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.

Heterogeneity of stage IIIA non-small cell lung cancers (NSCLC) and evaluation of late results of surgical treatment.

AIMS: The aim of the study was assessment of the heterogeneity of stage IIIA non-small cell lung cancers (NSCLC) and the late results of surgical treatment. METHODS: The study group consisted of 83 consecutive patients discharged between 1988 and 1992 undergoing radical operative treatment for stage IIIA NSCLC. Squamous cell carcinoma was diagnosed in 54 (65.1%) patients, adenocarcinoma in 23 (27.7%), large cell carcinoma in 2 (2.4%) and mixed (i.e. adenoid-squamous type) in 4 (4.8%). In respect of pTNM staging, 19 (22.9%) patients had T3N1M0, 35 (42.2%) had T2N2M0 and 29 (34.9%) had T3N2M0. RESULTS: Overall, 13.3% of patients with stage IIIA NSCLC survived 5 years following the operation and 8.7% survived 10 years. Analysis of follow-up study indicated that this group was heterogenic. In T3N1M0 group 26.3% survived 5 years following the operation, in T2N2M0 group 14.3%, in T3N2M0 group 3.5% (P = 0.015). Of 23 patients with N2 disease and no metastases in hilar lymph nodes ('skip' metastases), 26.1% survived 5 years, whereas none of 41 patients with metastases spreading by continuity survived (P = 0.0015). If mediastinal lymph node metastases were diagnosed in one level, 25% patients survived 5 years, but if two or more levels were affected, 2.3% only (P = 0.0214): 85.7% of patients with well-differentiated (G1) cancer survived 5 years and 62.0% 10 years, whereas among those with moderately differentiated (G2) tumours, 11.8% and 8.8%, respectively. No patient survived 5 years after resection of poorly differentiated (G3) cancer (P < 0.001). CONCLUSIONS: (1) Patients operated for stage IIIA NSCLC are a heterogeneous group, which makes it difficult to predict late results. (2) Patients operated for stage IIIA NSCLC have a better prognosis if metastases are discovered in level one mediastinal lymph nodes, particularly in the superior part of mediastinum, or if 'skip' metastases (pulmonary hilus unaffected) are discovered, as compared to those with N2 disease. (3) Poor histologic differentiation of the tumour is a bad prognostic factor.

Thymoma--the usefulness of some prognostic factors for diagnosis and surgical treatment.

AIMS: The aim of the study was to identify prognostic factors which could help evaluate both the treatment offered to patients with thymoma and late results. METHODS: Forty patients were treated for mediastinal thymoma. The patients were staged clinico-pathologically (according to Masaoka) on the basis of the retrospective analysis of their operation protocols as follows: seven (17.5%)-stage I, 19 (22. 5%)-stage II, 17 (42.5%)-stage III, seven (17.5%)-stage IV. Analysis of DNA contents in cell nuclei of 23 thymomas was performed by the flow cytofluorometric method. RESULTS: From the whole group of patients, 65% survived for 5 years, 55% survived for 10 years and 43% survived for 15 years. We noted significant differences in survival time between stage I and stage IV (P<0.0012); stage II and stage IV (P<0.0006), as well as between stage III and stage IV (P<0. 005). Significantly worse prognosis was observed in the case of cortical thymomas as compared with medullary or mixed types (P<0. 0001 P<0.002). Analysis of DNA content showed signficantly higher probability of survival for the patients who had DI=1.0 (diploid), as compared with DNA >1.0 (aneuploid) (P<0.006). Of the 11 patients with diploid tumours, 91% survived for 5 years, but of the 12 aneuploid, only 23% survived. CONCLUSION: The most important positive prognostic factors influencing survival rate in patients with thymoma are: lower stage, medullary type (according to Muller-Hermelink classification), possibility of performing complete resection, diploidal nature of the tumour. Multivariate analysis of survival revealed clinico-pathological stage (according to Masaoka) and histological type (according to Salyer) as significantly independent prognostic factors.

