Minerva chirurgica
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Papillary thyroid cancer (PTC) is the most common endocrine malignancy and commonly metastasizes to regional lymph nodes. Surgical treatment of cervical lymph nodes in PTC remains controversial. It has traditionally been accepted that regional lymph node metastases in PTC may increase local recurrence rates but do not ultimately affect survival. ⋯ Thus, there has been renewed interest in operative control of nodal disease for PTC. A systematic review of central lymph node dissection (CLND) in the recent literature using evidence-based criteria permitted formation of the following five recommendations: 1) limited data suggest benefit with the addition of prophylactic CLND to thyroidectomy (grade C); 2) systematic compartment-oriented CLND may decrease recurrence of PTC and improve disease-specific survival (no grade); 3) the addition of CLND to total thyroidectomy can significantly reduce levels of serum thyroglobulin and increase rates of athyroglobulinemia (no grade); 4) there may be a higher rate of permanent hypoparathyroidism and unintentional permanent nerve injury when CLND is performed with total thyroidectomy than for total thyroidectomy alone (grade C); 5) reoperation in the central neck compartment for recurrent PTC may increase the risk of hypoparathyroidism and unintentional nerve injury when compared to total thyroidectomy with or without CLND, supporting a more aggressive initial operation by experienced endocrine surgeons (grade C). Taken together, these recommendations support the application of routine CLND at the initial operation for papillary thyroid cancer in expert hands.
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Papillary thyroid cancer (PTC) is the most common endocrine malignancy and commonly metastasizes to regional lymph nodes. Surgical treatment of cervical lymph nodes in PTC remains controversial. It has traditionally been accepted that regional lymph node metastases in PTC may increase local recurrence rates but do not ultimately affect survival. ⋯ Thus, there has been renewed interest in operative control of nodal disease for PTC. A systematic review of central lymph node dissection (CLND) in the recent literature using evidence-based criteria permitted formation of the following five recommendations: 1) limited data suggest benefit with the addition of prophylactic CLND to thyroidectomy (grade C); 2) systematic compartment-oriented CLND may decrease recurrence of PTC and improve disease-specific survival (no grade); 3) the addition of CLND to total thyroidectomy can significantly reduce levels of serum thyroglobulin and increase rates of athyroglobulinemia (no grade); 4) there may be a higher rate of permanent hypoparathyroidism and unintentional permanent nerve injury when CLND is performed with total thyroidectomy than for total thyroidectomy alone (grade C); 5) reoperation in the central neck compartment for recurrent PTC may increase the risk of hypoparathyroidism and unintentional nerve injury when compared to total thyroidectomy with or without CLND, supporting a more aggressive initial operation by experienced endocrine surgeons (grade C). Taken together, these recommendations support the application of routine CLND at the initial operation for papillary thyroid cancer in expert hands.
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Crush injuries and crush syndrome are common after natural (e.g. earthquake, land-slide, tornadoes, tsunami) or man-made catastrophes (e.g. wars, terrorist attacks), in fact the history of this disease is well reported both in earthquake rescue reviews and in military literature. However, there are instances due to conventional causes, such as building collapses, road traffic accident, accident at work or altered level of consciousness after stroke or drug overdose. These situations of ''big or small'' catastrophes can occur at any time and anywhere, for this reason every clinician should be prepared to address issues of crush syndrome quickly and aggressively. ⋯ This article reviews the various evidences and summarizes the treatment strategies available. Fundamental targets in crush syndrome management are early aggressive hydration, urine alkalinization and, when possible, forced diuresis. Since electrolyte imbalance may be fatal due to arrhythmias secondary to hyperkalemia (especially associated with hypocalcemia), it's necessary to correct these abnormalities using insulin-glucose solution and/or potassium binders, and if nevertheless serum potassium levels remain high this serious disease will necessitate dialysis, which is often a vital procedure.
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The term locally advanced breast cancer (LABC) encompasses a heterogeneous group of breast neoplasms; in the last revision of the American Joint Committee on Cancer (AJCC) staging system, all of stage III disease is considered locally advanced. LABC constitutes up to 20% of breast cancer in medically underserved populations in the United States and up to 75% of breast cancers in developing countries. ⋯ However, a multidisciplinary approach is always recommended combining surgery, radiotherapy and systemic therapy (chemotherapy and/or hormone therapy). In this paper, we discuss the possible options in the management of operable (stage IIIA) and inoperable (stage IIIB-IIIC) LABC.
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The epidemic of obesity in the United States has triggered an exponential increase in the number of bariatric procedures performed. This has led to an elevated awareness of the complications of bariatric surgery. Several recent studies have suggested that the mortality rate from bariatric surgery is substantially higher than previously stated, particularly in the elderly and disabled population. ⋯ Additionally, complications specific to the adjustable gastric band are addressed. The etiology, diagnosis and management of these complications is discussed. The long-term viability of bariatric surgery as a treatment for severe obesity will depend upon the prevention and appropriate treatment of bariatric complications.