Hemithyroidectomy is the preferred initial operative approach for an indeterminate fine needle aspiration biopsy diagnosis.

Background: Fine needle aspiration biopsy represents the critical initial diagnostic test used for evaluation of thyroid nodules. Our objectives were to determine the cytological distribution, the utility of clinicopathologic characteristics for predicting malignancy and the true proportion of cancer among individuals who presented with indeterminate cytology and had undergone thyroid surgery for suspicion of cancer.

Methods: We retrospectively reviewed 1040 consecutive primary thyroid operations carried out over an 8-year period at a tertiary care endocrine referral centre.

Intestinal spirochetosis presenting as acute appendicitis.

Acute appendicitis is a frequent pathology encountered by general surgeons. On the differential of aetiologies that can lead to this diagnosis lies the spectrum of infectious disease. We present a case report of a patient who presented to our institution as a classic acute appendicitis.

Determinants of Tc-99m sestamibi SPECT scan sensitivity in primary hyperparathyroidism.

Background: The aim of this study was to evaluate the influence of patient and adenoma characteristics on (99m)Tc-methoxy isobutyl isonitrile (MIBI) scan performance in individuals diagnosed with primary hyperparathyroidism (PHP).

Methods: Records of patients undergoing parathyroidectomy for PHP over 6 years at a single center were reviewed.

Results: The overall true-positive (TP) rate for (99m)Tc-MIBI scans was 56%.

Intact parathyroid hormone measurement 1 hour after thyroid surgery identifies individuals at high risk for the development of symptomatic hypocalcemia.

Background: There is currently no consensus regarding the utilization of intact parathyroid hormone (iPTH) for predicting postthyroid surgery hypocalcemia. The objective of this study was to determine a threshold value for the 1-hour postoperative iPTH level that can identify those patients at significantly increased risk for the development of symptomatic hypocalcemia.

Methods: A prospective study of 21 individuals undergoing either total or completion thyroid operations was performed.

The cost-effectiveness of three strategies for the surgical treatment of symptomatic primary hyperparathyroidism.

Introduction: Modern surgical approaches to the treatment of primary hyperparathyroidism [unilateral neck exploration (UNE) and minimally invasive parathyroidectomy (MIP)] have become commonplace in recent years. However, the cost-effectiveness of these strategies has been questioned since the effectiveness of the gold standard, bilateral neck exploration (BNE), is well established. The objective of our study was to determine the incremental cost effectiveness of UNE and MIP compared with BNE for treatment of primary hyperparathyroidism (HPT).

Utility of intraoperative parathyroid hormone measurement in predicting postparathyroidectomy hypocalcemia.

Objective: To evaluate the role of a standardized intraoperative parathyroid hormone (PTH) assay in predicting postoperative hypocalcemia following parathyroidectomy for primary hyperparathyroidism.

Study Design: Prospective series of 66 patients undergoing unilateral or bilateral parathyroidectomy between January 2004 and June 2005.

Setting: Tertiary care centre in Vancouver, British Columbia.

Cell cycle regulators show diagnostic and prognostic utility for differentiated thyroid cancer.

Background: Differentiated thyroid cancer (DTC) generally has a favorable outcome, but some patients develop local recurrence and/or distant metastases and ultimately die of their disease. Molecular markers that accurately predict tumor behavior are lacking. This study's aim was to ascertain the role of cell cycle regulators in predicting malignant histology and tumor behavior in DTC.

Anaplastic thyroid carcinoma: expression profile of targets for therapy offers new insights for disease treatment.

Background: Anaplastic thyroid cancer is an endocrine malignancy. Its rare and rapidly lethal disease course has made it challenging to study. Little is known regarding the expression by anaplastic tumors of molecular targets for new human anticancer agents that have been studied in the preclinical or clinical setting.

Hemithyroidectomy: the preferred initial surgical approach for management of Hurthle cell neoplasm.

Background: The objective of this study was to evaluate the cancer risk of patient clinicopathologic characteristics to determine the optimal approach for the surgical management of individuals with Hurthle cell neoplasm (HN) diagnosed by cytology.

Methods: Patient clinicopathologic characteristics evaluated included age, sex, tumor size, and ipsilateral thyroid lobe nodularity. The association of these characteristics with a pathologic cancer diagnosis was evaluated using Fisher's exact test and Student t test.

Normocalcemic parathyroid carcinoma: an unusual clinical presentation.

Background: Parathyroid carcinoma is a rare cause of primary hyperparathyroidism and may be associated with significant disease related morbidity and mortality. Preoperative diagnosis remains a challenge, which may jeopardize appropriate and successful patient treatment.

Case Presentation: We report a case of parathyroid carcinoma diagnosed in a 60-year-old woman that presented with a tender nodule located at the left lower thyroid pole and had been present for several years.

Hemithyroidectomy: the optimal initial surgical approach for individuals undergoing surgery for a cytological diagnosis of follicular neoplasm.

Background: The primary objective of this study was to determine the true proportion and optimal surgical approach for individuals undergoing thyroid operation for a suspicion of cancer based on a fine-needle aspiration biopsy diagnosis of a follicular neoplasm (FN). A secondary objective of this study was to determine whether patient characteristics could assist the clinician in predicting malignancy in this FN patient cohort.

Methods: A retrospective chart, pathology, and cytology review of 370 consecutive primary thyroid operations was performed over a 4-year period at a tertiary care referral center.

Selective unilateral parathyroid exploration: an effective treatment for primary hyperparathyroidism.

