Image in endocrinology: Intratracheal ectopic thyroid mass.
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Adult↗
Biomedical subjects
Bassam Abboud
Publications and source records attributed to Bassam Abboud.
Prevalence and risk factors for primary hyperparathyroidism in hyperthyroid patients.
BACKGROUND: Coexistence of hyperthyroidism and primary hyperparathyroidism may be more prevalent than previously recognized. We report 13 cases of concomitant occurrence of both diseases to estimate their combined prevalence and its factors. METHODS: Ninety-six unselected patients admitted for elective hyperthyroidism surgery were retrospectively included. Eighty-three patients were initially seen for hyperthyroidism with normocalcemia (group 1), and 13 patients were initially seen for hyperthyroidism with associated primary hyperparathyroidism (group 2). Patients' characteristics, examinations, and pathology reports were reviewed. Risk factors were identified using a logistic regression model. RESULTS: The prevalence of concomitant hyperparathyroidism was 13.5%. No patients manifested hypercalcemia in the absence of organic parathyroid disease. Eleven patients had a parathyroid adenoma, and two patients had parathyroid hyperplasia. Group 2 patients were older (median 61 vs 43 years, p = .006). Thyroid-stimulating hormone levels were more depressed in group 2 (median 0.01 vs 0.032 UI/L, p = .034). On multivariate analysis, age was the unique factor significantly different between groups (odds ratio, 1.05; 95% confidence interval, 1.008-1.098; p = .020). CONCLUSIONS: Hypercalcemia in patients with hyperthyroidism, particularly older patients, should warrant a thorough investigation for concomitant primary hyperparathyroidism that would dictate a combined thyroidectomy and parathyroidectomy.
Adolescent↗
Existence and anatomic distribution of double parathyroid adenoma.
BACKGROUND: Double parathyroid adenomas occur in 2% to 15% of primary hyperparathyroidism cases, but the very existence of double adenomas has been controversial. This study was conducted to evaluate the clinical significance and anatomic distribution of parathyroid double adenomas. STUDY DESIGN: Mono-institutional retrospective study of the medical records of 183 unselected consecutive patients who underwent intervention for primary hyperparathyroidism between 1996 and 2003. RESULTS: A total of 14 (7.65%) patients were found to have double parathyroid adenomas. Intraoperative parathyroid hormone (PTH) levels were measured in every case. Two enlarged parathyroid glands were identified in four possible configurations: two both superior, one both inferior, two both right, three both left, two right superior and left inferior, and three left superior and right inferior. There was a preferential crossed bilateral distribution of double adenomas. In all patients, intraoperative PTH levels dropped by at least 50% from baseline after removal of both abnormal parathyroid glands. In this series, no patient developed persistent hypoparathyroidism or had recurrent laryngeal nerve injuries or neck hematoma. All patients remained normocalcemic 9 to 96 months postoperatively. One patient had persistently elevated PTH values with normal serum calcium levels. CONCLUSION: The drop in intraoperative PTH levels and maintenance of normocalcemia postoperatively confirm previous reports that double adenomas do exist and are not simply missed cases of four-gland hyperplasia. There was a preferential crossed bilateral distribution of double adenomas in this series.
Adenoma↗
Non-recurrent inferior laryngeal nerve in thyroid surgery: report of three cases and review of the literature.
The non-recurrent inferior laryngeal nerve (NRILN) is a nerve anomaly that can be associated with an increased risk of vocal fold paralysis. The purpose of this study was to report three new cases of this anomaly, underline the necessity of recognizing its possibility for the prevention of intra-operative nerve damage and a review of the literature. Three cases of thyroid surgery associated with right NRILN are reported. Two patients underwent bilateral thyroidectomy for a multinodular goitre and for a toxic multinodular goitre respectively. The third patient had a right lobectomy and isthmectomy for a thyroid nodule. All patients had identification of the recurrent laryngeal nerve on the left side and NRILN on the right side. The diagnosis of the NRILN was made per-operatively on all cases. A post-operative computed tomography (CT) scan in two patients, showed a retrooesophageal aberrant right subclavian artery. Post-operatively, all patients had normal vocal fold function on laryngoscopy. The NRILN is a rare anomaly but overlooking its possibility may lead to severe operative morbidity. This is an additional argument in favour of systematic dissection of the recurrent inferior laryngeal nerve during thyroid surgery.
