1
|
Milinkovic M, Soldatovic I, Zivaljevic V, Bozic V, Zivotic M, Tatic S, Dundjerovic D. Comprehensive Investigation of Angiogenesis, PASS Score and Immunohistochemical Factors in Risk Assessment of Malignancy for Paraganglioma and Pheochromocytoma. Diagnostics (Basel) 2024; 14:849. [PMID: 38667494 PMCID: PMC11049119 DOI: 10.3390/diagnostics14080849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 04/02/2024] [Accepted: 04/12/2024] [Indexed: 04/28/2024] Open
Abstract
A challenging task in routine practice is finding the distinction between benign and malignant paragangliomas and pheochromocytomas. The aim of this study is to conduct a comparative analysis of angiogenesis by assessing intratumoral microvascular density (MVD) with immunohistochemical (IHC) markers (CD31, CD34, CD105, ERG), and S100 immunoreactivity, Ki67 proliferative index, succinate dehydrogenase B (SDHB) expressiveness, tumor size with one the most utilized score Pheochromocytoma of Adrenal Gland Scales Score (PASS), using tissue microarray (TMA) with 115 tumor samples, 61 benign (PASS < 4) and 54 potentially malignant (PASS ≥ 4). We found no notable difference between intratumoral MVD and potentially malignant behavior. The group of potentially malignant tumors is significantly larger in size, has lower intratumoral MVD, and a decreased number of S100 labeled sustentacular cells. Both groups have low proliferative activity (mean Ki67 is 1.02 and 1.22, respectively). Most tumors maintain SDHB expression, only 6 cases (5.2%) showed a loss of expression (4 of them in PASS < 4 group and 2 in PASS ≥ 4). PASS score is easily available for assessment and complemented with markers of biological behavior to complete the risk stratification algorithm. Size is directly related to PASS score and malignancy. Intratumoral MVD is extensively developed but it is not crucial in evaluating the malignant potential.
Collapse
Affiliation(s)
- Marija Milinkovic
- Department of Pathology, University Clinical Center of Serbia, 11000 Belgrade, Serbia;
| | - Ivan Soldatovic
- Institute for Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia;
| | - Vladan Zivaljevic
- Clinic for Endocrine Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia;
| | - Vesna Bozic
- Department of Pathology, University Clinical Center of Serbia, 11000 Belgrade, Serbia;
| | - Maja Zivotic
- Institute of Pathology, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (M.Z.); (S.T.); (D.D.)
| | - Svetislav Tatic
- Institute of Pathology, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (M.Z.); (S.T.); (D.D.)
| | - Dusko Dundjerovic
- Institute of Pathology, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (M.Z.); (S.T.); (D.D.)
| |
Collapse
|
2
|
Apostolou K, Paunovic I, Frountzas M, Zivaljevic V, Tausanovic K, Karanikas M, Koutelidakis I, Schizas D. Posthemithyroidectomy Hypothyroidism: Updated Meta-Analysis of Risk Factors and Rates of Remission. J Surg Res 2024; 293:102-120. [PMID: 37734294 DOI: 10.1016/j.jss.2023.08.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 07/09/2023] [Accepted: 08/23/2023] [Indexed: 09/23/2023]
Abstract
INTRODUCTION The aim of this study was to determine the incidence and risk factors for hypothyroidism, both clinical and subclinical, following hemithyroidectomy in preoperatively euthyroid patients, as well as hypothyroidism remission and its time of remission. MATERIALS AND METHODS A search was performed in Medline (via PubMed), Web of Science, and the Cochrane Library using the keywords "hemithyroidectomy + postoperative + hypothyroidism" and "hemithyroidectomy + hormone supplementation". RESULTS Fifty-four studies with a total of 9,999 patients were included. After a mean follow-up interval of 48.2 mo, the pooled hypothyroidism rate was 29%. The subclinical hypothyroidism rate was 79% of patients with hypothyroidism (18 studies). Moreover, a meta-analysis of 12 studies indicated a pooled hypothyroidism remission rate after hemithyroidectomy of 42% (95% CI: 24%-60%). Older patient age (MD = -2.54, 95% CI = -3.99, -1.10, P = 0.0006), female gender (OR = 0.69, 95% CI = 0.58, 0.82, P < 0.0001), higher preoperative thyroid-stimulating hormone levels (MD = -0,81, 95% CI = -0.96, -0.66, P < 0.00001), pathological preoperative anti-thyroid peroxidase antibodies (OR = 0.37, 95% CI = 0.24, 0.57, P < 0.00001) and anti-thyroglobulin antibodies (OR = 0.52, 95% CI = 0.36, 0.75, P = 00,005), and right-sided hemithyroidectomy (OR = 0.54, 95% CI = 0.43, 0.68, P < 0.00001) were associated with postoperative hypothyroidism development. In metaregression analysis, Asia presented a significantly higher hypothyroidism rate after hemithyroidectomy (34.6%, 95% CI = 29.3%-9.9%), compared to Europe (22.9%, 95% CI = 16.2%-29.5%, P = 0.037) and Canada (1.8%, 95% CI = -22.6%-26.2%, P = 0.013). CONCLUSIONS Hypothyroidism is a frequent and significant postoperative sequela of hemithyroidectomy, necessitating individualization of treatment strategy based on the underlying disease as well as the estimated risk of hypothyroidism and its risk factors.
Collapse
Affiliation(s)
- Konstantinos Apostolou
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece.
| | - Ivan Paunovic
- Centre for Endocrine Surgery, Clinical Centre of Serbia, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Maximos Frountzas
- 1st Department of Propaedeutic Surgery, Medical School University of Athens, "Hippocratio" General Hospital, Athens, Greece
| | - Vladan Zivaljevic
- Centre for Endocrine Surgery, Clinical Centre of Serbia, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Katarina Tausanovic
- Centre for Endocrine Surgery, Clinical Centre of Serbia, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Michael Karanikas
- 1st University Surgical Department, University Hospital of Alexandropoulis, Democritus University of Thrace, Alexandroupolis, Greece
| | - Ioannis Koutelidakis
- Second Department of Surgery, Aristotle University of Thessaloniki, G. Gennimatas General Hospital, Thessaloniki, Greece
| | - Dimitrios Schizas
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| |
Collapse
|
3
|
Pantelic V, Zunjic S, Paunovic I, Zivaljevic V, Pilipovic M, Radosavljevic I. The clinical and histopathological characteristics of thyroid gland diseases in adolescents requiring surgical treatment: a ten-year follow-up study. Nagoya J Med Sci 2023; 85:733-744. [PMID: 38155612 PMCID: PMC10751504 DOI: 10.18999/nagjms.85.4.733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 11/21/2022] [Indexed: 12/30/2023]
Abstract
The present research aimed to determine the clinical and pathohistological characteristics of thyroid gland diseases in adolescents who were previously surgically treated at the Endocrine Surgery Center of the University Medical Center of Serbia from 01/01/2001 to 01/01/2011. The study covered 170 patients of both sexes from the population of adolescents (aged 16 to 20 years) with various malignant and benign thyroid gland diseases. The data for this study were extracted from the medical histories of patients and the electronic database of the Center for Endocrine Surgery. Detailed data analysis included diagnosis, symptomatology, surgical intervention type, and disease stage. The following thyroid status parameters were analyzed from preoperative data: thyroxine (T4), thyroxine free fraction (FT4), triiodothyronine (T3), triiodothyronine free fraction (FT3), and thyroid stimulating hormone (TSH). In addition, the pathohistological features of diagnosed thyroid diseases were also determined, with a special focus on the presence of well-differentiated cancers. Papillary carcinomas were the most common of well-differentiated cancers in adolescents over the ten-year follow-up period. Based on the assessed data, total thyroidectomy was the most commonly used type of surgical intervention in these patients. The conducted research provides essential information related to both the biological characteristics and diagnostics of these cancers and their surgical treatment in such a sensitive population. Moreover, research showed that the clinical presentation of thyroid cancer in adolescents is almost identical to that in adults.
Collapse
Affiliation(s)
| | - Sasa Zunjic
- Department of Surgery, General Hospital Valjevo, Valjevo, Serbia
| | - Ivan Paunovic
- Center for Endocrine Surgery, Institute of Endocrinology, Diabetes and Metabolism Diseases, Clinical Center of Serbia, Belgrade, Serbia
| | - Vladan Zivaljevic
- Center for Endocrine Surgery, Institute of Endocrinology, Diabetes and Metabolism Diseases, Clinical Center of Serbia, Belgrade, Serbia
| | - Miljana Pilipovic
- Department of Pulmonology, University Clinical Center of Vojvodina, Novi Sad, Serbia
| | - Ivan Radosavljevic
- Department of Surgery, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| |
Collapse
|
4
|
Jovanovic M, Zivaljevic V, Sipetic Grujicic S, Tausanovic K, Slijepcevic N, Rovcanin B, Jovanovic K, Odalovic B, Buzejic M, Bukumiric Z, Paunovic I. Effects of successful parathyroidectomy on neuropsychological and cognitive status in patients with asymptomatic primary hyperparathyroidism. Endocrine 2023; 81:592-601. [PMID: 37340287 DOI: 10.1007/s12020-023-03426-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 06/10/2023] [Indexed: 06/22/2023]
Abstract
PURPOSE Besides typical clinical symptoms, primary hyperparathyroidism (pHPT) is associated with impaired quality of life and cognitive status. The aim of this study was to evaluate the quality of life and cognitive impairment in patients with pHPT, before and after parathyroidectomy. METHODS We conducted a panel study, which included asymptomatic pHPT patients scheduled for parathyroidectomy. Besides demographic and clinical data, patients' quality of life and cognitive capacity were recorded before, 1 month, and 6 months following parathyroidectomy using the Short Form 36 questionnaire (RAND-36), Beck Depression Inventory (BDI), Depression Anxiety Stress Scales (DASS), Mini-Mental State Examination (MMSE), and Symptom Check List 90-revised version (SCL90R). RESULTS During a 2-year follow-up, 101 patients entered the study (88 women), with an average age of 60.7 years. The Global score of RAND-36 test ameliorated by almost 50% 6 months after parathyroidectomy. The most sustained subscores of the RAND-36 test were role functioning/physical and health change, with an improvement of more than 125%. According to the BDI, DASS depression subscore, and SCL90R depression subscore, the extent of depressive symptoms reduction was approximately 60% 6 months postoperatively. The level of anxiety was reduced by 62.4%, measured by both the DASS and SCL90R anxiety subscores. The stress level was almost halved according to the DASS stress subscore (from 10.7 to 5.6 points). The results of the MMSE test showed a significant improvement postoperatively, for 1.2 points (4.4%). A worse preoperative score of each tool was related to the higher magnitude of improvement 6 months after parathyroidectomy. CONCLUSION A considerable number of pHPT patients, even without other typical symptoms, show signs of impaired quality of life and neurocognitive status preoperatively. After a successful parathyroidectomy, there is an improvement in quality of life, declined levels of depression, anxiety, and stress, as well as amelioration of cognitive status. Patients with more impaired quality of life and pronounced neurocognitive symptoms may expect more benefits from the surgery.
Collapse
Affiliation(s)
- Milan Jovanovic
- Clinic for Endocrine Surgery, University Clinical Center of Serbia, Belgrade, Serbia.
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
| | - Vladan Zivaljevic
- Clinic for Endocrine Surgery, University Clinical Center of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | | | - Katarina Tausanovic
- Clinic for Endocrine Surgery, University Clinical Center of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Nikola Slijepcevic
- Clinic for Endocrine Surgery, University Clinical Center of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Branislav Rovcanin
- Clinic for Endocrine Surgery, University Clinical Center of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Ksenija Jovanovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Center for Anesthesiology and Resuscitation, University Clinical Center of Serbia, Belgrade, Serbia
| | - Bozidar Odalovic
- Clinic for Endocrine Surgery, University Clinical Center of Serbia, Belgrade, Serbia
- Faculty of Medicine Pristina/K. Mitrovica, University of Pristina/K. Mitrovica, K. Mitrovica, Serbia
| | - Matija Buzejic
- Clinic for Endocrine Surgery, University Clinical Center of Serbia, Belgrade, Serbia
| | - Zoran Bukumiric
- Institute of Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Ivan Paunovic
- Clinic for Endocrine Surgery, University Clinical Center of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| |
Collapse
|
5
|
Zivaljevic V, Zivic R, Slijepcevic N, Buzejic M, Dundjerovic D, Trbojevic Stankovic J, Stojakov D, Jovanovic M, Paunovic I. Parathyroid carcinoma in chronic renal disease - a case series of three patients and review of literature. Acta Chir Belg 2023; 123:199-206. [PMID: 34459368 DOI: 10.1080/00015458.2021.1970438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Apart from being a rare endocrine tumor, parathyroid carcinoma is also one of the rarest malignancies in human beings. Parathyroid carcinoma is even more uncommon in haemodialysis patients with end-stage renal disease. The pathogenesis of parathyroid hyperplasia in haemodialysis patients is well known, but the mechanism of development of parathyroid carcinoma in these patients remains unclear. METHODS Three cases of parathyroid carcinoma in haemodialysis patients are presented in this study: a 69-year-old male patient and two female patients (67 and 61 years old). In all cases parathyroid carcinoma infiltrated the ipsilateral thyroid lobe and in one patient the right laryngeal nerve was involved as well. One patient underwent three surgical procedures. RESULTS After surgical treatment, all patients were normocalcaemic and showed a significant reduction in PTH levels. CONCLUSION In patients with secondary hyperparathyroidism, who develop parathyroid carcinoma, surgical resection is the only viable treatment option.
