[Contribution of technological aids to the extraction of orbital foreign bodies]. / Apport des aides technologiques dans l'extraction des corps étrangers orbitaires.

BACKGROUND: Removal of orbital foreign bodies is a surgical challenge. The purpose of this study is to report our experience in the removal of orbital foreign bodies and to evaluate the usefulness of various technological aids in their removal. MATERIALS AND METHODS: We conducted a single-center retrospective study at Nice University Hospital (France) from January 2017 to December 2023. All patients undergoing surgery for an orbital foreign body during the study period were included. Data recorded included the nature of the orbital foreign body, its size, location, surgical route, outcome (success, partial success, failure), and technological aids used (intraoperative navigation, intraoperative imaging scope, orbital magnet). Concurrently, we designed a dedicated orbital magnet, which was tested in the anatomy laboratory and in two of our patients. RESULTS: Six patients, all young men, were included during the study period. Removal was successful, partially successful, or unsuccessful in one-third of cases, respectively. Failure was associated with orbital foreign bodies located in the intraconal or posterior orbital space. Preoperatively, the use of a "low-artifact" scanner allowed us to better determine the exact size and shape of the orbital foreign body. Intraoperative navigation was not accurate enough, due to the mobility of the orbital bodies within the orbital fat. In our experience, intraoperative scope imaging was more accurate. The use of a dedicated orbital magnet was successfully tested in the anatomy laboratory and allowed the removal of a small orbital foreign body in one of our patients. Intraoperative surgical videos are provided. CONCLUSION: Vegetal orbital foreign bodies must be systematically removed. Removal of non-vegetal orbital foreign bodies should be considered on a case-by-case basis based on their size, best assessed using a "low artifact" scanner, their location, and their intrinsic ferromagnetism. Intraoperative navigation does not appear useful, while intraoperative scope imaging does. A dedicated orbital magnet might be helpful in removing ferromagnetic orbital foreign bodies. However, an orbital magnet may be ineffective in removing intraorbital bullets, since they are made primarily of an alloy of copper and lead.

Purulent thyroiditis--a clinical study of 5 cases.

UNLABELLED: Between 1 January 1990 and 31 December 2006, 13,279 patients were operated on due to various forms of goitre, of which five cases were diagnosed with purulent thyroiditis--one child aged 8, three women and one man all between 35 and 81 years of age. The course of the disease was unusual. In three of the patients cancer was suspected. In all of the patients hard nodules were discovered within the thyroid gland, ultrasonographically heterogeneous and hypo-echogenic, although scintigraphic examination showed "cold" nodules. The child presented regional lymph node enlargement. Except in one case, all patients were apyretic. The rapid growth of the thyroid gland and symptoms of compression were observed in 2 cases. In one of them, tracheostomy was required. Fine needle aspiration biopsy of the thyroid gland revealed the presence of profuse purulent infiltration in one case. Neither thyroid dysfunction nor autoimmune changes were detected. A subtotal thyroidectomy was performed in all patients. In the paediatric case, the enlarged lymph nodes were also resected. In 3 cases, thyroid abscess was diagnosed and drained and staphylococcus epidermidis, streptococcus epidermidis and streptococcus pyogenes were found. Microscopic examination proved the presence of aspergillus fumigatus in one case. Antibiotic therapy was applied postoperatively and all the patients recovered. CONCLUSIONS: (1) The clinical course of purulent thyroiditis leads to a diagnostic challenge. The surgical treatment of purulent thyroiditis allows for a faster recovery for the patient.

Purulent Thyroiditis-a Clinical Study of 5 Cases.

UNLABELLED: Between 1 January 1990 and 31 December 2006, 13279 patients were operated on due to various forms of goitre, of which five cases were diagnosed with purulent thyroiditis-one child aged 8, three women and one man all between 35 and 81 years of age. The course of the disease was unusual. In three of the patients cancer was suspected. In all of the patients hard nodules were discovered within the thyroid gland, ultrasonographically heterogeneous and hypo-echogenic, although scintigraphic examination showed "cold" nodules. The child presented regional lymph node enlargement. Except in one case, all patients were apyretic. The rapid growth of the thyroid gland and symptoms of compression were observed in 2 cases. In one of them, trache-ostomy was required. Fine needle aspiration biopsy of the thyroid gland revealed the presence of profuse purulent infiltration in one case. Neither thyroid dysfunction nor autoimmune changes were detected. A subtotal thyroidectomy was performed in all patients. In the paediatric case, the enlarged lymph nodes were also resected. In 3 cases, thyroid abscess was diagnosed and drained and staphylococcus epidermidis, streptococcus epidermidis and streptococcus pyogenes were found. Microscopic examination proved the presence of aspergillus fumigatus in one case. Antibiotic therapy was applied postoperatively and all the patients recovered. CONCLUSIONS: 1. The clinical course of purulent thyroiditis leads to a diagnostic challenge. The surgical treatment of purulent thyroiditis allows for a faster recovery for the patient.

Unusual malignant thyroid tumours--a clinical study of 20 cases.

