Purpose: Post-thyroidectomy hemorrhage has been conducted on re-operated reactive hemorrhage usually occurred within 24 hours.We investigated all hemorrhages including reoperated or not and also secondary hemorrhages occurred after discharge.Methods: We retrospectively reviewed 16,701 patients from 1999 to 2019 and investigated the risk factors and time patterns of post-thyroidectomy hemorrhagic events.Results: The annual incidence of hemorrhage decreased from 1.7% to 0.1%.The risk factors included age ≥55 years, male sex, body weight ≥60 kg, larger thyroid specimens, and advanced stage (stage III or IV).The type of surgery and body mass index showed no significant associations with the hemorrhagic events.Ligation methods were associated with a greater incidence of hemorrhagic events than energy devices (0.6% vs. 0.3%), but they were not independent predictive factors (odds ratio [OR]=1.5;P=0.157).The OR was high for surgeons' experience <3.5 years (OR=1.8),age ≥55 years (OR=1.8),weight ≥60 kg (OR=1.9),and aggressive tumor stage (OR=4.8).The highest OR was observed for Surgeon X's procedures (OR=9.6).Extremely severe airway obstruction was observed in 17% of the patients and one patient did not survive.Most of the hemorrhagic events occurred during hospitalization, but 13% of the events occurred at home after discharge, or in the dialysis chamber of another hospital.Conclusion: Post-thyroidectomy hemorrhagic events are life-threatening complications that can occur at unexpected times and places.Delicate hemostasis and careful monitoring even after normal discharge constitute the best approach to prevent these events.Moreover, we do not recommend routine outpatient-based thyroidectomy.
Purpose: We investigated the incidence and risk factors of hypothyroidism after thyroid lobectomy, and evaluated the possibility to predict hypothyroidism preoperatively with serologic markers, such as thyrotropin (TSH), thyroglobulin (TG), anti- thyroglobulin (ATA), and anti-microsomal antibody (AMA). Methods: We enrolled 123 consecutive patients who underwent thyroid lobectomy due to benign conditions between May 2004 and April 2008. Only preoperative euthyroid patients were included. Patients were divided into two groups by postoperative thyroid function outcomes, into hypothyroid (n=97) and euthyroid groups (n=26), and analyzed specially for the preoperative levels of TSH, TG, ATA, and AMA. Results: Twenty-six (21.1%) patients developed hypothyroidism following thyroid lobectomy within 35.7 months of follow-up. The proportion of post-lobectomy hypothyroidism was high in patients with high-normal preoperative TSH level, and the cut-off value was 2.0 mIU/L, with 67% sensitivity and 75% specificity. The quantitative titer of preoperative TG, ATA, and AMA was not significant, but the outcome of categorical analysis of two or more positivities on these three markers was significantly higher in hypothyroid patients than in euthyroid patients (28.6% vs. 3.9%, P=0.024). The combined positivity of preoperative TSH and two or more positivities of TG, ATA, and AMA possess 100% positive predictive value and 81% negative predictive value. Conclusion: The incidence of hypothyroidism following thyroid lobectomy was 21.1%. High-normal preoperative TSH and two or more positivities for TG, ATA, and AMA are good pre-operative predictive markers. Such high-risk patients need close TSH monitoring before the onset of clinical hypothyroidism.
Granular cell tumor is a rare disease, and it is even rarer in the male breast. Although it is typically a benign tumor, due to its features and image findings, it can be easily misdiagnosed and managed as a malignant tumor. Therefore, the extent of the surgery can inappropriately be expanded. To avoid misdiagnosis and overtreatment, surgeons must perform a careful evaluation. We describe a case of a granular cell tumor of the male breast treated with mastectomy.
Drought stress is one of the major environmental problems in the growth of crops and woody perennials, but it is getting worse due to the global climate crisis. XERICO, a RING (Really Interesting New Gene) zinc-finger E3 ubiquitin ligase, has been shown to be a positive regulator of drought tolerance in plants through the control of abscisic acid (ABA) homeostasis. We characterized a poplar (Populus trichocarpa) RING protein family and identified the closest homolog of XERICO called PtXERICO. Expression of PtXERICO is induced by both salt and drought stress, and by ABA treatment in poplars. Overexpression of PtXERICO in Arabidopsis confers salt and ABA hypersensitivity in young seedlings, and enhances drought tolerance by decreasing transpirational water loss. Consistently, transgenic hybrid poplars overexpressing PtXERICO demonstrate enhanced drought tolerance with reduced transpirational water loss and ion leakage. Subsequent upregulation of genes involved in the ABA homeostasis and drought response was confirmed in both transgenic Arabidopsis and poplars. Taken together, our results suggest that PtXERICO will serve as a focal point to improve drought tolerance of woody perennials.
