Papillary thyroid carcinoma is the most common type of thyroid cancer, for which surgery following preoperative staging and risk assessment is the standard treatment. Afatinib is an orally active irreversible ErbB-family inhibitor that binds to the kinase domain of epidermal growth factor receptors (EGFRs), HER2, and HER4, and has been approved as monotherapy for the treatment of locally advanced or metastatic non-small cell lung cancer with activated EGFR mutations. Recently, we observed an unexpected effect of afatinib administered to treat lung cancer on untreated papillary thyroid carcinoma.

BACKGROUND: We examined whether increases of intra-abdominal pressure would decrease compliance (C) of both lung and chest wall. METHODS: We measured airway and esophageal pressure in 10 anesthetized/paralyzed tracheally intubated patients during mechanical ventilation at the respiratory rate of 10 freq/min and the tidal volume of 10 ml/kg undergoing laparoscopic cholecystectomy. Measurements were made at 0 mmHg intra- abdominal pressure the (Pab) in supine position and at 15 mmHg Pab in 10 head-up (reverse Trendelenburg) position at 0, 5, 10 and 15 min. after CO2 insufflation. RESULTS: We found that abdominal carbon dioxide insufflation caused a marked increase in peak airway pressure, plateau pressure and esophageal pressure (p<0.05); a reduction in compliance of respiratory system and chest wall (p<0.05). CONCLUSION: These changes should be considered in patients such as those with pulmonary disease, undergoing laparoscopic cholecystectomy where increase in impendance may be critical.
Carbon Dioxide ; Cholecystectomy, Laparoscopic* ; Compliance* ; Humans ; Insufflation ; Lung ; Lung Diseases ; Respiration, Artificial ; Respiratory Rate ; Respiratory System* ; Supine Position ; Thoracic Wall ; Tidal Volume

BACKGROUND: We evaluated whether the time required for a seizure to spread contralaterally, interhemispheric propagation time (IHSPT) could be related to post-surgical outcome in temporal lobectomy. METHODS: We performed a retrospective study of 28 patients. All patients had previously undergone a phase I presurgical evaluation including MRI and video-EEG monitoring with scalp and sphenoidal electrodes, which strongly suggested the diagnosis of mesial temporal lobe epilepsy, but proved inadequate to lateralize the epileptogenic zone. All patients performed the video-EEG monitoring with bilateral subdural strip electrodes on their basal and mesial temporal area and unilateral temporal lobectomy with a minimum of 1-year follow up postoperatively. IHSPT was divided into two categories, 0~5.0 seconds, 5.1 seconds or longer. RESULTS: Sixteen patients (57.1%) were seizure free and 12 suffered persistent seizures. A prolonged IHSPT (> 5.0sec) significantly correlated with a favorable surgical outcome (P = 0.05). Hippocampal atrophy on MRI significantly correlated with prolonged IHSPT (P<0.05). CONCLUSIONS: Our result suggests that hippocampal atrophy on MRI and IHSPT can predict the surgical outcome and may be used as the selection criteria of temporal lobectomy for patients with intractable temporal lobe epilepsy.
Atrophy ; Diagnosis ; Electrodes* ; Epilepsy, Temporal Lobe* ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging ; Patient Selection ; Retrospective Studies ; Scalp ; Seizures ; Temporal Lobe*

PURPOSE: The laparoscopic adrenalectomy (LA) has become the preferred procedure for adrenal tumors due to many advantages; a more rapid and comfortable recovery, shortened hospitalization period, and fewer complications. This study reports on an initial 4 year period of experience with LA and describes various unusual findings encountered during the treatment. METHODS: From February 1997 to November 2000, a total of 20 LA were performed. Of the several LA techniques previously described we prefer the transabdominal approach in the lateral decubitus position utilizing 3 or 4 trocars, and this method was employed in all the cases presented here. RESULTS: All 20 patients had a unilateral tumor. The pathological findings consisted of 11 aldosteronomas, 6 Cushing adenomas, 2 pheochromocytomas and 1 cortical carcinoma. Of the 20 patients, 18 were successfully operated with the laparoscopic procedure and the remaining 2 cases were converted to open adrenalectomy. The reasons for conversion were sudden cardiac arrest of unknown origin in one and intraoperative bleeding due to periadrenal massive fat in the other. During LA, 2 patients with non-catecholamine-secreting cortical adenomas pathologies displayed abnormal EKG findings, which reverted to normal after the operation. The average complete LA operation times was 186 minutes in the first 9 cases and 132 minutes in the next 9 cases. The first oral intake was started within 24 hours in all cases. There were no postoperative complications, operative morbidity or mortality. The average hospital stay was 6.2 days in the first 9 cases and 4.2 days in the next 9 cases. CONCLUSION: LA is a relatively fast and safe method and has become is accepted as the preferred procedure for adrenal tumors but it requires good perioperative preparation. Surgeons and anesthesiologists need to be aware of the possible cardiovascular complications and of the problems inherent in the manipulation of the adrenal gland during LA.
Adenoma ; Adrenal Glands ; Adrenalectomy* ; Death, Sudden, Cardiac ; Electrocardiography ; Hemorrhage ; Hospitalization ; Humans ; Length of Stay ; Mortality ; Pathology ; Pheochromocytoma ; Postoperative Complications ; Surgical Instruments

