Occult micro medullary thyroid carcinoma: therapeutic strategy and follow-up.

Twenty micro medullary thyroid carcinomas (MTCs) were found in histologic specimens of 19 patients in our department from 1990 to 1998. There were 14 women and 5 men, with a median age of 63 years. The indication for surgery was goiter in 12 patients and a solitary nodule in 7 patients (three differentiated cancers). Altogether, 18 patients had unifocal micro-MTCs with a median diameter of 3.6 mm. One patient had a bilateral MTC (3 and 5 mm, respectively). Surgical procedures consisted of 9 total thyroidectomies and 10 lobectomies or subtotal thyroidectomies. Of these 10 patients, 4 underwent reoperation (totalization). One was operated on 48 months after a positive pentagastrin test: There was no thyroid residual tumor but three lymph node micrometastases. Among the six patients in whom thyroid tissue was left, a 91-year-old woman died of unrelated cause and the five others remain disease-free without biologic abnormalities at follow-ups of 18 to 70 months. Considering the aggressiveness of MTCs, total thyroidectomy with central compartment dissection is theoretically indicated. However, among the nine total thyroidectomies and four secondary totalizations associated with at least central compartment dissection, no other thyroid lesion was observed and only one case of lymph node microinvasion was found. Because of the morbidity associated with reoperation and neck dissection, we propose that it is indicated only for microcarcinomas > 5 mm in diameter, in cases of an abnormal response to pentagastrin, or when it is difficult to ensure prolonged follow-up of the patient.

[Surgery for primary hyperparathyroidism in 1998. Apropos of 66 patients and 3 methods of approach]. / Les opérations pour hyperparathyroïdie primaire en 1998. A propos de 66 patients et de trois voies d'abord.

STUDY AIM: The aim of this prospective study was to assess the advantages and disadvantages of cervicotomy, selective lateral approach and video-assisted surgery in the treatment of primary hyperparathyroidism (HPT 1). PATIENTS AND METHODS: During 1998, 66 patients were operated on for HPT 1 in the same center. There were 48 women and 18 men (mean age: 58 years, range: 21-84), familial HPT 1 or MEN1 excluded. The interventions were performed via classical cervicotomy (n = 32), via selective lateral approach (n = 8) and were video-assisted (n = 25). A mediastinal adenoma was removed via cervicotomy and another one via left thoracoscopy. The procedure was associated with intraoperative parathormone (PTH) quick-assay. Calcium testing was controlled before leaving the hospital and 2 months later. RESULTS: A double adenoma and 65 single adenomas were confirmed by pathological report. Circulating PTH levels, 20 minutes after removal of the adenoma, always decreased significantly. In video-assisted procedures, there were 11 conversions to open cervicotomy (44%) and morbidity consisted of one case of laryngeal nerve paralysis. At the end of the study, all patients except one had a normal calcium level. CONCLUSION: Video-assisted parathyroidectomy is feasible but requires a preoperative localisation of the adenoma and intraoperative PTH quick-assay. Its main benefit in cervical adenoma is to reduce the scar and in mediastinal adenoma to avoid sternotomy. With the elective approach, results are similar to those of video-assisted surgery and the procedure is much easier to perform. Classical cervicotomy is still the best option in case of previous cervicotomy, of simultaneous thyroidectomy, of negative preoperative imaging and in elderly patients less concerned about cosmetic benefit.

[Diagnosis and treatment of hydatid cysts of the liver. Apropos of 87 cases operated on between 1980 and 1992]. / Diagnostic et traitement des kystes hydatiques du foie. A propos de 87 cas opérés entre 1980 et 1992.

Human echinococcosis is still endemic in some areas of the world, including Mediterranean countries and Lebanon. Because there is no effective medical therapy, surgery remains the principal mode of treatment. A consecutive series of 87 patients operated on for liver hydatid disease between January 1980 and March 1992 in the division of General Surgery at Saint George's Hospital, Beirut, were analyzed. Patients with hydatic cysts in other sites than liver were excluded from the study. There were 39 men (45%), and 48 women (55%) aged 12 to 75 years (mean 43). The right lobe of the liver was affected in 67 cases (77%), the left lobe in 18 cases (20.6%), and both lobes in 2 cases (2.4%). Clinical symptomatology consisted of abdominal pain, fever, jaundice, urticaria, and an abdominal mass. Preoperative diagnosis was established using imaging studies: plain abdominal films, ultrasonography, computed tomography, and serologic tests. Cases were classified into 3 groups: G1 (n = 44, 50.5%) had a partial resection of the cyst followed by an external drainage; G2 (n = 15, 17.2%) had a partial resection of the cyst with a filling of the residual cavity; G3 (n = 28, 32.2%) made benefit of complete resection of the cyst (pericystectomy) with or without partial hepatectomy. In this retrospective study we compared the results of these different surgical techniques: postoperative complications and mortality, hospital stay of patient. We noted the better postoperative course of the non-drained patient (G2 and G3). Three patients died during the postoperative period because of septic complications. Conclusions and general recommendations are proposed.