Role of malignancy and preoperative embolization in the management of carotid body tumors.

The purpose of this retrospective study is to present our approach to the management of patients with carotid body tumors (CBTs), emphasizing the role of malignancy and preoperative embolization. Between 1975 and 1998 a series of 18 patients with CBTs were treated, and 16 of them underwent successful excision of the tumor. According to the Shamblin classification, six of the tumors were type I, six type II, and six type III. In three of these patients (two with type II tumors and one with type III) in whom preoperative embolization had been performed, mean intraoperative blood loss was 400 ml, whereas in the remaining 13 cases this loss was 700 ml. Two patients with intracranial tumor spread underwent only radiotherapy. Neither postoperative deaths nor strokes occurred. Temporary cranial nerve injury occurred in four cases (25%). Local lymph node invasion was found in two patients, establishing the diagnosis of malignancy. One of these patients developed distal metastases 3 years after the operation and was treated with radiotherapy and octreotide. Follow-up ranging from 30 months to 23 years (mean 5 years) revealed no local recurrence except for the two patients who were treated with radiotherapy only. In conclusion, surgical excision remains the treatment of choice for CBTs and can be performed without major risks and with low morbidity and mortality. Preoperative embolization is helpful by diminishing intraoperative bleeding, and malignancy, though rare justifies early management.

Fournier's gangrene: still highly lethal.

Five patients with necrotizing soft tissue infections of the perineum and scrotum are presented. There were one female and four male patients, aged from 35 to 70 years. Portals of entry were perirectal abscesses in four cases and a scrotal abscess in one case. All patients required extensive surgical debridement and intravenous broad-spectrum antibiotics. Operative debridement involved the scrotum, the perineal and inguinal area, the upper thighs and the anterior abdominal wall. One patient required transverse loop colostomy and one loop sigmoidostomy. One patient was reoperated on after inadequate drainage of a perirectal abscess. Three patients were referred to our unit after some delay, while one patient did not seek medical care until after being febrile for 2 weeks. Despite aggressive debridement, this last patient died of fulminant sepsis. Fournier's gangrene, which is not so rare as in generally considered, is still associated with a high mortality, which can be reduced only by improving medical awareness and early treatment both of the primary cause and of necrotizing fasciitis.

Scanning of the adrenals in Cushing's syndrome.

131I-19-iodocholesterol adrenal scans were obtained in seven patients with Cushing's syndrome. Characteristic imaging patterns were seen in three patients with bilateral adrenal hyperplasia with symmetrical uptake of the isotope. Two patients with adrenocortical adenoma and one patient with a well-differentiated adrenocortical carcinoma showed intense activity in one adrenal gland and absent activity in the contralateral gland. In one patient with adrenal nodular hyperplasia asymmetrical uptake was found with increased activity in the right adrenal gland where a larger adenomatous nodule was found at histologic examination. Adrenal imaging with radioactive cholesterol is a useful noninvasive technique for the diagnosis and treatment of Cushing's syndrome.

Cushing's syndrome. Analysis of 18 cases.

Eighteen patients with Cushing's syndrome were analyzed retrospectively. Eleven patients had diffuse or adenomatous hyperplasia, 5 an adenoma and 3 a carcinoma. Iodocholesterol scanning provides considerable help in localization of the disease. Surgical treatment, while curative for benign cases, affects only slightly the course of malignant disease.

Cystosarcoma phyllodes: a clinicopathological analysis of 14 cases.

Experience with 14 cases of cystosarcoma phyllodes encountered at the 2nd Department of Propedeutic Surgery, Athens, University, between October, 1928 and December, 1978 is reported. Local excision including a wide cuff of uninvolved breast tissue is indicated for histologically proven benign and small tumors. For bulky or malignant tumors, a simple mastectomy is indicated. none of these neoplasms had metastasized to the axillary lymph nodes and, for this reason, and axillary node dissection was contraindicated.

Thyroid disease in children and adolescents.

Thyroid diseases in children and adolescents are not common. The present paper describes 73 patients, aged 5 to 18 years, who had thyroid disease which was treated by surgery. Of these, 18 had diffuse simple goiter, 11 had diffuse toxic goiter and 44 had nodular goiter. Of those patients with nodular goiter, 34 had adenomatous goiter, one had lymphocytic thyroiditis, one had lymphosarcoma and eight had cancer. In the patients with nodular goiter under the age of ten years, 40% had cancer, and of those aged 11 to 18 years, 14.7% had cancer. Thyroid nodules were more frequent in girls than in boys, but the incidence of cancer in nodular goiter was higher in boys than in girls.

Sarcoma of the breast.

The records of seven patients with primary sarcoma of the breast were reviewed. The clinical course, gross and microscopic pathologic aspects as well as the optimal treatment of primary breast sarcoma are discussed. During the same period, 800 patients with carcinoma of the breast were seen.

Prediction of malignancy in solitary thyroid nodules in a country with endemic goiter.

From January 1962 through October 1975, 455 patients with single thyroid nodules were operated on at King Paul Hospital. Malignancy was proved in forty-three patients. The overall incidence of carcinoma was 9.5 per cent. A higher incidence of cancer was found in patients less than ten years of age (40 per cent), between eleven and twenty years of age (20 per cent), and more than sixty-one years of age (17.4 per cent). Malignant nodules were more frequent in males (17.5 per cent) than in females (8.3 per cent). Radioactive iodine scanning does not distinguish benign from malignant nodule. Solitary thyroid nodules require operative excision supplemented with replacement therapy.

Thyroid nodules and thyroid carcinoma.

Seventy carcinomas of the thyroid gland were found in 1300 thyroidectomies for an incidence of 5.4%. The incidence of malignancy in single nodules was 9.7% and in multinodular nontoxic goiter 4.3%. The risk of cancer was higher (14.2%) in males than in females (4.3%). The highest incidence of cancer was found in children under the age of 10 (40%). Radioactive iodine scintiscanning was of limited help in differentiating benign from malignant nodules. Early surgery is advised for all patients with single thyroid nodules and all thyroid nodules in children should be excised.