The value of bacterial metagenomic analysis in post-surgical examination of gallstones

Gallstone disease is one of the most common causes of hospitalization for gastrointestinal diseases in the world. Recent studies have examined the presence of bacteria in the formation of stones. Our main goal was to determine the overall composition of gallstone microflora. Gallstones were obtained from 24 patients during laparoscopic cholecystectomy from which DNA were extracted. Composition of bacterial flora was evaluated on 16 s rDNA sequencing technique. In the vast majority of samples, bacteria were present, and four groups could be differentiated regarding the flora. Overall composition shows that 87% of the stones were cholesterol/mixed type of gallstone. Additionally, potentially harmful microorganisms (Streptococcus, Clostridium and Kocuria) that could cause post-surgery complications were identified in several patients. The obtained results indicate that this technique may be useful in analyzing the type of stones and in pinpointing the presence of pathogenic bacteria.

Thyroid nodules with Hürthle cells: the malignancy risk in relation to the FNA outcome category

PURPOSE

The aim was to find whether the presence of Hürthle cells (HC) in a smear influences the categorization of FNA results or the risk of malignancy (RoM) of particular categories of cytological diagnosis.

METHODS

25,220 FNA performed in a single center in years 2005-2017 were analyzed. Almost all the examined patients were exposed to moderate iodine deficiency for most of their lives. The distribution of FNA outcome categories was compared between two groups: with or without HC (HC and non-HC). The RoM was evaluated on the basis of postoperative histopathological examination (3082 patients).

RESULTS

HC were found in 7.5% of diagnostic FNA. HC nodules were classified into categories II (78.2% vs. 91.9%, p < 0.0000) and VI (0.4% vs. 1.2%, p = 0.0017) less often than non-HC nodules, but more frequently to categories III (14.4% vs. 5.8%, p < 0.0000), IV (11.2% vs. 0.9%, p < 0.0000) and V (1.5% vs. 0.8%, p = 0.0013). There were no significant differences in RoM between HC and non-HC nodules. The RoM in HC and non-HC nodules of particular categories of the Bethesda system was as follows: II: 1.8% vs. 0.8%, III: 9.7% vs. 3.8% when only the last FNA was considered and 10.8% vs. 6.4% when the category III in any performed FNA was considered; IV: 12.7% vs. 10.9%; V: 41.7% vs. 58.2%; and VI: 100% vs. 96.9%.

CONCLUSIONS

HC nodules are classified into categories of equivocal cytological outcomes more often than nodules without HC. Nevertheless, the presence of HC in a smear does not significantly affect the RoM of FNA categories.

Nodal status in the papillary thyroid vancer. Comparison of the results of routine histopathological examination, immunohistochemistry and reverse transcription - polymerase chain reaction

Immunohistochemistry (IE) and polymerase chain reaction (PCR) are tools enabling to find small number of tumor cells in lymph nodes (LNs) or peripheral blood. Perhaps these methods will allow early detection of cell dissemination and refine risk group within papillary thyroid cancer (PTC) that might benefit from more extensive surgical procedures or adjuvant therapy. In our study we detected PTC cells in the cervical LNs by routine histopathological examination RHE), IE and RT-PCR and compared obtained results. We also estimated the impact of RT-PCR and IE results on TNM staging and clinical staging according to UICC in patients with PTC. Each of 216 LNs from 28 patients with PTC were divided into two parts: one for RHE and IE the other one for Tg mRNA RT-PCR. Nodal metastases of PTC, in the regional LNs, were found by RT-PCR only in 1(3.6%) patient more than in RHE. In other 4(14.3%) patients molecular examination increased number of involved LNs. In the other patient it revealed less metastasized LNs. The molecular examination changed nodal status in 5(17.9%) of 28 patients. TNM staging was altered from N0 to N1 in one patient. In the others was changed only the number of involved LNs Our research prooved that Tg mRNA RT-PCR technique was sensitive method for detection of nodal metastases of PTC. The outcomes of RT-PCR are similar to RHE so that examination really does not change the estimation of the disease staging according to UICC classification and main surgical therapy in PTC patients.

Detection of lymph node metastases of papillary thyroid cancer-comparison of the results of histopathology, immunohistochemistry and reverse transcription-polymerase chain reaction-a preliminary report

BACKGROUND

The range of lymphadenectomy in differentiated thyroid cancer remains still a matter of controversy because of the lack of reliable diagnostic methods for nodal metastases, other than histopathology.

AIM

To compare the results of detection of lymph node metastases of papillary thyroid cancer by conventional histopathology and immunohistochemistry with the results of reverse transcription-polymerase chain reaction for thyroglobulin mRNA.