UNLABELLED: The aim of this study is to assess late results of surgical treatment for primary non-Hodgkin lymphoma (PNHL), thyroid sarcomas (TS) and tumour metastases (TM) of the thyroid gland. MATERIALS AND METHODS: Between January 1st, 1990 and December 31st, 2005, 12725 patients were surgically treated for various types of goitre. Malignant tumour was diagnosed in 617 (4.9%) cases, consisting of 597 (96.8%) patients with thyroid carcinoma and 20 (3.2%) with other tumours, which included 9 (1.5%) cases of PNHL, 9 (1.5%) cases of TM and 2 (0.2%) patients who showed TS. RESULTS: In the group of patients diagnosed with PNHL, variant B-cell lymphoma predominated (77.8%), and in cases of patients with TM renal cell carcinoma prevailed (77.8%). In all cases, hypo-echogenic nodules were observed in ultrasonography and cold nodules in scintigraphy. All patients were surgically treated with possible complementary chemotherapy and/or radiotherapy. At present, 5 patients with PNHL are alive--43-93 (average of 63.8) months after the operation. Others have died within a period of 2 days to 3 months after the operation. Two patients with TM are alive--19 and 46 (median 32.5) months after the operation. Others have died within a period of 3 to 62 (median 21) months after the operation. Patients with TS have died respectively 19 days and 13 months after the operation. CONCLUSIONS: 1. Patients with primary thyroid lymphomas should be approached individually using all available methods of treatment, including surgery and radiotherapy and/or chemotherapy. 2. Diagnosis of cold nodules in patients with oncological history should always arouse suspicion of metastases to the thyroid gland. 3. Diagnosis of non-thyroid cancer prior to surgery is difficult to obtain. 4. The need for surgery is usually based on local compression.

[Surgical treatment of Graves-Basedow disease]. / O leczeniu chirurgicznym choroby Gravesa-Basedowa.

Authors indicate the usefulness of surgical procedures in treatment of Graves-Basedow disease to obtain the best and permanent therapeutic effects and suggest its important place in modern methods of treatment. They pay attention to difficulties in deciding about the range of thyroid gland tissue resection for preserving the state of hormonal balance in postoperative period. Importance of right surgery techniques, for minimizing the number of postoperative complications is also emphasized.

[Low obturation ileus caused by gallstone incarceration in sigmoid colon]. / Niska niedroznosc jelit spowodowana uwieznieciem kamienia zólciowego w esicy.

Authors presents two cases of low obturation ileus caused by gallstone which had obstructed sigmoid colon. They pay attention to diagnostic problems and usefulness of sonography and X-ray techniques also in case of biliary ileus. Authors shows difficulties in surgical procedures, prefering enterotomy and evacuation of concrement, without simultaneous internal biliary fistula liquidation, especially in cases of increased risk and in old age patients.

[TSH-receptor antibodies in thyroid diseases]. / Przeciwciala przeciw receptorom dla TSH w chorobach tarczycy.

The clinical usefulness of detection of TSH receptor antibodies (TRAK-assay, Henning) in differential diagnosis of thyroid disorders and in follow up of treatment of Graves' disease was evaluated and compared to thyroperoxidase antibodies estimation (DYNOtest antiTPO Henning). 313 patients with various thyroid diseases and 50 persons from control group were examined. Thyroperoxidase antibody (TPO-Ab) titers were frequently elevated in Graves' disease before treatment (88.6%, median 3361 U/ml) and in Hashimoto thyroiditis (100%, median 6055 U/ml). Median TPO-Ab was in normal range in other thyroid disorders and in control group (toxic nodular goiter: 58.5 U/ml, neutral nodular goiter: 46.0 U/ml, thyroid cancer after thyroidectomy: 58.8 U/ml, control group: 0 U/ml). TSH-receptor antibodies (TRAb) were detected in 94.1% in patients with Graves' disease (median 52 U/l) and only in 12.5% with Hashimoto disease (median 4.1 U/l), in 25% with toxic nodular goiter (median 4.1 U/l), in 10.9% with neutral nodular goiter (median 4.6 U/l) in 17.4% with thyroid cancer (median 1.6 U/l) and in 4.8% in control group (median 1.7 U/l). The TPO-Ab titers did not decrease significantly during thyrostatic treatment of Graves' disease. Patients in clinical remission after treatment exhibited TPO-Ab in 76.9% (median 615.5 U/ml). In contrast, the TRAb titers failed in patients treated with thyrostatics longer then six months (64%, median 16 U/l). After treatment 86.7% of them had normal values (median 1.0 U/l). The increase of TPO-Ab persisted in patients investigated two years after subtotal thyroidectomy (92.3%, median 750 U/ml). Only in patients operated before 10 years the titers declinedsignificantly (32%, median 43.4 U/ml). The TRAb titers fell significantly after thyroidectomy (two years: 62.5%, median 10.7% U/l, 10 years: 36.4%, median 4.2 U/l). Estimation of TRAb is a powerful tool for differential diagnosis of Graves' disease and enables better monitoring of the applied treatment than estimation of TPO-Ab.