Purpose: There are no guidelines for the optimal timing of the decision of when to perform completion thyroidectomy, and controversy exists regarding how the timing of completion thyroidectomy impacts survival patterns. We investigated the legitimacy of an observational strategy in central node metastasis after thyroid lobectomy for papillary thyroid cancer (PTC). Methods: We retrospectively evaluated 522 consecutive patients who underwent thyroid lobectomy. Of the 69 patients with central metastasis, 61 patients (88.4%) were included in an observational study under cautious evaluation with informed consent by the patients, and compared with an observation arm of 180 postlobectomy N0 (node negative proven) patients. Results: Of the 522 patients, six (1.1%) thyroid, five (0.9%) central, and two (0.4%) lateral recurrences were observed. Lateral recurrences occurred in the immediate completion N0 and Nx groups but not in the N1a observation arms. There were two (3.3%) central recurrences without thyroid or lateral recurrence on the observation arm of N1a observation patients. But two (1.1%) thyroid and three (1.7%) central recurrences were on the observation arm of N0 patients. In Kaplan-Meier survival curves for central or lateral recurrences between observation arms for the N1a and N0 groups, no significant difference was found between the N1a and N0 observation arms (P = 0.365). Conclusion: The timing of when to perform completion thyroidectomy in central metastases-proven patients after lobectomy for PTC should be based on the patient`s risk category.
Abstract This work presents a novel micro electrical impedance spectroscopy (μEIS) technique that can measure and discriminate the electrical signal responses of biotissues in real time. An EoN (EIS‐on‐a‐needle), EIS on the surface of a fine needle (400 μm in diameter), was fabricated using a newly developed flexible photomask film. The base material of the photomask is parylene‐C, which allows uniform contact on the curved surface of the needle; thus, the designed electrode patterns of the photomask can be transferred onto the needle surface with a high resolution (2.95 % or less in dimensional error). To validate the developed EoN as an electrical sensor, ex vivo experiments with various biotissues—butchered pork (skin, fat, and muscle) and human breast tissues (normal and cancerous)—were conducted by measuring real‐time electrical impedance during a frequency sweep. The conductivities (relative permittivity) of the pork tissues were evaluated by electrical equivalent circuit analysis: 56.6 mS/m (37,800), 68.0 mS/m (74,755), and 74.9 mS/m (26,145) for the skin, fat, and muscle, respectively. Moreover, the normal and cancerous tissues were well distinguished by electrical resistance at 4.04 kHz for various cancer grades (Elston grades 1, 2, and 3). Analysis of the electrical impedance suggests that the EoN can be utilized to diagnose the physiological states of biotissues in clinical use.
Breast conserving surgery using mesh can effectively fill the defective space, but there is the risk of infection.From June 2007 to August 2010, 243 patients who underwent breast conserving surgery with polyglactin 910 mesh insert for breast cancer at our institution were retrospectively studied.Infection occurred in 25 (10.3%) of 243 patients. When comparing the infection and non-infection groups in multivariate analysis, there was no significant difference in age, underlying disease, preoperative biopsy methods, mass location, axillary lymph node dissection, operative methods, neoadjuvant or adjuvant chemotherapy use, mass size and removed breast volume. The infection appeared more common only in patients with body mass index (BMI) greater than 25. Infection symptoms occurred, on average, 119.5 days after surgery, and the average duration of the required treatment was 34.4 days. Out of 25 patients with postoperative infection complications, 16 (64%) patients underwent incision and drainage with mesh removal, whereas the remaining 9 (36%) only required conservative treatment.During breast conserving surgery, the risk of infection is increased in patients with high BMI, and should be taken into account when considering insertion of a polyglactin 910 mesh. Patient's age, underlying disease and perioperative treatment methods were not significant risk factors for developing mesh infection. Given that most infections seem to develop symptoms one month after surgery, a long enough observation period should be initiated. Early detection and appropriate conservative treatments may effectively address infections, thus reducing the need for more invasive therapies.
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