Vignette hyperparathyroidism: glimpse into its history.

The parathyroid gland was first described by Sir Richard Owen. Ivor Sandstrom coined the term glandulae parathyroidiae. Vassale and Generali Francesco observed that tetany occurs following parathyroidectomy. Harald Salvesen firmly established the relationship of the parathyroid gland to calcium metabolism. A patient with skeletal disease and a tumor near the parathyroid gland was described by Max Askanazy in 1904. Schlagenhaufer suggested in 1915 that in an attempt to cure bone disease, solitary parathyroid enlargement, if present, should be excised. The term hyperparathyroidism (HPT) was coined by Henry Dixon and colleagues. The parathyroid surgeries on Albert J. and Charles Martell were the first experience with successful parathyroidectomy. From a grossly symptomatic disease of bones, stones, abdominal groans, and psychic moans, HPT has evolved into asymptomatic HPT. Improvements in knowledge about the pathology of parathyroid diseases, including the genetic basis of HPT, and advances in the surgical techniques have brought about changes in the management of HPT over the decades.

Vignette thyroid surgery: a glimpse into its history.

At present, physicians and surgeons treating thyroid disorders can rely on highly accurate and precise investigations, modern equipment, and state of the art operating theater to achieve optimum results; however, this was not the case at the beginning of the treatment of thyroid diseases centuries ago. We present a short history of the treatment and understanding of thyroid diseases in the past few decades. Also we present the contributions of the important surgeons who tried to perfect the treatment of thyroid diseases, including surgery, thus making modern day management easier.

Differentiated carcinoma of the thyroid: a paradigm shift in surgical approach.

Thyroid cancer commonly present with a thyroid nodule, a few with cervical lymphadenopathy or metastases. Total of 1320 patients with differentiated thyroid cancer (DTC) managed in Surgical department, Government General Hospital, Chennai, India for a period of 11 years (1990-2001) were analyzed and 600 patients followed up for a mean of 5.5 years (range, 1-11 years). Aim was to discuss the advantage of ultrasound guided fine needle aspiration cytology (FNAC) in increasing the preoperative pick up of DTC, Papillary microcarcinoma, advantages of total thyroidectomy as the initial operation for DTC and management of thyroid remnant by completion thyroidectomy or radioiodine I 131 ablation. McNemer's test used for estimating efficacy of ultra sound guided (USG) FNAC, Kaplan-meier survival analysis to calculate mortality and Cox's proportional hazards regression analysis for disease free survival were used in the study.

The effect of vaccination of pullets against Ornithobacterium rhinotracheale infection.

The effect of vaccination of chickens with different inactivated vaccines against experimental Ornithobacterium rhinotracheale challenge was investigated. Eight different vaccines, with different inactivating substances (Formalin and thiomersal) and with or without adjuvant (mineral oil, alum and aluminium hydroxide gel), were produced. Following vaccination of experimental chickens at week 8 with formalin-inactivated mineral oil adjuvant bacterin, the mean O. rhinotracheale antibody titres rose to 5.88 2log 21 days after primary vaccination and enhanced to a titre of 6.59 2log 21 days after booster vaccination. The bacterin in mineral oil adjuvant induced the highest serologic response and a significant decrease of lesions such as air sacculitis and pneumonia in vaccinated birds compared with the unvaccinated challenge control birds. The bacterin in either alum or aluminium hydroxide gel adjuvant induced a moderate serologic response and a decrease of lesions compared with the unvaccinated challenge controls. The study showed that vaccination of layer chicken at the eighth week followed by a booster dose at the 12th week of age can effectively protect against O. rhinotracheale infections.

Review analysis of medullary carcinoma of the thyroid: a 15-year Indian experience.

