No abstract

WDTC can manifest with highly variable and unusual clinical features. Rare sites of metastases should be considered in the absence of the more common extra-cervical disease recurrence locations.

Background: Parathyroid dysfunction leading to symptomatic hypocalcemia is not uncommon following a total or completion thyroidectomy and is often associated with significant patient morbidity and a prolonged hospital stay. A simple, reliable indicator to identify patients at risk would permit earlier pharmacologic prophylaxis to avoid these adverse outcomes. We examined the role of intact parathormone (PTH) levels 1 hour after surgery as a predictor of post-thyroidectomy hypocalcemia. Methods:We prospectively reviewed the cases of consecutive patients undergoing total or completion thyroidectomy. Ionized calcium (Ca 2+ ) and intact PTH levels were measured preoperatively and at 1-, 6-and 24-hour intervals postoperatively. The specificity, sensitivity, negative and positive predictive values of the 1-hour PTH serum levels (PTH-1) in predicting 24-hour post-thyroidectomy hypocalcemia and eucalcemia were determined. Results:We reviewed the cases of 149 patients. Biochemical hypocalcaemia (Ca 2+ < 1.1 mmol/L) developed in 38 of 149 (25.7%) patients 24 hours after thyroidectomy. The sensitivity, specificity, positive and negative predictive values of a low PTH-1 were 89%, 100%, 97% and 100%, respectively. Conclusion:We found that PTH-1 levels were predictive of symptomatic hypocalcemia 24 hours after thyroidectomy. Routine use of this assay should be considered, as it could prompt the early administration of calcitriol in patients at ris k of hypocalcemia and allow for the safe and timely discharge of patients expected to remain eucalcemic.

In the US setting, the most cost-effective strategy was routine GEC + selective GMP. In the Canadian setting, standard management was most likely to be cost effective. The cost of these molecular diagnostics will need to be reduced to increase their cost-effectiveness for practice settings outside the United States.

To our knowledge, this is the largest series of SLN biopsy in patients with differentiated thyroid carcinoma. Our experience suggests that this is an accurate and noninvasive means to identify subclinical lymph node metastasis. Because negative SLNs correlate strongly with a negative central compartment (100% in this study, P < .001), this technique can be used as an intraoperative guide when determining the extent of surgery necessary in cervical level VI.

No abstract

Brachytherapy has proven to be an extremely valuable method of treatment for head and neck cancer. The data supporting its application, however, is based on continuous low-dose-rate brachytherapy. To benefit from improved radiation protection, outpatient treatments, and increased patient tolerance of treatment set-up over that encountered in conventional low-dose-rate manually afterloaded brachytherapy, we implemented a high-dose-rate remote afterloading approach in selected patients with head and neck cancers. This treatment was utilized in two different roles in managing 29 patients. In its first role, it was used as the sole treatment in 13 patients with T1-2 N0 malignancies. A total of ten treatments of 450-500 cGy each were delivered twice a day with a minimum of 5-6 h between treatments. With a median follow-up of 9 months, only 1 patient failed locally. In a second role, brachytherapy was applied in a post-operative adjuvant setting following wide local excision of tumors in patients who presented with recurrent disease (12 cases) or a second primary in the head and neck (4 cases). All patients had previously received external irradiation to the head and neck. Due to this previous course of irradiation, only eight treatments of 300 cGy each were delivered, for a total of 2400 cGy over a period of 4 days. However, with a follow-up of 2-16 months, only 3 patients remain disease-free.

The carbon dioxide laser was used for the treatment of 20 lesions of the oral mucosa in 14 patients. These lesions ranged histologically from benign hyperkeratosis to verrucous carcinoma. The patients selected for this treatment were identified at high risk to develop malignant lesions in the oral cavity. Precise vaporization of the affected mucosa were carried out using the Cavitron 40-300-A CO2 Surgical Laser. Destruction of the surface epithelium and submucosa was achieved by using defocused beam at a setting of 10W. Biopsies were taken at 1 cm intervals at the time of laser treatment. Fourteen of the 20 procedures were carried out under local anesthesia on an outpatient basis. Seven procedures were performed under general anesthesia and 2 patients required 24 h postoperative observation. Local control was achieved in 17 of the 20 treated sites. Two of the three treatment failures occurred in patients in whom the final histology revealed either in situ or invasive squamous carcinoma. Only one patient with dysplasia was not controlled after vaporization of the lesion by the carbon dioxide laser. The laser continues to show encouraging results as an alternative to surgical resection of precancerous mucosal lesions of the oral cavity. Vaporization of the dysplastic lesion(s) with carbon dioxide laser is recommended for patients with an identifiable risk for the development of intraoral malignancy. This is an effective, nonmorbid, inexpensive, quick, and relatively painless method of managing this condition.