Collapse
Affiliation(s)
- Vladan Zivaljevic
- Center for Endocrine Surgery, Clinical Center of Serbia, Belgrade, Serbia.,School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Rastko Zivic
- School of Medicine, University of Belgrade, Belgrade, Serbia.,Surgery Clinic, Clinical Centre "Dr. Dragisa Misovic - Dedinje", Belgrade, Serbia
| | - Nikola Slijepcevic
- Center for Endocrine Surgery, Clinical Center of Serbia, Belgrade, Serbia.,School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Matija Buzejic
- Center for Endocrine Surgery, Clinical Center of Serbia, Belgrade, Serbia
| | - Dusko Dundjerovic
- School of Medicine, University of Belgrade, Belgrade, Serbia.,School of Medicine, Institute for Pathological Anatomy, University of Belgrade, Belgrade, Serbia
| | - Jasna Trbojevic Stankovic
- School of Medicine, University of Belgrade, Belgrade, Serbia.,Department of Nephrology, Urological Clinic, Clinical Centre "Dr. Dragisa Misovic - Dedinje", Belgrade, Serbia
| | - Dejan Stojakov
- School of Medicine, University of Belgrade, Belgrade, Serbia.,Surgery Clinic, Clinical Centre "Dr. Dragisa Misovic - Dedinje", Belgrade, Serbia
| | - Milan Jovanovic
- Center for Endocrine Surgery, Clinical Center of Serbia, Belgrade, Serbia.,School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Ivan Paunovic
- Center for Endocrine Surgery, Clinical Center of Serbia, Belgrade, Serbia.,School of Medicine, University of Belgrade, Belgrade, Serbia
| |
Collapse
|
6
|
Tausanovic K, Zivaljevic V, Grujicic SS, Jovanovic K, Jovanovic V, Paunovic I. Case Control Study of Risk Factors for Occurrence of Postoperative Hematoma After Thyroid Surgery: Ten Year Analysis of 6938 Operations in a Tertiary Center in Serbia. World J Surg 2022; 46:2416-2422. [PMID: 35798991 DOI: 10.1007/s00268-022-06634-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Post-thyroidectomy bleeding is rare, but potentially life-threatening complication. Early recognition with immediate intervention is crucial for the management of this complication. Therefore, it is very important to identify possible risk factors of postoperative hemorrhage as well as timing of postoperative hematoma occurrence. METHODS Retrospective review of 6938 patients undergoing thyroidectomy in a tertiary center in a ten year period (2009-2019) revealed 72 patients with postoperative hemorrhage requiring reoperation. Each patient who developed postoperative hematoma was matched with four control patients that did not develop postoperative hematoma after thyroidectomy. The patients and controls were matched by the date of operation and surgeon performing thyroidectomy. RESULTS The incidence of postoperative bleeding was 1.04%. On univariate analysis older age, male sex, higher BMI, higher ASA score, preoperative use of anticoagulant therapy, thyroidectomy for retrosternal goiter, larger thyroid specimens, larger dominant nodules, longer operative time, higher postoperative blood pressure and the use of postoperative subcutaneous heparin were identified as risk factors for postoperative bleeding. Sixty-nine patients (95.8%) bled within first 24 h after surgery. CONCLUSION The rate of postoperative bleeding in our study is consistent with recent literature. Male sex, the use of preoperative anticoagulant therapy, thyroidectomy for retrosternal goiter and the use of postoperative subcutaneous heparin remained statistically significant on multivariate analysis (p < 0.001). When identified, these risk factors may be an obstacle to the outpatient thyroidectomy in our settings.
Collapse
Affiliation(s)
- Katarina Tausanovic
- Clinic for Endocrine Surgery, University Clinical Center of Serbia, Koste Todorovica 8, 11000, Belgrade, Serbia. .,Faculty of Medicine, Belgrade University, Doktora Subotica 8, 11000, Belgrade, Serbia.
| | - Vladan Zivaljevic
- Clinic for Endocrine Surgery, University Clinical Center of Serbia, Koste Todorovica 8, 11000, Belgrade, Serbia.,Faculty of Medicine, Belgrade University, Doktora Subotica 8, 11000, Belgrade, Serbia
| | - Sandra Sipetic Grujicic
- Faculty of Medicine, Institute of Epidemiology, Belgrade University, Visegradska 26, 11000, Belgrade, Serbia.,Faculty of Medicine, Belgrade University, Doktora Subotica 8, 11000, Belgrade, Serbia
| | - Ksenija Jovanovic
- Center for Anesthesiology and Resuscitation, University Clinical Center of Serbia, Pasterova 2, 11000, Belgrade, Serbia.,Faculty of Medicine, Belgrade University, Doktora Subotica 8, 11000, Belgrade, Serbia
| | - Vesna Jovanovic
- Center for Anesthesiology and Resuscitation, University Clinical Center of Serbia, Pasterova 2, 11000, Belgrade, Serbia.,Faculty of Medicine, Belgrade University, Doktora Subotica 8, 11000, Belgrade, Serbia
| | - Ivan Paunovic
- Clinic for Endocrine Surgery, University Clinical Center of Serbia, Koste Todorovica 8, 11000, Belgrade, Serbia.,Faculty of Medicine, Belgrade University, Doktora Subotica 8, 11000, Belgrade, Serbia
| |
Collapse
|
7
|
Jovanovic K, Kalezic N, Sipetic Grujicic S, Zivaljevic V, Jovanovic M, Kukic B, Trailovic R, Zlatanovic P, Mutavdzic P, Tomic I, Ilic N, Davidovic L. Preoperative Anxiety is Associated With Postoperative Complications in Vascular Surgery: A Cross-Sectional Study. World J Surg 2022; 46:1987-1996. [PMID: 35507076 DOI: 10.1007/s00268-022-06575-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Preoperative anxiety is associated with increased morbidity and/or mortality in surgical patients. This study investigated the incidence, predictors, and association of preoperative anxiety with postoperative complications in vascular surgery. METHODS Consecutive patients undergoing aortic, carotid, and peripheral artery surgery, under general and regional anesthesia, from February until October 2019 were included in a cross-sectional study. Anesthesiologists assessed preoperative anxiety using a validated Serbian version of the Amsterdam Preoperative Anxiety and Information Scale. Patients were divided into groups with low/high anxiety, both anesthesia- and surgery-related. Statistical analysis included multivariate linear logistic regression and point-biserial correlation. RESULTS Of 402 patients interviewed, 16 were excluded and one patient refused to participate (response rate 99.7%). Out of 385 patients included (age range 39-86 years), 62.3% had previous surgery. High-level anesthesia- and surgery-related anxieties were present in 31.2 and 43.4% of patients, respectively. Independent predictors of high-level anesthesia-related anxiety were having no children (OR = 0.443, 95% CI: 0.239-0.821, p = 0.01), personal bad experiences with anesthesia (OR = 2.294, 95% CI: 1.043-5.045, p = 0.039), and time since diagnosis for ≥ 4 months (OR = 1.634, 95% CI: 1.023-5.983, p = 0.04). The female sex independently predicted high-level surgery-related preoperative anxiety (OR = 2.387, 95% CI: 1.432-3.979, p = 0.001). High-level anesthesia-related anxiety correlated with postoperative mental disorders (rpb = 0.193, p = 0.001) and pulmonary complications (rpb = 0.104, p = 0.042). Postoperative nausea (rpb = 0.111, p = 0.03) and postoperative mental disorders (rpb = 0.160, p = 0.002) correlated with high-level surgery-related preoperative anxiety. CONCLUSIONS Since preoperative anxiety affects the postoperative course and almost every third patient experiences anxiety preoperatively, routine screening might be recommended in vascular surgery.
Collapse
Affiliation(s)
- Ksenija Jovanovic
- Center for Anesthesiology and Resuscitation, University Clinical Center of Serbia, Pasterova 2 St, 11000, Belgrade, Serbia. .,Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
| | - Nevena Kalezic
- Center for Anesthesiology and Resuscitation, University Clinical Center of Serbia, Pasterova 2 St, 11000, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | | | - Vladan Zivaljevic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Center for Endocrine Surgery, University Clinical Center of Serbia, Belgrade, Serbia
| | - Milan Jovanovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Center for Endocrine Surgery, University Clinical Center of Serbia, Belgrade, Serbia
| | - Biljana Kukic
- Center for Anesthesiology and Resuscitation, University Clinical Center of Serbia, Pasterova 2 St, 11000, Belgrade, Serbia
| | - Ranko Trailovic
- Center for Anesthesiology and Resuscitation, University Clinical Center of Serbia, Pasterova 2 St, 11000, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Petar Zlatanovic
- Clinic for Vascular and Endovascular Surgery, University Clinical Center of Serbia, Belgrade, Serbia
| | - Perica Mutavdzic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Clinic for Vascular and Endovascular Surgery, University Clinical Center of Serbia, Belgrade, Serbia
| | - Ivan Tomic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Clinic for Vascular and Endovascular Surgery, University Clinical Center of Serbia, Belgrade, Serbia
| | - Nikola Ilic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Clinic for Vascular and Endovascular Surgery, University Clinical Center of Serbia, Belgrade, Serbia
| | - Lazar Davidovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Clinic for Vascular and Endovascular Surgery, University Clinical Center of Serbia, Belgrade, Serbia
| |
Collapse
|
8
|
Jovanovic K, Kalezic N, Sipetic Grujicic S, Zivaljevic V, Jovanovic M, Savic M, Bukumiric Z, Dragas M, Sladojevic M, Trailovic R, Koncar I, Davidovic L. Translation and validation of the Amsterdam preoperative anxiety and information scale (APAIS) in Serbia. Brain Behav 2022; 12:e2462. [PMID: 34908243 PMCID: PMC8785621 DOI: 10.1002/brb3.2462] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 06/22/2021] [Accepted: 11/14/2021] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVES Preoperative anxiety is common and might affect surgical treatment outcomes. The aim was to translate and validate the Serbian version of the Amsterdam Preoperative Anxiety and Information Scale (APAIS). METHODS Following translation and initial evaluation, the Serbian version (S-APAIS) was administered to 385 patients. Internal consistency, construct validity, prognostic criteria validity, and concurrent validity between S-APAIS and Visual Analogue Scale for Anxiety (VAS-A) were evaluated. RESULTS Factor analysis revealed two factors: APAIS-anesthesia (items 1, 2, 3) and APAIS-procedure (items 4, 5, 6). The whole scale, APAIS-anesthesia, and APAIS-procedure subscales showed an adequate level of internal consistency (Cronbach's αs: 0.787, 0.806, and 0.805, respectively). High concurrent validity was observed between APAIS-anesthesia and VAS-A (ρ = 0.628, p < .001). A moderate correlation was found between APAIS-procedure and VAS-A scale (ρ = 0.537, p < .001). At the cut-off point of 9, the area under the curve (AUC) of APAIS-anesthesia was 0.815 (95% CI: 0.77-0.85, p < .001). For the APAIS-procedure, AUC was 0.772 (95% CI: 0.73-0.81, p < .001) at the cut-off point of 8. CONCLUSION The structure of S-APAIS substantially differs from the original and allows separate measurement of anesthesia- and procedure-related anxieties. S-APAIS is a comprehensive, valid, and reliable instrument for the measurement of preoperative anxiety.
Collapse
Affiliation(s)
- Ksenija Jovanovic
- Center for Anesthesiology and ResuscitationUniversity Clinical Center of SerbiaBelgradeSerbia
- Faculty of MedicineUniversity of BelgradeBelgradeSerbia
| | - Nevena Kalezic
- Center for Anesthesiology and ResuscitationUniversity Clinical Center of SerbiaBelgradeSerbia
- Faculty of MedicineUniversity of BelgradeBelgradeSerbia
| | | | - Vladan Zivaljevic
- Faculty of MedicineUniversity of BelgradeBelgradeSerbia
- Center for Endocrine SurgeryUniversity Clinical Center of SerbiaBelgradeSerbia
| | - Milan Jovanovic
- Faculty of MedicineUniversity of BelgradeBelgradeSerbia
- Center for Endocrine SurgeryUniversity Clinical Center of SerbiaBelgradeSerbia
| | - Milica Savic
- Center for Anesthesiology and ResuscitationUniversity Clinical Center of SerbiaBelgradeSerbia
| | - Zoran Bukumiric
- Institute of Medical Statistics and InformaticsFaculty of Medicine, University of BelgradeBelgradeSerbia
| | - Marko Dragas
- Faculty of MedicineUniversity of BelgradeBelgradeSerbia
- Clinic for Vascular and Endovascular SurgeryUniversity Clinical Center of SerbiaBelgradeSerbia
| | - Milos Sladojevic
- Faculty of MedicineUniversity of BelgradeBelgradeSerbia
- Clinic for Vascular and Endovascular SurgeryUniversity Clinical Center of SerbiaBelgradeSerbia
| | - Ranko Trailovic
- Center for Anesthesiology and ResuscitationUniversity Clinical Center of SerbiaBelgradeSerbia
- Faculty of MedicineUniversity of BelgradeBelgradeSerbia
| | - Igor Koncar
- Faculty of MedicineUniversity of BelgradeBelgradeSerbia
- Clinic for Vascular and Endovascular SurgeryUniversity Clinical Center of SerbiaBelgradeSerbia
| | - Lazar Davidovic
- Faculty of MedicineUniversity of BelgradeBelgradeSerbia
- Clinic for Vascular and Endovascular SurgeryUniversity Clinical Center of SerbiaBelgradeSerbia
| |
Collapse
|
9
|
Stojanovic M, Kalezic N, Milicic B, Zivkovic M, Ivosevic T, Lakicevic M, Zivaljevic V. Risk Factors for New Onset Atrial Fibrillation during Thyroid Gland Surgery. Med Princ Pract 2022; 31:570-577. [PMID: 36273458 PMCID: PMC9841760 DOI: 10.1159/000527272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 09/21/2022] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE Thyroid dysfunction is a common cause of atrial fibrillation (AF). Incidence of AF is high in patients with both expressed and subclinical hyperthyroidism. The aim of our study was to determine the incidence and predictors of new onset atrial fibrillation (NOAF) in euthyroid patients undergoing thyroid surgery. SUBJECT AND METHODS The study included 1,252 euthyroid patients with American Society of Anesthesiologists (ASA) physical status ASA 2 and ASA 3, who were 18 years and older and were in sinus rhythm. Patients without comorbidity and patients with persistent AF were excluded. We investigated the influence of the following preoperative characteristics on the occurrence of NOAF: age, sex, body mass index, ASA score, admission diagnoses, and comorbidity. We noted the influence of difficult intubation of trachea, type and duration of surgery, and time under general anaesthesia. Univariate and multivariate logistic regression were used to determine predictors of occurrence of NOAF. RESULTS NOAF was noted in 0.72% of patients. Patients with NOAF were older (63.11 vs. 56.81 years) than patients without NOAF, but this was not statistically significant. Significantly more patients from the NOAF group had preoperative heart rhythm disturbance and a history of angina pectoris, in contrast to patients without registered NOAF (p = 0.001; p = 0.017). Multivariate analysis showed that a history of heart rhythm disturbance was an independent predictor of NOAF. CONCLUSIONS Incidence of NOAF during thyroid surgery is similar to the other type of surgery, if the values of thyroid hormones are normal.
Collapse
Affiliation(s)
- Marina Stojanovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Centre for Anaesthesia, University Clinical Centre of Serbia, Belgrade, Serbia
- *Marina Stojanovic,
| | - Nevena Kalezic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Centre for Anaesthesia, University Clinical Centre of Serbia, Belgrade, Serbia
- Centre for Endocrine Surgery, University Clinical Centre of Serbia, Belgrade, Serbia
| | - Biljana Milicic
- Faculty of Dentistry, University of Belgrade, Belgrade, Serbia
| | - Milana Zivkovic
- Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Centre of Serbia, Belgrade, Serbia
| | - Tjasa Ivosevic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Centre for Anaesthesia, University Clinical Centre of Serbia, Belgrade, Serbia
| | - Mirko Lakicevic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Department of Anesthesia, Resuscitation and Pain therapy, Clinical Hospital Centre Zemun, Belgrade, Serbia
| | - Vladan Zivaljevic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Centre for Endocrine Surgery, University Clinical Centre of Serbia, Belgrade, Serbia
| |
Collapse
|
10
|
Rovcanin B, Gopcevic K, Kekic D, Zivaljevic V, Diklic A, Tatic S, Jovanovic M, Odalovic B, Paunovic I. Redox metabolism correlates with cellular turnover and clinical phenotype of papillary thyroid carcinoma and colloid goiter. Arch Med Sci 2022; 18:1308-1317. [PMID: 36160341 PMCID: PMC9479590 DOI: 10.5114/aoms.2019.88374] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 05/01/2019] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Papillary thyroid carcinoma (PTC) and colloid goiter (CG) represent the most common thyroid malignant and benign diseases, respectively. Oxidative stress is considered to have an important role in the pathogenesis of both diseases, but without sufficient and comprehensive data. The aim was to evaluate the redox profile, its influence on cell survival of PTC, comparing it with CG as a control and its relation with demographic, pathological and clinical parameters. MATERIAL AND METHODS We evaluated for the first time the PTC and CG tissue profile of advanced oxidation protein products (AOPP) and total thiols as parameters of redox metabolism and deoxyribonuclease I (DNase I) and deoxyribonuclease II (DNase II) activity as biomarkers of cell turnover and apoptosis. Tissue levels of biochemical parameters were quantified in PTC and CG tissue using spectrophotometric methods. Study parameters were evaluated in light of different demographic, clinical and pathological features of PTC and CG. RESULTS Papillary thyroid carcinoma tissue is characterized by increased antioxidant activity and a normal prooxidation level. Biochemical parameters show numerous correlations with demographic and clinical characteristics of PTC and CG patients. DNase I and II activities are dependent upon the AOPP concentration in PTC tissue. The size of CG can be predicted with combined use of AOPP, DNase I and DNase II. AOPP is the most powerful predictor of PTC capsular invasion, multicentric intrathyroid dissemination and lymph node metastasis phenotype. CONCLUSIONS Evaluated parameters can be used for assessment of tumor redox and survival status and the clinical course of PTC and CG.
