Browsing by Author "Perunovic, Radoslav (7801615315)"

Purpose: In contrast to other thyroid carcinomas it is diffi cult to establish a correct preoperative diagnosis for oxyphile carcinoma of the thyroid. In this study we looked for predic tive malignancy factors in order to enable surgeons to choose operative treatment and to perform an adequate operation for each patient with an oxyphile neoplasm of the thyroid. Methods: In this retrospective study we have analyzed the medical files of all patients with oxyphile tumors of the thy roid operated between 1999 and 2008 in our institution. A total of 256 patients were included and divided into oxy phile adenomas (142) and carcinomas (114) on the basis of their definite histopathological diagnosis. The most import ant demographic and clinical characteristics were analyzed by univariate and multivariate logistic regression analysis. Results: Univariate analysis showed that male gender, thyroglobulin concentrations ≥300 ng/ml and tumor diam eter >30 mm were significantly more frequent in patients with oxyphile carcinoma compared to patients with oxy phile adenoma, while coexisting Hashimoto thyreoiditis and positive AntiTPO antibodies appeared significantly less frequent in the carcinoma group. All variables with a p value <0.1 in the univariate test were subjected to multi variate regression analysis in which elevated preoperative thyroglobulin concentrations (≥ 300 ng/ml) was shown as the only independent predictive factor for oxyphile thyroid carcinomas (OR=5.88, 95%Ci 2.78-12.05, p=0.001). Conclusions: Preoperative thyroglobulin concentration is an independent predictor of malignancy for oxyphile thy roid carcinomas.

Purpose: In contrast to other thyroid carcinomas it is diffi cult to establish a correct preoperative diagnosis for oxyphile carcinoma of the thyroid. In this study we looked for predic tive malignancy factors in order to enable surgeons to choose operative treatment and to perform an adequate operation for each patient with an oxyphile neoplasm of the thyroid. Methods: In this retrospective study we have analyzed the medical files of all patients with oxyphile tumors of the thy roid operated between 1999 and 2008 in our institution. A total of 256 patients were included and divided into oxy phile adenomas (142) and carcinomas (114) on the basis of their definite histopathological diagnosis. The most import ant demographic and clinical characteristics were analyzed by univariate and multivariate logistic regression analysis. Results: Univariate analysis showed that male gender, thyroglobulin concentrations ≥300 ng/ml and tumor diam eter >30 mm were significantly more frequent in patients with oxyphile carcinoma compared to patients with oxy phile adenoma, while coexisting Hashimoto thyreoiditis and positive AntiTPO antibodies appeared significantly less frequent in the carcinoma group. All variables with a p value <0.1 in the univariate test were subjected to multi variate regression analysis in which elevated preoperative thyroglobulin concentrations (≥ 300 ng/ml) was shown as the only independent predictive factor for oxyphile thyroid carcinomas (OR=5.88, 95%Ci 2.78-12.05, p=0.001). Conclusions: Preoperative thyroglobulin concentration is an independent predictor of malignancy for oxyphile thy roid carcinomas.

BACKGROUND: Stenting of malignant hilar strictures remains a standard endoscopic treatment in patients with unresectable tumors. The aim of this two-center prospective study was to compare unilateral versus bilateral drainage in hilar malignant stenosis Bismuth-Corlette type II. METHODS: During a 3-year period, a total of 49 patients with hilar tumors (Bismuth-Corlette type II) were referred for endoscopic treatment, following the criteria of unresectability. Ultrasound, computed tomography scan and magnetic resonance cholangiopancreatography (MRCP) were previously performed in all patients in order to facilitate endoscopic retrograde cholangiopancreatography (ERCP). The stricture was first passed by the hydrophilic guide-wire and then contrast medium was injected. Mechanical bile duct dilation was performed, followed by plastic stent placement only in the liver lobe which was previously opacified. The procedures were performed under conscious sedation. The patients were followed up for the next 12 months with a stent exchange every 3 months. Primary outcome was assessed by patient survival in the first 12 months after the procedure. RESULTS: All 49 patients were treated with ERCP while 39 (79.59%) had successful stent placement. Among these, 32 had hilar cholangiocarcinoma (82%) and 7 (18%) had gallbladder cancer. Two groups of patients had Bismuth II strictures: A, 21 patients (54%) with unilateral contrast injection and drainage, and B, 18 (46%) with bilateral contrast injection and drainage. A total of 57 plastic stents were used (10 Fr, 89%; 11.5 Fr, 11%). Group B showed a lower bilirubin level 7 days after the procedure (P=0.008). Early complications were cholangitis (3 patients, 2 in group A and 1 in group B) and acute pancreatitis (2 patients, 1 each in A and B) with no statistical difference between the groups. Late complications were stent migration (5 patients, 1 in A and 4 in B) and stent clogging (6 patients, 2 in A and 4 in B) showing a significant difference between the groups (P<0.01). The first stent replacement after 3 months was successful in 87% of patients (four died due to disease progression and one due to cardiopulmonary insufficiency) showing no statistical difference between the groups. At 6 months follow-up, 72% patients survived, with no statistical difference between the groups. A final follow-up (12 months) showed the survival rate of 18% (4 patients from group A and 3 from group B) (P>0.05). CONCLUSIONS: A minimally invasive approach, based on the criterion that every bile duct being opacified needs to be drained, is associated with a lower incidence of early complications. Considering that the clinical outcome measured by bilirubin level was lower in patients with bilateral drainage 7 days after the procedure, we assumed that drainage of 50% or more of the liver volume leads to sufficient drainage effectiveness. © 2012, Hepatobiliary Pancreat Dis Int.