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Direct anterior approach for THA has gained popularity over the last years. However, concerns have been raised regarding the cosmetic, related to the incision that does not respect the Langer’s skin tension line and may produce hypertrophic scars. The aim of this study was to analyze the preliminary results in 22 young female patients undergoing THA through a minimally invasive direct anterior approach using a modified oblique bikini incision. Clinical evaluations showed an improvement of WOMAC, UCLA and Harris Hip Score at 5-month follow-up. The technique ensured proper implant positioning and showed advantages in terms of complications, transfusion rates, hospital length of stay and functional recovery. From the aesthetic point of view, the expected cosmetic results were obtained. Minimally invasive direct anterior approach using a modified oblique bikini incision represent a viable option for THA, combining both the advantages of a minimal invasive procedure with a better aesthetic appearance.

Context: The immune system seems to play a key role in preventing metastasis and recurrence of thyroid cancer. T regulatory lymphocytes (Tregs) and natural killer (NK) cells play an important role in the dysfunction of the host immune system in cancer patients., Objective: We investigated thyroid gland infiltration by Tregs and NK cells in patients with papillary thyroid cancer (PTC) and thyroid nodular goiter (TNG). The correlation between the extent of the disease and the lymphocytic infiltration of Tregs and NK cells was examined., Design, Setting, and Participants: A total of 65 patients with PTC, 25 with TNG, and 50 healthy controls were studied. Blood and tissue samples from 28 patients with PTC and 13 with TNG and blood samples from the healthy controls were analyzed for T4 (CD3(+)CD4(+)), T8 (CD3(+)CD8(+)), NK (CD3(-)CD16(+)CD56(+)), and CD4(+)CD25(+)CD127(-/low) Tregs by flow cytometry (FC). Tissue samples were also analyzed for Foxp3(+) Tregs by immunohistochemistry., Results: Tregs showed greater infiltration in thyroid tissue of PTC patients compared with patients with TNG (P < 0.0009 for FC and P < 0.0001 for immunohistochemistry); FC analysis of blood samples showed no difference between the groups. Flow cytometry analysis showed significantly increased NK cells in PTC tissue compared with TNG tissue (P = 0.037), whereas blood samples showed no difference. CD4(+) and CD8(+) T cells did not differ in blood and tissue samples. Increased Tregs tissue infiltration was positively correlated with advanced disease stage (P < 0.0026), whereas NK infiltration was negatively correlated (P < 0.0041)., Conclusion: Tregs and NK cells may be important regulators of thyroid cancer progression.

Objective: To evaluate the application of color flow Doppler (CFD) sonography in the preoperative management of benign and malignant cold thyroid nodules., Design: Eighty-five patients with a cold thyroid nodule larger than 1cm were examined with CFD sonography prior to thyroidectomy. The histological examination revealed that 18 (21%) patients had malignant nodules and 67 (79%) had benign ones. The sonographic characteristics of the nodules used for evaluation were: a) absence of vascularization, b) presence of peripheral vascularization, c) presence of central vascularization and d) size of the nodule. The correlations between the pre-operative sonographic characteristics, as defined above, and the histological findings of the nodules were determined. results: The results showed that the vascular signals were absent in 4/18 (22%) of malignant nodules and 16/67 (23%) of benign ones. The smaller nodules (<2.5 cm.) were more frequently avascular (15/37=40%) compared to the larger ones (5/48=10%) (p<0.05). Moreover, for the nodules with vascularization, the peripheral distribution of vascularization was more frequently encountered in benign nodules (p<0.01 specificity=0.77, sensitivity=0.46), while central vascularization was more frequent in malignant ones (p<0.01, specificity=0.70, sensitivity=0.66). Thus, absence of vascularization in a nodule does not exclude the probability of malignancy, since vascularization depends on the size rather than the histological features of the nodule. Furthermore, for the vascularized nodules, peripheral distribution of vascularization is a characteristic of benignancy with high specificity, while central distribution is a characteristic of malignancy with medium specificity., Conclusions: CFD sonography contributes to the differential diagnosis of the large vascularized nodules, but it is less helpful in the smaller non-vascularized ones.

The purpose of this study was to investigate the value of "high-resolution ultrasonography" in the differential diagnosis of benign from malignant thyroid nodules. The study included ultrasonography examination of 77 patients with thyroid nodules, who underwent thyroidectomy. The histological findings were subsequently compared with pre-operative sonographic findings. Thirty patients had malignant nodules and 47 patients had benign nodules. The sonographic features that were studied were: hypoechogenicity or isoechogenicity of the nodules, the presence of peripheral halo, the regular or irregular contour, the presence of microcalcifications, the presence of cystic degeneration and the existence of solitary or multiple nodules. The results revealed that low echogenicity constitutes a sonographic feature of malignancy with high sensitivity and medium specificity. The presence of microcalcifications is a feature of malignancy with low sensitivity but high specificity. Conversely, the regular contour of a nodule and the presence of peripheral halo are features of benign nodule with high sensitivity and specificity. Cystic degeneration occurs at the same rate in benign and malignant nodules. Solitary nodules were malignant more often than were multiple nodules, a finding that was not, however, statistically significant. We conclude that high-resolution ultrasonography contributes greatly in the preoperative differential diagnosis of thyroid nodules. It constitutes an important diagnostic means complementary to needle biopsy in the management of thyroid nodules and it is even more valuable in those nodules that cannot undergo biopsy.

