Lessons Learned from the Transoral Endoscopic Thyroidectomy with Vestibular Approach (TOETVA) for the Treatment of Thyroid Carcinoma.

BACKGROUND: Early detection of thyroid carcinoma has become commonplace. Consequently, the endoscopic approach has become a widely used method. OBJECTIVE: Our aim was to report our experience with the transoral endoscopic thyroidectomy vestibular approach (TOETVA). METHODS: We reviewed the records of 46 patients who underwent TOETVA. Only patients with no regional lymph node metastases (N0) and fine needle aspiration biopsy-confirmed thyroid cancer were included. The surgical technique used was as described by Angkoon Anuwong. RESULTS: Forty-six patients with a mean age of 43.6 years (range 17-71) were included (37 women and 9 men). The mean time of surgery was 207 min (range 95-345), and the conversion to open thyroidectomy rate was 13% (six cases). CONCLUSION: TOETVA is an acceptable approach for thyroid carcinoma. Poorly differentiated cancer, as well as extrathyroidal extension, result in patients being unsuitable for TOETVA. It is imperative to identify the circumstances under which conversion to open thyroidectomy must take place.

Maxillofacial Rehabilitation With Zygomatic Implants in an Oncologic Patient: A Case Report.

Tumor ablation results in significant sequelae in the appearance, function, and esthetics of a patient with cancer, especially resection for head and neck cancer. Reconstruction with local and microvascular flaps is a workable option; however, the esthetic results will occasionally be unfulfilling and inadequate for the rehabilitation of lost structures. Prosthetic rehabilitation with conventional and zygomatic implants can provide favorable and predictable long-term results. We report the clinical case of a 53-year-old female patient with adenoid cystic carcinoma (ACC). The treatment protocol included radical surgery, radiotherapy, and maxillofacial rehabilitation with conventional and zygomatic implants. Management of an ACC case requires a timely, radical, and multidisciplinary approach. In our patient, rehabilitation of masticatory function was accomplished in the immediate postoperative period and before radiotherapy. The rehabilitation of masticatory function improved the patient's systemic and nutritional status and her speech, with coverage of the esthetic defect. These outcomes reduced the psychological and emotional effects of tumor ablation.

Anaplastic thyroid cancer: multimodal treatment results.

BACKGROUND: Anaplastic thyroid cancer is a rare and lethal disease. It accounts for 1-2% of thyroid malignancies, but specific mortality is higher than 90%. It is an aggressive locoregional disease with a high metastatic capacity. There is no agreement with regards to the best treatment. We analysed the results of treatment in a mestizo population treated in the National Cancer Institute (Mexico). METHODS: We reviewed 1,581 files of thyroid carcinomas; of these, 29 (1.83%) had anaplastic thyroid carcinoma. Demographic variables, clinical manifestations, tumour characteristics, and treatments were analysed. RESULTS: The median age was 64.5 ± 13.2 years. Females were more affected (female/male ratio: 2.6:1); 21 cases occurred in women (72.4%), and eight in males (27.6%). The most common manifestations were neck enlargement (93.10%) and hoarseness (71.31%). The median tumour size was 8 cm (range: 4-20 cm). The percentage of cases which presented in clinical stage IVA was 10.3%, with 62.1% presenting in clinical stage IVb and 27.6% presenting in clinical stage VIc. Complete resection (R0) (p = 0.05), radiation doses of higher than 33.1 Gy (p = 0.04), and multimodal therapy were associated with better survival. Surgery plus radiotherapy with or without systemic treatment (p = 0.006). The median overall survival was 119 days (IC 95%, 36.3-201.6). Six-month, one-year and two-year survival was 37.9%, 21% and 13%, respectively. CONCLUSION: Complete surgical resection is associated with better survival but is very difficult to achieve due to aggressive biological behaviour. Multimodal therapy is associated with better survival and a better quality of life. There is a need for more effective systemic treatments as extensive surgical resections have little overall benefit in highly invasive and metastatic disease.

Pancreatic hemolymphangioma.

