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Abstract Objective: Goiters and benign nodules detected in the thyroid are growing lesions and the COVID-19 pandemic have negatively impacted on their surgical treatment. The appropriate selection of patients to treatment will improve the overall health status. This article review will focus on the impact of the COVID-19 pandemic on treatment of benign conditions of the thyroid gland and their implications. Methods: This review pointed out the status of the health system in developing country and the problems to treat benign surgical diseases of thyroid. Aspects of epidemiology, incidence, clinical presentation and surgical treatment of goiters, economic and health status impact were cited. Results: All surgical treatment of goiter and other benign conditions were postponed, forced to redirect, and reschedule all benign surgeries, situation aggravated by poor public management and closure of hospital beds. These conditions have caused deterioration in patients' physical (decompensated thyroid disease) and mental health status, increasing work disabilities and burdening society by increasing the social and health cost. The overall situation could be catastrophic in emergent countries where this increased disease-related social expenditure on surgical treatment may increase the risk of national impoverishment as increase the treatment cost. Brazilian Society Head and Neck Surgery related some recommendations and new suggestions were made to safely treat these high potential hazard surgical conditions. Conclusions: Surgeries for goiter and benign thyroid conditions can be performed during the COVID-19 pandemic, following strict safety protocols for the patient and the medical team, reducing the negative economic and on patient health impact.
Resumo Objetivo: Bócios e nódulos benignos detectados na tireoide são lesões em crescimento e a pandemia de Covid-19 impactou negativamente seu tratamento cirúrgico. A seleção adequada de pacientes para o tratamento vai melhorar o estado geral de saúde. Esta revisão de artigos se concentrará no impacto da pandemia de Covid-19 no tratamento de condições benignas da glândula tireoide e suas implicações. Método: Esta revisão evidenciou a situação do sistema de saúde em países em desenvolvimento e os problemas para tratar doenças cirúrgicas benignas da tireoide. Aspectos da epidemiologia, incidência, apresentação clínica e tratamento cirúrgico do bócio, impacto econômico e no estado de saúde foram relatados. Resultados: Todos os tratamentos cirúrgicos de bócio e outras condições benignas foram adiados, forçados a se redirecionar e a remarcar todas as cirurgias benignas, situação agravada pela má gestão pública e fechamento de leitos hospitalares. Essas condições têm causado deterioração do estado de saúde física (doença da tireoide descompensada) e mental dos pacientes, aumentam as incapacidades para o trabalho e sobrecarregando a sociedade e o custo social e de saúde. A situação geral pode ser catastrófica em países emergentes, onde esse aumento dos gastos sociais relacionados à doença sob tratamento cirúrgico pode aumentar o risco de empobrecimento nacional à medida que aumenta o custo do tratamento. A Sociedade Brasileira de Cirurgia de Cabeça e Pescoço forneceu algumas recomendações e novas sugestões foram feitas para tratar com segurança essas condições cirúrgicas de alto risco potencial. Conclusão: As cirurgias para bócio e condições benignas da tireoide podem ser feitas durante a pandemia de Covid-19, se forem seguidos rigorosos protocolos de segurança para o paciente e equipe médica, o que reduz o impacto negativo na economia e na saúde do paciente.