Objective: To assess the outcome of parathyroidectomy for renal failure-related hyperparathyroidism., Design: A retrospective analysis with a mean follow-up of 4.34 years of a case series of 67 consecutive patients with renal failure-associated hyperarathyroidism., Setting: All patients were operated on at the University Hospital of Wales and Cardiff Royal Infirmary between October 1981 and December 1991., Patients: Of the 67 consecutive patients, 35 were receiving hemodialysis and 32 had received a renal transplant., Intervention: Total parathyroidectomy with autotransplantation was performed in 52 patients and subtotal parathyroidectomy was performed in 15., Main Outcome Measures: Symptomatic improvement after parathyroidectomy, the normalization of biochemical parameters, and the rate of recurrent hyperparathyroidism after parathyroidectomy., Results: Symptomatic improvement after parathyroidectomy occurred in 81% of hemodialysis patients and in 72% of transplant patients. The best predictor for successful relief of skeletal pain after parathyroidectomy was an elevated preoperative alkaline phosphatase level. Recurrent hyperparathyroidism developed in four of 38 patients after total parathyroidectomy with autotransplantation and in one of 14 surviving patients after subtotal parathyroidectomy. All five patients with recurrent disease were hemodialysis patients (22%)., Conclusions: Transplant patients usually present with less severe disease, have better normalization of biochemical parameters after parathyroidectomy, and rarely develop recurrent hyperparathyroidism compared with hemodialysis patients. Both total parathyroidectomy with autotransplantation and subtotal parathyroidectomy result in good control of renal hyperparathyroidism with excellent improvement of symptoms.

Serum and urine total alpha-amylase isoenzymes values were estimated in two groups of patients, who underwent either elective cholecystectomy and operative cholangiogram (group A-59 patients) or cholecystectomy without operative cholangiogram (group B - 68 patients). Serum and urine total alpha-amylase and pancreatic isoamylase (p-type) values were statistically significantly increased within the first 24 postoperative hours as compared to the preoperative levels only in group A (p less than 0.05). No clinical signs of pancreatitis were observed. Serum lipase alterations did not reach any statistically significant difference in either group. It is concluded that transient hyperamylasaemia after preoperative cholangiogram may be due to a reversible chemical pancreatitis caused by the infused opacifying agent into the common bile duct.

Fourteen guinea pigs were given prednisolone daily for 20 days and 11 for 40 days. Another 20 formed the two control groups. Short-term prednisolone treatment significantly increased serum gastrin levels and antral G-cell population as compared to the control group. The same parameters significantly decreased following 40 days of prednisolone treatment as compared to the group of short-term prednisolone treatment. Forty days of prednisolone treatment significantly increased antral D-cell population as compared to the control and short-term prednisolone treatment groups. It is concluded that hypergastrinaemia and antral G-cell hyperplasia following corticosteroid administration is temporary and is accompanied by antral D-cell hyperplasia.

In the present study antral G-cells which secrete gastrin and antral and fundic D-cells which secret somatostatin, an inhibitor of gastric acid secretion were revealed immunocytochemically and the population size estimated along with serum gastrin levels in ten male and eight female guinea pigs. Serum gastrin, antral G-cells, antral D-cells and fundic D-cells were 41.90 +/- 6.10 SD pg/ml, 210 +/- 18.03 SD cells/cm, 128.20 +/- 17.64 SD cells/cm and 121 +/- 17.91 SD cells/cm respectively in males and 35 +/- 4.62 SD pg/ml, 176 +/- 13.80 SD cells/cm, 108.40 +/- 6.90 SD cells/cm and 106.8 +/- 6.50 SD cells/cm respectively in females. The differences in serum gastrin levels, antral G-cell population and antral D-cell population between the two sexes were statistically significant (P less than 0.05, P less than 0.001, P less than 0.01). It is possible that endogenous androgens induce a relative hyperplasia and endogenous oestrogens a relative hypoplasia of G-cells. Antral D-cell differences may reflect an adaptive hormonal mechanism to the possible different states of gastric secretory functions.

Prednisolone was administered to two groups of rats for 2 or 4 weeks, respectively. A third group served for control. Serum glucose and insulin levels were measured, and changes in population size along with alterations in staining density of the intracellular granules in pancreatic B-, A- and D-cells were assessed. Two weeks of prednisolone treatment induced significant increases in the staining density of the intracellular granules of B- and D-cells as well as the population size of A-cells, while significant hyperglucosaemia and hyperinsulinaemia were observed. Four weeks of prednisolone administration induced significant increases in population size of B- and D-cells and significant decrease in the population size of A-cells, while hyperglucosaemia and hyperinsulinaemia were even greater. It is concluded that corticosteroids cause an increase in pancreatic B-cell activity and, eventually A-cell numerical atrophy by altering the glucose metabolism. The changes in activity of D-cells possibly reflect functional adaptation to increased B-cell activity.