We analyzed the clinical and histological features of patients operated on for toxic multinodular goiter (TMG) to determine the clinical profile and evaluate the surgical results.
We reviewed 672 ...patients who underwent surgery for multinodular goiter (MG), 112 (17%) of whom had hyperthyroidism, and analyzed the epidemiological, clinical, and surgical variables.
The patients with TMG tended to be older than those with nontoxic MG, with a greater evolution time of the goiter and a higher rate of positive antithyroid antibodies. In the multivariate analysis, the only feature characteristic of TMG, as opposed to nontoxic MG, was the evolution time. Morbidity was 34%, representative of the fact that that most of the patients were seen before the establishment of our endocrine surgical unit. The hyperthyroid symptoms resolved in all patients, but 4 of 17 patients who underwent partial surgical resection showed signs of relapse within a follow-up period of 98 +/- 71 months.
TMG is characterized by a long evolution time and is most effectively treated by total thyroidectomy, which achieves complete remission from symptoms, without relapse, and is necessary if there is associated carcinoma. However, the incidence of complications may be high if this procedure is not carried out by surgeons with experience in endocrine surgery.
Open surgery (OS) is currently the ''gold standard'' for liver metastasis (LM) treatment. However, in order to evaluate the efficiency of laparoscopic surgery (LS) for LM treatment, it is necessary ...to carry out studies to demonstrating that this technique can obtain the same results as OS. In this study the current position of LS for LM is presented.
The authors carried out a bibliographical search of all the series of LM resected using LS from the following sources: Medline, Embase, Ovid and Cochrane. The following aspects of LM treatment using LS were examined: intraoperative objectives, postoperative morbidity and mortality and follow-up (5-year survival rate).
In selected cases for LS, there are similar postoperative morbidity and mortality rates with LS and OS. However, LS does not meet the intraoperative objectives because there is under staging of the abdominal cavity and of the liver. Therefore, hand-assisted laparoscopic liver surgery (HALLS) could be a valid alternative. There are few studies that have shown survival rates at 5 years, although in selected cases, the results of LS and OS are similar.
OS continues to be the ''gold standard'' for the surgical treatment of LM. HALLS is a valid alternative to totally LS so long as there is no improvement in the pre and intraoperative means of staging.
Phosphorylated FTY720 is an analog of Sphingosine 1 Phosphate (S1P) with immunosuppressive activity that negatively regulates the expression of S1P-Receptor 1. It also inhibits the migration of CD4 ...and CD8 single-positive T cells from the thymus to the periphery, sequesters peripheral blood lymphocytes in lymph nodes and Peyer’s patches, and delays the exit of effector T cells toward the graft. The aim of our work was to study the effect of FTY720 on the kinetics of skin allograft rejection in a fully mismatched model; euthymic (Euthy) versus thymectomized (ATX) C57BL/6 mice (haplotype H-2
b) recipients of BALB/c mice (haplotype H-2
d) donor cells. The animals were injected daily with FTY720 (1 mg/kg) intraperitoneally for 2 weeks. To monitor the humoral immune response, serum samples collected at day 0 (pre-immune) and at day 23 after skin graft rejection were examined using BALB/c thymocytes as antigens in flow cytometry. To confirm the effect of FTY720 on peripheral lymphocytes, peripheral blood was analyzed by flow cytometry. Euthy and ATX FTY720-treated mice showed prolongation of skin allograft survival when compared with nontreated Euthy and ATX controls (
P < .005). Unexpectedly, FTY720-treated Euthy mice showed significantly delayed graft rejection when compared to similarly treated ATX mice (
P < .005). The delayed graft rejection in FTY720-treated Euthy mice correlated with a reduced content of Th1-mediated IgG
2a and IgG
2b antibodies when compared with FTY720-treated ATX mice (
P < .05). In conclusion, FTY720 delays the kinetics of allograft rejection in a fully mismatched model by inhibiting Th1-mediated humoral immune responses. The presence of the host thymus appears to be required for this phenomenon.