Collapse
Affiliation(s)
- Branislav Rovcanin
- Center for Endocrine Surgery, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Kristina Gopcevic
- Institute for Chemistry in Medicine, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Dusan Kekic
- Institute for Microbiology and Immunology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Vladan Zivaljevic
- Center for Endocrine Surgery, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Aleksandar Diklic
- Center for Endocrine Surgery, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Svetislav Tatic
- Institute for Pathology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Milan Jovanovic
- Center for Endocrine Surgery, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Bozidar Odalovic
- Center for Endocrine Surgery, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Ivan Paunovic
- Center for Endocrine Surgery, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| |
Collapse
|
11
|
Apostolou K, Zivaljevic V, Tausanovic K, Zoric G, Chelidonis G, Slijepcevic N, Jovanovic M, Paunovic I. Prevalence and risk factors for thyroid cancer in patients with multinodular goitre. BJS Open 2020; 5:6054049. [PMID: 33688954 PMCID: PMC7944849 DOI: 10.1093/bjsopen/zraa014] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 08/25/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Rates of thyroid cancer in patients with multinodular goitre (MNG) vary widely, from 3 per cent in older studies to 35 per cent in more recent studies. The purpose of the present study was to evaluate the prevalence of thyroid cancer in patients operated on for MNG, and to determine risk factors for incidental thyroid malignancy. METHODS A prospectively developed database of all patients who underwent thyroidectomy for a benign MNG at the high-volume endocrine surgery unit of a tertiary referral university hospital was interrogated. RESULTS A total of 3233 patients were analysed, separated into three groups according to their functional thyroid status (hypothyroid, hyperthyroid or euthyroid). There were 2788 women (86.2 per cent); the mean patient age was 56.4 years and mean preoperative disease duration was 106.2 months. Incidental thyroid cancer was identified in 1026 patients (31.7 per cent), of which 917 (89.4 per cent) were papillary cancers. Multivariable regression analysis identified functional thyroid status, younger age, male sex, smaller adenoma size, smaller thyroid glands, Hashimoto's thyroiditis and chronic non-specific thyroiditis as independent risk factors for thyroid cancer. CONCLUSION MNG was associated with a considerable rate of incidental thyroid cancer, which has been underestimated. A variety of factors should be taken into account when considering the malignant potential of a presumed benign MNG.
Collapse
Affiliation(s)
- K Apostolou
- Centre for Endocrine Surgery, Clinical Centre of Serbia, Belgrade, Serbia
| | - V Zivaljevic
- Centre for Endocrine Surgery, Clinical Centre of Serbia, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - K Tausanovic
- Centre for Endocrine Surgery, Clinical Centre of Serbia, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - G Zoric
- Centre for Endocrine Surgery, Clinical Centre of Serbia, Belgrade, Serbia
| | | | - N Slijepcevic
- Centre for Endocrine Surgery, Clinical Centre of Serbia, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - M Jovanovic
- Centre for Endocrine Surgery, Clinical Centre of Serbia, Belgrade, Serbia
| | - I Paunovic
- Centre for Endocrine Surgery, Clinical Centre of Serbia, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| |
Collapse
|
12
|
Rovcanin B, Stojsavljevic A, Kekic D, Gopcevic K, Manojlovic D, Jovanovic M, Knezevic S, Zivaljevic V, Diklic A, Paunovic I. Correction to: Redox Status and Antioxidative Cofactor Metals Influence Clinical and Pathological Characteristics of Papillary Thyroid Carcinoma and Colloid Goiter. Biol Trace Elem Res 2020; 197:360. [PMID: 32303946 DOI: 10.1007/s12011-020-02155-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The original version of this article unfortunately contained a mistake.
Collapse
Affiliation(s)
- Branislav Rovcanin
- Center for Endocrine Surgery, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
| | | | - Dusan Kekic
- Institute for Microbiology and Immunology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Kristina Gopcevic
- Institute for Chemistry in Medicine, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Dragan Manojlovic
- Faculty of Chemistry, University of Belgrade, Studentski trg 12-16, Belgrade, Serbia
- South Ural State University, Lenin Prospect 76, Chelyabinsk, Russia
| | - Milan Jovanovic
- Center for Endocrine Surgery, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Sasa Knezevic
- Center for Anesthesiology and Resuscitation, Clinical Center of Serbia, Belgrade, Serbia
| | - Vladan Zivaljevic
- Center for Endocrine Surgery, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Aleksandar Diklic
- Center for Endocrine Surgery, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Ivan Paunovic
- Center for Endocrine Surgery, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| |
Collapse
|
13
|
Rovcanin B, Stojsavljevic A, Kekic D, Gopcevic K, Manojlovic D, Jovanovic M, Knezevic S, Zivaljevic V, Diklic A, Paunovic I. Redox Status and Antioxidative Cofactor Metals Influence Clinical and Pathological Characteristics of Papillary Thyroid Carcinoma and Colloid Goiter. Biol Trace Elem Res 2020; 197:349-359. [PMID: 31811573 DOI: 10.1007/s12011-019-01995-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 11/26/2019] [Indexed: 12/22/2022]
Abstract
Papillary thyroid carcinoma (PTC) is the endocrine neoplasm that occurs the most often worldwide, and its molecular pathophysiology is still not well characterized. Redox status is recognized as an important factor of carcinogenesis, but its influence on the PTC's clinical course needs to be better elucidated. The aim of this research was to determine the tissue redox status of 65 PTC and 45 colloid goiter (CG) patients together with antioxidative cofactor metal profiling. The malondialdehyde (MDA) concentration was used to access the prooxidation level, while antioxidant mechanisms were estimated by assaying the activities of superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GPx), and glutathione reductase (GR). The antioxidative cofactor metals included quantification of Se, Cu, Zn, and Mn concentration. PTC tissues had normal prooxidation levels and increased GPx and GR activity. The activity of SOD has been significantly reduced in multicentric PTC dissemination and increased in smokers. SOD activity was directly dependent on MDA levels in CG tissues. CG patients with retrosternal goiter had reduced MDA concentration and SOD activity. Numerous correlations between redox parameters in PTC tissues reveal good co-activation of antioxidative mechanisms and cooperative response on prooxidation. PTC tissues had decreased Se levels and increased concentration of Cu and Mn in comparison to other tissues. MDA concentration and SOD activity were significant predictors of PTC's multicentric dissemination and for the existence of lymph node metastases, respectively. Particularly, the concentration of Cu predicted the retrosternal localization in CG patients. Significant findings presented in this study provide a possibility for development of novel prognostic molecular biomarkers of PTC and CG.
Collapse
Affiliation(s)
- Branislav Rovcanin
- Center for Endocrine Surgery, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
| | | | - Dusan Kekic
- Institute for Microbiology and Immunology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Kristina Gopcevic
- Institute for Chemistry in Medicine, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Dragan Manojlovic
- Faculty of Chemistry, University of Belgrade, Studentski trg 12-16, Belgrade, Serbia
- South Ural State University, Lenin Prospect 76, Chelyabinsk, Russia
| | - Milan Jovanovic
- Center for Endocrine Surgery, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Sasa Knezevic
- Center for Anesthesiology and Resuscitation, Clinical Center of Serbia, Belgrade, Serbia
| | - Vladan Zivaljevic
- Center for Endocrine Surgery, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Aleksandar Diklic
- Center for Endocrine Surgery, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Ivan Paunovic
- Center for Endocrine Surgery, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| |
Collapse
|
14
|
Paunovic I, Rovcanin B, Jovanovic M, Buzejic M, Dundjerovic D, Zivaljevic V. Ectopic thyroid tissue in adrenal gland, case report and review of literature. Gland Surg 2020; 9:1573-1578. [PMID: 33224833 DOI: 10.21037/gs-20-471] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Ectopic thyroid tissue is a rare pathological finding bellow the diaphragm and extremely rare finding is ectopic thyroid tissue in the adrenal gland (ETTAG). Thyroid tissue can be located anywhere along the way of embryological migration pathway of thyroglossal duct. In most cases of ectopic thyroid tissue, it is located in the neck. Here we present a case of 29 years old patient that was laparoscopically operated because of adrenal incidentaloma which showed 28 mm in maximal diameter on MRI. The patient had normal adrenal function. Pathohistological finding confirmed ETTAG. Follicular cells express TTF-1, Thyroglobulin, PAX8, and cytokeratin 7, and lack expression of calretinin. This is the 15th such case described in literature. Women are much more affected than men (14:1), and it usually presents in the fifth decade (mean age 49). In all cases ETTAG was composed of normal follicular cells, and C cells were not found. Review of the literature reveals that adrenal ectopic thyroid tissue is almost always cystic, and has distinctive pathologic features. The most important thing is that ETTAG must be distinguished from metastatic deposits from thyroid gland carcinoma. Our patient had normal thyroid function, without any nodules in thyroid gland. We report the youngest patient with ectopic thyroid tissue located in the adrenal gland.
Collapse
Affiliation(s)
- Ivan Paunovic
- Center for Endocrine surgery, Clinical Center of Serbia, Belgrade, Serbia.,School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Branislav Rovcanin
- Center for Endocrine surgery, Clinical Center of Serbia, Belgrade, Serbia
| | - Milan Jovanovic
- Center for Endocrine surgery, Clinical Center of Serbia, Belgrade, Serbia
| | - Matija Buzejic
- Center for Endocrine surgery, Clinical Center of Serbia, Belgrade, Serbia
| | - Dusko Dundjerovic
- Institute for Pathology, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Vladan Zivaljevic
- Center for Endocrine surgery, Clinical Center of Serbia, Belgrade, Serbia.,School of Medicine, University of Belgrade, Belgrade, Serbia
| |
Collapse
|
15
|
Zivaljevic V, Jovanovic M, Diklic A, Zdravkovic V, Djordjevic M, Paunovic I. Differences in primary hyperparathyroidism characteristics between children and adolescents. J Pediatr Surg 2020; 55:1660-1662. [PMID: 31706616 DOI: 10.1016/j.jpedsurg.2019.09.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 09/17/2019] [Accepted: 09/19/2019] [Indexed: 01/16/2023]
Abstract
BACKGROUND In children and adolescents, primary hyperparathyroidism (pHPT) is rare, associated with severe morbidity, and has different clinical characteristics than in adults. The aim of this study was to analyze differences in clinical and laboratory characteristics between children and adolescents with pHPT. METHODS A retrospective cohort study was conducted to analyze pHPT characteristics in young patients, who have been operated at our institution. All patients were divided into two groups: group of patients ≤15 years (children) and group of patients >15 and ≤20 years (adolescents). RESULTS Out of 1363 pHPT patients surgically treated during the study period, 14 patients (1%) were younger than 20 years: 6 children and 8 adolescents. Male-to-female ratio in children was 2:1, and in adolescents 1:1.7. Kidney stones were found in 62.5% of the adolescents and in none of the children patients. Bone form of the disease was the most frequent in children (in 83.1%), while in adolescents the kidney form was the most frequent (in 50%). Only 16.7% of children and 25% of adolescents did not have classical symptoms. All adolescent patients had single parathyroid adenoma, while 4 children patients had single parathyroid adenoma, one patient had hyperplasia, and one had parathyroid carcinoma. Both preoperative serum calcium and PTH levels were higher in children than in adolescents (3.87 mmol/L vs. 3.17 mmol/L; 812 ng/mL vs. 392 ng/mL, respectively). In all patients vitamin D level was low. All patients had normal postoperative values of serum calcium and PTH. CONCLUSION There is a significant difference in clinical and biochemical characteristics between children and adolescent pHPT patients. Therefore, these two groups should be analyzed and treated separately. TYPE OF STUDY Retrospective comparative study. LEVEL OF EVIDENCE Level III.
Collapse
Affiliation(s)
- Vladan Zivaljevic
- Center of Endocrine Surgery, Clinical Center of Serbia, Belgrade, Serbia; School of Medicine, Belgrade University, Serbia
| | - Milan Jovanovic
- Center of Endocrine Surgery, Clinical Center of Serbia, Belgrade, Serbia.
| | - Aleksandar Diklic
- Center of Endocrine Surgery, Clinical Center of Serbia, Belgrade, Serbia; School of Medicine, Belgrade University, Serbia
| | - Vera Zdravkovic
- School of Medicine, Belgrade University, Serbia; University Children Hospital, Belgrade, Serbia
| | - Maja Djordjevic
- School of Medicine, Belgrade University, Serbia; Mother and Child Health Care Institute "Dr Vukan Cupic", Belgrade, Serbia
| | - Ivan Paunovic
- Center of Endocrine Surgery, Clinical Center of Serbia, Belgrade, Serbia; School of Medicine, Belgrade University, Serbia
| |
Collapse
|
16
|
Jovanovic M, Paunovic I, Zdravkovic V, Djordjevic M, Rovcanin B, Tausanovic K, Slijepcevic N, Zivaljevic V. Case-control study of primary hyperparathyroidism in juvenile vs. adult patients. Int J Pediatr Otorhinolaryngol 2020; 131:109895. [PMID: 31982848 DOI: 10.1016/j.ijporl.2020.109895] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Revised: 01/18/2020] [Accepted: 01/18/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Primary hyperparathyroidism in juveniles is extremely rare condition, but in the last few decades the incidence is increasing. The aim of this study was to compare biochemical and clinical characteristics of juvenile and adult primary hyperparathyroidism patients. METHODS A retrospective case-control study was conducted from 2004 until 2017 in high volume endocrine surgery center. Juvenile group consisted of all primary hyperparathyroidism patients younger than 20 who have undergone parathyroidectomy, and two-fold more patients older than 20 were classified in control (adult) group. RESULTS A total of 14 patients with the age ≤20 years were included in the juvenile group, while 28 patients older than 20 were selected for the control group. Female-to-male ratio in juveniles was 1:1, and in adults 8:1 (p = 0.005). The most common form of the disease in juveniles was bone disease (42.9%) and most of adults were asymptomatic (39.3%). Mean preoperative serum calcium level was significantly higher in juveniles than in adults, 3.47 ± 0.74 mmol/L vs. 2.96 ± 0.25 mmol/L, p = 0.025. Mean preoperative PTH level was higher in juveniles than in control group, 572.6 ± 533.3 ng/L vs. 331.8 ± 347.5 ng/L, p = 0.089. CONCLUSION Clinical manifestations of primary hyperparathyroidism significantly differ in juvenile and adult patients. Juvenile primary hyperparathyroidism represents more severe form of the disease, often with end-organ damages, and it should be considered in patients with unspecific symptoms.
