Surgical treatment of Graves' disease: subtotal thyroidectomy might still be the preferred option.

OBJECTIVE: The aim of this prospective study was to report our results after thyroidectomy for Graves' disease. In addition, the relationship between the thyroid remnant and postoperative thyroid function was studied. MATERIAL AND METHODS: Forty-nine consecutive patients were operated on for Graves' disease. The indications for surgery were persistent or recurrent hyperthyroidism after medical treatment in 34 patients (69.4%), mechanical symptoms due to a large goiter in 7 (14.3%), increased ophthalmopathy in 7 (14.3%), and allergy to antithyroid medications in 1 patient (2.0%). Total thyroidectomy (TT) was performed in 28 and subtotal thyroidectomy (STT) in 21 patients. Follow-up lasted 24 to 70 months. RESULTS: There was no statistically significant difference in the rate of postoperative complications comparing TT and STT. The patients who underwent TT had no recurrence during a mean follow-up of 47 months. After STT, with the mean weight of the thyroid remnant 3.0+/-1.0 g, there was no relapse of Graves' disease during a mean follow-up of 52 months. After STT, postoperative hypothyroidism developed in 14 patients (66.7%); 7 patients (33.3%) remained euthyroid during follow-up. Comparison of the euthyroid patients and the hypothyroid patients revealed no difference in the weight of the remnant (3.3 g vs. 2.8 g), but a statistically significant difference occurred in the weight of the resected gland (61.0 g vs. 94.4 g, P=0.026) and in the proportion of the remnant (5.6% vs. 3.3%, P=0.030). CONCLUSIONS: Both TT and STT are safe procedures regarding postoperative complication rate. STT with the thyroid remnant of about 3 g allows to permanently cure hyperthyroidism ensuring the euthyroid state in a significant proportion of patients. Postoperative thyroid function after STT is best predicted by the proportion of the remnant.

Life expectancy of patients with malignant pleural effusion treated with video-assisted thoracoscopic talc pleurodesis.

The aim of the current study was to analyse postoperative complications and survival after video-assisted thoracoscopic (VATS) talc pleurodesis for malignant pleural effusion. All patients with morphologically proven malignant pleural effusion who underwent VATS talc pleurodesis from November 1995 to November 2002 were included in retrospective analysis. VATS was performed in general anaesthesia and 5 g of asbestos-free talc was insufflated into the pleural cavity. Postoperative pleural drainage was used until fluid output was less than 100 ml/24 h. Ninety-eight patients (28 male and 70 female) with mean age 59.6 (range 18-82) years were included. Thirteen patients had a bilateral pleural effusion. The most common primary cancer sites were lung (30 cases), breast (25) and ovarium (11). Average duration of the operation was 46 (range 10-120) min. Median duration of postoperative drainage was 3 (range 1-20) days and postoperative hospitalisation 7 (range 3-70) days. Twenty-eight patients had postoperative complications (fever in 17 cases). In seven cases pleurodesis was ineffective. Median survival was 8.4 months. Six-, 12- and 24-month survival was 58% (95% CI [0.47-0.67]), 39% [0.29-0.49] and 20% [0.12-0.29], respectively. Survival data after VATS talc pleurodesis advocate use of this invasive treatment method despite the advanced stage of cancer.

Parents' satisfaction with medical and social assistance provided to children with Down syndrome: experience in Estonia.

OBJECTIVE: Parents of children with mental or physical disabilities have been assumed to live more stressful lives than other parents, and people with Down syndrome (DS) may get second-rate care because of their diagnosis. The aim of this work is to investigate the extent of parents' satisfaction with medical and social services in Estonia provided for the DS individuals and their families. METHODS: From 1999 to 2001, fifty-nine DS families answered questionnaires in which we inquired about their satisfaction with medical and social assistance. RESULTS: We found that satisfaction with the quality of the information about DS is low, and most of the parents are not satisfied with the social benefits and rehabilitation options. CONCLUSIONS: The DS families need more medical information about this syndrome. The medical staff has to learn more about how to deliver bad news and how to support parents. More work needs to be done in the area of rehabilitation options and social assistance.