PATIENTS AND METHODS

Each of 166 cervical lymph nodes obtained from 21 patients was divided into two halves: one was used for conventional histopathology and immunohistochemistry, the other part was investigated by molecular examination.

RESULTS

We obtained different results from examination of the lymph nodes in six (28.6%) patients. In four patients (19.1%) reverse transcription-polymerase chain reaction (RT-PCR) was more sensitive in detection of positive lymph nodes; in two patients (9.5%) it revealed fewer metastasised lymph nodes than did histopathology. The rest of the patients did not have any differences: 12 (57.1%) of them had negative lymph nodes and three (14.3%) had positive lymph nodes in all examinations.

CONCLUSIONS

(1) Thyroglobulin (Tg) RT-PCR is an appropriate method of detection for thyroid cancer cells. (2) In combination with histopathology, it might help to qualify patients' nodal status better.

Differences in glycosylation of intracellular proteins between benign and malignant thyroid neoplasms

Differences in glycosylation of nuclear and cytosolic proteins isolated from benign and malignant human thyroid neoplasms were analyzed by lectin blotting and enzyme linked lectino-solid-phase assay using Erythrina cristagalli and Ricinus communis agglutinins. The results reported in this study have not shown any significant differences in lectin binding by nuclear proteins of benign and malignant tumors, however, quantitative and qualitative differences were observed in the patterns of cytosolic glycoproteins. In the majority of carcinomas samples lectin binding to cytosolic proteins was definitely weaker in comparison with adenomas and non-neoplastic specimens, which suggested alterations in glycosylation of cytosolic proteins in malignant tumors.

Carcinogenic effect of combined administration of 2,4-diaminoanisole sulfate, 4,4'-thiodianiline and N,N'-diethylthiourea in male Wistar rats

Male Wistar rats were divided into two groups. Rats of group 1 were fed basal powdered diet containing 610 ppm 2,4- diaminoanisole sulfate (DAAS), 46 ppm 4,4'-thiodianiline (TDA) and 200 ppm N,N'-diethylthiourea (DETU) for 52 weeks (DTD treatment). Rats of group 2 were maintained on basal diet throughout the experiment as controls. At 52 weeks all surviving rats were sacrificed and subjected to an autopsy. Thyroid, lungs, stomach, liver, spleen, kidneys, testes and all gross lesions suspected of being a tumor were removed. After DTD treatment, the incidence of thyroid hyperplasia and papillary thyroid carcinoma was 59% (10/17) and 65% (11/17), respectively. Hepatocellular adenoma was induced in 2 of 17 rats (12%). Papillary thyroid carcinoma metastasis was found in the lung of 1 rat. No neoplastic tumors were found in kidney, spleen, stomach and testis tissue.

[Cervical lymph node surgery in differentiated thyroid cancer: selective or elective lymphadenectomy?]

The value and prognostic significance of regional lymph node dissection in patients with thyroid cancer remains a matter of controversy. The classification of the cervical lymph nodes and the extent of their resection in patients with different thyroid cancers is also discussed. The aim of the paper was to present the space classification of regional lymph nodes, the incidence of their involvement and the extent of their resection in patients with differentiated thyroid cancer. The results of multicenter studies have indicated that regional lymph node metastases in patients with differentiated thyroid cancer, especially of a papillary type, have been frequent. Ipsilateral central, ipsilateral lateral, contralateral lateral, and mediastinal lymph nodes have been affected in 42-86%, 32-68%, 12-24%, and 3-20% of patients respectively. In 20% of patients only central lymph nodes have been affected, whereas in others metastases have been determined at least in 2 or more lymph node groups. Regional lymph nodes have been classified into Groups I-IV. Moreover, lymph node recurrences have been more frequent in patients who either have not got the regional lymph nodes removed or have only enlarged ones determined as involved excised. Therefore, primary regional lymph nodes dissection is indicated. Elective resection of the lymph nodes of Group I (central lymph nodes) as a part of primary total thyroidectomy in patients with thyroid cancer and more selective excision of the lymph nodes of Groups II-IV are recommended. The author has presented his own experience in lymph node dissection in patients with differentiated thyroid cancer and compared it with other results.