Collapse
Affiliation(s)
- Milan Jovanovic
- Center of Endocrine Surgery, Clinical Center of Serbia, Belgrade, Serbia.
| | - Ivan Paunovic
- Center of Endocrine Surgery, Clinical Center of Serbia, Belgrade, Serbia; School of Medicine, Belgrade University, Serbia
| | - Vera Zdravkovic
- School of Medicine, Belgrade University, Serbia; University Children Hospital, Belgrade, Serbia
| | - Maja Djordjevic
- School of Medicine, Belgrade University, Serbia; Mother and Child Health Care Institute "Dr Vukan Cupic", Belgrade, Serbia
| | - Branislav Rovcanin
- Center of Endocrine Surgery, Clinical Center of Serbia, Belgrade, Serbia
| | - Katarina Tausanovic
- Center of Endocrine Surgery, Clinical Center of Serbia, Belgrade, Serbia; School of Medicine, Belgrade University, Serbia
| | - Nikola Slijepcevic
- Center of Endocrine Surgery, Clinical Center of Serbia, Belgrade, Serbia; School of Medicine, Belgrade University, Serbia
| | - Vladan Zivaljevic
- Center of Endocrine Surgery, Clinical Center of Serbia, Belgrade, Serbia; School of Medicine, Belgrade University, Serbia
| |
Collapse
|
17
|
Zlatibor L, Paunovic I, Zivaljevic V, Dundjerovic D, Tatic S, Djukic V. Prognostic significance of immunohistochemical markers in adrenocortical carcinoma. Acta Chir Belg 2020; 120:23-29. [PMID: 30499377 DOI: 10.1080/00015458.2018.1543822] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background: To present basic demographic and clinical characteristics of patients with adrenocortical carcinoma (ACC), to determine the overall survival rate and to analyze the results of immunohistochemical staining and its correlation with the length of survival.Material and methods: The study was conducted during the period between 1996 and 2010 and included 30 patients with ACC. Immunohistochemical staining (MMP9, melan A, inhibin, caltretinin, D2-40, synaptophysin and Ki-67) was performed.Results: ACC was diagnosed in 19 females and 11 men (1.7:1). The average age was 50.1 years. The median tumor size was 10 cm, the median weight 400 g. Majority of subjects had positive immunohistochemical staining for the markers of interest. Patients with any negative staining had shorter cancer-specific survival than ones with positive staining. According to the log-rank test results as well as according to the results of the univariate Cox analysis, negative staining for inhibin, D2-40 and synaptophysin and Ki-67 expression ≥7% were associated with poorer prognosis.Conclusions: The results of our study suggest that the absence of staining for some immunohistochemical markers and increased expression of Ki-67 are associated with a poorer prognosis and shorter survival of patients with ACC. Immunohistochemical markers may serve as a prognostic factor for ACC.
Collapse
Affiliation(s)
- Loncar Zlatibor
- 1Emergency Centre, Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Ivan Paunovic
- 2Centre for Endocrine Surgery, Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Vladan Zivaljevic
- 2Centre for Endocrine Surgery, Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Dusko Dundjerovic
- 3Faculty of Medicine, Institute of Pathology, University of Belgrade, Belgrade, Serbia
| | - Svetislav Tatic
- 3Faculty of Medicine, Institute of Pathology, University of Belgrade, Belgrade, Serbia
| | - Vladimir Djukic
- 1Emergency Centre, Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| |
Collapse
|
18
|
Todorovic L, Mandusic V, Vucetic-Tadic B, Zivaljevic V, Paunovic I, Stanojevic B. Altered expression of microRNA-30a-3p in papillary thyroid cancer and its association with clinicopathological characteristics. ARCH BIOL SCI 2020. [DOI: 10.2298/abs191004063t] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
A growing number of studies suggest a tumor suppressive role and potential prognostic significance of miR- 30a-3p in different types of cancer. However, relatively few studies have focused on this microRNA in neoplastic thyroid lesions, including papillary thyroid cancer (PTC). The aim of our study was to shed more light on the potential involvement and clinical relevance of miR-30a-3p in this type of cancer. We examined the expression levels of this microRNA in 42 pairs of PTCs and matched non-tumor thyroid tissues using quantitative RT-PCR. We analyzed their association with clinical and histopathological parameters. The results revealed that miR-30a-3p was significantly downregulated in the majority of PTC tissues compared to corresponding non-tumor tissues. Moreover, decreased expression of miR-30a-3p was associated with advanced clinical stage, presence of multiple tumor foci and capsular invasion, suggesting a role in aggressive disease. Although the role of this microRNA and its prognostic utility remain to be elucidated, the presented data suggest that downregulated expression of miR-30a-3p indicates poorer prognosis in PTC patients, warranting further investigations.
Collapse
Affiliation(s)
- Lidija Todorovic
- Laboratory for Radiobiology and Molecular Genetics, “Vinča” Institute of Nuclear Sciences, University of Belgrade, Belgrade, Serbia
| | - Vesna Mandusic
- Laboratory for Radiobiology and Molecular Genetics, “Vinča” Institute of Nuclear Sciences, University of Belgrade, Belgrade, Serbia
| | | | - Vladan Zivaljevic
- Center for Endocrine Surgery, Clinical Center of Serbia, Belgrade, Serbia + School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Ivan Paunovic
- Center for Endocrine Surgery, Clinical Center of Serbia, Belgrade, Serbia + School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Boban Stanojevic
- Laboratory for Radiobiology and Molecular Genetics, “Vinča” Institute of Nuclear Sciences, University of Belgrade, Belgrade, Serbia
| |
Collapse
|
19
|
Zivaljevic V, Jovanovic M, Perunicic V, Paunovic I. Surgical treatment of metastasis to the thyroid gland: a single center experience and literature review. Hippokratia 2018; 22:137-140. [PMID: 31641335 PMCID: PMC6801123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Metastasis to the thyroid gland or nonthyroid malignancy (NTM) is rarely an indication for thyroidectomy and constitute 1-3 % of all thyroid carcinomas. NTM has a poor prognosis, due to the advanced stage of the primary tumor. This study aimed to present the incidence, clinical characteristics, and treatment outcome of NTM in a single, high volume center. CASE SERIES We retrospectively analyzed all patients who had undergone thyroidectomy at the Center for Endocrine Surgery in Belgrade, during the period from 1995 to 2015. Out of 13,385 patients who were submitted to thyroidectomy, 3,344 (24.2 %) patients had thyroid malignancy. The diagnosis of NTM, based on the histopathological findings, was found in ten patients (0.075 % of all patients who had thyroid surgery, i.e., in 0.3 % of patients with thyroid cancer), with a mean age of 59.5 years. The most frequent primary tumor location in NTM was kidney in four patients, esophagus in two patients, and pharynx, breast and lungs (one case each). Total thyroidectomy was performed in four patients and lobectomy in two patients. Mean survival time following thyroid surgery was 43.2 months. CONCLUSION NTM are uncommon, and their prognosis is generally poor and depends on the characteristics of the primary tumor. Nevertheless, in selected cases, surgical treatment of NTM should be considered. HIPPOKRATIA 2018, 22(3): 137-140.
Collapse
Affiliation(s)
- V Zivaljevic
- Center for Endocrine Surgery, Clinical Center of Serbia, Belgrade, Serbia
- School of Medicine, University of Belgrade, Belgrade, Serbia
| | - M Jovanovic
- Center for Endocrine Surgery, Clinical Center of Serbia, Belgrade, Serbia
| | - V Perunicic
- Department of Surgery, General Hospital, Cacak, Serbia
| | - I Paunovic
- Center for Endocrine Surgery, Clinical Center of Serbia, Belgrade, Serbia
- School of Medicine, University of Belgrade, Belgrade, Serbia
| |
Collapse
|
20
|
Slijepcevic N, Zivaljevic V, Diklic A, Jovanovic M, Oluic B, Paunovic I. Risk factors associated with intrathyroid extension of thyroid microcarcinomas. Langenbecks Arch Surg 2018; 403:615-622. [PMID: 29770856 DOI: 10.1007/s00423-018-1680-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 05/07/2018] [Indexed: 10/16/2022]
Abstract
PURPOSE The aims of this study were to investigate the rate of intrathyroid extension of papillary thyroid microcarcinoma (PTMC) in patients operated for benign thyroid disease and to identify independent risk factors associated with it. METHODS A retrospective study of 301 patients operated for benign thyroid diseases (hyperthyroid diseases, multinodular goitre, Hashimoto thyroiditis and benign thyroid tumours) was performed at a high-volume endocrine surgery unit of a tertiary referral academic hospital, in a 5-year period. These patients had a PTMC incidentally discovered on definite histopathological findings following total or near-total thyroidectomy. Since distinguishing between intrathyroid extension of PTMC as the result of intrathyroid dissemination or as the result of multicentricity is challenging, we observed them together as multifocality. In statistical analysis, we used standard descriptive statistics and univariate and multivariate logistic regression analysis to determine independent risk factors associated with multifocality. RESULTS In our study, there were 85.4% females and 14.6% males with a median age of 54 years. A multinodular goitre (32.5%) was the most common indication for an operation. Most patients (68.4%) had a PTMC that was 5 mm or smaller. The most frequent histological variants of PTMC were the follicular variant (52.8%), followed by the papillary variant (22.6%) and the mixed follicular-papillary variant (18.6%). A multifocal PTMC was present in 26.6% of cases. An independent protective factor for multifocality of PTMC was a thyroid gland that weighed more than 38 g (OR 0.55, 95% CI 0.31-0.97, p = 0.039). Size of PTMC greater than 5 mm was an independent risk factor for a multifocal PTMC (OR 3.26, 95% CI 1.85-5.75, p = 0.000). Finally, the mixed follicular-papillary variant of PTMC represents an independent risk factor for a multifocal PTMC (OR 2.42, 95% CI 1.09-5.36, p = 0.030). CONCLUSIONS Intrathyroid extension is present in more than a quarter of PTMCs found in patients operated for benign thyroid disease. Independent risk factors for intrathyroid extension are size of PTMC greater than 5 mm and the mixed follicular-papillary variant of PTMC, while a large thyroid gland is an independent protective factor.
Collapse
Affiliation(s)
- Nikola Slijepcevic
- Centre for Endocrine Surgery, Clinical Centre of Serbia, Koste Todorovica 8, Belgrade, 11000, Serbia. .,Faculty of Medicine, University of Belgrade, Dr Subotica 8, Belgrade, 11000, Serbia.
| | - Vladan Zivaljevic
- Centre for Endocrine Surgery, Clinical Centre of Serbia, Koste Todorovica 8, Belgrade, 11000, Serbia.,Faculty of Medicine, University of Belgrade, Dr Subotica 8, Belgrade, 11000, Serbia
| | - Aleksandar Diklic
- Centre for Endocrine Surgery, Clinical Centre of Serbia, Koste Todorovica 8, Belgrade, 11000, Serbia.,Faculty of Medicine, University of Belgrade, Dr Subotica 8, Belgrade, 11000, Serbia
| | - Milan Jovanovic
- Centre for Endocrine Surgery, Clinical Centre of Serbia, Koste Todorovica 8, Belgrade, 11000, Serbia
| | - Branislav Oluic
- Faculty of Medicine, University of Belgrade, Dr Subotica 8, Belgrade, 11000, Serbia.,Emergency Centre, Clinical Centre of Serbia, Pasterova 2, Belgrade, 11000, Serbia
| | - Ivan Paunovic
- Centre for Endocrine Surgery, Clinical Centre of Serbia, Koste Todorovica 8, Belgrade, 11000, Serbia.,Faculty of Medicine, University of Belgrade, Dr Subotica 8, Belgrade, 11000, Serbia
| |
Collapse
|
21
|
Abstract
Aims and background The aim of the present study was to test some hypothetical risk factors for anaplastic thyroid cancer. Study design A case-control study comprised 110 patients with histologically or cytologically verified anaplastic thyroid cancer and 110 hospital controls individually matched with cases by sex, age, place of residence and time of hospitalization. Univariate and multivariate logistic regressions were used for data analysis. Results According to the conditional logistic regression analysis, the following factors were significantly and independently related to anaplastic thyroid cancer: history of goiter or thyroid nodules (odds ratio, OR, 37.55; 95% confidence interval, CI, 4.86–290.11), history of residence in endemic goiter area (OR, 2.56; 95% CI, 1.05–6.22), history of previous malignant non-thyroid tumor (OR, 5.51; 95% CI, 1.04–29.25), diabetes mellitus (OR, 4.06; 95% CI, 1.29–12.81) and low educational level (OR, 2.44; 95% CI, 1.17–5.06). Conclusions The results are in line with the current knowledge on factors related to thyroid cancer, except for the association between thyroid cancer and diabetes mellitus, which as far as we know has not yet been reported.
Collapse
Affiliation(s)
- Vladan Zivaljevic
- Center for Endocrine Surgery, Institute of Endocrinology, Clinical Center of Serbia, Belgrade, Serbia and Montenegro.
| | | | | | | | | | | |
Collapse
|
22
|
Abstract
Aims and background Thyroid cancer, whose etiology is largely uncertain, has been negatively associated with cigarette smoking in a several studies. We examined the association between cigarette smoking and risk for female thyroid cancer. Methods A case-control study including 204 histologically verified female thyroid cancer patients and an equal number of hospital controls individually matched with cases by sex, age (± 2 years), place of residence and time of hospitalization was carried out during the period 1996-2000. In the analysis of data, univariate and multivariate conditional logistic regression methods were applied. Results According to univariate analysis, female thyroid cancer was negatively associated with the initiation of smoking at a younger age, before the age of 20 (OR = 0.66, 95% CI = 0.50-0.90). None of the smoking habits remained independently related to female thyroid cancer after adjustment for other factors which were significantly associated with thyroid cancer in the present study. Conclusions The results of the study do not suggest a role of cigarette smoking in the development of thyroid cancer in women.
Collapse
Affiliation(s)
- Vladan Zivaljevic
- Center for Endocrine Surgery, Institute of Endocrinology, Clinical Center of Serbia, Belgrade, Serbia and Montenegro.
| | | | | | | | | | | |
Collapse
|
23
|
Abstract
An extremely rare case of parathyroid cancer in a hemodialysis patient is presented here. A 69-year-old man was operated on for secondary hyperparathyroidism due to chronic renal failure. A locally invasive tumor of the right inferior parathyroid gland and enlargement of the other three parathyroid glands were found during bilateral neck exploration. Surgical management consisted of en bloc resection of the right inferior parathyroid gland with the right thyroid lobe and part of a sternothyroid muscle along with subtotal parathyroidectomy of the three enlarged parathyroid glands. Histological examination of the resected tumor provided evidence of a parathyroid cancer in the right inferior parathyroid gland. Nodular hyperplasia was confirmed histologically in the other three glands. With less than 20 previous cases described in the literature, parathyroid cancer is a very rare condition in hemodialysis patients.
