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Occult Disease (occult + disease)
Selected AbstractsI-123-guided excision of metastatic papillary thyroid cancerJOURNAL OF SURGICAL ONCOLOGY, Issue 2 2007Saurabh Khandelwal MD Abstract The use of a gamma probe for intraoperative localization of a cervical lymph node, which contained recurrent metastatic papillary thyroid cancer, facilitated a radio-guided minimally invasive outpatient surgical procedure and resulted in complete excision of clinically occult disease. The technique raises the issue of whether nonpalpable regional node recurrences should be locally excised, removed in a formal modified neck dissection, or treated with therapeutic doses of I-131. J. Surg. Oncol. 2007;96:173,175. © 2007 Wiley-Liss, Inc. [source] Safety of Completion Thyroidectomy Following Unilateral Lobectomy for Well-Differentiated Thyroid Cancer,THE LARYNGOSCOPE, Issue 7 2002Michael E. Kupferman MD Abstract Objectives When a diagnosis of thyroid cancer is returned following unilateral lobectomy, removal of the contralateral lobe is frequently necessary. Morbidity for completion thyroidectomy includes a reported 2% to 5% risk of recurrent laryngeal nerve (RLN) injury and an 8% to 15% incidence of hypoparathyroidism. In this study, to determine morbidity following completion thyroidectomy, we reviewed our results of reoperative surgery among patients with thyroid cancer. Study Design Retrospective chart review. Methods Between 1997 and 2000, 36 consecutive patients, 32 females and 4 males, with a mean age of 43.6 years (range, 19,59 y), underwent completion thyroidectomy. Preoperative fine-needle aspiration revealed follicular derived neoplasm in 32 patients (88.9%), indeterminate in 3 patients (8.3%), and Hürthle cell neoplasm in 1 patient (2.8%). The interval between the first and second operation was a mean of 43.3 days (range, 2,103 d). Results At the primary surgery, 29 patients (80.6%) had a follicular variant of papillary carcinoma, 6 (16.7%) had follicular carcinoma, and 1 (2.8%) had Hürthle cell carcinoma. Of these, 14 had multifocal disease. In the completion lobe, 20 patients (55.6%) had evidence of thyroid carcinoma. There was a 0% incidence of RLN injury, and the mean pre- and post-completion thyroidectomy serum calcium was 8.9 mg/dL and 8.6 mg/dL, respectively. There was one postoperative hematoma, requiring re-exploration. Five patients (13.9%) had a transient postoperative serum calcium (Ca) <8.0 mg/dL, with one being symptomatic. None required vitamin D or prolonged calcium supplementation. Conclusions When completion thyroidectomy is necessary for the treatment of thyroid malignancy, the procedure can be performed safely with low morbidity and is effective for diagnosing and removing occult disease in the remaining thyroid. [source] A prospective evaluation of occult disorders in obstructed defecation using the ,iceberg diagram'COLORECTAL DISEASE, Issue 9 2006M. Pescatori Abstract Objective, Surgical treatment of constipation and obstructed defecation (OD) carries frequent recurrences, as OD is an ,iceberg syndrome' characterized by ,underwater rocks' or occult diseases which may affect the outcome of surgery. The aim of this study was to evaluate occult disorders in order to alert the clinician of these and minimize failures. Method, One hundred consecutive constipated patients with OD symptoms, 81 female patients, median age 52 years, underwent perineal examination, proctoscopy, anorectal manometry, and anal/vaginal ultrasound. Anorectal physiology and imaging tests were also carried out when indicated, as well as psychological and urogynaecological consultation. Symptoms were graded using a modified 1,20 constipation score. Both evident (e.g. rectocele) and occult (e.g. anismus) diseases were prospectively evaluated using a novel ,iceberg diagram'. The type of treatment, whether conservative or surgical, was also recorded. Results, Fifty-four (54%) patients had both mucosal prolapse and rectocele. All patients had at least two occult OD-related diseases, 66 patients had at least three: anxiety-depression, anismus and rectal hyposensation were the most frequent (66%, 44% and 33% respectively). The median constipation score was 11 (range 2,20), the median number of ,occult disorders' was 5 (range 2,8). Conservative treatment was carried out in most patients. Surgery was carried out in 14 (14%) patients. Conclusion, The novel ,iceberg diagram' allowed the adequate evaluation of OD-related occult diseases and better selection of patients for treatment. Most were managed conservatively, and only a minority were treated by surgery. [source] | ||||||||||