Background: Unilateral neck exploration (UNE) is a well-recognized approach in the treatment of primary hyperparathyroidism (PHP). The objective of this study was to review the success of an approach involving UNE guided by preoperative sestamibi (SM) scanning.

Methods: All data were gathered by retrospective chart review.

Detecting and defining hypothyroidism after hemithyroidectomy.

Background: The incidence of hypothyroidism after hemithyroidectomy for benign thyroid disease remains uncertain. This study examines the incidence, natural history, and the factors contributing to hypothyroidism after hemithyroidectomy.

Methods: A retrospective review of patients undergoing hemithyroidectomy over 37 months was performed.

An evaluation of prognostic scoring systems in patients with follicular thyroid cancer.

Background: Prognostic scoring systems for thyroid cancer have not been investigated in patients with pure follicular cancer; thus, the purpose of this study was to compare the following prognostic indices: the European Organization for Research and Treatment of Cancer (EORTC) method; the Age, Grade, Extent, Size (AGES) score; and the Age, Metastasis, Extent, Size (ALIES) score.

Patients And Methods: A retrospective study reviewing 122 patients actively treated between 1955 and 1990 was conducted. Scoring systems were calculated and survival analysis completed.

Fine-wire localization for nonpalpable mammographic abnormalities.

Objective: To determine the predictive value of fine-wire localization (FWL) biopsy.

Design: A chart review.

Setting: The Royal Columbian Hospital, New Westminster, BC.

Technetium99m-sestamibi scanning before initial neck exploration in patients with primary hyperparathyroidism.

Technetium99m (Tc) sestamibi(mibi) has been proposed as an alternative to the standard radionuclide imaging technique of thallium 201 chloride-99mTc pertechnetate subtraction scan (TTS) in patients with primary hyperparathyroidism. In the present study, mibi was evaluated as an alternative to TTS in 37 patients who had either mibi-99mTc pertechnetate subtraction scans, mibi-iodine123 (I) subtraction scans or mibi single isotope washout scans. There were 30 females and 7 males with an average age of 57 years (range, 27-78 years).

Review of the pathologic diagnoses of 2,216 appendectomy specimens.

A retrospective review of 2,216 patients surgically treated for a clinical diagnosis of acute appendicitis was performed. In 80% of cases, histologic acute appendicitis was found; 57% of these patients were male. The rate of normal appendectomy was 16%, and females comprised 68% of that group.

Role of frozen section and clinical parameters in distinguishing benign from malignant follicular neoplasms of the thyroid.

The determination of malignancy preoperatively or intraoperatively is difficult in patients with follicular neoplasms of the thyroid. This study reviews a series of 395 patients treated for follicular neoplasms at the Vancouver General Hospital and the British Columbia Cancer Agency between the years of 1955 and 1988, 198 of whom had frozen section at the time of surgery. Frozen section was 79% accurate in differentiating follicular adenomas from carcinomas, with a sensitivity of 52% and a specificity of 100%.

Management of blunt and penetrating colon injuries.

The records of 28 patients with traumatic colon injuries (TCI) were retrospectively reviewed. Sixteen patients (57%) with 17 TCI had blunt trauma, whereas 8 patients (29%) experienced penetrating trauma. Four TCI were from intraluminal injury.

Sternocleidomastoid flap following parotidectomy.

The sternocleidomastoid (SCM) muscle has been used in various ways for reconstruction following cancer resections in the head and neck. Its use has been restricted because of the presumed precarious nature of its blood supply and its proximity to disease. Patients with large or recurrent benign parotid tumors were the first in our series to have a SCM muscle flap (either superiorly or inferiorly based) used to improve cosmesis.

The analysis of natural killer cell activity by flow cytometry.

A flow cytometric assay was used to detect the lytic and binding capacities of both fresh peripheral blood lymphocytes and purified Leu-19+ natural killer cells against head and neck cancer cell lines. Results demonstrated that natural killer cell-mediated cytotoxicity and effector-target conjugate formation evaluated by flow cytometry was significantly correlated with the standard chromium 51 release assay and the single-cell microscopic assay, respectively. The sorted Leu-19+ natural killer cells demonstrated higher lytic capacity with a corresponding higher binding rate compared with the unsorted peripheral blood lymphocytes and sorted Leu-19- cells.

Differential sensitivity of head and neck cancers to non-major histocompatibility-restricted killer cell activity.

Cell lines derived from squamous cell carcinoma of the upper aerodigestive tract (head and neck cancer) were phenotypically characterized with regard to differential sensitivity to nonmajor histocompatibility restricted (non-MHCr) killer cell activity. Requirements for detectable lysis of the cell lines in a standard chromium release assay included either isolation of fresh enriched Leu 19+ large granular lymphocytes (both Leu 19+CD3+ and Leu 19+CD3- populations) or interleukin-2 (IL-2) stimulation of peripheral blood lymphocytes (PBL). In neither circumstance could lytic activity be identified among Leu 19- populations.

Inhibition of lymphokine-activated killer cell generation by blocking factors in sera of patients with head and neck cancer.

Cytolytic activation of peripheral blood lymphocytes by recombinant interleukin-2 (rIL-2) in patients with squamous cell carcinoma (SCC) of the head and neck may be inhibited by serum blocking factors, and this could influence therapeutic efficacy. Peripheral blood lymphocytes from 21 patients with this disease and 17 controls were incubated with 10-1000 U rIL-2 for 6 days in supplemented complete medium (containing 10% fetal calf serum) or the same medium plus 10% autologous serum. After washing the effector cells, we determined their cytotoxicity against K562 and MDA1386, a lymphokine-activated-killer(LAK)-sensitive SCC cell line, using a 51Cr-release assay.