Subacute thyroiditis after vaccination against SARS-CoV-2. / Subakutt tyreoiditt etter vaksinering mot SARS-CoV-2.

BACKGROUND: Subacute thyroiditis is a clinical condition usually seen 1-2 weeks after a viral infection in the upper respiratory tract, and has also been reported following infection with COVID-19. Cases of subacute thyroiditis following a seasonal influenza vaccination have been described, and recent case reports have reported clinical symptoms and signs typical of subacute thyroiditis following vaccination with mRNA SARS-CoV-2 vaccine. CASE PRESENTATION: A young, healthy female underwent surgery with left-side lobectomy for papillary thyroid carcinoma. Hashimoto's thyroiditis was revealed as an additional histological finding. Six days prior to complementary thyroidectomy of the right lobe the patient received mRNA SARS-CoV-2 vaccine. The histological slides showed features consistent with extensive subacute thyroiditis throughout the entire lobe. INTERPRETATION: As no other aetiology could account for the subacute thyroiditis, the vaccination against COVID-19 is seen as a plausible source.

Laparoscopic versus open surgery in stage I-III adrenocortical carcinoma -- a retrospective comparison of 32 patients.

Laparoscopic surgery (LS) for resectable adrenocortical carcinoma (ACC) has been questioned due to uncertainty with regard to long-term oncological outcome. We analyzed the experience with LS compared to open surgery (OS) at Oslo University Hospital (OUH). Material and methods. Between 1998 and 2011 32 patients were identified with ACC stage I-III operated either by LS (17 patients) or OS (15 patients). Patients' records were reviewed retrospectively with regard to pre- and intraoperative findings, short-term surgical outcome, relapse and survival. The patients in the LS group had significantly smaller tumors and higher body mass index, otherwise the groups did not differ significantly. Thirty-one patients had been operated at surgical departments of the OUH, and all had been followed at OUH. Results. Short-term outcome favored LS by significantly shorter operation time, lower blood loss and need for transfusions, fewer postoperative complications and shorter hospitalization. The completeness of resection was similar in both groups with R0 resection accomplished in 12 patients in the LS group and 12 in the OS group. Twelve and 15 patients have relapsed in the LS and OS groups, respectively, with a similar pattern of relapse (local, peritoneal or distant). Median progression-free survival (15.2 months for LS vs. 8.1 months for OS) and median overall survival (103.6 months for LS vs. 36.5 months for OS) were not significantly different. Discussion. LS seems to offer short-term advantages and similar long-term outcome compared to OS in patients with resectable ACC stage I-III.

Audit of intraoperative and early postoperative complications after introduction of mesorectal excision for rectal cancer.

OBJECTIVE: To compare complication rates after rectal resection using a conventional surgical technique (1983-1992) and mesorectal excision (1993-2000), and to find out whether the rate of complications changed with time after the introduction of mesorectal excision. DESIGN: Prospective, observational study. SETTING: University hospital, Norway. PATIENTS: All patients who had rectal resections for cancer in the period 1983-2000. INTERVENTIONS: In the conventional surgery period 217, and in the mesorectal excision period 176, patients had rectal resections. The mesorectal excision period was split in two, the early and the late mesorectal excision period, 88 rectal resections being performed in each period. Total mesorectal excision was done in 118 patients, and partial mesorectal excision in 58. MAIN OUTCOME MEASURES: Major surgical complications in both periods; intraoperative bleeding, transfusions during the hospital stay, and cardiovascular complications in the mesorectal excision period. RESULTS: 23/217 (11%) developed major surgical complications in the conventional surgery period, compared with 17/88 (19%) in the early mesorectal excision period (p = 0.04). This was caused by an increased incidence of anastomotic leaks after low anterior resection, being 11/122 (9%) in the conventional surgery period and 12/52 (23%) in the early mesorectal excision period (p = 0.01). The incidence of anastomotic leaks declined to 5/61 (8%) in the late mesorectal excision period (p = 0.03). Multiple regression analysis identified a low anastomosis, major bleeding, and age over 75 years as significant risk factors for the development of anastomotic leaks. Major intraoperative bleeding occurred in 36/84 (43%) of the patients in the early and 22/82 (27%) in the late mesorectal period (p = 0.04). Blood transfusions were given to 61/84 (74%) in the early mesorectal period and 41/82 (50%) in the late period (p < 0.01). CONCLUSIONS: The incidence of surgical complications increased significantly after the introduction of mesorectal excision, but declined with time.