The influence of a single acetic acid and lactic acid injection on rat normal thyroid tissue

Until now, the use of acetic and lactic acid for the treatment of thyroid nodular lesions, as well as histopathologic changes in the thyroid tissue after their intrathyroidal injections has not been described. The aim of this study is to evaluate macro- and microscopic changes in rat normal thyroid tissue induced by single intrathyroidal injection of acetic acid (AA) and lactic acid (LA) in different concentrations, as well as the influence of intrathyroidal acid injection on function of the recurrent laryngeal nerves. Male Wistar rats were divided into two groups of 50 (Group A and B). Rats of each group were divided into the subgroups of five. In each subgroup of Group A and B, AA and LA water solutions of different concentrations (0%, 2.5%, 5%, 10%, 20%, 30%, 40%, 50%, 60%, 80%), respectively, were injected into the right thyroid lobe. From Group A and B, 7 and 8 rats died, respectively (after injections of 50-80% AA and LA solutions). After 4 weeks post AA or LA injection the thyroid along with the surrounding tissues was excised and assessed macro- and microscopically in all rats that survived. Before the injection and just before the second operation, the vocal cord function was evaluated. Our results show that both, acetic and lactic acid of different concentrations damage rat normal thyroid tissue after a single intrathyroidal injection. The minimal concentrations of acetic and lactic acid that cause lethal changes in rat normal thyroid tissue are 20% and 10%, respectively. Acetic and lactic acid in the concentrations of 40% and 50%, respectively, and higher can cause injury of the tissues adjacent to the thyroid.

[The influence of thyroidectomy of serum VEGF levels in patients with Graves disease]

Angiogenic cytokines, including vascular endothelial growth factor (VEGF), play an important role in patients after surgery because they facilitate proper wound healing. The aim of the paper was the comparison of serum VEGF levels in patients before and after thyroidectomy due to Graves disease (Gd). A serum VEGF level was determined by means of ELISA method before the operation as well as 3 and 7 days after it in 24 patients. The mean serum VEGF level was 61.2 pg/ml (range, 33.7-105.0 pg/ml) before the operation and increased after the operation to 115.6 pg/ml (range, 36.3-214.2 pg/ml). After thyroidectomy, the mean level of serum VEGF level in all patients rose by for 79.5% (range, 7.7-115.4%). These results suggest that serum VEGF level increases in patients with Gd after subtotal thyroidectomy, although disorder in secreting cytokines is observed in Gd patients and they were administered thyrostatics up to the operation, which have an immunosuppressive activity.

Lymphocyctes Tgammadelta in clinically normal skin and peripheral blood of patients with systemic lupus erythematosus and their correlation with disease activity

Human Tgammadelta lymphocytes constitute from 1 to 15% of all peripheral blood lymphocytes. Recent work has demonstrated that this population plays a major role in the pathogenesis of infectious and immune diseases. Increased numbers of gammadelta T cells have been found in affected skin from systemic sclerosis and chronic cutaneous lupus erythematosus patients. In our study, we have determined the numbers of Tgammadelta lymphocytes and their subpopulations in peripheral blood from 29 patients with systemic lupus erythematosus (SLE) and in 19 healthy volunteers using flow cytometry and specific monoclonal antibodies. The same cells in uninvolved skin from SLE patients and human controls using immunohistochemical analysis were estimated. T-Cell receptor (TCR) delta chain gene rearrangement was identified with primers for Vdelta1, Vdelta2 and Vdelta3 by the polymerase chain reaction. Statistical analysis showed a significantly decreased number of gammadelta T cells in SLE patients (26.4+/-16.9/microl) compared with the control group (55.3+/-20.6/microl (p < 0.001). The number of Vdelta2 TCR+ and Vgamma9 TCR+ subpopulations was also lower in SLE patients than in healthy persons. No statistical correlation between disease activity and the number of gammadelta T cells was demonstrated. The percentage of Tgammadelta lymphocytes in clinically normal skin from SLE patients was twice (22.0+/-9.4%) that found in the skin from healthy persons (11.1+/-5.5%) (p < 0.002). Higher percentages of the Vdelta2 TCR+ and Vgamma9 TCR+ subpopulation of lymphocytes were found in the skin from SLE patients. We have also found positive correlation between the percentage of Tgammadelta lymphocytes in skin and the activity of SLE (r=0.594, p < 0.001), and between subpopulation Vdelta3 TCR+ and disease activity (r=0.659, p< 0.001). In conclusion, the results of our studies demonstrate that, in patients with SLE, accumulation of Tgammadelta lymphocytes can be seen in clinically normal skin, and the percentage of these cells correlates with the activity of the disease.