PURPOSE: The laparoscopic adrenalectomy (LA) has become the preferred procedure for adrenal tumors due to many advantages; a more rapid and comfortable recovery, shortened hospitalization period, and fewer complications. This study reports on an initial 4 year period of experience with LA and describes various unusual findings encountered during the treatment. METHODS: From February 1997 to November 2000, a total of 20 LA were performed. Of the several LA techniques previously described we prefer the transabdominal approach in the lateral decubitus position utilizing 3 or 4 trocars, and this method was employed in all the cases presented here. RESULTS: All 20 patients had a unilateral tumor. The pathological findings consisted of 11 aldosteronomas, 6 Cushing adenomas, 2 pheochromocytomas and 1 cortical carcinoma. Of the 20 patients, 18 were successfully operated with the laparoscopic procedure and the remaining 2 cases were converted to open adrenalectomy. The reasons for conversion were sudden cardiac arrest of unknown origin in one and intraoperative bleeding due to periadrenal massive fat in the other. During LA, 2 patients with non-catecholaminesecreting cortical adenomas pathologies displayed abnormal EKG findings, which reverted to normal after the operation. The average complete LA operation times was 186 minutes in the first 9 cases and 132 minutes in the next 9 cases. The first oral intake was started within 24 hours in all cases. There were no postoperative complications, operative morbidity or mortality. The average hospital stay was 6.2 days in the first 9 cases and 4.2 days in the next 9 cases. CONCLUSION: LA is a relatively fast and safe method and has become is accepted as the preferred procedure for adrenal tumors but it requires good perioperative preparation. Surgeons and anesthesiologists need to be aware of the possible cardiovascular complications and of the problems inherent in the manipulation of the adrenal gland during LA.
Adenoma ; Adrenal Glands ; Adrenalectomy* ; Death, Sudden, Cardiac ; Electrocardiography ; Hemorrhage ; Hospitalization ; Humans ; Length of Stay ; Methods ; Mortality ; Pathology ; Pheochromocytoma ; Postoperative Complications ; Surgeons ; Surgical Instruments

PURPOSE: The laparoscopic adrenalectomy (LA) has become the preferred procedure for adrenal tumors due to many advantages; a more rapid and comfortable recovery, shortened hospitalization period, and fewer complications. This study reports on an initial 4 year period of experience with LA and describes various unusual findings encountered during the treatment. METHODS: From February 1997 to November 2000, a total of 20 LA were performed. Of the several LA techniques previously described we prefer the transabdominal approach in the lateral decubitus position utilizing 3 or 4 trocars, and this method was employed in all the cases presented here. RESULTS: All 20 patients had a unilateral tumor. The pathological findings consisted of 11 aldosteronomas, 6 Cushing adenomas, 2 pheochromocytomas and 1 cortical carcinoma. Of the 20 patients, 18 were successfully operated with the laparoscopic procedure and the remaining 2 cases were converted to open adrenalectomy. The reasons for conversion were sudden cardiac arrest of unknown origin in one and intraoperative bleeding due to periadrenal massive fat in the other. During LA, 2 patients with non-catecholaminesecreting cortical adenomas pathologies displayed abnormal EKG findings, which reverted to normal after the operation. The average complete LA operation times was 186 minutes in the first 9 cases and 132 minutes in the next 9 cases. The first oral intake was started within 24 hours in all cases. There were no postoperative complications, operative morbidity or mortality. The average hospital stay was 6.2 days in the first 9 cases and 4.2 days in the next 9 cases. CONCLUSION: LA is a relatively fast and safe method and has become is accepted as the preferred procedure for adrenal tumors but it requires good perioperative preparation. Surgeons and anesthesiologists need to be aware of the possible cardiovascular complications and of the problems inherent in the manipulation of the adrenal gland during LA.
Adenoma ; Adrenal Glands ; Adrenalectomy* ; Death, Sudden, Cardiac ; Electrocardiography ; Hemorrhage ; Hospitalization ; Humans ; Length of Stay ; Methods ; Mortality ; Pathology ; Pheochromocytoma ; Postoperative Complications ; Surgeons ; Surgical Instruments