Collapse
Affiliation(s)
- Vladan Zivaljevic
- Center for Endocrine Surgery, Institute of Endocrinology, Clinical Center of Serbia, Belgrade, Yugoslavia.
| | | | | | | | | | | | | | | |
Collapse
|
24
|
Abstract
Aims and background Thyroid cancers are relatively rare tumors that appear more frequently in women than in men. Accordingly, most studies focus on studying risk factors for thyroid cancer in women and consequently on various hormonal or reproductive factors that are specific for women. The aim of our study was to examine risk factors for developing well-differentiated thyroid cancer in men. Heretofore, we did not encounter in the literature a study that was solely focused on studying risk factors for well-differentiated thyroid cancer in men. Methods A case-control study was performed from 2005 to 2010. The case group included 204 consecutive well-differentiated thyroid cancers in male patients (180 papillary and 24 follicular including Hürthle cell). The control group comprised the same number of cases. Patients were individually matched by gender, age and place of residence. Statistical analysis included conditional univariate and multivariate logistic regression Methods. Results According to univariate logistic regression, well-differentiated thyroid cancer in men was significantly related to smoking status, duration of smoking, number of cigarettes smoked per day, history of goiter or thyroid nodules, history of non-thyroid cancer, diabetes mellitus, radiotherapy of the head and neck, and history of malignant tumors. According to multivariate logistic regression, it was independently related to smoking status (OR = 0.36; 95% CI, 0.19–0.69), history of goiter or thyroid nodules (OR = 9.19; 95% CI, 1.25–64.58), and a history of malignant tumors (OR = 2.11; 95% CI, 1.19–7.33). Conclusions Risk factors for well-differentiated thyroid cancer in men were goiter or thyroid nodules and family history of malignant tumors. Cigarette smoking was negatively associated with the disease.
Collapse
Affiliation(s)
- Vladan Zivaljevic
- Center for Endocrine Surgery, Clinic for endocrinology, Clinical Centre of Serbia, Koste Todorovica 8, Belgrade
- School of Medicine, University of Belgrade, Dr Subotica 8, Belgrade, Serbia
| | - Nikola Slijepcevic
- Center for Endocrine Surgery, Clinic for endocrinology, Clinical Centre of Serbia, Koste Todorovica 8, Belgrade
| | - Sandra Sipetic
- Institute of Epidemiology, School of Medicine, University of Belgrade, Visegradska 26, Belgrade
- School of Medicine, University of Belgrade, Dr Subotica 8, Belgrade, Serbia
| | - Ivan Paunovic
- Center for Endocrine Surgery, Clinic for endocrinology, Clinical Centre of Serbia, Koste Todorovica 8, Belgrade
- School of Medicine, University of Belgrade, Dr Subotica 8, Belgrade, Serbia
| | - Aleksandar Diklic
- Center for Endocrine Surgery, Clinic for endocrinology, Clinical Centre of Serbia, Koste Todorovica 8, Belgrade
- School of Medicine, University of Belgrade, Dr Subotica 8, Belgrade, Serbia
| | - Goran Zoric
- Center for Endocrine Surgery, Clinic for endocrinology, Clinical Centre of Serbia, Koste Todorovica 8, Belgrade
| | - Nevena Kalezic
- Center for Endocrine Surgery, Clinic for endocrinology, Clinical Centre of Serbia, Koste Todorovica 8, Belgrade
- School of Medicine, University of Belgrade, Dr Subotica 8, Belgrade, Serbia
| |
Collapse
|
25
|
Oluic B, Paunovic I, Loncar Z, Djukic V, Diklic A, Jovanovic M, Garabinovic Z, Slijepcevic N, Rovcanin B, Micic D, Filipovic A, Zivaljevic V. Survival and prognostic factors for survival, cancer specific survival and disease free interval in 239 patients with Hurthle cell carcinoma: a single center experience. BMC Cancer 2017; 17:371. [PMID: 28545571 PMCID: PMC5445517 DOI: 10.1186/s12885-017-3370-x] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 05/17/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hurthle cell carcinoma makes up 3 to 5% of all thyroid cancers and is considered to be a true rarity. The aim of our study was to analyze clinical characteristics and survival rates of patients with Hurthle cell carcinoma. METHODS Clinical data regarding basic demographic characteristics, tumor grade, type of surgical treatment and vital status were collected. Methods of descriptive statistics and Kaplan-Meier survival curves were used for statistical analysis. Cox proportional hazards regression was used to identify independent predictors. RESULTS During the period from 1995 to 2014, 239 patients with Hurthle cell carcinoma were treated at our Institution. The average age of the patients was 54.3, with female to male ratio of 3.6:1 and average tumor size was 41.8 mm. The overall recurrence rate was 12.1%, with average time for relapse of 90.74 months and average time without any signs of the disease of 222.4 months. Overall 5-year, 10-year and 20-year survival rates were 89.4%, 77.2%, 61.9% respectively. The 5-year, 10-year and 20-year cancer specific survival rates were 94.6%, 92.5%, 87.4%, respectively. When disease free interval was observed, 5-year, 10-year and 20-year rates were 91.1%, 86.2%, 68.5%, respectively. The affection of both thyroid lobes and the need for reoperation due to local relapse were unfavorable independent prognostic factors, while total thyroidectomy as primary procedure was favorable predictive factor for cancer specific survival. CONCLUSION Hurthle cell carcinoma is a rare tumor with an encouraging prognosis and after adequate surgical treatment recurrences are rare.
Collapse
Affiliation(s)
- Branisav Oluic
- Emergency Center, Clinical Center of Serbia, Pasterova 2, Belgrade, 11000, Serbia.
| | - Ivan Paunovic
- Center for Endocrine Surgery, Clinical Center of Serbia, Pasterova 2, Belgrade, 11000, Serbia.,Faculty of Medicine, University of Belgrade, Dr Subotica 8, Belgrade, 11000, Serbia
| | - Zlatibor Loncar
- Emergency Center, Clinical Center of Serbia, Pasterova 2, Belgrade, 11000, Serbia.,Faculty of Medicine, University of Belgrade, Dr Subotica 8, Belgrade, 11000, Serbia
| | - Vladimir Djukic
- Emergency Center, Clinical Center of Serbia, Pasterova 2, Belgrade, 11000, Serbia.,Faculty of Medicine, University of Belgrade, Dr Subotica 8, Belgrade, 11000, Serbia
| | - Aleksandar Diklic
- Center for Endocrine Surgery, Clinical Center of Serbia, Pasterova 2, Belgrade, 11000, Serbia.,Faculty of Medicine, University of Belgrade, Dr Subotica 8, Belgrade, 11000, Serbia
| | - Milan Jovanovic
- Center for Endocrine Surgery, Clinical Center of Serbia, Pasterova 2, Belgrade, 11000, Serbia
| | - Zeljko Garabinovic
- Clinic for Thoracic Surgery, Clinical Center of Serbia, Pasterova 2, Belgrade, 11000, Serbia
| | - Nikola Slijepcevic
- Center for Endocrine Surgery, Clinical Center of Serbia, Pasterova 2, Belgrade, 11000, Serbia
| | - Branislav Rovcanin
- Center for Endocrine Surgery, Clinical Center of Serbia, Pasterova 2, Belgrade, 11000, Serbia
| | - Dusan Micic
- Emergency Center, Clinical Center of Serbia, Pasterova 2, Belgrade, 11000, Serbia
| | - Aleksandar Filipovic
- Clinical Center of Montenegro, Department of Endocrine Surgery, University of Montenegro, Podgorica, Montenegro
| | - Vladan Zivaljevic
- Center for Endocrine Surgery, Clinical Center of Serbia, Pasterova 2, Belgrade, 11000, Serbia.,Faculty of Medicine, University of Belgrade, Dr Subotica 8, Belgrade, 11000, Serbia
| |
Collapse
|
26
|
Stevanovic K, Sabljak V, Kukic B, Toskovic A, Markovic D, Zivaljevic V. A Brief History of Carotid Artery Surgery and Anesthesia. J Anesth Hist 2016; 2:147-150. [PMID: 27852463 DOI: 10.1016/j.janh.2016.09.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 02/06/2016] [Accepted: 09/26/2016] [Indexed: 11/15/2022]
Affiliation(s)
- Ksenija Stevanovic
- Center for Anesthesiology and Resuscitation, Clinical Center of Serbia, Belgrade.
| | - Vera Sabljak
- Center for Anesthesiology and Resuscitation, Clinical Center of Serbia, Belgrade; School of Medicine, University of Belgrade, Serbia
| | - Biljana Kukic
- Center for Anesthesiology and Resuscitation, Clinical Center of Serbia, Belgrade
| | - Anka Toskovic
- Center for Anesthesiology and Resuscitation, Clinical Center of Serbia, Belgrade
| | - Dejan Markovic
- Center for Anesthesiology and Resuscitation, Clinical Center of Serbia, Belgrade; School of Medicine, University of Belgrade, Serbia
| | - Vladan Zivaljevic
- School of Medicine, University of Belgrade, Serbia; Center for Endocrine Surgery, Clinical Center of Serbia, Belgrade
| |
Collapse
|
27
|
Zivic R, Diklic A, Sipetic Grujicic S, Paunovic I, Vekic B, Perunovic R, Radovanovic D, Zivaljevic V. Analysis of malignancy predictors for oxyphile thyroid tumors. J BUON 2016; 21:1496-1500. [PMID: 28039714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
PURPOSE In contrast to other thyroid carcinomas it is difficult to establish a correct preoperative diagnosis for oxyphile carcinoma of the thyroid. In this study we looked for predictive malignancy factors in order to enable surgeons to choose operative treatment and to perform an adequate operation for each patient with an oxyphile neoplasm of the thyroid. METHODS In this retrospective study we have analyzed the medical files of all patients with oxyphile tumors of the thyroid operated between 1999 and 2008 in our institution. A total of 256 patients were included and divided into oxyphile adenomas (142) and carcinomas (114) on the basis of their definite histopathological diagnosis. The most important demographic and clinical characteristics were analyzed by univariate and multivariate logistic regression analysis. RESULTS Univariate analysis showed that male gender, thyroglobulin concentrations ≥300 ng/ml and tumor diameter >30 mm were significantly more frequent in patients with oxyphile carcinoma compared to patients with oxyphile adenoma, while coexisting Hashimoto thyreoiditis and positive AntiTPO antibodies appeared significantly less frequent in the carcinoma group. All variables with a p value <0.1 in the univariate test were subjected to multivariate regression analysis in which elevated preoperative thyroglobulin concentrations (≥300 ng/ml) was shown as the only independent predictive factor for oxyphile thyroid carcinomas (OR=5.88, 95% CI 2.78-12.05, p=0.001). CONCLUSIONS Preoperative thyroglobulin concentration is an independent predictor of malignancy for oxyphile thyroid carcinomas.
Collapse
Affiliation(s)
- Rastko Zivic
- Surgical Clinic, Clinical Center "Dr Dragisa Misovic-Dedinje", Belgrade, Serbia
| | | | | | | | | | | | | | | |
Collapse
|
28
|
Rovcanin B, Damjanovic S, Zivaljevic V, Diklic A, Jovanovic M, Paunovic I. The results of molecular genetic testing for RET proto-oncogene mutations in patients with medullary thyroid carcinoma in a referral center after the two decade period. Hippokratia 2016; 20:187-191. [PMID: 29097883 PMCID: PMC5654434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Medullary thyroid carcinoma (MTC) is a type of thyroid neoplasm which originates from parafollicular cells, and it is commonly diagnosed by calcitonin screening. Besides the sporadic form, the heritable form of MTC is characterized by constitutive activation of the RET (REarranged during Transfection) proto-oncogene caused by different mutations. METHOD We collected data regarding RET genetic screening performed in the Center for Endocrine Surgery in Belgrade during a 20-year-period. The study group included 249 MTC patients who were genetically tested for RET mutations by Sanger's sequencing method. RESULTS Genetic screening of the study population revealed nine different mutations of the RET gene in 42 carriers. The most common mutation was C634F, and it has been detected in 31 % (13/42) of individuals, while C618R, L790F, and S904S were present in only 2 % (1/42) each in the study group. Detected mutations were unequally distributed in different RET gene exons. Among MTC patients, 67 % (28/42) had mutation harbored in exon 11, while the rarest mutation was located in exons 10 and 15, each present in only 2 % (1/42) of patients. CONCLUSIONS The RET gene mutation profile has a unique distribution in this study population when compared with the other European populations. The mutations in codon 634 are most common; therefore the cost-reducing genetic screening should primarily target this codon, and if the negative outcome appears, then other codons should be examined in the order that depends on their occurrence. Hippokratia 2016, 20(3): 187-191.
Collapse
Affiliation(s)
- B Rovcanin
- Center for Endocrine Surgery, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - S Damjanovic
- Institute of Endocrinology, Diabetes and Metabolic Disease, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - V Zivaljevic
- Center for Endocrine Surgery, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - A Diklic
- Center for Endocrine Surgery, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - M Jovanovic
- Center for Endocrine Surgery, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - I Paunovic
- Center for Endocrine Surgery, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| |
Collapse
|
29
|
Affiliation(s)
- B. Kovacevic
- KBC Zvezdara University Medical Centre, Clinic for Surgery “Nikola Spasic”, Belgrade, Serbia
| | - M. Ignjatovic
- KBC Zvezdara University Medical Centre, Clinic for Surgery “Nikola Spasic”, Belgrade, Serbia
| | - V. Cuk
- KBC Zvezdara University Medical Centre, Clinic for Surgery “Nikola Spasic”, Belgrade, Serbia
| | - V. Zivaljevic
- Clinical Center of Serbia, Center for Endocrine Surgery, Institute of Endocrinology, Diabetes and Diseases of Metabolism, Belgrade, Serbia
| | - I. Paunović
- Clinical Center of Serbia, Center for Endocrine Surgery, Institute of Endocrinology, Diabetes and Diseases of Metabolism, Belgrade, Serbia
| |
Collapse
|
30
|
Slijepcevic N, Zivaljevic V, Paunovic I, Diklic A, Zivkovic P, Miljus D, Grgurevic A, Sipetic S. Rising incidence of thyroid cancer in Serbia. Hippokratia 2016; 20:9-23. [PMID: 27895436 PMCID: PMC5074408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND In the past decade, the incidence of thyroid cancer (TC) has shown a stable increase, for both sexes, in many parts of the world at a rate faster than for any other type of malignancy. The aim of our study was to analyze and report changes in TC incidence in Serbia, as well as to evaluate potential reasons for these changes. So far, the incidence of TC in Serbia has not been reported. MATERIAL AND METHODS This is a retrospective descriptive epidemiological study of TC data from the Cancer Register for Serbia for a ten year period, from 1999 to 2008. Crude rates (CR), age-specific rates (ASR), age-adjusted rates (AAR), linear trends and average annual percentage changes (AAPC) were calculated and analyzed. RESULTS TC incidence increased substantially for both genders with the highest increase in 2007 for the age group 50-59 (females 14.2, males 10.3). TC was three times more common in females (CR 4.7:1.5). The AAR for females ranged 1.9-4.8 (3.3, 95% CI 2.6-4.0), for males 1.0-2.6 (1.0, 95% CI 0.8-1.2) and for both sexes combined 1.4-3.2 (2.2, 95% CI 1.7-2.6). The incidence trend for males showed an increase (y =0.05x + 0.70, p =0.058). It was highly statistically significant for females (y =0.31x + 1.61, p <0.001) and both genders combined (y =0.18x + 1.18, p <0.001). AAPC was highest for ages 20-29 and 30-39, for females (+25.2%) and males (+17.3%), respectively. CONCLUSIONS We found a substantial increase in TC incidence in Serbia for both genders. The highest increase in TC incidence was found in females aged 20 to 29 years while the highest incidence was found in the age group 50 to 59.
