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1.
Br J Health Psychol ; 23(2): 352-370, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29356226

RESUMO

OBJECTIVE: Thyroid cancer is one of the most common cancers affecting young people and carries an excellent prognosis. Little is known about the psychosocial issues that face young people diagnosed with a treatable cancer. This study explored how young people experienced diagnosis, treatment, and how they made sense of an experience which challenged their views on what it means to have cancer. METHOD: Semi-structured interviews were conducted with eight young people diagnosed with either papillary or follicular thyroid cancer, and analysed with interpretative phenomenological analysis (IPA). RESULTS: Two inter-related aspects of their experience are discussed: (1) the range of feelings and emotions experienced including feeling disregarded, vulnerability, shock and isolation; (2) how they made sense of and ascribed meaning to their experience in the light of the unique nature of their cancer. A thread running throughout the findings highlights that this was a disruptive biographical experience. CONCLUSIONS: Young people experienced a loss of youthful immunity which contrasted with a sense of growth and shift in life perspective. Having a highly treatable cancer was helpful in aiding them to reframe their situation positively but at the same time left them feeling dismissed over a lack of recognition that they had cancer. The young peoples' experiences point to a need for increased understanding of this rare cancer, more effective communication from health care professionals and a greater understanding of the experiential impact of this disease on young people. Suggestions to improve the service provision to this patient group are provided. Statement of contribution What is already known on this subject? Differentiated thyroid cancer has an excellent prognosis. Quality of life of thyroid cancer has marginally been explored in the literature. Little is known on the support needs of young people diagnosed with thyroid cancer. What does this study add? Increased understanding of how young people make sense and cope with thyroid cancer despite the lack of support resources. Addressing illness perceptions through improved information support may aid coping and adjustment. Insight into the needs of young people diagnosed with thyroid cancer and recommendations on service improvements.


Assuntos
Atitude Frente a Saúde , Acontecimentos que Mudam a Vida , Neoplasias da Glândula Tireoide/psicologia , Adaptação Psicológica , Adulto , Emoções , Feminino , Humanos , Entrevistas como Assunto , Masculino , Qualidade de Vida/psicologia , Adulto Jovem
2.
J Invest Surg ; 31(4): 300-306, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28498785

RESUMO

PURPOSE: Adrenalectomy has the potential to cure or improve the control of hypertension in patients with primary hyperaldosteronism due to unilateral adrenal adenoma (Conn's syndrome). This study assesses the patients' perception of, and costs associated with, laparoscopic adrenalectomy for Conn's syndrome. MATERIALS AND METHODS: Clinical, radiological, operative, and pathological data were collected on patients undergoing adrenalectomy for Conn's syndrome over 8-years period in a UK tertiary referral center. RESULTS: Thirty-eight patients (17M:21F, age 34-79 yrs, median 54 yrs) operated between Jan2005-Sept2012 had lateralization based on CT scans (n = 30) and/or MRI scans (n = 18) and confirmed on selective adrenal venous sampling (n = 25). Laparoscopic adrenalectomy was performed in all patients, with two cases requiring conversion to open operation. Median operative time was 105 min (range: 27-315). Costs were estimated as £19k for preoperative investigations, £20k for in-hospital stay, £53k for operating theatre use and £29k for disposable surgical instruments, with average £3499/patient (national tariff for adrenalectomy in 2015/2016 £3624). Follow-up at a mean of 30 months postoperatively using a visual analogue scale and a standardized questionnaire showed significantly improved quality of life (QoL) post-operatively. Majority of patients (85%) reported taking none or fewer anti-hypertensive medications (median reduction of 2 antihypertensive drugs). All patients stated that they would definitely have the operation again in preference to anti-hypertensive medications and they would recommend the operation to friends/relatives. CONCLUSIONS: Laparoscopic adrenalectomy for Conn's syndrome has a positive impact on hypertension control, leads to improved QoL and its costs are covered in the NHS financial model.


