used postoperatively on each breast at 0, 1, 3, 8 and 24 hours at rest and after movement. The change in pain score difference over time was analyzed with a mixed effect linear regression model

Results : Cohort 1 and 2 consisted of 13 and 15 patients respectively. Pectoralis major muscle infiltration and intercostal nerve block were easily performed and no complications were reported. When comparing pectoralis major muscle infiltration to intercostal nerve block, there was no difference in pain on admission to the recovery room at rest [p = 0.98], or after movement [p = 0.79]. Postoperative pain gradually decreased with time and no difference in pain was found across time at rest [p = 0.91], or on movement [p = 0.92]. The comparison of pectoralis major muscle infiltration to placebo yielded similar results with no difference in pain on admission or across time

Conclusion: Intercostal nerve block and pectoralis major muscle infiltration do not offer any significant analgesic benefit following breast augmentation

[Regional analgesia and breast cancer surgery]

Breast cancer surgery is frequently associated with postoperative nausea, vomiting, pain and painful restricted movement. It is well established that thoracic paravertebral block with or without general anesthesia provides better postoperative analgesia and reduces the risk of nausea and vomiting after breast surgery as well as the incidence of chronic pain. Paravertebral block improves the quality of recovery after breast cancer surgery and provides the patient with the option of ambulatory discharge