Colorectal carcinoid tumors--own experience

Symptomatology, diagnostics and treatment problems in 5 patients with colorectal carcinoid are presented. From 1974 to 1999 in the Clinic of Endocrinological and General Surgery of the Medical University of Lódź, 3001 patients underwent surgery due to acute appendicitis and 431 for colorectal cancer. Among them, there were 5 patients in whom the histological examination revealed colorectal carcinoid. The carcinoids were localized in the appendix in 4 patients and in the left colon flexure in 1 patient. The mean age of these 5 carcinoid patients at the time of diagnosis was 38.4 years (range 18-72 yr). The female-to-male ratio amounted to 4:1. The symptoms of all 5 patients was not typical for carcinoid of the colon. In four surgery was performed for acute appendicitis and one patient complained of chronic obstipation and pain in the left epi- and mesogastrium. The double-contrast examination of the large intestine revealed tumor of the left colon flexure. Four carcinoid patients with the signs of acute appendicitis had emergency surgery. The carcinoid tumors were diagnosed microscopically after surgery only. In 3 of them the tumor extended beyond the appendix and a reoperation was performed. In one patient with the tumor of small diameter (5 mm) involving only the mucosa and submucosa a reoperation was not indicated. In 3 reoperated patients right hemicolectomy with regional lymphadenectomy was performed. The patient with the tumor of the left colon flexure diagnosed preoperatively underwent radical surgery with regional lymphadenectomy. The postoperative histological examination of the tumor confirmed carcinoid. No carcinoid metastases were found in lymph nodes of all studied cases. Until today, all 5 carcinoid patients are alive with no signs of local reccurrence or distant metastases over the 1-20 year follow-up period.

Medullary thyroid carcinoma (MTC)--clinical and molecular aspects on the basis of own experience

In our clinic 19615 patients were operated over 25 years on for goiter. Malignant thyroid neoplasms were found in 1049 (5.3%) patients including 875 (83.4%) women and 174 (16.6%) men. Sixty two adult patients (42 women and 20 men were operated on for medullary thyroid carcinoma (MTC). Thyroid cancer was diagnosed in this group pre or intraoperatively in 44 (71%) patients and postoperatively, on histologic examination, in 18 (29%) patients. These patients were reoperated. Radical operations (total thyroidectomy with regional lymph node removal) were conducted in 43 (69.3%) patients and palliative ones in 19 (30.7%) patients. After MTC surgery, MEN 2A (MTC and an adrenal tumor) were diagnosed by means of imaging techniques (USG, CT) in 6 (9.7%) patients. All adrenal tumors were unilateral. Five of these patients were operated, and pheochromocytoma was confirmed by histopathologic examination. Two years after the MTC operation, 1 women was lost to follow-up. After a year, she was admitted to hospital for severe hypertension and died of cerebral hemorrhagia. Pheochromocytoma was revealed by autopsy. All patients were treated complementarily after the MTC operation. Different combinations of teleradiotherapy, chemotherapy and substitutive doses of levothyroxine were used. Ten (23.2%) of 43 patients operated radically were reoperated 1-3 years after the first operation due to loco-regional tumor recurrence. Radical reoperations were performed in 4 patients, and palliative ones in 6. Over a 0.5-23-year follow-up period, 26 (41.9%) patients died, including 20 of cancer, and 6 of other reasons. Four out of 36 living patients have clinical or biochemical symptoms of neoplastic disease. The follow-up period of MEN 2 patients operated on ranged from 1 to 6 years. Up to now, no tumor in the second adrenal gland has been diagnosed in any of these patients. Genetic (molecular) tests performed in 31 out of 36 living patients revealed mutations of RET gene in 4 (12.9%).

[The diagnosis and operative treatment of solitary thyroid nodule: a prospective study]

The aim of the paper is to evaluate the usefulness of pre- and intraoperative examination methods in the diagnostics of solitary thyroid nodules, as well as the assessment of the histologic structure of these nodules. From 1.12.1997 to 15.06.1998 in the Clinic of Endocrinological and General Surgery at the Medical University of Lodz, 102 patients were operated for a solitary nodule. The solitary nodule was diagnosed on the basis of the clinical and ultrasound examination. A fine needle aspiration biopsy (FNAB) was performed in all patients. During the operation the presence of the solitary nodule was confirmed on the basis of macroscopic examination. If malignancy was suspected on intraoperative macroscopic examination, intraoperative histologic examination was carried out. In 82 patients with the solitary nodule, the benign nodule was diagnosed on the basis of FNAB in 45 (54.9%) patients and malignant one in 8 (9.7%). Malignancy in the nodule (follicular tumour, Hürthle cell tumour, cellulae suspectae) was suspected in 29 (35.4%) patients--in this group the intraoperative histologic examination was conducted. On the basis of postoperative histologic examination a thyroid malignant neoplasm was detected in 18 (21.9%) of 82 patients with the solitary nodule. Finally, out of 18 thyroid cancers, 8 (44.4%) were recognised preoperatively (FNAB), 3 (16.7%) intraoperatively and 7 postoperatively. Since the incidence of malignancy in solitary thyroid nodules is high the authors suggest that their precise pre- and intraoperative diagnostics is necessary. The use of described diagnostic methods enabled to recognise malignancy in the solitary nodule and to perform a primary radical operation in 61.1% patients. On the basis of the obtained results it seems justifiable to search new diagnostic methods which enable better pre- and intraoperative differentiation of benign and malignant thyroid nodules.

