[Hereditary thyroid cancer can be cured by prophylactic surgery]. / Arftlig tyreoideacancer kan botas med profylaktisk kirurgi.

Multiple endocrine neoplasia type 2 (MEN 2) is a rare syndrome in which the consequences for the patient and family members are considerable. Mutation analysis of the RET proto-oncogene is crucial for decision-making regarding each patient. Today, carriers of MEN 2 mutations should be offered prophylactic thyroidectomy with the potential to eliminate the risk for potentially lethal medullary thyroid carcinoma (MTC). Here, we present the first Swedish experience of such operations performed mainly on the basis of genetic analysis. Twenty patients underwent total thyroidectomy at a mean age of 13.5 (6-43) years. In all cases, either manifest MTC (n = 11) or C-cell hyperplasia was found. So far, no patient has any sign of recurrence or developmental insufficiency at 1-5 years follow-up. As the medical and ethical problems in this group of patients are substantial, and as the operations are performed in otherwise healthy children, they should be treated at centers with adequate multidisciplinary expertise and competence.

Fixation of femoral neck fractures. A four-flanged nail versus threaded pins in 200 cases.

Two methods of internal fixation for cervical hip fractures were compared in a "randomized to surgeons" type of study. One hundred patients were treated with the Rydell four-flanged nail and 100 with the Gouffon pins. Redisplacement, nonunion, or segmental collapse occurred in 27 patients operated on with the Rydell nail and in 29 patients operated on with the Gouffon pins. According to the actuarial method of follow-up, the failure rates after 2 years were 31 and 33 percent in the two groups.

To drain or not to drain in thyroid surgery. A controlled clinical study.

Drainage after thyroid surgery is widely used to prevent postoperative complications by evacuation of blood and fluids. However, to our knowledge no study has shown the benefit of drainage. Therefore, we performed a prospective, randomized study on the rate of complications after drainage or no drainage in thyroid surgery. One hundred fifty patients were allocated to drainage or no drainage. No difference was seen between the two groups according to the experience of the surgeon, type of operation, diagnosis, weight of thyroid specimens, operation time, and hospital stay. All complications were recorded and resulted in two patients receiving reoperation because of bleeding, two permanent laryngeal nerve palsies, one case of permanent hypocalcemia, ten minor hematomas, one wound infection, and one lymphatic leakage. No difference was seen between the groups. This study does not support prophylactic routine drainage after uncomplicated thyroid surgery.

The effect of washing with chlorhexidine soap on wound infection rate in general surgery. A controlled clinical study.

Postoperative wound infections in clean surgery were studied to compare the effect of preoperative whole body disinfection with chlorhexidine soap with that of local washing and no washing at all, respectively. The study includes 1530 operations for biliary tract disease, inguinal hernia and breast cancer. The overall infection rate was 3.4%. Among patient who had a preoperative shower with Chlorhexidine the wound infection rate was significantly reduced.