Gland surgery最新文献

Background: Postoperative pancreatic fistula (POPF) is a common complication after pancreaticoduodenectomy (PD). The effect of the location of the main pancreatic duct on POPF development is not completely elucidated. This study aimed to investigate the association between the location of the main pancreatic duct and POPF, and the effect of pancreaticojejunostomy based on the location of the main pancreatic duct on the risk of POPF.

Methods: This retrospective study enrolled 871 patients who underwent PD between January 2018 and December 2021. Logistic regression analysis was performed to identify the independent risk factors associated with POPF. Predictive performance was evaluated using the receiver operating characteristic curves. In addition, a novel pancreaticojejunostomy strategy that could reduce the risk of POPF was adopted.

Results: Based on the multivariate analysis, the pancreatic texture and the location of the main pancreatic duct were the independent risk factors of POPF. A threshold ratio of 0.397 was used to distinguish the central from the eccentric pancreatic ducts. Notably, patients with the central pancreatic duct had a significantly lower incidence rate of POPF than those with the eccentric pancreatic ducts (10.6% vs. 44.8%, P<0.001). The novel group exhibited a significantly lower incidence rate of POPF than the conventional group (13.7% vs. 23.0%, P=0.02), and the incidence rate of other complications was not high.

Conclusions: The location of the main pancreatic duct is associated with POPF development. However, implementing the novel pancreaticojejunostomy approach can effectively reduce the risk of POPF while ensuring safety.

Background: Polyacrylamide hydrogel (PAAG) injection has been used for breast augmentation, enjoying popularity for nearly 20 years in the late 20^th century. However, numerous complications were gradually observed in the years following the injection, including breast lumps, inflammation, firmness, and migration. Distant migration of breast fillers is relatively rare.

Case description: This case report describes the treatment of a patient who experienced complications due to distant migration of fillers after PAAG injection for breast augmentation. The patient had a right-sided lumboabdominal mass measured approximately 35 cm × 20 cm, with asymmetrical breasts and a significantly smaller right-side breast compared to the left-side. The patient underwent surgery to extract the breast augmentation material from the lumboabdominal wall and breasts, followed by a robot-assisted excision of the lumboabdominal wall capsule and removal of residual breast augmentation agent in breasts, and immediate prosthetic breast reconstruction. Postoperative abdominal scarring was strategically concealed in an area that can be covered by pants, and the breast incisions were hidden under the axillary regions. The patient was satisfied with the abdominal scarring and reconstructed breasts.

Conclusions: Robot-assisted excision of the lumboabdominal wall capsule is a feasible technique for extensive migration of breast fillers in the future. Further follow-up is needed to determine the long-term effects.

Background: Breast cancer with lung metastases (BCLM) is a serious condition that often leads to early death. This study aims to screen the risk factors of early death in BCLM patients and establish a simple and accurate nomogram prediction model. Identifying prognostic markers and developing accurate prediction models can help guide clinical decision-making.

Methods: The Surveillance, Epidemiology, and End Results (SEER) database was used to analyze a sizable sample of data, encompassing 4,238 BCLM patients diagnosed between 2010 and 2015. Stepwise regression was used to manage the collinearity of variables and to construct a prediction model based on the histogram. The results were subjected to internal validation and contrasted with those of related investigations.

Results: Of the 4,238 BCLM patients in this study, 3,232 did not die early. Of the 1,006 premature deaths, 891 were cancer specific. Lymph node involvement, tumor size, age, and race were all recognized as prognostic markers for premature mortality. A nomogram was constructed based on these factors to reliably predict cancer-specific death and early all-cause death.

Conclusions: This study gives new insights into the prognosis of individuals with BCLM and finds critical prognostic variables for early mortality. The created nomogram might assist physicians in identifying individuals at high risk of early mortality and making treatment options.

Background: Recently, endoscope has been widely used in thyroid surgery and gasless insufflation transaxillary endoscopic thyroidectomy (GTET) has been the mainstay of thyroid surgery. Parathyroid gland (PG) damage is a common complication of thyroid surgery. Therefore, the aim of this study was to investigate the effect of GTET on hypoparathyroidism (HPT) in patients with thyroid cancer.

Methods: According to the surgical approach, the patients were divided into a GTET group and a conventional open thyroidectomy (COT) group. Univariate analysis and logistic regression were used to identify factors associated with PG injury. The odds ratio (OR) and 95% confidence interval (CI) for each independent variable were calculated.

Results: A retrospective analysis was conducted on 405 patients diagnosed with papillary thyroid cancer (PTC). A total of 51 patients experienced PG injury, including 7 cases (5%) of GTET group and 44 cases (16.5%) of COT group (P<0.001). Among them, the incidence of GTET group injury with one PG was 50.4%, two were 2.9%, and COT group were 59.8% and 7.9%, respectively (P=0.006). Univariate and multivariate analysis revealed that GTET was a protective factor for PG injury (OR, 0.251; 95% CI, 0.110-0.576; P=0.001), while Hashimoto's thyroiditis (HT) was identified as a risk factor for PG injury (OR, 2.722; 95% CI, 1.114-6.654; P=0.02).