Assuntos
Neoplasias das Glândulas Suprarrenais/complicações , Adrenalectomia/métodos , Hiperaldosteronismo/cirurgia , Hipertensão/cirurgia , Laparoscopia/métodos , Adrenalectomia/economia , Adulto , Idoso , Análise Custo-Benefício , Inglaterra , Feminino , Seguimentos , Humanos , Hiperaldosteronismo/etiologia , Hipertensão/etiologia , Laparoscopia/economia , Tempo de Internação/economia , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Estudos Prospectivos , Qualidade de Vida , Estudos Retrospectivos , Inquéritos e Questionários , Resultado do Tratamento
3.
World J Surg ; 38(11): 2825-30, 2014 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-24964756

RESUMO

BACKGROUND: A recent British Association of Endocrine and Thyroid Surgeons consensus document suggested that day-case thyroidectomy is feasible in a small proportion of patients but has to be balanced against risks. Currently, there is no large reported series of same-day discharge in thyroid and parathyroid surgery from the UK. The aim of this study was to assess the outcomes of day-case thyroid and parathyroid surgery. METHODS: We conducted a retrospective study of patients who underwent thyroid or parathyroid surgery between January 2000 and December 2011 at Oxford University Hospitals. The end points analysed were complications in the form of bleeding, hypocalcaemia, wound infection, and seroma. RESULTS: A total of 2,102 patients (495 males and 1,607 females, age range = 13-90 years) underwent surgery for parathyroid (n = 776) or thyroid (n = 1,326) conditions. The operations included minimally invasive parathyroidectomy (MIP) (n = 331), open parathyroidectomy (n = 445), lobectomy (n = 687), isthmusectomy (n = 23), total thyroidectomy (n = 580) and thyroglossal cyst excision (n = 36). Routine arrangements were in place for consideration of same-day discharge for lobectomies, thyroglossal cyst surgery, and MIPs; lobectomies accounted for 63 % of same-day cases, followed by parathyroidectomy (35 %). Over the decade, day-case surgery increased from 4 to 17 % for thyroid surgery and from 20 to 40 % for parathyroid surgery. None of the 435 patients who had same-day discharge was readmitted for bleeding [confidence interval (CI) 0-0.6 %]. There was no 30-day mortality for the whole cohort. Complications in patients who underwent surgery in the whole cohort versus those who were discharged the same day were temporary hypocalcaemia (4 vs. 0.2 %), permanent hypocalcaemia (1 vs. 0.4 %), bleeding (0.4 vs. 0 %), seroma (0.3 vs. 0 %), and wound infection (0.3 vs. 0 %). CONCLUSION: Current protocols for thyroid or parathyroid surgery make same-day discharge feasible and safe in carefully selected patients.


Assuntos
Procedimentos Cirúrgicos Ambulatórios/tendências , Doenças das Paratireoides/cirurgia , Paratireoidectomia/tendências , Doenças da Glândula Tireoide/cirurgia , Tireoidectomia/tendências , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Procedimentos Cirúrgicos Ambulatórios/efeitos adversos , Estudos de Viabilidade , Feminino , Humanos , Hipocalcemia/etiologia , Masculino , Pessoa de Meia-Idade , Paratireoidectomia/efeitos adversos , Alta do Paciente , Hemorragia Pós-Operatória/etiologia , Estudos Retrospectivos , Seroma/etiologia , Infecção da Ferida Cirúrgica/etiologia , Cisto Tireoglosso/cirurgia , Tireoidectomia/efeitos adversos , Reino Unido , Adulto Jovem
4.
Eur J Endocrinol ; 171(1): K1-5, 2014 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-24743399

RESUMO

OBJECTIVE: Hypercalcaemia is an important cause of increased morbidity and mortality in patients with parathyroid carcinoma. Surgical resection is the mainstay of treatment but, equally, managing hypercalcaemia is of paramount importance. At present, few therapies have been shown to be effective in the most severe cases. This report describes the efficacy of denosumab in a patient with parathyroid carcinoma when conventional therapies had been shown to be relatively ineffective.SUBJECT, METHODS AND RESULTS: A 50-year-old man presented with symptomatic hypercalcaemia 1 year after the surgery for his parathyroid carcinoma. Investigations revealed raised serum calcium and parathyroid hormone concentrations consistent with the recurrence of the disease. Imaging failed to localise any surgically remediable foci. Medical management with loop diuretics, calcimimetics and bisphosphonates failed to provide a sustained response. Denosumab, as a monthly injection, led to a gradual decrement in his peak calcium concentrations with the values now persistently below 3 mmol/l. CONCLUSIONS: Denosumab, a fully human MAB that binds to the 'receptor activator of nuclear factor κB ligand (RANKL)', was shown to have a profound effect in modulating malignant hypercalcaemia. This medication should be considered as an effective option in patients with refractory hypercalcaemia secondary to parathyroid carcinoma.