Collapse
Affiliation(s)
- N Slijepcevic
- Centre for Endocrine surgery, Clinical Centre of Serbia, Belgrade, Serbia
| | - V Zivaljevic
- Centre for Endocrine surgery, Clinical Centre of Serbia, Belgrade, Serbia; School of Medicine, University of Belgrade, Belgrade, Serbia
| | - I Paunovic
- Centre for Endocrine surgery, Clinical Centre of Serbia, Belgrade, Serbia; School of Medicine, University of Belgrade, Belgrade, Serbia
| | - A Diklic
- Centre for Endocrine surgery, Clinical Centre of Serbia, Belgrade, Serbia; School of Medicine, University of Belgrade, Belgrade, Serbia
| | | | - D Miljus
- Institute of Public Health of Serbia, Belgrade, Serbia
| | - A Grgurevic
- Institute of Epidemiology, School of Medicine, University of Belgrade, Belgrade, Serbia; School of Medicine, University of Belgrade, Belgrade, Serbia
| | - S Sipetic
- Institute of Epidemiology, School of Medicine, University of Belgrade, Belgrade, Serbia; School of Medicine, University of Belgrade, Belgrade, Serbia
| |
Collapse
|
31
|
Loncar Z, Djukic V, Zivaljevic V, Pekmezovic T, Diklic A, Tatic S, Dundjerovic D, Olujic B, Slijepcevic N, Paunovic I. Survival and prognostic factors for adrenocortical carcinoma: a single institution experience. BMC Urol 2015; 15:43. [PMID: 26013141 PMCID: PMC4443614 DOI: 10.1186/s12894-015-0038-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 05/19/2015] [Indexed: 12/24/2022] Open
Abstract
Background Adrenocortical carcinoma (ACC) is aggressive, but rare tumours that have not been sufficiently studied. The aim of our study was to present the demographic and clinical characteristics of patients with ACC, to determine the overall survival rates, analyse the effect of prognostic factors on survival, as well as to identify favorable and unfavourable predictors of survival. Method The study included 72 patients (42 women and 30 men) with ACC. We analysed the prognostic value of the demographic and clinical characteristics of the patients, tumour characteristics, therapy administered and survival rates. Kaplan-Meier survival curves and the log-rank test were used to estimate the overall and specific survival probabilities and the Cox regression model was used to identify independent prognostic factors for survival. Results The patients had mean age of 50 years. The 1-, 5-, and 10-year probabilities of survival in patients with ACC were 52.5 %, 41.1 %, and 16.4 %, respectively. The median survival time was 36 months. The results of multivariate Cox regression analysis showed that the presence of lymphatic metastases (HR = 7.37, 95 % CI = 2.31-23.48, p = 0.001) and therapy with mitotane (HR = 0.11, 95 % CI = 0.04-0.27, p = 0.001) were independent prognostic factors for survival. Conclusion The presence of lymphatic metastasis is an unfavourable prognostic factor, while postoperative therapy with mitotane is a favorable prognostic factor for survival in patients with ACC.
Collapse
Affiliation(s)
- Zlatibor Loncar
- Emergency Centre, Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Pasterova 2, 11000, Belgrade, Serbia.
| | - Vladimir Djukic
- Emergency Centre, Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Pasterova 2, 11000, Belgrade, Serbia.
| | - Vladan Zivaljevic
- Centre for Endocrine Surgery, Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Pasterova 2, 11000, Belgrade, Serbia.
| | - Tatjana Pekmezovic
- Institute of Epidemiology, Faculty of Medicine, University of Belgrade, Visegradska 26A, Belgrade, 11000, Serbia.
| | - Aleksandar Diklic
- Centre for Endocrine Surgery, Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Pasterova 2, 11000, Belgrade, Serbia.
| | - Svetislav Tatic
- Institute of Pathology, Faculty of Medicine, University of Belgrade, Dr Subotica 1, 11000, Belgrade, Serbia.
| | - Dusko Dundjerovic
- Institute of Pathology, Faculty of Medicine, University of Belgrade, Dr Subotica 1, 11000, Belgrade, Serbia.
| | - Branislav Olujic
- Emergency Centre, Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Pasterova 2, 11000, Belgrade, Serbia.
| | - Nikola Slijepcevic
- Centre for Endocrine Surgery, Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Pasterova 2, 11000, Belgrade, Serbia.
| | - Ivan Paunovic
- Centre for Endocrine Surgery, Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Pasterova 2, 11000, Belgrade, Serbia.
| |
Collapse
|
32
|
Slijepcevic N, Zivaljevic V, Marinkovic J, Sipetic S, Diklic A, Paunovic I. Retrospective evaluation of the incidental finding of 403 papillary thyroid microcarcinomas in 2466 patients undergoing thyroid surgery for presumed benign thyroid disease. BMC Cancer 2015; 15:330. [PMID: 25925164 PMCID: PMC4423135 DOI: 10.1186/s12885-015-1352-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Accepted: 04/23/2015] [Indexed: 12/22/2022] Open
Abstract
Background The aim of our study was to investigate the incidence of papillary thyroid microcarcinoma (PTMC) in patients operated for benign thyroid diseases (BTD) and its relation to age, sex, extent of surgery and type of BTD. Methods Retrospective study of 2466 patients who underwent thyroid surgery for BTD from 2008 to 2013. To determine independent predictors for PTMC we used three separate multivariate logistic regression models (MLR). Results There were 2128 (86.3%) females and 338 (13.7%) males. PTMC was diagnosed in 345 (16.2%) females and 58 (17.2%) males. Age ranged from 14 to 85 years (mean 54 years). Sex and age were not related to the incidence of PTMC. The overall incidence of PTMC was 16.3%. The highest incidence was in Hashimoto thyroiditis (22.7%, χ2 = 10.80, p < 0.001); and in patients with total/near-total thyroidectomy (17.7%, χ2 = 7.05, p < 0.008). The lowest incidence (6.6%, χ2 = 9.96, p < 0.001) was in a solitary hyperfunctional thyroid nodule (SHTN). According to MLR, Hashimoto thyroiditis (OR 1.54, 95% CI 1.15-2.05, p < 0.003) and SHTN (OR 0.43, 95% CI 0.21-0.87, p < 0.019) are independent predictors. Since the extent of surgery was an independent predictor (OR 1.45, 95% CI 1.10-1.92, p = 0.009) for all BTD, and sex and age were not; when the MLR model was adjusted for them, Graves disease (OR 0.72, 95% CI 0.53-0.99, p < 0.041) also proved to be an independent predictor. Conclusions Sex and age are not statistically related to the incidence of PTMC in BTD. The incidence of PTMC is higher in Hashimoto thyroiditis and patients with total/near-total thyroidectomy; and lower in patients with a SHTN and Graves disease.
Collapse
Affiliation(s)
- Nikola Slijepcevic
- Centre for endocrine surgery, Clinical Centre of Serbia, Koste Todorovica 8, Belgrade, 11000, Serbia.
| | - Vladan Zivaljevic
- Centre for endocrine surgery, Clinical Centre of Serbia, Koste Todorovica 8, Belgrade, 11000, Serbia. .,School of Medicine, University of Belgrade, Dr Subotica 8, Belgrade, 11000, Serbia.
| | - Jelena Marinkovic
- School of Medicine, University of Belgrade, Dr Subotica 8, Belgrade, 11000, Serbia. .,Institute of Medical Statistics and Informatics, School of Medicine, University of Belgrade, Dr Subotica 8, Belgrade, Serbia.
| | - Sandra Sipetic
- School of Medicine, University of Belgrade, Dr Subotica 8, Belgrade, 11000, Serbia. .,Institute of Epidemiology, School of Medicine, University of Belgrade, Visegradska 26a, Belgrade, 11000, Serbia.
| | - Aleksandar Diklic
- Centre for endocrine surgery, Clinical Centre of Serbia, Koste Todorovica 8, Belgrade, 11000, Serbia. .,School of Medicine, University of Belgrade, Dr Subotica 8, Belgrade, 11000, Serbia.
| | - Ivan Paunovic
- Centre for endocrine surgery, Clinical Centre of Serbia, Koste Todorovica 8, Belgrade, 11000, Serbia. .,School of Medicine, University of Belgrade, Dr Subotica 8, Belgrade, 11000, Serbia.
| |
Collapse
|
33
|
Bojic T, Paunovic I, Diklic A, Zivaljevic V, Zoric G, Kalezic N, Sabljak V, Slijepcevic N, Tausanovic K, Djordjevic N, Budjevac D, Djordjevic L, Karanikolic A. Total thyroidectomy as a method of choice in the treatment of Graves' disease - analysis of 1432 patients. BMC Surg 2015; 15:39. [PMID: 25888210 PMCID: PMC4422312 DOI: 10.1186/s12893-015-0023-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 03/19/2015] [Indexed: 11/10/2022] Open
Abstract
Background Graves’ disease represents an autoimmune disease of the thyroid gland where surgery has an important role in its treatment. The aim of our paper was to analyze the results of surgical treatment, the frequency of microcarcinoma and carcinoma, as well as to compare surgical complications in relation to the various types of operations performed for Graves’ disease. Methods We analysed 1432 patients (221 male and 1211 female) who underwent surgery for Graves’ disease at the Centre for Endocrine Surgery in Belgrade during 15 years (1996–2010). Average age was 34.8 years. Frequency of surgical complications within the groups was analyzed with nonparametric Fisher’s test. Results Total thyroidectomy (TT) was performed in 974 (68%) patients, and Dunhill operation (D) in 221 (15.4). Carcinoma of thyroid gland was found in 146 patients (10.2%), of which 129 (9%) were a microcarcinoma. Complication rates were higher in the TT group, where there were 31 (3.2%) patients with permanent hypoparathyroidism, 9 (0.9%) patients with unilateral recurrent nerve paralysis and 10 (1.0%) patients with postoperative bleeding. Combined complications, such as permanent hypoparathyroidism with bleeding were more common in the D group where there were 2 patients (0,9%), while unilateral recurrent nerve paralysis with bleeding was more common in the TT group where there were 3 cases (0,3%). Conclusions Frequency of complications were not significantly statistically different in relation to the type of surgical procedure. Total thyroidectomy represents a safe and efficient method for treating patients with Graves’ disease, and it is not followed by a greater frequency of complications in relation to less extensive procedures.
Collapse
Affiliation(s)
- Toplica Bojic
- Department for Endocrine Surgery and Breast Surgery, Clinic of General Surgery, Clinical Centre Nis, Bul. Dr Zorana Djindjica 48, 18000, Nis, Serbia.
| | - Ivan Paunovic
- Centre for Endocrine Surgery, Clinic of Endocrinology Diabetes and Metabolic Disease, Clinical Centre Serbia, Dr Subotica 13, 11000, Belgrade, Serbia.,University of Belgrade School of Medicine, Dr Subotica 8, 11000, Belgrade, Serbia
| | - Aleksandar Diklic
- Centre for Endocrine Surgery, Clinic of Endocrinology Diabetes and Metabolic Disease, Clinical Centre Serbia, Dr Subotica 13, 11000, Belgrade, Serbia.,University of Belgrade School of Medicine, Dr Subotica 8, 11000, Belgrade, Serbia
| | - Vladan Zivaljevic
- Centre for Endocrine Surgery, Clinic of Endocrinology Diabetes and Metabolic Disease, Clinical Centre Serbia, Dr Subotica 13, 11000, Belgrade, Serbia.,University of Belgrade School of Medicine, Dr Subotica 8, 11000, Belgrade, Serbia
| | - Goran Zoric
- Centre for Endocrine Surgery, Clinic of Endocrinology Diabetes and Metabolic Disease, Clinical Centre Serbia, Dr Subotica 13, 11000, Belgrade, Serbia
| | - Nevena Kalezic
- University of Belgrade School of Medicine, Dr Subotica 8, 11000, Belgrade, Serbia.,Centre for Anaesthesia and Resuscitation, Clinical Centre Serbia, Pasterova 2, 11000, Belgrade, Serbia
| | - Vera Sabljak
- University of Belgrade School of Medicine, Dr Subotica 8, 11000, Belgrade, Serbia.,Centre for Anaesthesia and Resuscitation, Clinical Centre Serbia, Pasterova 2, 11000, Belgrade, Serbia
| | - Nikola Slijepcevic
- Centre for Endocrine Surgery, Clinic of Endocrinology Diabetes and Metabolic Disease, Clinical Centre Serbia, Dr Subotica 13, 11000, Belgrade, Serbia
| | - Katarina Tausanovic
- Centre for Endocrine Surgery, Clinic of Endocrinology Diabetes and Metabolic Disease, Clinical Centre Serbia, Dr Subotica 13, 11000, Belgrade, Serbia
| | - Nebojsa Djordjevic
- Department for Endocrine Surgery and Breast Surgery, Clinic of General Surgery, Clinical Centre Nis, Bul. Dr Zorana Djindjica 48, 18000, Nis, Serbia.,University of Nis School of Medicine, Bul. Dr Zorana Djindjica 81, 18000, Nis, Serbia
| | - Dragana Budjevac
- Department for Endocrine Surgery and Breast Surgery, Clinic of General Surgery, Clinical Centre Nis, Bul. Dr Zorana Djindjica 48, 18000, Nis, Serbia
| | - Lidija Djordjevic
- Department for Endocrine Surgery and Breast Surgery, Clinic of General Surgery, Clinical Centre Nis, Bul. Dr Zorana Djindjica 48, 18000, Nis, Serbia
| | - Aleksandar Karanikolic
- Department for Endocrine Surgery and Breast Surgery, Clinic of General Surgery, Clinical Centre Nis, Bul. Dr Zorana Djindjica 48, 18000, Nis, Serbia.,University of Nis School of Medicine, Bul. Dr Zorana Djindjica 81, 18000, Nis, Serbia
| |
Collapse
|
34
|
Bukvic B, Zivaljevic V, Sipetic S, Diklic A, Tausanovic K, Stojanovic D, Stevanovic D, Paunovic I. Improved quality of life in hyperthyroidism patients after surgery. J Surg Res 2015; 193:724-30. [DOI: 10.1016/j.jss.2014.07.061] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Revised: 07/16/2014] [Accepted: 07/23/2014] [Indexed: 10/25/2022]
|
35
|
Watt T, Barbesino G, Bjorner JB, Bonnema SJ, Bukvic B, Drummond R, Groenvold M, Hegedüs L, Kantzer V, Lasch KE, Marcocci C, Mishra A, Netea-Maier R, Ekker M, Paunovic I, Quinn TJ, Rasmussen ÅK, Russell A, Sabaretnam M, Smit J, Törring O, Zivaljevic V, Feldt-Rasmussen U. Cross-cultural validity of the thyroid-specific quality-of-life patient-reported outcome measure, ThyPRO. Qual Life Res 2014; 24:769-80. [DOI: 10.1007/s11136-014-0798-1] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2014] [Indexed: 10/24/2022]
|
36
|
Paunovic· I, Zivaljevic V, Diklic A, Tausanovic K, Stojanic R, Sipetic S. Prognostic parameters after surgery for adrenal metastases: a single institution experience. Acta Chir Belg 2014; 114:198-202. [PMID: 25102710 DOI: 10.1080/00015458.2014.11681008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Clinically isolated adrenal metastases are rare and therefore present a therapeutic challenge. We report our experience with surgery of adrenal metastases and analyze factors that may influence postoperative survival. METHODS A consecutive series of 31 patients (16 male, 15 female) underwent adrenal surgery for metastases at a single institution over 10-year period (1999-2008). The Kaplan-Meier method and log-rank test were used to determine overall survival. Potential prognostic factors were identified by univariate and multivariate Cox regression analysis. RESULTS The primary tumor diagnoses were non-small-cell lung carcinoma (NSCLC) 20, colorectal carcinoma 5, renal cell carcinoma (RCC) 2, malignant melanoma and breast carcinoma, one each. The median survival was 12 months, with one year and five year survival of 21% and 3.4% respectively. According to multivariate analysis independent prognostic factors of favorable survival were disease free interval (DFI) longer than 12 months (Hazard ratio (HR) = 0.28, 95% CI = 0.09-0.90), potentially curative resection (Hazard ratio (HR) = 0.35, 95% CI = 0.12-1.00) and postoperative radiotherapy of adrenal bed (Hazard ratio (HR) = 0.33, 95% CI = 0.12-0.91). CONCLUSIONS Overall survival after surgery for adrenal metastases is poor. In multivariate analyses, survival is influenced by DFI, curative resection, and postoperative radiotherapy.