Pregnancy following operative and complementary treatment of thyroid cancer

In 1974-1998, 18,602 patients were operated on due to goitre, including 16,575 (89.1%) women and 2,027 (10.9%) men. Thyroid cancer was diagnosed in 975 (5.2%) by histopathologic examination. According to the WHO classification, there were 449 (46.1%) patients with papillary carcinoma, 309 (31.7%) with follicular, 54 (5.5%) with medullary, 106 (10.9%) with anaplastic, and 57 (5.8%) with other types of thyroid malignant neoplasms. Among them, there were 812 (83.3%) women and 163 (16.7%) men. Out of 758 patients with differentiated thyroid cancer, 545 (71.8%) were treated complementarily with 131I. After surgery and complementary treatment, 23 (3%) thyroid cancer women (19 with papillary cancer and 4 with follicular one) became pregnant. Seven (30.5%) women were treated complementarily with 131I and levothyroxine, 3 (13.0%) with teleradiotherapy, 131I and levothyroxine, 1 (4.3%) with teleradiotherapy and thyroxine, and 12 (52.2%) only with levothyroxine. All women gave birth to healthy children. None of them developed recurrence before, during and after pregnancy. On the basis of the results obtained and the literature data one can conclude that it is possible to give birth to a healthy child after thyroidectomy and complementary treatment due to thyroid cancer, and that conception should occur after remission is confirmed and not earlier than 1 year after 131I treatment.

Thyroid cryotherapy in an experimental rat model-topography of temperature during therapy and functional results

The aim of this study was to investigate post cryotherapy thyroid function status of normal rat thyroid tissue and to determine the topography of temperature of cryotreated tissues and of tissues adjacent to them. Nitrous oxide cryotherapy was performed in 40 male Wistar rats. They were divided into four groups of 10. In group I, the right thyroid lobe was subjected to cryotherapy and the left lobe was not frozen. In group II, both thyroid lobes were cryotreated. In group III, the right lobe was frozen and the left lobe was excised. In group IV, the thyroid was subjected to neither cryotherapy nor surgery. During cryotherapy, the temperature in various places of the thyroid and in the surrounding tissues was measured. Serum thyrotropin concentrations were determined before an experiment and 4 weeks after in all rats. The results of temperature measurements proved that it is possible to limit cryotherapy to certain areas of thyroid tissue and to spare the neighboring tissues, because they are not subjected to temperatures that are damaging. The effectiveness of cryotherapy was confirmed by functional effect. Cryotherapy changed function of thyroid tissue. There was a statistically significant difference between mean baseline and follow-up concentrations in rats of groups II and III. In both groups hypothyroidism occurred post cryotherapy.

[Treatment of solitary toxic thyroid nodules with the use of percutaneous ethanol injections]

Twenty women aged 18-76 years (mean 42 +/- 23 years) with solitary benign toxic thyroid nodule were treated with intranodular percutaneous 96%-ethanol injection, performed under ultrasound guidance. 1 ml of ethanol was instilled per 1 cm3 of nodule tissue. 2-5 (mean 3.1) sessions were conducted every month. The early follow-up evaluation of the results (the evaluation of nodule size by means of clinical and ultrasound examination) was performed in 6 months, and the long-term one in 2 years after last injection. A morphological evaluation was conducted according to the following scale: 1--nodule disappearance, 2--cicatricial nodule (solid structure and less than 0.5 cm in diameter), 3--nodule smaller by [symbol: see text] 50% of its initial dimensions, 4--nodule smaller by < 50% of its initial dimensions. A functional evaluation was carried out according to the following scale: I--permanent euthyroidism, II--permanent decrease of hyperthyroidism, III--no functional effect. A final follow-up evaluation revealed: nodule disappearance in 2 (10%) patients (Group 1), cicatricial nodule in 8 (40%) patients (Group 2), nodules smaller by [symbol: see text] 50% of its initial dimensions in 2 (10%) patients (Group 3) and nodules smaller by < 50% of initial dimensions in 8 (40%) patients (Group 4). The results in Group 1 and 2 were defined as good (50%), in Group 3 as satisfactory (10%) and in Group 4 as bad; and I--permanent euthyroidism in 16 (80%) patients, II--permanent decrease of hyperthyroidism in 1 (5%) patient, III--no functional effect in 3 (15%) patients. 2 patients in whom new nodules appeared and 1 patient with bad morphological and no functional treatment effects were operated on. A histological examination revealed haemorrhagic necrosis surrounded by fibrous tissue in removed nodules. The following complications were observed: 1) pain during and after the injection in 15 (75%) patients, 2) subfebrile body temperature in 3 (15%) patients and fever up to 39 degrees C on the 1-st day after the injection in 1 (5%) patient, 3) local ecchymosis in 1 (5%) patient, 4) temporary dysphonia in 1 (5%) patient. It seems that percutaneous ethanol injection treatment can be an useful treatment method of solitary benign toxic thyroid nodules in patients who do not give their consent to surgical or 131I treatment or with contraindications to an operation or radioiodine therapy.