Assuntos
Anticorpos Monoclonais Humanizados/uso terapêutico , Hipercalcemia/sangue , Hipercalcemia/tratamento farmacológico , Síndromes Paraneoplásicas/sangue , Síndromes Paraneoplásicas/tratamento farmacológico , Neoplasias das Paratireoides/sangue , Neoplasias das Paratireoides/tratamento farmacológico , Cálcio/sangue , Denosumab , Humanos , Masculino , Pessoa de Meia-Idade , Hormônio Paratireóideo/sangue
5.
Laryngoscope ; 123(9): 2319-23, 2013 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-23824630

RESUMO

OBJECTIVES/HYPOTHESIS: To evaluate patient perception of morbidity after thyroid surgery. STUDY DESIGN: Survey of consecutive patients (case series). METHODS: A standardized questionnaire was mailed to 312 patients who underwent thyroid surgery during a 3-year period (January 2008 to December 2010). RESULTS: Replies were received from 202 (64%) patients (56 male, 166 female; age, 55 ± 16 years) at 6 to 39 months (median, 23 months) after lobectomy (n = 119) or total thyroidectomy (n = 76) for benign (n = 160) or malignant (n = 42) conditions. Subjective voice assessment using a visual analogue scale was normal in 111 patients, deteriorated in 80 patients, and improved in 21 patients. Voice handicap index scores were normal in 126 (62%) patients and increased in 76 (38%) patients to a median of 17 (range, 11-29). Voice-related quality of life was excellent in 107 (53%) patients, fair to good in 66 patients, and poor to fair in 29 patients. Subjective assessment of swallowing was reported as normal in 84 patients, moderately affected in 56 patients (score, 11-15) and severely affected in 62 patients (score, 16-40; median, 23). Calcium supplements prescribed routinely after bilateral surgery were interrupted within 2 to 4 weeks in 56 patients and within 3 to 6 months in 18 patients. None of the respondents had persistent hypoparathyroidism. Appearance of the scar assessed using the Manchester score ranged from 5 to 16 (median, 7). Asked whether they would consider robotic thyroid surgery to avoid a cervical scar, only 38 patients said they were definitely interested. CONCLUSIONS: A large proportion of patients report persistent moderate voice and swallowing problems after thyroid surgery. These findings are similar to a recent international multicenter survey of more than 2,000 patients with thyroid cancer. Hypocalcemia and cosmetic outcome raised no significant concerns.


Assuntos
Cicatriz/etiologia , Transtornos de Deglutição/diagnóstico , Tireoidectomia/efeitos adversos , Distúrbios da Voz/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Cicatriz/fisiopatologia , Estudos Transversais , Transtornos de Deglutição/epidemiologia , Transtornos de Deglutição/etiologia , Feminino , Seguimentos , Humanos , Hiperparatireoidismo/patologia , Hiperparatireoidismo/cirurgia , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/fisiopatologia , Qualidade de Vida , Medição de Risco , Inquéritos e Questionários , Neoplasias da Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/cirurgia , Tireoidectomia/métodos , Fatores de Tempo , Resultado do Tratamento , Distúrbios da Voz/epidemiologia , Distúrbios da Voz/etiologia , Qualidade da Voz , Adulto Jovem
6.
Int J Surg ; 11(3): 275-7, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23415773

RESUMO

BACKGROUND: Minimally invasive parathyroidectomy (MIP) is the choice of treatment in patients with sporadic adenomas localized on preoperative imaging. Currently there is no centre in the UK which performs this procedure under local anaesthesia. The aim of this study was to assess the efficacy and safety of MIP under local anaesthesia in patients with sporadic primary hyperparathyroidism (pHPT). METHODS: This is a prospective, nonrandomized study of 86 patients with pHPT localized with Tc99m Sestamibi scan and ultrasound. MIPs were performed under local anaesthesia and sedation at the Oxford University Hospitals. Serum Ca and PTH were measured before discharge, at 6 weeks follow up, and at 6 months. Main outcome measures were cure at 6 months, complications with the procedure and operative time. RESULTS: 86 patients (58 females: 28 males) with a mean age of 65 (range 24-87) underwent MIP under local anaesthesia and sedation. All patients (100%) were normocalcaemic at 6 months following surgery. There was no incidence of temporary or permanent recurrent laryngeal nerve palsy or persistent hypercalcaemia. Two patients had temporary hypocalcaemia that resolved in 6 weeks. In one patient the neck incision needed extension for bleeding, with no incidence of wound haematoma or infection. CONCLUSION: This study demonstrates that MIP (without ioPTH) can be safely performed under local anaesthesia for patients with sporadic primary hyperparathyroidism.


