A. Ben Nun, M. Soudack and L.A. Best
Background: Thyroidectomy for goiter is a common surgical procedure performed in most hospitals in Israel. Both general and ear, nose and throat surgeons are familiar with thyroidectomy for cervical goiters. In about 1–15% of thyroidectomies, the goiter is intrathoracic and requires somewhat different management. This topic has not been reviewed in the literature recently.
Objective: To evaluate the clinical presentation, preoperative workup, surgical complications and risk of malignancy in retrosternal goiters.
Methods: We retrospectively reviewed the records of 75 patients who underwent thyroidectomy for retrosternal goiter in the General Thoracic Surgical Department of our institution during a 15 year period, January 1990 to January 2005.
Results: All the patients (41 women and 34 men) were symptomatic at presentation, with choking and dyspnea being the most common complaint. Computerized tomography scan of the neck and chest were obtained before the operation in 71 patients (95%). Ten patients (13%) had a previous partial thyroidectomy. A cervical approach was used in 68 patients (91%). Seven patients (9%) required median sternotomy to complete the operation. One patient (1.3%) died from postoperative respiratory failure. Transient recurrent laryngeal nerve palsy occurred in 5 patients (7%) and permanent RLNP[1] in 3 (4%). The incidence of transient and permanent hypoparathyroidism was 10% and 2.6% respectively. Sixty-six lesions (88%) were benign and 9 (12%) were malignant.
Conclusions: Choking and dyspnea are the most common presenting symptoms of retrosternal goiter. CT scan is an important component of the preoperative evaluation and operative planning. Surgical removal of the thyroid is the treatment of choice and most patients have symptomatic improvement following the operation. Since a substernal thyroidectomy may be technically different from cervical thyroidectomy, a surgical team familiar with its unique pitfalls should perform the procedure.
R. Dabby, M. Sadeh, O. Herman, E. Berger, N. Watemberg, S. Hayek, J. Jossiphov and Y. Nevo
Background: Persistent creatine kinase elevation is occasionally encountered in subjects without any clinical manifestation of a neuromuscular disorder or any condition known to be associated with increased serum CK[1] levels. It is still unresolved whether extensive investigations and specifically a muscle biopsy should be performed in clinically normal individuals with elevated CK levels.
Objective: To study the muscle pathology of patients with asymptomatic or minimally symptomatic hyperCKemia.
Methods: The clinical and laboratory data of patients with persistent hyperCKemia and normal neurologic examination were reviewed and their muscle biopsies evaluated.
Results: The study group included 40 patients aged 7–67 years; the male to female ratio was 3:1. Nineteen patients were completely asymptomatic, 20 had mild non-specific myalgia, and 1 had muscle cramps. Electromyography was performed in 27 patients and showed myopathic changes in 7 (26%). Abnormal muscle biopsy findings (e.g., increased variation in fiber size, increased number of central nuclei and occasional degenerating fibers) were detected in 22 of the 40 patients (55%). No fat or glycogen accumulation was detected. Immunohistochemistry demonstrated abnormal dystrophin staining in 3 patients (8%), resembling the pathologic changes of Becker muscular dystrophy. No abnormal findings were detected on immunohistochemical staining for merosin, dysferlin, caveolin 3, or alpha and gamma sarcoglycans. The EMG[2] findings did not correlate with the pathologic findings.
Conclusions: Abnormal muscle biopsies were found in 55% of patients with asymptomatic or minimally symptomatic hyperCKemia. Specific diagnosis of muscular dystrophy, however, was possible in only 8% of the patients.
A. Peretz, H. Checkoway, J.D. Kaufman, I. Trajber and Y. Lerman
Evidence that crystalline silica is associated with an increased rate of lung cancer led the International Agency for Research on Cancer to conclude in 1997 that crystalline silica is a known human carcinogen. In Israel too, crystalline silica is considered as such. The decision raised a debate in the scientific arena, and a few scientists have questioned the basis upon which causality was determined. We review the literature regarding the level of evidence of crystalline silica carcinogenicity.
J. Rovensky
Klinefelter's syndrome, which occurs in males, is not a rare gonosomal aberration. The disorder is characterized by micro-orchidism.
T. Ben-Hur
Human embryonic stem cells may serve as a potentially endeless source of transplantable cells to treat various neurologic disorders. Accumulating data have shown the therapeutic value of various neural precursor cell types in experimental models of neurologic diseases. Tailoring cell therapy for specific disorders requires the generation of cells that are committed to specific neural lineages. To this end, protocols have been developed recently for the derivation of dopaminergic neurons, spinal motor neurons and oligodendrocytes from hESC. These protocols recapitulate normal development in culture conditions. However, a novel concept emerging from these studies is that the beneficial effect of transplanted stem cells is not only via cell replacement in damaged host tissue, but also by trophic and protective effects, as well as by an immunomodulatory effect that down-regulates detrimental brain inflammation.
E. Averbukh and E. Banin
Diabetic retinopathy is one of the leading causes of blindness worldwide.
S.C. Shapira
The care of the trauma victim can be divided into five to six phases, none of which can be bypassed.
R.M Spira, P. Reissman, S. Goldberg, M. Hersch and S. Einav
Three decades have elapsed since the inception of Level I trauma centers as the final link in the trauma system "chain of survival".
M. Stein
The first Trauma Unit in Israel was founded at the Hadassah (Ein Kerem) Medical Center in 1992 - the result of increased awareness to the new concept of optimal care for the injured patient.
S. Kivity, B. Shalmon and Y. Sidi
Intravascular lymphoma is a rare sub-type of extranodal diffuse large B cell lymphoma characterized by the presence of lymphoma cells only in the lumina of small vessels, particulary capillaries
Y. Raniel, Z. Machamudov and H.J. Garzozi
Dirofilariasis is a parasitic disease of domestic and wild animals that occasionally appears in humans.
K. Khazim, C. Simsolo, M. Nahir, F. Vigder and A. Blum
Chronic periaortitis is a rare disease affecting the abdominal aorta, usually below the level of the renal arteries.
J.U. Holle, D. Capraru, E. Csernok, W.L. Gross and P. Lamprecht
Tumor necrosis factor-associated fever syndrome is an autosomal dominant disorder caused by mutations of the TNFRSF 1A gene encoding the 55 kD TNF receptor (p55 TNF-RI).
G.P. Georghiou, B.A. Vidne and M. Saute
A 32 year old man presented with a huge tumor in the right chest wall that had increased dramatically in size over the previous 6 months.