The influence of a single ethanol injection on normal thyroid tissue of the rat

Macro- and microscopic changes in the normal thyroid gland of rats, and in the surrounding tissues 2 and 4 weeks after a single intrathyroidal ethanol injection (IEI), together with the influence of such treatment on the function of the recurrent laryngeal nerves and of the parathyroid glands, were assessed. The intraoperative macroscopic evaluation at 2 weeks (20 rats) and 4 weeks (20 rats) after IEI revealed the presence of a scar at the site of the IEI-treated lobe in seven (35%) and six (30%) rats, respectively, and the reduction of lobe dimensions in thirteen (65%) and fourteen (70%) rats, respectively. The microscopic evaluation of the lobe after IEI showed coagulative necrosis, reduction in thyroid follicle volume, disturbance of follicle structure, haemorrhage, haemosiderin deposits, inflammatory infiltration and fibrosis. No microscopic changes were observed in the tissues surrounding the thyroid, nor in the parathyroid glands located extrathyroidally or in the second thyroid lobe. No vocal cord dysfunction or significant changes in serum calcium levels after IEI were detected.

Metastasis as the first sign of thyroid cancer

The aim of this paper is to review our experience with patients who presented with a metastatic tumor in the lymph nodes or other organs as the first sign of thyroid cancer. In 1974-1998, 18 602 patients were operated on due to goitre. There were 975 (5.2%) patients with thyroid malignant neoplasms. The group comprised 449 (46.1%) patients with papillary carcinoma, 309 (31.7%) with follicular carcinoma, 54 (5.5%) with medullary carcinoma, 106 (10.9%) with anaplastic carcinoma, and 57 (5.8%) with other types of thyroid malignant neoplasms. Out of these 975 patients, thyroid cancer was diagnosed on the basis of the detection of a metastatic tumor in 26 (2.7%) patients. In 16 (61.5%) of these patients the metastatic tumor was located in the regional lymph nodes. In 10 (38.5%) patients distant metastasis beyond the regional lymph nodes was the first sign of thyroid cancer. In (50%) patients metastasis was located in the bones, in 2 (20%) in the lung, in 1 (10%) in the heart, in 1 (10%) in the buttock, and in 1 (10%) in a central neck cyst. Metastasis was the initial manifestation of thyroid cancer in 18 (4%) of 449 papillary carcinoma patients, in 6 of 309 (1.9%) follicular carcinoma patients, and in 2 (3.7%) of 54 medullary carcinoma patients. Lymph node metastasis was the first sign of thyroid cancer in 13 (2.9%) patients with papillary carcinoma, 1 (0.3%) patients with follicular carcinoma and in 2 (3.7%) medullary carcinoma patients, and distant metastasis in 5 (1.1%) patients with papillary carcinoma and in 5 (1.6%) patients with follicular carcinoma. After the detection of the primary focus of thyroid cancer total thyroidectomy and modified neck dissection were performed in all patients. Differentiated thyroid carcinoma patients were treated complementarily with 131I and TSH suppressive doses of L-thyroxine, and medullary cancer patients with teleradiotherapy and substitutive doses of L-thyroxine.