Adult↗
Use of fine-needle aspiration cytology and frozen section in the management of nodular goiters.
BACKGROUND: This study evaluates the role of frozen section (FS) in surgical decisions for nodular thyroid disease when a preoperative fine-needle aspiration cytology (FNAC) is available. MATERIAL AND METHOD: The charts of 113 patients who underwent thyroidectomy for nodular goiter were reviewed. Each patient underwent FNAC, FS, or both. Results were compared with the final pathologic examination to evaluate their effectiveness in predicting malignancy. RESULTS: The sensitivity and specificity of FNAC alone (49 patients) were 73% and 93.5%, respectively, and of FS (111 patients) 68% and 99%, respectively. The result of fine-needle aspiration cytology was: benign (n = 8), malignant (n = 13), indeterminate (n = 25), and nondiagnostic (n = 3). All cases diagnosed as benign on FNAC were benign on final pathology, but of the six FS performed in these cases, four were benign and two were suspect. Of the 13 FNAC that were interpreted as malignant, 11 and 10 proved to be malignant on final pathology and FS, respectively. The 25 indeterminate cases on FNAC were on final pathology benign (n = 21) and malignant (n = 4) and on frozen section were benign (n = 12), malignant (n = 2), and suspect (n = 11). CONCLUSION: When results of FNAC are interpreted as benign or malignant, FS is of little value, because it does not change the extension of thyroidectomy. FS proved useful in determining the extent of thyroidectomy only when results of the FNAC were suspect or atypical.
Adult↗
Interventions in heart and thyroid surgery: can they be safely combined?
OBJECTIVE: Thyroid diseases are relatively common problems in patients with cardiac disease. The aim of this study was to evaluate the feasibility of combined interventions in heart and thyroid surgery. METHODS: A retrospective study of 2530 cardiac operations yielded six patients who underwent thyroid intervention combined with cardiac surgery (coronary artery bypass grafting, valvular surgery or both) between 1996 and 2003. All patients were examined for age, gender, cardiac problems, thyroid pathology and related symptoms. RESULTS: four males and two females were operated for coronary artery disease, valvular disease or both and for thyroid pathologies. All patients had anticoagulation with intravenous heparin peroperatively and then postoperatively. No patient suffered from bleeding at the neck neither per- or postoperatively. No hemodynamic or cardiovascular compromises were noted. CONCLUSION: The combined staged thyroid and cardiac surgery was feasible with a little risk for the both operations.
Adult↗
Risk factors for postthyroidectomy hypocalcemia.
BACKGROUND: Hypocalcemia is a common complication of thyroidectomy. The aim of this study was to evaluate the incidence of hypocalcemia after thyroid operation and its relation to clinical, biologic, and surgical factors. STUDY DESIGN: A retrospective study of 265 patients who underwent unilateral (n = 50) or bilateral (n = 215) thyroidectomy between 1996 and 2000 was done to determine incidence and risk factors for hypocalcemia. Free thyroxine and thyrotropin levels were obtained before operation in 254 patients, together with preoperative and postoperative calcium and phosphorus levels. All patients were examined for age, gender, extent of thyroidectomy, initial versus reoperative neck operation, pathologic characteristics of resected thyroid tissue, substernal thyroid extension, and parathyroid resection and autotransplantation. RESULTS: Hypocalcemia, defined as a calcium level less than 2 mmol/L, occurred in 42 of 265 patients (16%), including 11 (4%) symptomatic patients who required vitamin D, calcium, or both for 2 to 6 weeks. Factors significantly predictive of postoperative hypocalcemia in univariate analysis included elevated free thyroxine level (p = 0.0064), bilateral thyroidectomy (p = 0.00064), parathyroid autotransplantation (p = 0.0128), and female gender (p = 0.0028). Independent risk factors on multivariate analysis were elevated free thyroxine level (p = 0.0476), bilateral thyroidectomy (p = 0.0338), and parathyroid autotransplantation (p = 0.0003). CONCLUSIONS: Bilateral thyroidectomy, elevated free thyroxine level, and parathyroid autotransplantation are independent risk factors for postthyroidectomy hypocalcemia. Oral calcium supplements may be of value in this group of patients to enhance early hospital discharge.