Conclusions: GTET reduces the incidence of PG injury and nerve injury, when PTC is combined with HT, it increases the risk of PG injury.

Background: Ectopic thyroid carcinoma in the mandible is extraordinarily rare; few histologically proven cases have been reported in the literature. Embryologically, cases of ectopic thyroid occur with a developmental abnormality during the migration of the thyroid gland from the floor of the primitive foregut to its final position in the neck. Ectopic thyroid tissue can be found around the course of the thyroglossal duct or laterally in the neck, and even in the mediastinum or below the diaphragm. Since 90% of ectopic thyroid tissues are located at tongue bases, the mandible ectopic thyroid gland is extremely rare. Theoretically, ectopic thyroid glands in the mandible are unlikely to become cancerous. Clinically, follicular carcinoma is less common than papillary carcinoma in both the ectopic thyroid regions and the eutopic anterior neck position. This case is the first to report a cancerous ectopic thyroid in the mandibular bone with eutopic thyroid follicular adenoma and adenomatous goiter.

Case description: Here, we report a case of mandible follicular thyroid cancer (MFTC). A 72-year-old male was presented with a chief complaint of pain and discomfort in the lower right back tooth that had persisted for over 3 months, with cone-beam computed tomography (CBCT) revealing a mass in the right mandible. The patient's mandible mass was removed via right hemimandibulectomy, and reconstruction was simultaneously performed using free autogenous rib grafts. The postoperative pathology diagnosis revealed follicular thyroid carcinoma. In addition, this patient underwent a total thyroidectomy at another hospital 3 years ago for benign thyroid lesions.

Conclusions: In conclusion, we present a rare case of ectopic follicular thyroid carcinoma located in the right mandible, accompanied by benign eutopic thyroid lesions. Effective management of such cases necessitates a multidisciplinary approach, and surgical resection is recommended for ectopic follicular thyroid carcinoma.

Background: Bronchogenic cysts are rare congenital diseases, which are believed to occur through the separation of small diverticula buds from an abnormal budding process in the primitive foregut during the formation of the tracheobronchial tree. Ectopic types located in the thyroid region are extremely rare.

Case description: In this study, we present two cases of cervical bronchogenic cysts identified during minimally invasive video-assisted thyroidectomy (MIVAT). The first case involved a 24-year-old male who presented with a persistent neck mass measuring 41 mm in the right cervical region for a duration of 2 weeks. The second case involved a 36-year-old male diagnosed with right papillary thyroid cancer for 2 months. The presence of any additional lesions was not identified prior to surgery. During surgery, the cysts were identified, resembling metastatic lymph nodes or lymphatic tuberculosis. Both cases were diagnosed with bronchogenic cysts with typical pathological features. The patients achieved successful recovery with no recurrence observed during the follow-up period. The morphological characteristics showed both variations and commonalities intraoperatively.

Conclusions: This report aims to enhance the awareness of cervical bronchogenic cysts by providing comprehensive insights into the imaging, pathology, and clinical features. Since the lack of trustworthy preoperative diagnosis, we recommend suitable patients to have all suspected bronchogenic cysts removed via surgery, especially complete excision.

Background: Tuberculosis (TB) poses a significant global health challenge. While the incidence of breast TB (BTB) is relatively low, it can easily be mistaken for breast cancer or breast granulomatous lobulitis, potentially delaying timely intervention. The gold standard for diagnosis consists of Mycobacterium TB culture and Ziehl-Neelsen staining. Treatment typically consists of a combination of anti-TB therapy and surgical intervention.

Case description: Our research group recently reported a case of BTB accompanied by rib bone destruction. Initially, imaging examinations suggested breast cancer with bone metastasis. However, subsequent real-time ultrasound-guided biopsy revealed chronic inflammation with granulomatous inflammation and extensive necrosis, which led to the diagnosis of BTB. Further T cells spot test (T-SPOT) testing predicted the likelihood of the presence of TB infection, and magnetic resonance imaging (MRI) indicated a high likelihood of TB. A biopsy of the breast lesions was performed and subsequent polymerase chain reaction (PCR) analysis of the aspirated specimens confirmed the presence of DNA from the Mycobacterium TB complex, as well as genes associated with rifampicin resistance. These findings led to the definitive diagnosis of BTB complicated by bone destruction. The patient underwent a 4-month course of anti-TB medication, followed by surgical intervention and an additional regimen of anti-TB drugs. Nine months post-surgery, the patient exhibited no indications of recurrence.

Conclusions: The diagnosis of BTB with bone destruction is challenging, and clinicians need to be vigilant not to misdiagnose it as breast cancer or granulomatous lobulitis.