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Objective@#To investigate the principles of diagnosis and treatment of breast cancer during pregnancy.@*Methods@#Clinical data of patients with breast cancer during pregnancy admitted to Obstetrics and Gynecology Hospital of Fudan University between January 2012 to July 2017 were analyzed retrospectively. A total of 17 patients were diagnosed with breast cancer in pregnancy, the median age was 32 years (range from 25 to 45 years old), pathological staging revealed 2 patient with stage 0, 1 with stage Ⅱa, 7 with stage Ⅱb, 1 with stage Ⅲa, 2 with stage Ⅲc, 4 with stage Ⅳ.@*Results@#Thirteen patients received surgical treatment in pregnancy, the gestational age at surgery was (27.7±4.6) weeks; 2 patients with ductal carcinoma in situ received mastectomy, 11 patients with breast cancer underwent modified radical mastectomy. In patients undergoing surgery during pregnancy, no prophylactic contractions were used in 4 patients who had been treated earlier, there were 2 patients with frequent contractions within 24 hours after operation in these patients. Follow-up 9 patients were given oral nifedipine to prevent contractions, no obvious contractions occurred after the operation. Seven patients received chemotherapy during pregnancy; the chemotherapy of 4 cases of triple negative breast cancer was weekly paclitaxel sequential epirubicin and cyclophosphamide, the chemotherapy of the other three patients was docetaxel sequential epirubicin and cyclophosphamide. Fifteen patients underwent cesarean section to terminate pregnancy, 2 patients underwent spontaneous labor. The gestational age of birth was (36.9 ±1.3) weeks. Less than 35 weeks of termination of pregnancy occurred in one patient, the fetus was delivered to the neonatal intensive care unit due to neonatal respiratory distress syndrome, and suffered from congenital dysaudia. The prognosis of the other 16 survived infants was good. The median follow-up time was 10 months (range from 4 to 27) months, in 13 patients of stage 0 to Ⅲc, one patient were diagnosed with bone metastasis at 12 months after surgery, the remaining 12 patients had no disease progression, the progression free survival rate was 12/13, the overall survival rate was 13/13. Among the 4 patients with stage Ⅳ, one died in 7 months after delivery, one had new liver metastasis in 8 months after delivery. The remaining 2 patients were in stable condition.@*Conclusions@#Breast cancer in pregnancy can be treated effectively, multidisciplinary cooperation and detailed assessment of maternal-fetal risks and benefits are necessary. Chemotherapy during pregnancy is safe for maternal-fetal, but it needed a large sample of clinical studies and long-term follow-up. The neonatal outcome was associated with gestational age, and therefore premature delivery was avoided as much as possible during treatment.
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Objective To analyze the pathology of the patients with nonfunctional adrenal tumor (NFA), and explore the optimal diameter cut-off value. Methods The clinical data of 243 patients with NFA, evaluated in the Department of Endocrinology and operated in the Department of Urology of General Hospital of Chinese PLA from Feb. 1996 to Jan. 2016, were collected. The patients were divided into two groups according to pathology: those in real demand of surgery were classified to the surgery-need group (n=S7), while the others were categorized as the surgery-unwanted group (n=186). The general situation, pathological type and tumor diameter of the two groups and the factors affecting the surgery were analyzed, and the ROC curve was used to explore the optimal surgery cut-off value, which represents the maximum value of the sum of sensitivity and specificity. Results Of the 57 patients in surgery-need group (27 males and 30 females), the lesions were on the right in 31 cases, on the left in 25 cases, and on bilateral sides in 1 case; the median of lesion diameter was 4.5cm, and the average age was 41.5 ± 12.1 years old. Of the 186 patients in surgery-unwanted group (87 males and 99 females), the lesions were on the right in 99 cases, on the left in 86 cases, and on bilateral sides in 1 case; the median of lesion diameter was 3.0cm, and the average age was 50.6 ± 10.9 years old. Logistic regression revealed that lesion diameter might be a risk factor (OR= 1.340, 95%CI 1.266-1.418, P=0.000) and age be a protective factor (OR=0.942, 95%CI 0.929-0.955, P=0.000) for real demand of surgery. The area under the ROC curve (AUC) of lesion diameter was 0.757(95%CI 0.681-0.833). The optimal cut-off value was 4.1cm (sensitivity 60.7% and specificity 83.0%). Conclusions Younger patients with bigger lesion diameter may have greater possibility for surgery. The optimal surgery cut-off value of the lesion diameter is 4.1cm.
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Objective To evaluate the diagnosis and treatment of duodenal neuroendocrine tumors.Method We retrospectively analyzed data of 15 patients with duodenal neuroendocrine tumors admitted between August 1999 and July 2012.Result In all the 15 cases accurate and definitive diagnosis were achieved via pathological examination and immunohistochemistry.Clinical diagnostic methods included ultrasound,endoscopy,upper gastrointestinal imaging,abdominal CT,MRI,etc.7 cases underwent pancreaticoduodenectomy,2 cases were treated by local excision,4 cases by endoscopic excision,and total gastrectomy and distal gastrectomy was performed in one each case.Conclusions The diagnosis of duodenal neuroendocrine tumors is established mainly by endoscopy and diagnostic imaging.Surgical resection is the treatment of choice.Pancreatoduodenectomy and local excision is applicable for G2 and G3 patients while endoscopic excision can be used for G1 patients.