The aim of this study was to emphasize the importance of adequate primary surgery in cases of medullary carcinoma of the thyroid. We retrospectively reviewed 44 cases of medullary carcinoma of the thyroid treated in Government General Hospital, Chennai between 1987 and 2002. Patients who underwent total thyroidectomy with only central compartment dissection were compared with those who had undergone total thyroidectomy with meticulous triple compartment (bilateral lateral and central groups) nodal dissection. The group of total thyroidectomy with only central compartment dissection had a high rate of lymph nodal recurrence and persistent hypercalcitoninemia compared with the group with total thyroidectomy with meticulous triple compartment nodal dissection. (chi square, 4.503; P > 0.05). Primary surgery with total thyroidectomy with meticulous triple compartment dissection is superior to total thyroidectomy with central compartment dissection alone in terms of preventing nodal and local recurrences and achieving normal (basal and stimulated) serum calcitonin levels postoperatively.

Management of incidentalomas of the adrenal gland in an Indian hospital set-up between 1991 and 2000.

The use of imaging techniques and their increasing sensitivity have resulted in increased detection of incidentalomas of the endocrine organs. The aim of our study was to review the currently used evaluation schemes and the outcomes of surgical and conservative management of adrenal incidentalomas at an Indian center. Fifty-eight cases of adrenal incidentalomas diagnosed and treated at the Govt. General Hospital, Chennai, and private practice were reviewed. Ultrasonogram of the abdomen was the most frequently used investigation (88%). The common complaint was upper abdominal discomfort. The mean duration of treatment of symptoms before diagnosis was 3.5 months. Thirty-three cases underwent adrenalectomy. The cases not subjected to resection were followed every 6 months for 2 years and follow-up ceased if no increase in size was detected. Of these, two patients required subsequent adrenalectomy. Thirty-six of these tumors were eventually detected to be nonfunctioning adenomas, of which 15 underwent resection because of size >3 cm. Cortical carcinoma was detected in nine patients, pheochromocytoma in seven, myelolipoma in one, metastatic tumor in one, and cyst, ganglioneuroma, and tuberculoma in four. Of these, 20 developed features of hypersecretion during preparation for surgery. In tumors between 3 and 5 cm, in view of noncompliance of patients to repeated follow-up and cost factors, surgery was considered the most effective treatment option. There is a need for prospective studies to formulate diagnostic and treatment strategy.

Review analysis of medullary carcinoma thyroid--15-year Indian experience.

To emphasize the importance of adequate primary surgery in cases of medullary carcinoma of the thyroid, 44 cases of treated medullary carcinoma of thyroid were retrospectively reviewed in Government General Hospital, Chennai between 1987 and 2002. Patients who underwent total thyroidectomy with only central compartment dissection were compared with those who had undergone total thyroidectomy with meticulous triple compartment (bilateral lateral and central groups) nodal dissection. The group of total thyroidectomy with only central compartment dissection had high rate of lymph nodal recurrence and persistent hypercalcitoninaemia when compared with the group of total thyroidectomy with meticulous triple compartment nodal dissection. (Chi square value 4.503 with p<0.05).

Salivary gland tumors: a 10-year retrospective study of survival in relation to size, histopathological examination of the tumor, and nodal status.

Salivary gland neoplasms represent the most complex and diverse group of tumors encountered by the head and neck oncologist. Their diagnosis and management is complicated by their relative infrequency. The significance of the study was to analyze the different types of salivary gland tumors, the modalities of treatment given, and their varied outcomes in relation with morbidity, prognosis, and survival rate. A total of 436 patients were treated for salivary gland neoplasm at Madras Medical College and Research Institute between 1991 and 2001, and the results were analyzed retrospectively. The patients were between 11 and 72 years of age (mean, 41.5 years), and 334 were male and 102 were female. They were from different socioeconomic groups. Fine-needle aspiration cytology was done for all patients that presented with salivary gland swelling. Univariate analysis was done, the confidence interval and odds ratio were calculated, and the significance was noted. Kaplan-Meier survival analysis was estimated, and the results were analyzed. Pleomorphic adenoma was the most common benign tumor affecting the salivary glands. In our series, 155 patients had malignant parotid gland neoplasms, and 20 patients had cervical lymph node metastasis at the time of presentation. Facial nerve paralysis was noted in 21 cases. The recurrence after total parotidectomy for malignant salivary gland tumors was effectively managed with external beam irradiation in 19 patients. The survival, prognosis, and the mortality rate of the malignant parotid neoplasms and their relation to the sex of the patient, histopathological type of tumor, nodal status, and size of the tumor were analyzed.