Assuntos
Anestesia Local/métodos , Hiperparatireoidismo/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Paratireoidectomia/efeitos adversos , Paratireoidectomia/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Anestesia Local/efeitos adversos , Feminino , Humanos , Hiperparatireoidismo/sangue , Hiperparatireoidismo/diagnóstico por imagem , Hiperparatireoidismo/patologia , Masculino , Pessoa de Meia-Idade , Monitorização Fisiológica , Duração da Cirurgia , Hormônio Paratireóideo/sangue , Estudos Prospectivos , Cintilografia
7.
Langenbecks Arch Surg ; 398(3): 377-82, 2013 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-23274361

RESUMO

BACKGROUND: Central compartment lymph node (CCLN) metastasis in papillary thyroid cancer (PTC) is associated with higher risk of loco-regional recurrence and distant metastasis. This study evaluated the prognostic implication of the number of metastatic CCLN in PTC. METHODS: Prospective data collection on 91 patients with PTC who underwent total thyroidectomy and CCLN dissection with or without lateral neck dissection between January 2005 and December 2010 was made. Number of positive CCLN was correlated with known prognostic factors (age, gender, tumour size, extrathyroidal extension and lateral node metastasis). RESULTS: Patients were divided into three groups according to the number of positive CCLN: group A = 0 (n = 35); B = 1-2 nodes (n = 32) and C = >3 nodes (n = 24). The risk of lateral compartment disease increased in parallel with the number of positive CCLN (31 vs. 50 vs. 75 % in groups A-B-C, respectively; p < 0.004). Gender/age/tumour size/extrathyroidal extension did not correlate with number of positive CCLN. The increasing number of positive CCLN did not influence post-ablation iodine uptake (1.25 vs. 1.14 vs. 2.63 %) and correlated with mean thyroglobulin values at 1-year post-ablation (12.3 vs. 42.3 vs. 91.48 µg/L) CONCLUSIONS: The number of CCLN metastasis is a risk factor for lateral compartment disease with no correlation with other prognostic markers.


Assuntos
Carcinoma/mortalidade , Carcinoma/secundário , Linfonodos/patologia , Recidiva Local de Neoplasia/patologia , Neoplasias da Glândula Tireoide/mortalidade , Neoplasias da Glândula Tireoide/secundário , Adulto , Idoso , Carcinoma/cirurgia , Carcinoma Papilar , Distribuição de Qui-Quadrado , Bases de Dados Factuais , Intervalo Livre de Doença , Feminino , Humanos , Excisão de Linfonodo/métodos , Excisão de Linfonodo/estatística & dados numéricos , Linfonodos/cirurgia , Masculino , Pessoa de Meia-Idade , Esvaziamento Cervical/métodos , Invasividade Neoplásica/patologia , Recidiva Local de Neoplasia/mortalidade , Recidiva Local de Neoplasia/cirurgia , Estadiamento de Neoplasias , Prognóstico , Estudos Retrospectivos , Medição de Risco , Análise de Sobrevida , Câncer Papilífero da Tireoide , Neoplasias da Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/cirurgia , Tireoidectomia/métodos , Resultado do Tratamento , Reino Unido
8.
Langenbecks Arch Surg ; 397(2): 225-31, 2012 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-22134748

RESUMO

BACKGROUND: Most patients with adrenocortical cancer (ACC) continue to present with advanced disease. Invasion into the inferior vena cava (IVC) defines stage III disease and the management of such patients raises additional difficulties. METHOD: A multicentre survey was organized by emailing a standardized proforma to members of the European Society of Endocrine Surgery (ESES). Anonymised retrospective clinical data were collected. RESULTS: Replies were received from 18 centres in nine countries. ACC with IVC invasion was encountered in 38 patients (18F:20M, age 15-84 years, median 54 years). There were 16 nonfunctioning tumours and 22 functioning tumours predominantly right-sided (26R:12L) and measuring 18-255 mm (median 115 mm). Fourteen patients had metastatic disease at presentation. Tumour thrombus extended in the prehepatic IVC (n = 21), subdiaphragmatic IVC (n = 6) or into the SVC/right atrium (n = 3). Open adrenalectomy was associated with resection of surrounding viscera in 24 patients (nephrectomy n = 16, liver resection n = 14, splenectomy n = 3, Whipple procedure n = 2). IVC was controlled locally (n = 27), at suprahepatic levels (n = 6) or necessitated cardiac bypass (n = 5). Complete resection (R0, n = 20) was achieved in the majority of patients, with a minority having microscopic persistent disease (R1, n = 7) or macroscopic residual disease (R2, n = 4). Perioperative 30-day mortality was 13% (n = 5). Postoperative Mitotane was used in 23 patients and chemotherapy in eight patients. Twenty-five patients died 2-61 months after their operation (median 5 months). Currently, 13 patients are alive at 2-58 months (median 16 months) with known metastatic disease (n = 7) or with no signs of distant disease (n = 6). CONCLUSION: This dataset is limited by the lack of a denominator as it remains unknown how many other patients with ACC presenting with IVC invasion did not undergo surgery. The relatively low perioperative mortality and the long disease-free survival achieved by some patients should encourage surgeons with adequate experience to offer surgical treatment to patients presenting with advanced adrenocortical cancers.


