World journal of surgery
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World journal of surgery · Jun 2010
Randomized Controlled TrialFive-year follow-up of a randomized clinical trial of unilateral thyroid lobectomy with or without postoperative levothyroxine treatment.
The aim of this study was to compare the prevalence of recurrent nodular goiter in the contralateral thyroid lobe among patients after unilateral thyroid lobectomy for unilateral multinodular goiter (MNG) receiving versus not receiving postoperative prophylactic levothyroxine (LT4) treatment. ⋯ Prophylactic LT4 treatment significantly decreased the recurrence rate of nodular goiter in the contralateral thyroid lobe and the need for completion thyroidectomy, mostly among patients with iodine deficiency.
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World journal of surgery · Jun 2010
Impairment of cognitive function reported by patients suffering from carcinoid syndrome.
Carcinoid syndrome (CS) is characterized by symptoms of diarrhea, flushing, bronchospasm, and valvular heart disease. It has been our impression that patients with CS also exhibit features of cognitive impairment. The purpose of this pilot study was to evaluate if symptoms of cognitive impairment were reported by patients with CS. ⋯ Patients with CS report high levels of symptoms of impairment in all cognitive domains; however, on formal neurocognitive testing, patients scored lower than expected only in tests of verbal memory delayed recall and visual-perceptual function. These findings appear to confirm our clinical impression that cognitive impairment may be an additional feature of CS. Further studies are needed to confirm and elucidate the cause of this cognitive impairment.
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World journal of surgery · Jun 2010
Comparative StudySingle-access retroperitoneoscopic adrenalectomy (SARA) versus conventional retroperitoneoscopic adrenalectomy (CORA): a case-control study.
Stimulated by the concept of Natural Orifice Transluminal Endoscopic Surgery (NOTES), minimizing the access even further has become a new trend in minimally invasive surgery. We compare our recently described new method of endoscopic single-access adrenalectomy with the conventional retroperitoneoscopic approach in a matched-pairs study. ⋯ Because feasibility and safety of SARA could be demonstrated in a large group of selected patients, this surgical technique may represent a new milestone in minimally invasive endocrine surgery.
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World journal of surgery · Jun 2010
Impact of prophylactic central neck lymph node dissection on early recurrence in papillary thyroid carcinoma.
Although the role of prophylactic central neck lymph node dissection (CNLD) in the treatment of papillary thyroid carcinoma (PTC) is controversial, many surgeons perform routine prophylactic CNLD. The present study compares local recurrence rates in PTC patients undergoing total thyroidectomy with and without prophylactic CNLD. ⋯ Routine CNLD as an adjunct to total thyroidectomy identifies positive nodes in over 30% of patients with PTC. The discovery of positive nodes is associated with higher doses of RAI for postoperative ablation, and there is a trend toward decreased recurrence in patients undergoing CNLD.
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World journal of surgery · Jun 2010
Total thyroidectomy is superior to subtotal thyroidectomy for management of Graves' disease in the United States.
In the United States, Graves' disease is most commonly treated with radioiodine, yet thyroidectomy remains an important option for correcting hyperthyroidism. In many countries, limited access to thyroid hormone makes subtotal thyroidectomy the procedure of choice. In the United States, where levothyroxine is widely available, we hypothesized that total (TT) or near-total thyroidectomy (NT) is superior to subtotal thyroidectomy (ST) for long-term control of Graves' disease. ⋯ Subtotal thyroidectomy resulted in 30% long-term failure to correct Graves' hyperthyroidism. We saw no recurrences and no increase in postoperative complications in the TT group. We feel that TT is safe and superior to ST for management of Graves' disease in the United States.