A descriptive study of papillary thyroid carcinoma in a teaching hospital in Chennai, India.

OBJECTIVE: In the 1994 Chennai population-based cancer registry, thyroid carcinoma constituted 1% and 2% of all incident cancers among males and females, respectively. The aim of our study was to conduct an epidemiological survey of the pattern of papillary thyroid carcinoma in the Chennai Government General Hospital and the Chennai Cancer Institute. METHODS: Our data base included a total of 264 (58 males and 206 females) consecutive cases of papillary thyroid carcinoma admitted to the Government General Hospital and 164 (42 males and 122 females) cases from the Chennai Cancer Institute. RESULTS: There was a female preponderance (100 males and 328 females) (p < 0.001). The median age at diagnosis was 39 years among males and 32 years among females. The distribution of cases by residential area lay scattered from < 1 km to > 100 km, with the majority (28%) from the city of Chennai and its suburbs in the Government General Hospital, while 52% of the cases in the cancer institute were from the neighbouring state. Iodine intake was present in 75% of cases (p < 0.001). The diagnosis of thyroid cancer was confirmed by fine needle aspiration cytology in most (88%) of the cases. The extent of disease in the Government General Hospital and the Cancer Institute were as follows: localized in 66% vs 32%; spread to surrounding structure with or without nodal involvement in 26% and 59% presence of only secondary nodal involvement in 3% and 1%, distant metastasis in 5% and 8%, respectively. The primary modality of treatment was surgery with total thyroidectomy being performed in 82%, while the rest underwent a hemithyroidectomy. CONCLUSION: The cumulative life-time risk of thyroid cancer in Chennai was one in 970 in males and one in 565 in females. High dietary intake of iodine was the most significant risk factor for the etiology of papillary thyroid carcinoma in our study.

Surgical treatment of endocrine hypertension experience in India.

Between 1980 and 1994, 162 cases of endocrine based hypertension were diagnosed and treated surgically. Seventy-nine cases (48.7%) of phaeochromocytoma, 63 cases (38.8%) of Cushing's syndrome, and 20 cases (12.3%) of Conn's syndrome were diagnosed. In phaeochromocytoma 75% of the tumours arose from the adrenal glands and 25% arose from the extra-adrenal sites. Cushing's syndrome was caused by adenoma (45%), diffuse bilateral adrenal hyperplasia (36%), pigmented macronodular hyperplasia (9%), and adrenal carcinoma (10%). The most common cause of Conn's syndrome was adenoma (95%) which arose mainly from the left adrenal gland (60%). In the present series the success rate of surgical treatment was 100% for phaeochromocytoma, 90% for Cushing's syndrome and 96% for Conn's syndrome. Trucut biopsy of the kidneys of these patients showed hypertensive changes, the moderate hypertension could be due to renal damage.

Solitary nodule of the thyroid and the role of fine needle aspiration cytology in diagnosis.

In this study the pre-operative diagnostic procedures carried out on 100 patients with clinically solitary nodule of the thyroid experienced over a period of one year with special emphasis on the usefulness of fine needle aspiration biopsy cytology (FNAC) was evaluated retrospectively. All of the 100 patients underwent operation except 2 patients with FNAC diagnosis of Hashimoto's thyroiditis and 7 patients with FNAC diagnosis of colloid goitre. Histopathological study of surgically resected specimens in 91 patients revealed 67 adenomas, one subacute thyroiditis, 3 Hashimoto's thyroiditis, 8 follicular carcinomas, 11 papillary carcinomas and one medullary carcinoma. FNAC tallied in 95% of cases. It was false positive in 2 cases (one case of subacute thyroiditis and one case of Hashimoto's thyroiditis), false negative in one case (a case of follicular carcinoma) and non-diagnostic in 2 cases (2 cases of Hashimoto's thyroiditis).