Assuntos
Neoplasias do Córtex Suprarrenal/cirurgia , Carcinoma Adrenocortical/secundário , Carcinoma Adrenocortical/cirurgia , Causas de Morte , Neoplasias Vasculares/secundário , Veia Cava Inferior/patologia , Adolescente , Neoplasias do Córtex Suprarrenal/mortalidade , Neoplasias do Córtex Suprarrenal/patologia , Adrenalectomia/métodos , Adrenalectomia/mortalidade , Carcinoma Adrenocortical/mortalidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Procedimentos Cirúrgicos Endócrinos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica/patologia , Prognóstico , Estudos Retrospectivos , Medição de Risco , Sociedades Médicas , Análise de Sobrevida , Fatores de Tempo , Neoplasias Vasculares/mortalidade , Neoplasias Vasculares/cirurgia , Adulto Jovem
9.
Langenbecks Arch Surg ; 395(7): 941-6, 2010 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-20658300

RESUMO

BACKGROUND: Parathyroidectomy for primary hyperparathyroidism (PHPT) is followed by a decrease in the severity of symptoms reported on the Pasieka's parathyroid symptoms score (PPSS) and SF-36 questionnaires. Some argue that such benefits are short-lived. This study investigates the severity of symptoms at more than 12 months after parathyroidectomy. METHODS: A prospective database collected clinical/operative data on consecutive patients with PHPT. PPSS was calculated as the sum of the 13 parameters self-assessed using a visual analog scale. SF-36(v2) was analyzed using commercially available software (QualityMetric Inc., Lincoln, USA). RESULTS: Over 3-year interval, 166 patients (119 F/47 M, age 15-89 years) were operated for with PHPT (Ca 2.90 ± 0.25 mmol/L, PTH 21.64 ± 23.05 pmol/L). Their preoperative PPSS ranged 0-1,260 (median 413) and did not correlate with the severity of hypercalcemia. One hundred and seven patients responded when contacted by post at 18 ± 6 months postoperatively. Their postoperative PPSS was significantly lower (398 ± 226 to 231 ± 203, p < 0.001) and in 55 of 107 patients the severity of symptoms reduced by at least 50%. Most significant improvements were for mood (36 ± 33 vs. 16 ± 23), weakness/tiredness (37 ± 32 vs. 17 ± 23), irritability (35 ± 31 vs. 17 ± 21), and thirst (37 ± 32 vs. 18 ± 25; p < 0.0001). Physical and mental component scores of SF-36 questionnaire improved in patients whose PPSS decreased postoperatively. CONCLUSION: Symptomatic benefits persist for at least 1 year after parathyroidectomy in the majority of patients with PHPT.


Assuntos
Hiperparatireoidismo Primário/diagnóstico , Hiperparatireoidismo Primário/cirurgia , Paratireoidectomia/métodos , Qualidade de Vida , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Bases de Dados Factuais , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Hormônio Paratireóideo/sangue , Satisfação do Paciente , Cuidados Pós-Operatórios/métodos , Estudos Prospectivos , Índice de Gravidade de Doença , Perfil de Impacto da Doença , Resultado do Tratamento , Adulto Jovem
10.
Clin Endocrinol (Oxf) ; 71(6): 787-91, 2009 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-19222492