Adolescent↗
Perforation of the rectum and colon during barium enema examination. Report of four cases.
BACKGROUND: The barium enema examination (BEE) is an important diagnostic study and considered to be safe without adverse effects. Perforation of the bowel is rare but is the most frequent complication of BEE and can be life-threatening. STUDY DESIGN: We report four cases of barium extravasation due to BEE treated at our institution, three rectal perforations and one perforation in the descending colon. RESULTS: The four patients underwent surgery because signs of peritonitis developed. Two of them recovered and two died from multiple organ failure. CONCLUSION: Perforation of the colon and rectum during BEE constitutes a surgical emergency in most cases. Prompt recognition and management are vital in decreasing morbidity and mortality.
Aged↗
Tertiary hyperparathyroidism in patients on hemodialysis for chronic renal failure: subtotal parathyroidectomy or conservative treatment?
BACKGROUND: To report our experience in novel surgical strategy in the treatment of tertiary hyperparathyroidism in hemodialysis patients for chronic renal failure and to assess the impact of this type of surgery on postoperative clinical and laboratory variables in this population. METHODS: Fifteen hemodialysis (12 female and 3 male) patients with chronic renal failure were operated on for tertiary hyperparathyroidism. Cervical ultrasound was performed in all patients (n = 15). RESULTS: Preoperative cervical ultrasound showed one enlarged parathyroid gland (n = 4) or few enlarged parathyroid glands (n = 11). Group I consisted of four patients with single parathyroid gland enlargement on ultrasound. These patients underwent resection of only the enlarged gland; three by unilateral approach under local anesthesia and one by cervicotomy under general anesthesia. Group II consisted of 11 patients with enlargement of all parathyroid glands on ultrasound. These patients were assumed to have hyperplasia and underwent subtotal parathyroidectomy (3.5 glands) and thymectomy by cervicotomy under general anesthesia. Postoperatively, patients in group I were normocalcemic (n = 4) and patients in group II were normocalcemic (n = 4) or had transient hypocalcemia (n = 7). The pathology showed an adenoma in patients of group I (n = 4) and hyperplasia in patients of group II (n = 11). Postoperatively, both patients in Group I and II had a similar resolution of their symptoms. CONCLUSION: Tertiary hyperparathyroidism secondary to chronic renal failure may be treated by parathyroidectomy of one or few enlarged parathyroid gland(s). Parathyroidectomy by unilateral approach under local anesthesia may be of value when preoperative localization studies show a single parathyroid gland enlargement.
Adult↗
[Metaplastic carcinoma of the breast: case report of a sarcomatoid type and literature review].
OBJECTIVE: Metaplastic changes are a rare entity that occurs in fewer than 5% of breast carcinomas. Their sarcomatoid variant is the rarest primary malignancy of the breast. We report a case of sarcomatoid breast cancer and insist on the diagnosis and treatment of this rare tumor. CASE REPORT: A 71-year-old female patient presented for a right breast mass above the nipple, between the upper inner and upper outer quadrants, of 20 mm of diameter, highly dense on mammography with cystic and solid components on ultrasound. Core biopsy showed a probable sarcoma whereas the partial mastectomy revealed the sarcomatoid metaplastic breast carcinoma. The workout for distant metastasis was negative and the treatment was completed by a modified radical mastectomy and adjuvant CMF chemotherapy. Six months after treatment there was no evidence of locoregional recurrence nor distant metastases. CONCLUSION: Although metaplastic carcinoma is a rare breast malignancy, with no specific clinical or radiologic features, it should be considered as an independent entity and included in the differential diagnosis of breast tumors.
