RESUMEN
The incidence rates of phaeochromocytoma and colorectal cancer (CRC) are approximately 1 and 65 per 100,000 per year, respectively. Simultaneous presentation of these conditions is rare and poses unique management challenges. We report on treatment strategies and clinical outcomes in a series of patients with colorectal neoplasia and phaeochromocytoma. Demographic and clinical details of four patients over a 4-year period were reviewed. The median (range) age at first presentation was 66 (52-70) years. Phaeochromocytoma (2.5-12.5 cm) was confirmed on biochemistry after incidental detection of an adrenal mass on CT scan-three had CT for staging of CRC and one had CT scan for weight loss. Adrenalectomy (three retroperitoneoscopic and one open procedure) was first performed after maximally tolerated alpha blockade; no significant complications were observed. Normalisation of biochemistry was confirmed and the patients then underwent colorectal surgery-laparoscopic right hemicolectomy, open right hemicolectomy (with further extensive surgery) for locally advanced cancer, laparoscopic low anterior resection and open high anterior resection. One respiratory infection and a seroma were the post-operative complications seen. In patients with a simultaneous diagnosis of phaeochromocytoma and CRC, surgical interventions should be staged. Adrenalectomy should first be performed to avoid haemodynamic instability during colorectal resection. A retroperitoneoscopic approach to the adrenal in patients with ipsilateral colonic tumours avoids transgressing the planes for colorectal resection. The synchronous diagnosis of these two rare conditions and the reported stimulatory effect of catecholamines on colorectal epithelia raise the possibility of an increased incidence of colorectal neoplasia in patients with phaeochromocytoma.
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BACKGROUND: Near infrared fluorescence imaging using intravenous methylene blue (MB) is a novel technique that has potential to aid the parathyroid gland (PG) localization during thyroid and parathyroid surgery. The aim of this study was to examine MB fluorescence in the rabbit neck and determine the influence of MB dose and time following administration on fluorescence from thyroid and PGs. METHODS: Thyroid and external PGs were exposed in six New Zealand white rabbits under anesthesia. Varying doses of MB (0.025-3 mg/kg) were injected through the marginal ear vein. Near infrared fluorescence from exposed tissues was recorded at different time intervals (10-74 min) using Fluobeam 700. Specimens of identified glands were then resected for histologic assessment. RESULTS: Histology confirmed accurate identification of all excised thyroid and PGs; these were the only neck structures to demonstrate significant fluorescence. The parathyroid demonstrated lower fluorescence intensities and reduced washout times at all MB doses compared with the thyroid gland. A dose of 0.1 mg/kg MB was adequate to identify fluorescence; this also delineated the blood supply of the external PGs. CONCLUSIONS: The study demonstrates that near infrared fluorescence with intravenous MB helps differentiate between thyroid and PGs in the rabbit. This has potential to improve outcomes in thyroid and parathyroid surgery by increasing the accuracy of parathyroid identification; however, the findings require replication in human surgery. The use of low doses of MB may also avoid the side effects associated with currently used doses in humans (3-7 mg/kg).
Asunto(s)
Azul de Metileno , Glándulas Paratiroides/anatomía & histología , Espectrometría de Fluorescencia/métodos , Espectroscopía Infrarroja Corta/métodos , Glándula Tiroides/anatomía & histología , Animales , Disección/métodos , Inhibidores Enzimáticos/farmacocinética , Femenino , Inyecciones Intravenosas , Periodo Intraoperatorio , Masculino , Azul de Metileno/farmacocinética , Cuello/cirugía , Glándulas Paratiroides/metabolismo , Glándulas Paratiroides/cirugía , Conejos , Glándula Tiroides/metabolismo , Glándula Tiroides/cirugíaRESUMEN
BACKGROUND: Differentiated thyroid cancer (DTC) has excellent long term survival in most patients. Long-term treatment related morbidity is therefore important, but may not be well characterised. The aim of this study was to conduct an electronic survey of clinicians involved in the care of patients with DTC to determine their views on treatment related morbidity. METHODS: A nine item questionnaire was developed, piloted locally and sent by email to members of three United Kingdom (UK) medical organisations (Thyroid Cancer Forum, British Association of Endocrine and Thyroid Surgeons, British Thyroid Association). RESULTS: 125 responses were received. Less than 5% of respondents had a formal protocol to detect morbidity associated with TSH suppression. Over 50% agreed that morbidity from TSH suppression is not well defined. The majority of responders also agreed that the long-term morbidity of hypocalcaemia, significant voice change and TSH suppression in DTC are not well characterised. Physicians perceived treatment related morbidity to be a bigger problem than surgeons (P = 0.019). CONCLUSION: Clinicians treating thyroid cancer agree that long-term treatment related morbidity from DTC is not well characterised. A study of the prevalence and severity of treatment related morbidity and its impact on health of patients with DTC is warranted.
RESUMEN
PURPOSE: This paper is a review of the evidence base to produce recommendations for the use of intraoperative parathyroid hormone (PTH), radioguided parathyroidectomy (RGP), methylene blue (MB), frozen section, and intraoperative neuromonitoring during surgery for primary hyperparathyroidism (PHPT). MATERIALS AND METHODS: A Medline keyword search of English-language articles led to the production of a draft document, subsequently revised by committee, containing levels of evidence and the grading of recommendations as proposed by the Agency for Healthcare Research and Quality. RESULTS: Literature review provides the basis for clear recommendations on the use of intraoperative PTH at surgery for PHPT. There is little evidence to support the use of RGP, MB, routine frozen section, and intraoperative neuromonitoring.