RESUMO

OBJECTIVE: Parathyroidectomy for primary hyperparathyroidism (PHPT) is curative in over 95% of cases. Although PHPT affects up to 2% of the elderly population, whose life expectancy may be a decade or more, such patients may be denied surgery because of perceived risk. This study investigates the outcomes of surgery for PHPT in the elderly. DESIGN AND PATIENTS: Consecutive patients with PHPT treated at a tertiary referral centre over 5 years. MEASUREMENTS: A prospective database recorded clinical, biochemical and pathological information. Pasieka's parathyroid symptom scores were obtained pre-operatively and post-operatively, from a recent subgroup of 70 consecutive patients. Deaths during follow-up were identified using the NHS Strategic Tracing Service. Statistical analysis was performed with spss v12.0. RESULTS: Between November 2002 and October 2007, 224 patients (17-89 years) underwent surgery for PHPT. In the subgroup comprising patients aged >75 years there was a significantly greater proportion of women (47/56 vs. 52/81, P < 0.05). Pre-operative indices of these patients were similar to younger patients, as were proportions undergoing minimally invasive parathyroidectomy (n = 134) or bilateral neck exploration (n = 90). Patients >75 years had a longer hospital stay (1.6 vs. 0.8 days, P = 0.003). Pasieka's symptom scores improved significantly at 3-6 months postoperatively in all age groups. During a minimum median follow-up of 22 months, there were seven patients with persistent/recurrent disease. Median 2-year survival of those aged 60-74 and those over 75 ranged from 85-90%. CONCLUSION: Parathyroidectomy is safe in the elderly and is associated with a significant improvement in symptoms. As survival after operation is similar to younger patients, surgery should be considered in all elderly patients with PHPT.


Assuntos
Hiperparatireoidismo Primário/cirurgia , Paratireoidectomia/efeitos adversos , Paratireoidectomia/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Hiperparatireoidismo Primário/mortalidade , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Adulto Jovem
11.
Thyroid ; 19(1): 33-7, 2009 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-18976164

RESUMO

BACKGROUND: Fine-needle aspiration (FNA) biopsy is the cornerstone of assessment of thyroid nodules. Cytological criteria for benign (THY2) and malignant (THY5) aspirates are well established and reliable. When cytology suggests a follicular neoplasm (THY3), only formal histological assessment can differentiate between benign and malignant lesions. The objective of this study was to determine the factors predictive of malignancy in thyroid nodules when cytological assessment is restricted to euthyroid patients living in an area without endemic goiter who undergo routine diagnostic lobectomy once the FNA raises the suspicion of a follicular neoplasm. METHOD: Retrospective review of histological and clinical data in a cohort of patients with a palpable thyroid nodule and THY3 cytology. RESULTS: Between January 2000 and December 2007, 1981 patients (346 males and 1635 females) underwent 2809 thyroid FNAs. There were 201 THY3 reports (9%). Histology demonstrated thyroid carcinomas in 57 patients (31 follicular carcinomas, 11 Hurthle cell carcinomas, 11 papillary carcinomas, 1 medullary thyroid carcinoma, 1 poorly differentiated thyroid cancer, 1 lymphoma, and 1 metastatic renal carcinoma). Benign tumors were found in 144 patients with follicular adenomas (n = 76), Hurthle cell adenomas (n = 33), multinodular goiter (n = 13), adenomatoid nodules (n = 15), colloid nodules (n = 4), and thyroiditis (n = 3). THY3 cytology was more predictive of malignancy in men (13/34 male symbol vs. 44/167 female symbol, p < 0.001, chi(2) test). The risk for malignancy was 1:4 for the entire group and 1:3 for patients under 30 years and over 60 years. About 17/46 nodules over 40 mm in diameter were carcinomas, compared with only 35/140 in nodules under 40 mm (p < 0.01, chi2 test). CONCLUSION: One in four patients with cytological features of a follicular neoplasm has a thyroid carcinoma. A large nodule (>4 cm) with THY3 cytology has a high likelihood of being a cancer, and arguably such patients could be offered total thyroidectomy rather than diagnostic lobectomy.


Assuntos
Carcinoma Papilar, Variante Folicular/diagnóstico , Carcinoma Papilar, Variante Folicular/patologia , Neoplasias da Glândula Tireoide/diagnóstico , Neoplasias da Glândula Tireoide/patologia , Nódulo da Glândula Tireoide/diagnóstico , Nódulo da Glândula Tireoide/patologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia por Agulha Fina , Carcinoma Papilar, Variante Folicular/cirurgia , Estudos de Coortes , Diagnóstico Diferencial , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Retrospectivos , Fatores de Risco , Neoplasias da Glândula Tireoide/cirurgia , Tireoidectomia , Adulto Jovem
12.
World J Surg ; 32(5): 807-14, 2008 May.
Artigo em Inglês | MEDLINE | ID: mdl-18324348