Collapse
Affiliation(s)
- I. Paunovic·
- Center for endocrine surgery, Clinical center of Serbia, Belgrade, Serbia
- Medical school University of Belgrade, Belgrade, Serbia
| | - V. Zivaljevic
- Center for endocrine surgery, Clinical center of Serbia, Belgrade, Serbia
- Medical school University of Belgrade, Belgrade, Serbia
| | - A. Diklic
- Center for endocrine surgery, Clinical center of Serbia, Belgrade, Serbia
- Medical school University of Belgrade, Belgrade, Serbia
| | - K. Tausanovic
- Center for endocrine surgery, Clinical center of Serbia, Belgrade, Serbia
| | - R. Stojanic
- Center for endocrine surgery, Clinical center of Serbia, Belgrade, Serbia
| | - S. Sipetic
- Medical school University of Belgrade, Belgrade, Serbia
| |
Collapse
|
37
|
Zivaljevic V, Slijepcevic N, Sipetic S, Paunovic I, Diklic A, Zoric G, Kalezic N. Risk factors for well-differentiated thyroid cancer in men. Tumori 2014. [PMID: 24326832 DOI: 10.1700/1361.15094] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS AND BACKGROUND Thyroid cancers are relatively rare tumors that appear more frequently in women than in men. Accordingly, most studies focus on studying risk factors for thyroid cancer in women and consequently on various hormonal or reproductive factors that are specific for women. The aim of our study was to examine risk factors for developing well-differentiated thyroid cancer in men. Heretofore, we did not encounter in the literature a study that was solely focused on studying risk factors for well-differentiated thyroid cancer in men. METHODS A case-control study was performed from 2005 to 2010. The case group included 204 consecutive well-differentiated thyroid cancers in male patients (180 papillary and 24 follicular including Hürthle cell). The control group comprised the same number of cases. Patients were individually matched by gender, age and place of residence. Statistical analysis included conditional univariate and multivariate logistic regression methods. RESULTS According to univariate logistic regression, well-differentiated thyroid cancer in men was significantly related to smoking status, duration of smoking, number of cigarettes smoked per day, history of goiter or thyroid nodules, history of non-thyroid cancer, diabetes mellitus, radiotherapy of the head and neck, and history of malignant tumors. According to multivariate logistic regression, it was independently related to smoking status (OR = 0.36; 95% CI, 0.19-0.69), history of goiter or thyroid nodules (OR = 9.19; 95% CI, 1.25-64.58), and a history of malignant tumors (OR = 2.11; 95% CI, 1.19-7.33). CONCLUSIONS Risk factors for well-differentiated thyroid cancer in men were goiter or thyroid nodules and family history of malignant tumors. Cigarette smoking was negatively associated with the disease.
Collapse
|
38
|
Zivaljevic V, Slijepcevic N, Paunovic I, Diklic A, Kalezic N, Marinkovic J, Zivic R, Vekic B, Sipetic S. Risk factors for anaplastic thyroid cancer. Int J Endocrinol 2014; 2014:815070. [PMID: 24949009 PMCID: PMC4052185 DOI: 10.1155/2014/815070] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Accepted: 04/29/2014] [Indexed: 12/04/2022] Open
Abstract
Background. Anaplastic thyroid cancer (ATC) is a form of thyroid cancer with very poor prognosis, but is fortunately quite rare. Its aetiology is unknown and not well researched. Aim. The aim of this study was to identify potential risk factors for ATC. Material and Method. Case-control study of 126 ATC patients (77 females and 49 males) and 252 controls individually matched by gender, age, and place of abode. In statistical analysis we used a Cox regression model. Results. Univariate logistic regression showed that the risk factors for ATC are low education level, type B blood group, goitre, other nonthyroid malignancies, diabetes, late menarche, and an early first pregnancy. Multivariate logistic regression analysis showed that independent risk factors for ATC are low education level (OR = 1.42, 95% CI = 1.09-1.86), type B blood group (OR = 2.41, 95% CI = 1.03-5.66), and goitre (OR = 25-33, 95% CI = 5.66-126.65). Conclusion. Independent risk factors for ATC are: low education level, type B blood group, and goitre.
Collapse
Affiliation(s)
- V. Zivaljevic
- Centre for Endocrine Surgery, Clinical Centre of Serbia, Koste Todorovica 8, 11000 Belgrade, Serbia
- School of Medicine, University of Belgrade, Dr Subotica 8, 11000 Belgrade, Serbia
| | - N. Slijepcevic
- Centre for Endocrine Surgery, Clinical Centre of Serbia, Koste Todorovica 8, 11000 Belgrade, Serbia
- *N. Slijepcevic:
| | - I. Paunovic
- Centre for Endocrine Surgery, Clinical Centre of Serbia, Koste Todorovica 8, 11000 Belgrade, Serbia
- School of Medicine, University of Belgrade, Dr Subotica 8, 11000 Belgrade, Serbia
| | - A. Diklic
- Centre for Endocrine Surgery, Clinical Centre of Serbia, Koste Todorovica 8, 11000 Belgrade, Serbia
- School of Medicine, University of Belgrade, Dr Subotica 8, 11000 Belgrade, Serbia
| | - N. Kalezic
- Centre for Endocrine Surgery, Clinical Centre of Serbia, Koste Todorovica 8, 11000 Belgrade, Serbia
- School of Medicine, University of Belgrade, Dr Subotica 8, 11000 Belgrade, Serbia
| | - J. Marinkovic
- School of Medicine, University of Belgrade, Dr Subotica 8, 11000 Belgrade, Serbia
- Institute of Medical Statistics and Informatics, School of Medicine, University of Belgrade, Dr Subotica 8, 11000 Belgrade, Serbia
| | - R. Zivic
- Clinical Centre “Dr Dragisa Misovic”, Heroja Milana Tepica 1, 11000 Belgrade, Serbia
| | - B. Vekic
- Clinical Centre “Dr Dragisa Misovic”, Heroja Milana Tepica 1, 11000 Belgrade, Serbia
| | - S. Sipetic
- School of Medicine, University of Belgrade, Dr Subotica 8, 11000 Belgrade, Serbia
- Institute of Epidemiology, School of Medicine, University of Belgrade, Visegradska 26A, 11000 Belgrade, Serbia
| |
Collapse
|
39
|
Zivaljevic V, Tausanovic K, Paunovic I, Diklic A, Kalezic N, Zoric G, Sabljak V, Vekic B, Zivic R, Marinkovic J, Sipetic S. Age as a prognostic factor in anaplastic thyroid cancer. Int J Endocrinol 2014; 2014:240513. [PMID: 25024703 PMCID: PMC4082884 DOI: 10.1155/2014/240513] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Accepted: 05/19/2014] [Indexed: 11/17/2022] Open
Abstract
Background. Anaplastic thyroid cancer (ATC) is one of the tumors with the shortest survival in human medicine. Aim. The aim was to determine the importance of age in survival of patients with ATC. Material and Methods. We analyzed the data on 150 patients diagnosed with ATC in the period from 1995 to 2006. The Kaplan-Meier method and log-rank test were used to determine overall survival. Prognostic factors were identified by univariate and multivariate Cox regression analysis. Results. The youngest patient was 35 years old and the oldest was 89 years old. According to univariate regression analysis, age was significantly associated with longer survival in patients with ATC. In multivariate regression analysis, patients age, presence of longstanding goiter, whether surgical treatment is carried out or not, type of surgery, tumor multicentricity, presence of distant metastases, histologically proven preexistent papillary carcinoma, radioiodine therapy, and postoperative radiotherapy were included. According to multivariate analysis, besides surgery (P = 0.000, OR = 0.43, 95% CI = 0.29-0.63), only patients age (P = 0.023, OR = 0.68, 95% CI = 0.49-0.95) was independent prognostic factor of favorable survival in patients with ATC. Conclusion. Age is a factor that was independently associated with survival time in ATC. Anaplastic thyroid cancer has the best prognosis in patients younger than 50 years.
Collapse
Affiliation(s)
- Vladan Zivaljevic
- Center for Endocrine Surgery, Clinical Center of Serbia, 11000 Belgrade, Serbia
- School of Medicine, Belgrade University, 11000 Belgrade, Serbia
| | - Katarina Tausanovic
- Center for Endocrine Surgery, Clinical Center of Serbia, 11000 Belgrade, Serbia
- *Katarina Tausanovic:
| | - Ivan Paunovic
- Center for Endocrine Surgery, Clinical Center of Serbia, 11000 Belgrade, Serbia
- School of Medicine, Belgrade University, 11000 Belgrade, Serbia
| | - Aleksandar Diklic
- Center for Endocrine Surgery, Clinical Center of Serbia, 11000 Belgrade, Serbia
- School of Medicine, Belgrade University, 11000 Belgrade, Serbia
| | - Nevena Kalezic
- Center for Endocrine Surgery, Clinical Center of Serbia, 11000 Belgrade, Serbia
- School of Medicine, Belgrade University, 11000 Belgrade, Serbia
| | - Goran Zoric
- Center for Endocrine Surgery, Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Vera Sabljak
- Center for Endocrine Surgery, Clinical Center of Serbia, 11000 Belgrade, Serbia
| | | | - Rastko Zivic
- Surgical Clinic, KBC Dedinje, 11000 Belgrade, Serbia
| | | | - Sandra Sipetic
- School of Medicine, Belgrade University, 11000 Belgrade, Serbia
| |
Collapse
|
40
|
Kalezic N, Stojanovic M, Ladjevic N, Markovic D, Paunovic I, Palibrk I, Milicic B, Sabljak V, Antonijevic V, Ivanovic B, Ugrinovic D, Zivaljevic V. Risk factors for intraoperative hypotension during thyroid surgery. Med Sci Monit 2013; 19:236-41. [PMID: 23548975 PMCID: PMC3659157 DOI: 10.12659/msm.883869] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Hypotension is a common adverse effect of IV anaesthetics, especially during the induction of anaesthesia. The aim of our study was to determine the incidence and risk factors for intraoperative hypotension (IOH) in thyroid surgery, as well as to determine whether and to what extent IOH affects the occurrence of postoperative hypotension. MATERIAL AND METHODS The study included 1252 euthyroid patients, ASA 2 and ASA 3 status (American Society of Anesthesiologists physical status classification), who had thyroid surgery between 2007 and 2011. IOH was defined as a decrease in systolic blood pressure of >20% of baseline values. We studied the influence of demographic characteristics (sex, age, body mass index-BMI), comorbidity, type and duration of surgery, and anaesthesia on the occurrence of IOH. Univariate and multivariate logistic regression were used to determine predictors of occurrence of IOH. RESULTS IOH was registered in 6.5% of patients. The most common operation was thyroidectomy. Patients with IOH were younger, had lower BMI, and significantly less often had hypertension as a coexisting disease. The multivariate regression model identified BMI and the absence of hypertension as a coexisting disease, and as independent predictors of occurrence of IOH. Significantly more patients with IOH had postoperative hypotension (9.9% vs. 2.4%, p=0.000). CONCLUSIONS IOH is common, even during operations of short duration and with minimal bleeding. It is necessary to pay special attention to these patients, given that many of these patients remained hypotensive during the postoperative period.
Collapse
Affiliation(s)
- Nevena Kalezic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia and Centre for Endocrine Surgery, Clinical Centre of Serbia, Belgrade, Serbia.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
41
|
Kalezic N, Stojanovic M, Milicic B, Antonijevic V, Sabljak V, Markovic D, Zivaljevic V. The incidence of intraoperative hypertension and risk factors for its development during thyroid surgery. Clin Exp Hypertens 2013; 35:523-7. [PMID: 23301599 DOI: 10.3109/10641963.2012.758735] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
We studied the influence of demographic characteristics, comorbidity, and type and duration of surgery and anesthesia on the occurrence of intraoperative hypertension (IOHTA). Logistic regression analyses were used in order to determine the predictors of occurrence of IOHTA. More than 60% of our patients had IOHTA. Multivariate analysis showed that independent predictors for IOHTA were older age, BMI 25 kg/m(2), and hypertension as a coexisting disease. Hypertension is common during thyroid surgery, and a significant number of patients remained hypertensive during the postoperative period.
Collapse
Affiliation(s)
- Nevena Kalezic
- Faculty of Medicine, University of Belgrade , Belgrade , Serbia
| | | | | | | | | | | | | |
Collapse
|
42
|
Paunovic I, Zivaljevic V, Stojanic R, Kalezic N, Kazic M, Diklic A. Primary hyperparathyroidism in children and young adults:--a single institution experience. Acta Chir Belg 2013; 113:35-9. [PMID: 23550467 DOI: 10.1080/00015458.2013.11680882] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Primary hyperparathyroidism (PHPT) is an extremely rare disorder in children and young adults. In the literature, only small case series or case reports can be found. The aim of this study was to show our experience in the management of PHPT patients under the age of 20. METHODS We performed a retrospective study of PHPT patients who underwent surgery in our institution. From 2004 to 2010, 522 patients underwent surgery (74, male; 478, female). Of these, 7 patients were under the age of 19 (4 [5%], male, 3 [0.6%], female). The following was analyzed demographic characteristics, length of the disease, clinical presentation, and preoperative and postoperative parathyroid hormone (PTH) and serum calcium levels. Ultrasonography, scintigraphy, and computerized tomography were performed for preoperative localization, and the types of operations and histopathological findings were assessed. RESULTS The average age of the patients was 15.7 years. Average duration of disease was 4.8 months. Only 2 patients (28%) were asymptomatic. The mean serum calcium level was 3.06 mmol/l, and the mean PTH level was 620.6 pg/ml. Both parameters showed significant reduction after surgery. One patient was positive for multiple endocrine neoplasia type I syndrome, while the other patients were sporadic. Five parathyroidectomies (72%), 1 double parathyroidectomy (14%), and 1 subtotal parathyroidectomy (14%) were performed. CONCLUSION PHPT in children and young adults is rare. It occurs more frequently in young adults than in children, with slight predominance in males. Most of the patients are symptomatic at diagnosis. Surgery is a successful method of treatment.