[The treatment of solitary thyroid nodules in non-toxic goiter with 96% ethanol injections]

40 patients (39 women and 1 man) aged 13-66 years (mean 35.9 years) with solitary benign non-toxic thyroid nodule confirmed by clinical and hormonal examination, ultrasonography and fine needle aspiration biopsy, were treated with intranodular percutaneous 96% ethanol injection, performed under ultrasound guidance. There were 34 patients with solid nodule (including 4 patients) with solitary nodule in recurrent goitre after thyroidectomy) and 6 patients with cyst. The nodules were 7-60 mm (mean 31 mm) in diameter. 1 ml of ethanol was instilled per 1 cm3 of nodule tissue. 1-5 (mean 2.6) sessions were conducted at one month intervals. The early follow-up evaluation of the results (the evaluation of nodule size by means of clinical and ultrasound examination) was performed after 6 months, and the long-term one after 2 years since the last injection. A morphological evaluation was conducted according to the following scale: 1--nodule disappearance, 2--cicatricial nodule (solid structure in the ultrasonography and less than 0.5 cm in diameter), 3--nodule smaller by [symbol: see text] 50% of initial dimensions, 4--nodule smaller by < 50% of initial dimensions. A final follow-up evaluation revealed: nodule disappearance in 15 (37.5%) patients (Group 1), cicatricial nodule in 10 (25%) patients (Group 2), nodules smaller by [symbol: see text] 50% of initial dimensions in 7 (17.5%) patients (Group 3) and nodules smaller by < 50% of initial dimensions in 8 (20%) patients (Group 4). The results in Group 1 and 2 were defined as good (25 patients--62.5%), in Group 3 as satisfactory (17.5%) and in Group 4 as bad. The results of treatment of cysts and nodules in recurrent goitre were good or satisfactory. The following complications were observed: 1) pain during and after the injection in 29 (72.5%) patients, 2) subfebrile body temperature ap to 38 degrees C in 4 (10%) patients and fever up to 39 degrees C on the 1-st day after the injection in 2 (5%) patients, 3) ecchymosis in 1 (2.5%) patient, 4) temporary dysphonia in 2 (5%) patients, 6) temporary unilateral vocal cord paralysis and temporary Horner syndrome in 1 (2.5%) patient. It seems that percutaneous ethanol injection can be useful treatment method of solitary benign non-toxic thyroid nodules, both cysts and solid nodules, in patients who do not consent to surgical treatment or with contraindications to an operation.

Thyroid cryotherapy in an experimental rat model

In recent years cryotherapy has been more and more frequently used for the treatment of tumors of different organs. Until now, the use of cryotherapy for the treatment of thyroid lesions, as well as histopathologic changes in thyroid tissue after cryotherapy, has not been described. Nitrous oxide cryotherapy of one thyroid lobe in twenty 12-week male Wistar rats was performed. After 2 and 4 weeks, the cryotreated thyroid lobe and the second lobe along with a part of the trachea, esophagus, and the subhyoid muscles adhering to the thyroid were excised and assessed macro- and microscopically. The macroscopic evaluation, performed 2 and 4 weeks postcryotherapy, revealed atrophy of the cryotreated lobe in 4 and 3 rats, respectively, and reduction of the cryotreated lobe dimensions in 6 and 7 rats, respectively. In the specimens of the lobes excised 2 weeks following cryotherapy, examined microscopically, necrosis, granulomatous inflammation, hemorrhages, and hemosiderin deposits were found most often, whereas in the specimens of the lobe excised after 4 weeks lymphocytic inflammation and fibrosis were mainly observed. No microscopic changes were observed in the thyroid lobes that were not frozen or in the parathyroid glands located inside these lobes or extrathyroidally, either ipsilaterally or contralaterally to the cryotreated thyroid lobes. There was no microscopic damage to other tissues adjacent to the thyroid gland. No rat developed vocal cord dysfunction after cryotherapy and no significant changes in serum calcium level before and after cryotherapy were observed. The results obtained show that it is possible to cryoblate thyroid tissue without damaging the tissues adjacent to the thyroid, as well as to spare function of the recurrent laryngeal nerves and parathyroid glands.

The surgical treatment of adrenal gland tumors--incidentaloma

Analysis of 32 patients operated on because of accidentally discovered adrenal tumors "incidentaloma" is presented. In 12 of them there was subclinical hormonal activity, in 9 of them tumors turned out to be pheochromocytoma and 3 of them were cortex adenoma. There were 20 hormonally inactive tumors, in 5 of them there were malignant lesions (4 of the cortex and 1 of the medulla). For evaluation of hormonal activity of adrenal tumors evaluation of chromogranin A and cortisol serum blood level or urine free cortisol level is recommended. For precise localization of the tumor beside USG also CT examination is of use. According to the high percentage of malignant lesions in "incidentaloma" type tumors, surgery treatment without delay is recommended. BAC or DHES in blood serum examinations were not found helpful in preoperative evaluating the lesions as benign or malignant. In case of preoperatively found subclinical hormonal hyperactivity of medulla pharmacological treatment with alpha and beta blockers in surgery preparation is recommended. Lateral extraperitoneal access for adrenalectomy is considered safe and provides good operational view. Laparoscopic procedure because of high percentage of malignant lesions in this group of patients is not justified.