RESUMO

BACKGROUND: Parathyroidectomy for primary hyperparathyroidism (PHPT) is expected to trigger an improvement in the quality of life. This has been demonstrated previously by using the SF-36 questionnaire, whose interpretation is difficult in routine clinical practice. As an alternative, the 13-item questionnaire developed by Pasieka et al. can be used to assess the severity of symptoms on a visual analogue from which a parathyroid assessment of symptoms score (PAS) can be calculated. The purpose of this study was to correlate results of these two assessment tools. METHODS: Prospective case-series study recruiting consecutive unselected patients who underwent successful parathyroidectomy for PHPT. SF-36(v2) and Pasieka's questionnaires were collected before parathyroidectomy and at 3, 6, and 12 months postoperatively. RESULTS: Between November 2005 and December 2006, 101 patients were diagnosed with PHPT (30 men; aged 18-89 years). Preoperative PAS ranged 0-1040 and did not correlate with the severity of hypercalcemia (2.91+/-0.25; range, 2.56-3.4 mmol/l). Scores from the SF-36 questionnaire were under the 50th percentile for the normal population in three domains (vitality, emotional role, and physical role). Minimally invasive parathyroidectomy was performed in 69 patients and bilateral cervical exploration in 32 patients. All were found to have a single parathyroid adenoma and were normocalcemic at 3-12 months after parathyroidectomy. At follow-up, there was a significant reduction of PAS from 460+/-257 preoperatively to 254+/-234 at 3 months postoperatively (n=72), to 245+/-215 at 6 months (n=50), and 249+/-212 at 12 months (n=63) (p<0.05, Student's t-test). There was a significant and persistent improvement in five domains of SF-36 questionnaire: bodily pain, general health, vitality, social functioning and mental health. Overall analysis of 244 assessments using both questionnaires demonstrated a negative correlation between increasing PAS and decreasing mental component scores and physical component scores of the SF-36 assessment (r2=0.372 and 0.301, respectively). CONCLUSIONS: Pasieka's parathyroid assessment of symptom scores (PAS) correlate with SF-36 questionnaire scores. Because PAS allows easier and faster analysis, we advocate that Pasieka's questionnaire should be integrated into the assessment of patients with PHPT as a reliable tool to identify symptomatic changes that correlate with improved quality of life.


Assuntos
Hiperparatireoidismo Primário/cirurgia , Paratireoidectomia , Índice de Gravidade de Doença , Inquéritos e Questionários , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Hiperparatireoidismo Primário/complicações , Hiperparatireoidismo Primário/psicologia , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Estudos Prospectivos , Qualidade de Vida , Reprodutibilidade dos Testes , Fatores de Tempo
13.
Clin Endocrinol (Oxf) ; 68(2): 155-64, 2008 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-17651448

RESUMO

Long-term follow-up is initially considered appropriate for the majority of patients with primary hyperparathyroidism (PHPT) having small increases in calcium levels (< 2.8 mmol/l) and lacking the 'classical' symptoms of PHPT. The supportive reasoning is that many such patients never progress to more severe biochemical or clinical disease. There are, however, arguments in favour of early surgical treatment of such patients but adequately powered studies have not been carried out in this subgroup of patients to asses the impact of PHPT on their quality of life, cardiovascular risk and bone density. Progressive loss in bone mineral density and an increased risk of bone fracture become increasingly significant in an ageing population. Left ventricular hypertrophy, an increased risk of arrhythmia and/or myocardial infarction in addition to changes in atherogenic lipid profile and impaired glucose tolerance may translate into an increased risk of premature death in this group of patients. Changes in the quality of life identified using standardized questionnaires are sometimes recognized by patients only in retrospect (i.e. after resolution of symptoms following successful parathyroidectomy). In addition, many series fail to assess and record accurately such symptoms. Multicentre cohort studies of patients with asymptomatic PHPT randomized to immediate or delayed surgical treatment could address some of the debated issues highlighted in this review. Until such studies are set up, most surgeons would consider that parathyroid surgery should represent the first choice of treatment for all patients, but many physicians would favour a long-term follow-up. Nevertheless, the threshold for referral for surgical treatment has been lowered since the introduction of scan-directed minimally invasive parathyroidectomy, which enables the experienced parathyroid surgeon to successfully treat patients with PHPT with a minimum of complications as a day-case operation. In the context of improved surgical treatment, we need more data on the benefits or otherwise in so-called asymptomatic patients with a thorough assessment of their bone quality, cardiovascular risk and quality of life.


