Conservative (non-invasive) management of children with splenic cysts

Surgeons’ views on tactics for treatment of splenic cysts (SC) in children are widely discussed in the literature. Indications and methods of conservative (non-invasive) management (observation) of children with SC is different issue. Purpose – to develop rational tactical approache for conservative (non-invasive) management of children with SC. Materials and methods. A retrospective analysis of conservative (non-invasive) management of 90 (33.96%) of 265 patients with SC was performed. Children were not operated if the SC was less than 20 mm (n=61) in diameter. They were first monitored by ultrasound 2 times for 6 months, then – 2 times a year, until puberty. We did not observe the progression of cyst growth in these children. Also did not operate children in whom the size of SC was from 20 to 62 mm, had an asymptomatic course and parents did not consent to surgical treatment (n=29). This is the most difficult group of patients to analyze, as most of them lack information about the dynamic observation. According to the results of dynamic observation in 19 of 29 examined patients’ regression of SC was not observed, which later served as an indication for surgical treatment. Results and conclusions. In the presence of SC, a choice of surgical treatment or conservative (non-invasive) management is possible. Tactical approach for treatment of children with SC is strictly individual and depends on the size and location of the parenchymal lesion. In SC up to 20 mm diameter, conservative (non-invasive) management is rational, which is confirmed by the lack of progression of cyst growth in these children. Dynamic observation of patients with SC with a diameter of more than 20 mm without regression, serves as an indication for surgical treatment. The research was carried out in accordance with the principles of the Helsinki declaration. The study protocol was approved by the Local Ethics Committee of an participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: spleen cyst, children, conservative, non-invasive, management, results.

Primary Hyperparathyroidism Due to Parathyroid Adenoma: Clinical Case

Primary hyperparathyroidism (PGPT) is an endocrine disease characterized by excessive secretion of parathyroid hormone (PTH) in upper — normal or elevated blood calcium levels due to primary parathyroid gland pathology (osch). Primary hyperparathyrosis, depending on the clinical manifestations, can occur in the normocalcemic, mild and manifest form. This article presents a clinical case of the development of the manifest form by the type of visceral disorders. Which appeared in the form of pathology of the gastrointestinal tract. This form of the disease is an indication for surgical treatment and further correction of calcium-phosphorus metabolism.

Score-based improvement of the indication for surgical treatment of thyroid lesions

Background The prevalence of focal lesions in the thyroid is high in Germany. In 2018 about 70 000 thyroid surgeries were performed, although the malignancy rate of such findings is low. For this reason it is important to conduct an adequate selection of patients for whom surgery is indicated. Aim The aim of our work was to validate the preoperative indication for surgery of thyroid lesions based on an independent, self-developed clinical score. Patients and Methods The patient data were evaluated retrospectively over the period 2013 to 2014. A prerequisite for inclusion was that the patients had carried out their complete treatment in domo. The multiparametic score was determined retrospectively and ranges from 3 to 15. The subjective improvement of symptoms (self-disclosure > 6 months postoperatively) and the presence of malignant histology were evaluated as positive outcome parameters. Results From a collective of 180 patients, 36 patients could be included, in whom all score-relevant parameters had been surveyed. The score distribution was 10 % score 3, 12.5 % score 4, 25 % score 5, 25 % score 6, 12.5 % score 7, 7.5 % score 8, 5 % score 9 and 2.5 % score 10. Using ROC analysis shows an AUC of 0.903, which is a very good differentiation. With a CUT-off score of 7 or higher, 86 % of patients have benefited from surgery. Conclusion Our score with the parameters clinical complaints, sonographically defined size of the thyroid and the cytological result of a fine needle biopsy can lead to an improvement of the indication for surgical treatment of thyroid nodules.