CONTEXT: Hemolymphangioma of pancreas is a tumor has its origins on vascular and lymphatic vessels malformation. At this time, only eight cases have been reported (PubMed). CASE REPORT: A 52-year-old woman with history of abdominal pain and early satiety was admitted to our external consultation. Laboratory data were normal. CT initially showed a high vascularized solid tumor, apparently arising from the right hepatic lobe, and it was considered to be a hemangioma. Two sessions of CT guided embolizations were performed. Control CT scan revealed a reduction in tumor´s size and location confined to pancreatic head. With this diagnosis studies and suspicion of neoplastic tumor, it was performed a pylorus preserving pancreatoduodenectomy. Pathology report was to be a pancreatic head hemolymphangioma. CONCLUSION: Diagnosis and management of cystic pancreatic tumors can be challenging. Cystectomy or even surgical procedures as pancreatoduodenectomy should be performed when is possible. We report a case of pancreatic hemolymphangioma, a benign cystic tumor with a rare incidence.

Two cases of sternectomy for bone metastasis due to aggressive variants of thyroid papillary carcinoma.

INTRODUCTION: There are only few cases reported about the role of surgery in the presence of single or multiple bulky bone metastases. The literature about treatment for bulky sternal metastases is scarce. PRESENTATION OF CASE: We present two patients treated surgically for metastatic thyroid lesions. Case 1 is a female with tumor of the thyroid right lobe, mediastinal extension and multiple pulmonary metastases. Bony infiltration was observed in the sternum and ribs. Case 2 is a female with a lesion in the cervical region of the thyroid left lobe and increase in volume on the upper sternal manubrium. DISCUSSION: Patients with well-differentiated thyroid cancer may present with extracervical metastasis in 5-10% of cases at diagnosis. Bone metastases occur in 0.4% of cases of papillary carcinoma. Management remains controversial. There are only isolated cases reported in the literature of the role surgery plays in the presence of single or multiple bulky bone metastases. The basis for initial surgical approach is keeping in mind that the surgical procedure is palliative in order to achieve optimal hypothetical ablation as a result of reduced tumor volume. CONCLUSION: Surgery is the elective treatment and can be performed safely and with adequate results, allowing proper optimization of the dose of (131)I for ablative therapy.

[Prevalence and associated risk factors of arterial hypertension in Sobremonte and Ojo de Agua Departments in Cordoba State]. / Prevalencia de hipertensión arterial y factores de riesgo asociados en el Dpto. Sobremonte y sur del Dpto. Ojo de Agua.

Arterial Hypertension (AH) is a disease with multiple risk factors (RF), and it is one of the most important risk factor for cardiovascular diseases. The objective of this study was to determine the prevalence of AH in Sobremonte area and its correlation to other risk factors. The study was done in an special programme called "Solidarity in Health" (SIH) supported by the College of Medicine at the National University of Córdoba, which provided primary care to residents of Cachi Yaco (Sobremonte Department). It is an small village near Santiago del Estero province located in 226 km from Córdoba city. They went to the city and they examined the patients at the the "French and Berutti" school for nine consecutive years (2000-2008). Sobremonte area is the poorest deparment in the province of Córdoba and it has the highest rate of lowest socio-economic development, and a very deficient health care system.. The only hospital providing primary care is in San Francisco del Chañar, and the access is not free. The study involved the determination of the arterial pressure (AP) according to the seventh "JNC"criteria, body mass index (BMI), levels of alcohol consumption, exercise, salt consumption, diabetes and smoking in all the patients. Additionally, three water samples from different representative zones were collected and tested for sodium concentration. 471 patients were included. The incidence of AH was 43.5% of the patients. (51% men and 36% women). Higher incidence of AH was found in patients between 50 and 59 years old. There was a stadistical difference in the BMI, diabetes, and alcohol consumption between healthy patients and patients with AH. There was not any correlation between AH and exercise. We found higher levels of sodium in the water of this area and it was between 13-35 higher than in C6rdoba city and it was correlated with AH. We conclude that the increased sodium consumption is one of the most important risk factor of AH in this population.