Percutaneous ethanol injection in treatment of benign nonfunctional and hyperfunctional thyroid nodules

In recent years a new method of treatment of thyroid disorders, percutaneous ethanol injection (PEI), has been successfully used as an alternative to surgery for the management of benign nodules. In this study 103 females and 5 males (34.4 +/- 11.3 yrs) with nonfunctional cystic (23) or solid (38) nodules, and also 47 with hyperfunctional solid nodules, were treated with single or repeated ethanol injections. In all patients, the cytological studies, ultrasound evaluation and the levels of free triiodothyronine (fT3), free thyroxine (fT4), and thyrotropin or thyroids-stimulating hormone (TSH) before and after ethanol administration, were determined. The patients were followed up for 12-36 months. The size of the benign nonfunctional nodules was totally reduced in 49.9% of cases with solid and in 60.9% of patients with cystic nodules. Hyperthyroidism was cured in 91.5% of patients. The PEI procedure was connected with a few significant complications only, in relation to the localization of nodules. It was cheap, possible on an outpatient basis, easy to perform and acceptable to patients. Since the cost of thyroidectomy is high and the complication rate significant, PEI is a suitable substitute treatment especially for some patients with small toxic benign nodules of the thyroid gland.

[About changes in the structure of surgically treated goiter]

On the base of our own goiter material treated surgically between 1974-1996, we compared incidence of various types of goiter and thyroid carcinoma in years 1974-1985 and 1986-1996. We stated statistically significant decrease of operated Basedow goiter and significant incidence increase of thyroid cancer. In given years frequency of incidence of differentiated and anaplastic thyroid carcinoma have been changed.

[Antigens CA-50 and CA-242 in digestive tract and thyroid neoplasms]

The aim of the study was to assess the CEA antigen and glycoproteins associated antigen CA-50 and CA-242 in tumours of digestive tract and thyroid gland. 84 patients were the material of the study-33 with digestive tracts' neoplasms (among them 22 cases of large bowel cancer and 11 with cancer of pancreas) and 51 with thyroid neoplasms (30 patients with well differentiated thyroid cancer, 21 follicular adenomas of thyroid). There were assessed level of CA-50 and CA-242 glycoprotein associated antigens. Results were compared with CEA-for digestive tract cancer and Tg levels in thyroid neoplasm respectively. In large bowel cancer (22 cases) there were in 10 patients (45%) with elevated level of CEA, 14 patients with elevated CA-50 (63%) and the same number for CA-242 (14 patients-63%). In cancer of pancreas (total 11 patients) there were CEA elevated level in 3 (27%) patients, CA-50 in 7 (64%) patients and CA-242 in 6 (55%) patients. Patients with well differentiated thyroid cancer (30 cases) revealed elevated level of Tg in 24 (80%) patients, CA-50 in 4 (13%), and CA-242 in 4 (13%) ones. The patients with follicular adenomas (21) had elevated Tg level in 17 (80%) cases, CA-50 in 3 (14%) cases and CA-242 in one patient (4.7%).

[Strumectomy in children and adolescents--personal studies with 12,000 operations]

At the Surgery Clinic of the Endocrinology Institute in Lódź we operated 12 344 patients between 1974 and 1992 because of various types of goitre. Among these there were 295 children and adolescents, 2.4%- aged between 9-18 years: 268 girls (90.8%) and 27 boys (9.2%). The goitre was 9.9 times more frequent in girls than in boys. In adults the ratio was 8:1.

[Thyroid neoplasms in children and adolescents--personal experience]

Between 1974-1992 we operated 12,344 patients at the Clinic of Surgery of the Institute of Endocrinology of the Lódź Medical Academy for various forms of goiter. Of these, 295 patients were between the ages of 9-18 years, including 268 (90.8%) girls and 27 (9.2%) boys. Malignant thyroid neoplasm was diagnosed in 19 of these children (6.4%). From among the 268 girls, malignant tumors were discovered in 15 (5.6%), while among the 27 boys, in 4 (14.8%). Ten of these neoplasms were carcinoma papillare, 9 carcinoma folliculare. All of the children are alive without signs of metastases or recurrence. None developed hypoparathyroidism, but one child presented unilateral paresis of the vocal chords.