Aged↗
[Papillary thyroid microcarcinoma revealed by cervical adenopathy].
AIM OF THE STUDY: To report retrospectively 5 cases of papillary microcarcinoma of the thyroid revealed by cervical adenopathy with the clinic and histologic characteristics. MATERIAL AND METHOD: Total thyroidectomy and bilateral cervical lymphadenectomy was realized in 5 patients. RESULTS: From 1996 to 2002, 4 females and one man of 33 years old mean age presented for cervical adenopathy. Biopsy confirmed thyroid metastatic nature. The final pathology showed: a papillary microcarcinoma, bilateral and multifocal in 4 patients (80%), bilateral adenopathy in 3 patients (60%). All patients had a radioactive iodine and hormonotherapy postoperatively. The follow-up varied from 12 to 30 months. No metastasis or local recurrence were noted. CONCLUSION: Total thyroidectomy and bilateral cervical lymphadenectomy is the treatment of choice for papillary microcarcinoma of the thyroid presenting as a cervical metastatic adenopathy because it was bilateral and multifocal in 80% of cases with bilateral positive adenopathy in 60% of cases. Radioactive iodine and hormonotherapy postoperatively are recommended.
Adult↗
[Utility of endoscopic ultrasonography on localization of insulinomas. Case report and review of the literature].
Insulinoma is the most common endocrine tumors of the pancreas. The diagnosis is suspected by clinical symptoms and confirmed by biologic tests. Because the majority of insulinomas have a small size, the real problem is the localization of these tumors. The non invasive radiologic exams (US, CT Scan, angiography or RMI) are not sensitive for the topographic localization of insulinomas. The invasive exams like per operative US and palpation of the parenchyma or dosage of insulin by transhepatic catheterization of portal vein or in hepatic vein after intrarterial stimulation are very sensitive. The only noninvasive preoperative exam with high sensitivity to localize insulinomas is endoscopic ultrasonography (EUS). We report a case of insulinoma localized by EUS with review of the literature.
Endoscopy, Digestive System↗
Intrathoracic transverse colon and small bowel infarction in a patient with traumatic diaphragmatic hernia. Case report and review of the literature.
OBJECTIVE: Herniation of abdominal contents through the diaphragm has been described for a variety of diaphragmatic defects and may be secondary to diaphragmatic injury, either traumatic or iatrogenic. The sequelae of diaphragmatic hernia include intestinal obstruction, strangulation, gangrene and, eventually, perforation. The aim of this study was to report a case of intrathoracic infarction of transverse colon and two meters of small bowel in a patient with traumatic diaphragmatic hernia. PATIENT: Young man with past history of blunt abdominal trauma presented abdominal pain with dyspnea. An exploratory laparotomy was performed. The esophageal hiatus was normal but a 4.5 cm rent was discovered in the posterior leaf of the left hemidiaphragm. Passing through the defect was the transverse colon and a proximal small bowel. The herniated transverse colon and jejunum were massively dilated with evidence of infarction. Transverse colectomy and resection of two meters of jejunum with direct anastomosis were performed. Following bowel removal, diaphragm was directly repaired without graft. Finally, a chest tube was placed in the left hemithorax. RESULTS: Postoperative course was uneventful and he recovered without complications. He was discharged from hospital 10 days after surgery. CONCLUSION: Surgeons, internists and emergency medicine personnel should be aware of the possibility of diaphragmatic hernia in patients with a known history of abdominal trauma. Though uncommon, strangulation of colon and small bowel through a rent in diaphragm should be considered when there is radiologic evidence of herniation.
Adult↗