[Observations related to causes and treatment of iatrogenic esophageal injuries]. / Spostrzezenia dotyczace przyczyn i sposobów leczenia jatrogennych uszkodzen przelyku.

One hundred and nine patients were treated in the years 1974-1996 at the Clinic of Thoracic Surgery, Silesian Academy of Medicine, for oesophageal perforation. The group consisted of 72 (66%) men and 37 (34%) women aged 6-89, mean 43 years. In 80 (73%) patients the condition was caused by foreign bodies and endoscopic interventions attempting to remove them, in 9 (8%) by dilation in result of postburn stenosis, in 6 (5%) by trauma, in 8 (7%) by spontaneous rupture, in 6 (5.5%) by other reasons, like tumor or burn. The injury was found within cervical segment in 53 (49%) patients, within thoracic segment in 55 (50%) patients and within abdominal segment in 1 (1%) patients. Fifty seven (52%) patients were admitted sooner than 24 hours after oesophageal injury while 52 (48%) were admitted later than that. A total of 21 (19.3%) patients died, including 3 (5.2%) of the former group and 18 (34.6%) of the latter. Surgical closure of the oesophageal perforation was applied in 40 (37%) patients- of them 4 (10%) died. Four patients with late (exceeding 24 h) diagnosis of oesophageal perforation had thoracotomy and two-layer closure. All of them have survived.

[Immediate and follow up results of surgical therapy for mesenchymal mediastinal tumors]. / Bezposrednie i odlegle wyniki operacyjnego leczenia chorych z mezynchymalnymi guzami sródpiersia.

35 patients (11 men, 24 women, aged 5-73) with mesenchymal tumor of mediastinum were surgically treated in the period 1970-1993. This group stated 10,3% of all patients treated because of cysts and tumors of mediastinum in this time. In 17 cases tumors were benign and in 18 malignant. In 31 pts total resection and in 3-partial resection were done. 5 out of 15 pts with malignant tumor are alive.

[Late results of treatment of bronchopulmonary carcinoids]. / Odlegle wyniki leczenia rakowiaków oskrzelowoplucnych.

In the years 1980-1989 in the Thoracosurgery Department, Silesian Medical Academy in Katowice, 12 patients were treated in whom primary bronchopulmonary carcinoid was diagnosed. Surgical treatment was given to 11 patients. In three of them atypical carcinoid structure was found. From the group of 12 patients three died after 3-22 months. No information was available about one patient but it could be supposed that this patient also died.

[Surgical treatment of primary neurogenic mediastinal tumors]. / Operacyjne leczenie pierwotnych neurogennych guzów sródpiersia.

In the years 1968-1989 out of 300 patients with surgically treated mediastinal tumors in 63 (21%) they were of neurogenic origin. Eighteen of these (29%) proved to be malignant. These tumors occurred in 23 males and 40 females, age range 14 months-67 years (mean 36 years). In all 45 patients with benign tumors and in 12 (66.7%) with malignant tumors the tumors were totally resected. In 4 patients the tumor was only partially resected in further two only a biopsy of the lesion was taken. During postoperative period one patient with a malignant tumor died. Ten (71.4%) patients survived 5 years with malignant lesions, while only 8 (61.5%) survived ten years. All patients that underwent resection of the benign tumor survived 10 years.

[Surgical therapy results in patients with mediastinal cysts]. / Wyniki operacyjnego leczenia chorych z torbielami sródpiersia.

During the years 1968-1988 270 patients with tumors and mediastinal cysts were treated surgically. In 48 (17.8%) cysts were found (26 males, 22 females, age ranged 10-63 years, mean 40.1 years). In 24 pericardial cysts were found. In 24 the cysts derived from the forgut. 23 subjects (47.9%) were symptomless. In all the cysts were removed. Mortality was not seen. 47 patients are included in long-term observation.