Collapse
Affiliation(s)
- I. Paunovic
- Center for Endocrine Surgery, Clinic of Endocrinology, Clinical Center of Serbia, University of Belgrade, Serbia
| | - V. Zivaljevic
- Center for Endocrine Surgery, Clinic of Endocrinology, Clinical Center of Serbia, University of Belgrade, Serbia
| | - R. Stojanic
- Center for Endocrine Surgery, Clinic of Endocrinology, Clinical Center of Serbia, University of Belgrade, Serbia
| | - N. Kalezic
- Center for Endocrine Surgery, Clinic of Endocrinology, Clinical Center of Serbia, University of Belgrade, Serbia
| | - M. Kazic
- Center for Endocrine Surgery, Clinic of Endocrinology, Clinical Center of Serbia, University of Belgrade, Serbia
| | - A. Diklic
- Center for Endocrine Surgery, Clinic of Endocrinology, Clinical Center of Serbia, University of Belgrade, Serbia
| |
Collapse
|
43
|
Kovacevic B, Ignjatovic M, Zivaljevic V, Cuk V, Scepanovic M, Petrovic Z, Paunovic I. Parathyroidectomy for the attainment of NKF-K/DOQI™ and KDIGO recommended values for bone and mineral metabolism in dialysis patients with uncontrollable secondary hyperparathyroidism. Langenbecks Arch Surg 2012; 397:413-20. [PMID: 22240976 DOI: 10.1007/s00423-011-0901-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2011] [Accepted: 12/29/2011] [Indexed: 12/29/2022]
Abstract
PURPOSE The National Kidney Foundation Kidney Disease Outcomes Quality Initiative (NKF-K/DOQI™) 2003 and Kidney Disease: Improving Global Outcomes (KDIGO) 2009 have established guidelines for the treatement of secondary hyperparathyroidism. This study evaluated the impact of parathyroidectomy to achieve recommended values for parathyroid hormone, calcium, phosphorus and CaxPO(4) product in dialysis patients with severe secondary hyperparathyroidism that is resistant to medical treatment. METHODS This study included 43 consecutive patients who underwent parathyroidectomy for a severe form of secondary hyperparathyroidism (SHPT) that is unresponsive to medical treatment. The serum iPTH, calcium and phosphorus levels were measured prior to surgery, every morning after surgery for 5 days and on the first, sixth and eighth postoperative months. RESULTS Following parathyroidectomy, a significant decline in iPTH values was observed in all patients; however, after the 8-month study period, only one of these patients achieved a serum iPTH concentration within the K/DOQI recommended target range. Unlike iPTH, targeting for calcium, phosphorus and CaxPO(4) at the last follow-up were 55.8%, 60.5% and 93%, respectively. These values indicated a significant improvement in comparison to preoperative percentages. In regards to the KDIGO recommended guidelines, the iPTH levels did not significantly change at the end of our study compared to preoperative values; however, calcium levels significantly declined and phosphorus levels significantly improved compared to preoperative values. CONCLUSIONS Although the majority of patients fail to reach recommended iPTH values, parathyroidectomy remains a valuable tool to attain these NKF-K/DOQI recommendations for serum calcium, phosphorus and CaxPO(4) in dialysis patients with secondary hyperparathyroidism resistant to medical therapy. Parathyroidectomy was shown to be an inadequate intervention for achieving KDIGO recommendations.
Collapse
Affiliation(s)
- Bojan Kovacevic
- KBC Zvezdara University Clinical Centre, Clinic for Surgery "Nikola Spasic", D. Tucovica 161, 11000 Belgrade, Serbia.
| | | | | | | | | | | | | |
Collapse
|
44
|
Kovacevic B, Ignjatovic M, Cuk V, Zivaljevic V, Paunović I. Early prediction of symptomatic hypocalcemia after total thyroidectomy. Acta Chir Belg 2011; 111:303-307. [PMID: 22191132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Hypocalcemia is the most common postoperative complication after total thyroidectomy. The aim of this prospective study was to determine biochemical parameters in the early postoperative period that could identify patients with significantly increased risk of symptomatic hypocalcemia development. METHODS The study included 100 individuals undergoing total thyroidectomy from January to May 2009. In all patients PTH, calcium, inorganic phosphate, magnesium, and albumin levels were measured immediately preoperatively, 30 minutes postoperatively and every morning for the following five days. RESULTS Clinically significant hypocalcemia was observed in 19% of all cases. Fall of the iPTH values by more than 88% from preoperative values, 30 min after completion of the surgery, showed 100% sensitivity and 100% specificity for the occurrence of symptomatic hypocalcemia. CONCLUSIONS According to our results immediate postoperative measurement of the iPTH may be considered as a useful method to predict with high certainty which patients will need calcium supplementation, and to separate them from patients who can be safely and early discharged.
Collapse
Affiliation(s)
- B Kovacevic
- KBC Zvezdara University Medical Centre, Clinic for Surgery "Nikola Spasic", Belgrade, Serbia.
| | | | | | | | | |
Collapse
|
45
|
Zivic R, Radovanovic D, Vekic B, Markovic I, Dzodic R, Zivaljevic V. Surgical anatomy of the pyramidal lobe and its significance in thyroid surgery. S AFR J SURG 2011; 49:110, 112, 114 passim. [PMID: 21933507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2009] [Accepted: 08/10/2010] [Indexed: 05/31/2023]
Abstract
AIM The purpose of this prospective study was to highlight some new findings about anatomical and morphological variations of the thyroid pyramidal lobe and to emphasise the necessity and importance of exploration of the visceral compartment of the neck and resection of this structure in primary thyroid operations. METHOD We analysed 100 consecutive primary thyroid operations with additional pathological examination of the specimens. RESULTS A pyramidal lobe was found in 61% of the cases. The lobe of Lalouette was found more often in women (61.96%) than in men (50%) and more often (67.3%) in patients less than 50 years old than in those older than 50 (54.2%). The lobe branched off more frequently from the midline (49.18%) than from other parts of the isthmus; its length ranged from 8 - 40 mm, with a median length of 20.13 mm. In diffuse thyroid diseases, the lobes were always pathologically involved and significantly longer. CONCLUSION Since the pyramidal lobe is a normal component of the thyroid gland, of varying position and size, with pathological changes in benign and malignant diseases, it should always be examined during thyroid surgery and mandatorily removed in total and subtotal thyroidectomies.
Collapse
Affiliation(s)
- R Zivic
- Surgical Clinic, Clinical Center Dr Dragisa Misovic, Belgrade, Serbia.
| | | | | | | | | | | |
Collapse
|
46
|
Bukvic B, Sipetic S, Kalezic N, Diklic A, Paunovic I, Kovacevic B, Knezevic A, Zivaljevic V. Changing trends in mortality of thyroid cancer in Belgrade population. J BUON 2011; 16:337-340. [PMID: 21766507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
PURPOSE Thyroid cancer patients have favorable prognosis. The aim of this study was to analyze changing trends in mortality of thyroid cancer in Belgrade, during the period between 1987 and 2006. METHODS Mortality data were obtained from the Belgrade Office of Statistics. Mortality rates per 100,000 inhabitants were standardized according to the Segi's world population. Regression analysis was used to estimate the thyroid cancer mortality trend for the period 1987-2006. RESULTS The average percent of deaths due to thyroid cancer among all deaths was almost 2-fold higher in females (0.11%) than in males (0.6%), as well as among deaths due to all malignancies (females 0.54% and males 0.27%). During this 20-year period, the average standardized mortality rate was 1.5 times higher in females (0.74 per 100.000) than in males (0.51 per 100.000). In the observed period, the mortality rates for thyroid cancer were increased (+0.40%) in women and decreased (-0.42%) in men. In particular, in the 60-69 years age group in males, a significant trend for mortality decrease of 3.5%/year was detected. CONCLUSION Belgrade is classified in the regions with low risk of dying due to thyroid malignancies. The increasing trend of thyroid cancer mortality in females during the examined period calls for improvement of methods for early detection of disease and differential diagnosis of thyroid nodules, so that surgical treatment of thyroid cancer could be performed at a stage when it is not life threatening.
Collapse
Affiliation(s)
- B Bukvic
- Center for Endocrine Surgery, Institute for Endocrinology, Clinical Centre of Serbia, Belgrade, Serbia
| | | | | | | | | | | | | | | |
Collapse
|
47
|
Zivaljevic V, Zivic R, Diklic A, Krgovic K, Kalezic N, Vekic B, Stevanovic D, Paunovic I. [Solitary hyperfunctioning thyroid gland carcinomas]. Zentralbl Chir 2010; 136:374-8. [PMID: 21082544 DOI: 10.1055/s-0030-1262541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Thyroid gland carcinomas usually appear as afunctional and hypofunctional lesions on thyroid scintigrams, but some rare cases of thyroid carcinoma with scintigraphic hyperfunctional lesions have also been reported. The aim of our retrospective study was to elucidate the frequency of carcinomas in patients operated for solitary hyperfunctional thyroid nodules and to represent their demographic and clinical features. PATIENTS AND METHODS During one decade (1997/2006), 308 patients were operated for solitary hyperfunctional thyroid nodules in the Centre for Endocrine Surgery in Belgrade. RESULTS Malignancy was revealed in 9 cases (about 3 %) by histopathological examination. In 6 cases papillary microcarcinomas were found adjacent to dominant hyperfunctional adenomas, while in 3 cases (about 1 %) real hyperfunctional carcinomas were confirmed. Follicular carcinoma was diagnosed in 2 cases and papillary carcinoma in one. All 3 patients were preoperatively hyperthyroid. In both patients with follicular carcinoma we performed lobectomies. In the third case we carried out a total thyroidectomy considering the intraoperative frozen section finding of a papillary carcinoma. CONCLUSIONS According to our results the frequency of solitary hyperfunctioning thyroid carcinomas is about 1 %, so that the possibility that a hyperfunctional nodule is malignant should be considered in the treatment of such lesions.
Collapse
Affiliation(s)
- V Zivaljevic
- Endocrine Surgery, Clinical Center of Serbia, Belgrade, Serbia
| | | | | | | | | | | | | | | |
Collapse
|
48
|
Jovanovic DB, Pejanovic S, Vukovic L, Djukanovic L, Jankovic R, Kalezic N, Paunovic I, Zivaljevic V. Ten Years' Experience in Subtotal Parathyroidectomy of Hemodialysis Patients. Ren Fail 2009. [DOI: 10.1081/jdi-42852] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
|
49
|
Abstract
Acute suppurative thyroiditis and thyroid abscess are extremely rare disorders. The most common pathogens causing acute suppurative thyroiditis are Gram-positive bacteria, including staphylococcal and streptococcal species. Thyroid abscess is mostly located in the left thyroid lobe. We report the case of a 75-year-old female patient with acute suppurative thyroiditis and right lobe thyroid abscess caused by Klebsiella spp. The patient had a firm, livid, hardly mobile cervical swelling. Axial computed tomography image showed soft-tissue swelling, an abscess in the right thyroid lobe and swelling of the thyroid gland. The diagnosis was established on a smear culture result. The patient was diabetic and had been operated on for goitre fifty years before. On indirect laryngoscopic examination, the patient was found to have right vocal cord paralysis. Infection and abscess resolved following surgical drainage and treatment with intravenous antibiotics, while the vocal cord paralysis persisted. Diabetes mellitus and previous thyroid surgery, in which sutures were used with unresorptive material, might have been the precipitating factors for the patient to acquire this unusual infection.
Collapse
|
50
|
Zivaljevic V, Paunovic I, Diklic A, Krgovic K, Kalezic N, Kazic M, Tatic S, Savic D, Stojanovic* D, Perunovic* R. The incidence of familial nonmedullary thyroid cancer in a large case series. Acta Chir Belg 2008; 108:328-32. [PMID: 18710108 DOI: 10.1080/00015458.2008.11680231] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSES OF THE STUDY In contrast to familial medullary carcinoma, familial nonmedullary thyroid carcinoma (FNMTC) is less frequent and has been less investigated. The aim of this study was to determine the frequency of FNMTC and analyse the main demographic and clinical characteristics of the patients. MATERIAL AND METHODS Data on 1411 patients surgically treated for nonmedullary thyroid carcinoma, in the Center for Endocrine Surgery in Belgrade, from 1995 to 2006 were analysed. The possible presence of malignant tumours of the thyroid gland was investigated in their closest relatives in order to identify cases of FNMTC. Only data on first-degree relatives (parents and children) and second-degree relatives (grandparents, grandchildren and siblings) were taken into account in the analysis. RESULTS Thirteen patients (11 females and 2 males) (0.92% of those with nonmedullary carcinoma of the thyroid gland) had a familial form of the disease. In five families two members had a tumour, and in one family three members. In five out of six families it was a papillary carcinoma and in one family a follicular carcinoma. Patient age varied from 20 to 79 years, with a mean age of 40 years. The tumour size ranged from 5 to 60 mm (mean 25 mm). In two of the thirteen cases the tumour penetrated the capsule of the thyroid gland. In four cases the tumour was multicentric and bilateral, and in a further two metastases were present in regional lymph nodes. During the follow-up period, which lasted from 2 to 12 years (mean 8.5 years), two relapses were detected. CONCLUSION Familial nonmedullary carcinoma of the thyroid gland occurs very rarely.
Collapse
Affiliation(s)
- V. Zivaljevic
- Center for Endocrine Surgery, Institute of Endocrinology, Clinical Center Dedinje, Belgrade, Serbia
| | - I. Paunovic
- Center for Endocrine Surgery, Institute of Endocrinology, Clinical Center Dedinje, Belgrade, Serbia
| | - A. Diklic
- Center for Endocrine Surgery, Institute of Endocrinology, Clinical Center Dedinje, Belgrade, Serbia
| | - K. Krgovic
- Center for Endocrine Surgery, Institute of Endocrinology, Clinical Center Dedinje, Belgrade, Serbia
| | - N. Kalezic
- Center for Endocrine Surgery, Institute of Endocrinology, Clinical Center Dedinje, Belgrade, Serbia
| | - M. Kazic
- Center for Endocrine Surgery, Institute of Endocrinology, Clinical Center Dedinje, Belgrade, Serbia
| | - S. Tatic
- Institute of Cardiovascular Disease, Clinical Center Dedinje, Belgrade, Serbia
| | - D. Savic
- Clinical Center of Serbia; Institute of Pathology, Clinical Center Dedinje, Belgrade, Serbia
| | - D. Stojanovic*
- School of Medicine, Belgrade University, Clinic for General Surgery, Clinical Center Dedinje, Belgrade, Serbia
| | - R. Perunovic*
- School of Medicine, Belgrade University, Clinic for General Surgery, Clinical Center Dedinje, Belgrade, Serbia
| |
Collapse
|