Coexistence of a large functioning parathyroid cyst with papillary thyroid carcinoma: A case report and review of the literature.

Parathyroid cysts constitute a rare cause of primary hyperparathyroidism (PHPT). PHPT may also rarely coexist with non-medullary thyroid carcinoma (NMTC). We describe a case of a 70-year-old woman who was diagnosed with PHPT, on the occasion of nephrolithiasis (corrected calcium and PTH levels: 10.8 mg/dl and 187 pg/ml, respectively). Ultrasonographic and scintigraphic investigation confirmed the diagnosis of a large parathyroid cyst attached to the lower pole of the right thyroid lobe and, consequently, the patient underwent parathyroidectomy. Due to the coexistence of multinodular goitre, with some nodules characterized as suspicious of malignancy, a total thyroidectomy was also performed. A histological diagnosis of cystic parathyroid adenoma was made. A unifocal papillary thyroid carcinoma of follicular subtype, 6 mm in diameter, was also detected. The patient's post-surgical course was uneventful and she remained normocalcaemic two years later. PHPT may rarely coexist with papillary thyroid carcinoma (PTC). The pathogenetic mechanisms linking these two endocrine entities are currently unknown.

Use of isolated Roux loop for pancreaticojejunostomy reconstruction after pancreaticoduodenectomy.

AIM: To evaluate the efficacy of the isolated Roux loop technique in decreasing the frequency of pancreaticojejunal anastomosis failure. METHODS: We retrospectively reviewed 88 consecutive patients who underwent pancreaticoduodenectomy (standard or pylorus-preserving). Single jejunal loop was used in 42 patients (SL group) while isolated Roux loop was used in 46 patients (RL group). Demographic characteristics (age, gender) and perioperative results (major/minor complications, mortality, hospital stay) were compared between the two groups. RESULTS: Mortality was almost equal in both groups and overall mortality was 2.27%. Leak rate from the pancreaticojejunal anastomosis and hospital stay were lower in the RL group without significant difference. Morbidity was 39.1% in the RL group, insignificantly higher than the SL group. Operative time was almost 30 min longer in the RL group. CONCLUSION: The isolated Roux loop, although an equally safe alternative, does not present advantages over the traditional use of a single jejunal loop. Randomized controlled studies are required to further clarify its efficacy.

Considerations concerning laparoscopic cholecystectomy in the extremely elderly.

BACKGROUND: Since octogenarians become a growing part of the population and surgical care is possible in them, this study was conducted to evaluate the outcome of laparoscopic cholecystectomy in patients 80 years of age and over. METHODS: From June 1993 to May 2006, a total of 1263 patients underwent a laparoscopic cholecystectomy, applying the four-trocar American technique; 21 among them were >/=80 years. We retrospectively reviewed patients' age, gender, indication for surgery, comorbid conditions, American Society of Anesthesiologists (ASA) score, conversion to open procedure, postoperative complications, and length of hospital stay. RESULTS: The mean age in the >/=80 group was 82.5+/-3 and 57% were women, while in the <80 group 72% of patients were women. Recurrent biliary colic was the most frequent (62%) indication for surgery among the elderly patients. Endoscopic retrograde cholangiopancreatography and endoscopic sphincterotomy were performed preoperatively in 6 elderly patients (29%); there were 4 cases of acute calculus pancreatitis and 2 cases of acute cholangitis. A high surgical risk (ASA score of III and IV) was estimated in 11 patients (52%) from the >/=80 group versus 32% in the <80 group (P =0.047). Conversion rate was higher (19%) and hospital stay was longer (4.9 days) in the >/=80 group, compared to younger patients (P =0.01). Mortality was zero and morbidity was 14% versus 3% in the <80 group (P =0.03), including 1 case of postoperative bleeding, 1 case of wound infection, and 1 case of pulmonary atelectasis, respectively. CONCLUSIONS: Laparoscopic cholecystectomy in the extremely elderly is safe and well tolerated; however, it is associated with a higher conversion rate, increased morbidity, and a longer hospital stay.

Risk factors influencing conversion of laparoscopic to open cholecystectomy.

BACKGROUND: Conversion of laparoscopic to open cholecystectomy is required in certain cases for the safe completion of the operation. Some factors contribute more to the need for conversion. METHODS: Over a 13-year period, the laparoscopic cholecystectomy procedure was attempted in 1263 patients whose mean age was 54 years and 28% being male. The conversion was necessary in 98 cases whose mean age was 60 years, with 42% being male. All data were studied retrospectively. Six factors were examined statistically for a possible correlation with the conversion rate, as well as the trend of it over time. RESULTS: The main reason for conversion was the unclear anatomy owing to previous inflammation, followed by bleeding and choledocholithiasis suspicion, gallbladder carcinoma, bile duct injury, or spilled gallstones. The overall conversion rate was 7.75%. It was significantly increased in males (11.6%) and the elderly (12.4 %), gallbladder inflammation (29%), and morbid obesity (50%). Conversion rate did not change significantly in the first half period (8.1%) of the study, the second half-period (7.6%), in patients with diabetes mellitus (6.7%), or hematological disorders (6%). CONCLUSIONS: The risk for the conversion of laparoscopic cholecystectomy increases significantly in males, the elderly, obese patients, and when inflammation is present. This observation remains unchanged over time. Diabetes mellitus and hematologic disorders do not predispose in a higher risk for conversion.

Effect of early octreotide administration on the development of esophageal varices in cirrhotic rats.

This study was conducted to investigate the effect of chronic octreotide administration on the development of esophageal varices in rats being at the early stages of carbon tetrachloride-induced cirrhosis. For the development of liver cirrhosis and esophageal varices 96 rats underwent ligation of left adrenal vein followed by phenobarbital and carbon tetrachloride administration. After 2 weeks of carbon tetrachloride administration, rats were randomly separated into three groups. Chronic octreotide administration started in group A, normal saline in group B, while 32 rats consisted control group. Haemodynamic studies and morphometric analysis of the lower esophagus were performed 2 weeks after complete induction of cirrhosis. Total submucosal vessel area, mean cross-sectional area of submucosal vessels, percentage of submucosa occupied by vessels, the area of the most dilated submucosal vessel as well as the number of submucosal vessels were studied. Octreotide administration induced a significant ( [Formula: see text] ) decrease of portal vein pressure. Morphometric analysis revealed a significant reduction ( [Formula: see text] ) in octreotide-treated rats of both "total submucosal vessel area" and area of "the most dilated submucosal vessel". Chronic octreotide administration partially prevented rats from the development of esophageal varices. Octreotide-treated rats were found to have a less pronounced dilatation of submucosal veins compared to placebo-treated group rats. We believe that this effect was mainly due to the decrease of portal vein pressure induced by chronic octreotide administration.