Assuntos
Hiperparatireoidismo/complicações , Hiperparatireoidismo/cirurgia , Intolerância à Glucose/patologia , Humanos , Hiperparatireoidismo/fisiopatologia , Estudos Multicêntricos como Assunto , Osteoporose/patologia , Paratireoidectomia , Qualidade de Vida
14.
World J Surg ; 30(5): 697-704, 2006 May.
Artigo em Inglês | MEDLINE | ID: mdl-16680585

RESUMO

BACKGROUND: Preoperative localization studies with Tc99m-sestamibi have become an integral step in the preoperative assessment of patients with primary hyperparathyroidism (PHPT). This enables scan-directed minimally invasive parathyroidectomy (MIP) to be the preferred treatment for PHPT in many units. This study aimed to identify factors that lead to negative imaging studies in patients with PHPT. METHODS: Over a 3-year period consecutive unselected patients with PHPT underwent Tc99m-sestamibi scanning and high-resolution ultrasound (US) scanning by the same radiologist. When localization studies were concordant, patients underwent MIP. Those patients with negative imaging studies underwent bilateral neck exploration. Histology slides were independently reviewed and the proportion of chief cells and oxyphil cells within each adenoma was estimated. RESULTS: One hundred and fifty-eight patients underwent localization studies (38 men and 120 women, aged 61.8 +/- 15.2 years). Sestamibi scans were negative in 52 (32%) and positive in 106 (68%) patients. There was a higher incidence of hyperplasia in the group of patients with negative sestamibi scans (4 out of 52 vs. 4 out of 103, P < 0.05, chi2 test). In patients with negative sestamibi scans the majority of adenomas were formed predominantly from chief cells (26 out of 36) while the majority of patients with adenomas composed predominantly of oxyphil cells had positive scans (21 out of 23) (P < 0.05, chi2 test). The weight of parathyroid adenomas was higher when sestamibi scans were positive (median: 1,180 vs. 517 mg, P < 0.05, Student's t-test). CONCLUSION: Successful preoperative localization of parathyroid adenomas using Tc99m-sestamibi scanning is influenced by the cytological predominance of individual tumors. Negative scans might therefore be unavoidable in a subgroup of patients.


Assuntos
Adenoma/patologia , Hiperparatireoidismo Primário/diagnóstico , Hiperparatireoidismo Primário/cirurgia , Neoplasias das Paratireoides/patologia , Paratireoidectomia , Adenoma/complicações , Adenoma/cirurgia , Idoso , Reações Falso-Negativas , Feminino , Humanos , Hiperparatireoidismo Primário/etiologia , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos , Neoplasias das Paratireoides/complicações , Neoplasias das Paratireoides/cirurgia , Cuidados Pré-Operatórios , Cintilografia , Compostos Radiofarmacêuticos , Reprodutibilidade dos Testes , Tecnécio Tc 99m Sestamibi , Ultrassonografia
16.
World J Surg ; 27(2): 208-11, 2003 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-12616438

RESUMO

Although fine-needle aspiration (FNA) has been accepted as a first-line test in patients with thyroid masses, the utilization of FNA varies even among experienced surgeons. To determine its utility we compared FNA results, pathology, and clinical results in patients who underwent thyroidectomy in two major endocrine centers on both sides of the Atlantic: one in the United States (US) and another in the United Kingdom (UK). Between January 1997 and March 1998 a total of 84 patients underwent thyroid surgery at the UK center, and 143 underwent thyroidectomy at the US center. The most common indication for thyroidectomy at the UK center was compressive goiter (CG), whereas follicular neoplasm (FN) was the most common indication at the US center. Bilateral thyroid resections, frozen section utilization, and thyroid cancer surgery were more common at the US center. Thyroidectomy for symptomatic multinodular goiter and Graves' disease was more prevalent at the UK center. Thyroid gland weights were also significantly greater in the UK, indicating a higher incidence of endemic goiter. FNA was more commonly employed in the US center (84% vs. 52%; p < 0.001). Despite the differing utilization of FNA at these major endocrine centers, only one thyroid cancer at each institution was not detected preoperatively (both patients had a benign FNA result). Therefore there were no clinically significant thyroid cancers found in patients who did not undergo preoperative FNA. In conclusion, FNA appears to be differentially utilized depending on the incidence of endemic goiter, Graves' disease, and thyroid cancer. In this series no clinically significant thyroid cancers were found in patients who did not undergo preoperative FNA. Therefore in the hands of experienced thyroid surgeons, FNA can be utilized selectively based on the clinical presentation.


Assuntos
Biópsia por Agulha/estatística & dados numéricos , Doenças da Glândula Tireoide/patologia , Doenças da Glândula Tireoide/cirurgia , Neoplasias da Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/cirurgia , Tireoidectomia , Feminino , Secções Congeladas , Doença de Graves/patologia , Doença de Graves/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Glândula Tireoide/patologia
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