Surgical treatment of papillary thyroid carcinoma without lymph nodal involvement

Background. In the treatment of differentiated thyroid cancer (DTC), in absence of enlarged lymph nodes, the role of routine central lymph node dissection (RCLD) remains controversial. The aim of this study is to analyze data resulting from total thyroidectomy (TT) not combined with RCLD in the treatment of DTC. Methods. We retrospectively evaluated the clinical records of 80 patients treated between January 1996 and December 2003 with TT without RCLND, in absence of suspected enlarged lymph nodes at preoperative ultrasonography and intraoperatively during neck exploration. In this series, 75 patients (93.7%) underwent radioiodine (RAI) ablation, followed by Thyroid Stimulating Hormone (TSH) suppression therapy. In case of locoregional lymph nodal recurrence, a central (VI) and ipsilateral (III-IV) selective lymph node dissection was performed. Results. Incidence of permanent hypoparathyroidism (iPTH < 10 pg/ml) and unilateral temporary vocal fold paralysis were respectively 2.55% and 2.55%. Locoregional recurrence, with positive cervical lymph nodes, after a 10.3 ± 4.7 years mean follow-up was observed in 3 patients (3.75%). They were submitted to a central (VI) and ipsilateral (III-IV) selective neck dissection without significant complications. Conclusions. In our series, TT not combined with RCLD was associated to a low locoregional recurrence rate, even if the lack of a control group treated with RCLD does not allow any generalized assumption. RCLD may be indicated in high risk patients, in whom lymph nodal recurrence is more frequent. More prospective randomized studies are needed to better define the role of RCLD and postoperative radioiodine ablation.

Surgical strategy for the treatment of sporadic medullary thyroid carcinoma: our experience

Background. Medullary thyroid carcinoma (MTC) is a rare disease which accounts for approximately 5-9% of all thyroid cancers and originates from the calcitonin-secerning parafollicular C cells. MTC can be divided into two subgroups: sporadic (75%) or inherited (25%). The majority of patients with invasive MTC have metastasis to regional lymph nodes at the time of diagnosis, as evidenced by the frequent finding of persistently elevated calcitonin levels after thyroidectomy and the high rates of recurrence in the cervical lymph nodes reported in retrospective studies. Objectives. The purpose of the study is to review our single institution's experience with MTC since 1998 and to evaluate surgical strategy, patterns of lymph node metastases and calcitonin response to compartment-oriented lymphadenectomy in patients with primary or recurrent sporadic medullary thyroid carcinoma. Methods. A retrospective review of 26 patients treated for MTC at the “Antonio Cardarelli” Hospital referral center, in Naples, between 1998 and 2012. There were 18 female and 8 male patients, median age at presentation was 55 years, and median follow-up for survivors was 5 years. Total thyroidectomy was performed in all 26 patients; central compartment (CC) node dissection (level VI) in 12 (46%) patients; central plus lateral compartment (LC) node dissection (levels II, III, and IV) in 7 (27%) patients. 4 patients (15%) underwent reoperation for loco-regional recurrent/persistent MTC. Results. After a median post-surgical follow-up of 5 years (range 1-10 years), 63 % of patients were living disease-free, 15% were living with disease and/or persistently elevated calcitonin levels after surgery, 11% were deceased due to MTC and 11 % were lost to follow-up. Conclusions. We agree with most authors advocating for a total thyroidectomy and prophylactic central neck dissection in the setting of clinically detected MTC. Lateral neck dissection may be best reserved for patients with positive preoperative imaging. Nevertheless MTC has a high rate of lymph node metastases that are sub optimally detected preoperatively in the central compartment by neck ultrasound or intra-operatively by the surgeon, and reoperation is associated with a higher rate of surgical complications. In our limited experience, patients with thyroid confined nodular pathology, without nodal disease and unknown preoperative diagnosis of MTC, underwent only total thyroidectomy with a good prognosis.

Incidental cancer in patients surgically treated for benign thyroid disease. Our experience at a single institution

Increased incidence of incidental cancer in patients operated for benign thyroid disease has been reported. We report our experience about incidental thyroid cancer (ITC) in order to better characterize this nosologic entity. Between 2001 and 2009 a total of 568 patients underwent surgery for benign thyroid disease. Patients with preoperative cytology undetermined or positive for malignancy were excluded. The most frequent indication for surgery was multinodular or diffuse nontoxic goiter. We performed total thyroidectomy in 499 cases and emithyroidectomy in 69 cases. Final histology revealed ITC in 53 patients (9.3%): 44 had papillary carcinoma (20 classic variant and 24 follicular variant), 4 follicular carcinoma, 4 medullary carcinoma and 1 primitive thyroid paraganglioma. The preoperative diagnosis was multinodular or diffuse goiter in 45 cases of ITC and uninodular goiter in 8 cases. We performed total thyroidectomy in 46 case, emithyroidectomy in 4 patients with past history of lobectomy, emithyroidectomy in 3 patients with following radicalization and central neck dissection. In 14 patients the tumor was multifocal and in 12 of these patients the tumor foci were bilateral. The lesion was a microcarcinoma in 34 cases. Mean diameter of the ITC was 1.14 cm. We retrospectively reconsidered the results of preoperative ultrasound examinations in relation to the exact position of the tumor in the specimens and we found a statistically significant association between echogenicity and papillary histotype. Twenty-six patients were followed up at our Hospital. The mean follow-up period was 38.2 months. A relapse was observed in 3/26 patients. Incidental thyroid cancer in patients operated for benign disease has its own surgical and oncological relevance. A correct preoperative assessment, with a careful selection of nodules for fine-needle aspiration cytology on the basis of ultrasound pattern, could better address the choice of surgical procedure. The non irrelevant incidence of incidental thyroid cancer, the eventuality of multifocality and bilaterality and the possible occurrence of relapse, support that total thyroidectomy without residuum is a valuable option for treating benign thyroid conditions such as multinodular goitre. When an incidental cancer is diagnosed after emithyroidectomy, a radicalization with central neck dissection could be considered. We suggest that natural history of papillary microtumors and the correct surgical approach for these lesions could be better defined with a more extensive use of “Porto proposal” criteria. Incidental thyroid cancer, Papillary microcarcinoma, Papillary microtumors, Total thyroidectomy.

Vorwort: Vom Medienprojekt zur nachhaltigen Mediennutzung auf dem Digitalen Campus

Digitale Medien haben sich durch verschiedene Initiativen als ein selbstverständlicher Bestandteil im Hochschulalltag etabliert, wie z.B. bei der Literaturrecherche und -beschaffung, bei der Dokumentbearbeitung und -distribution ebenso wie bei der Präsentation und Kommunikation und im weitesten Sinne: als Medien des Lehrens und Lernens. Die Entwicklung lässt dabei nicht erkennen, dass sich traditionelle Hochschulen auflösen und vermehrt „virtuellen Universitäten“ Platz machen, wie noch vor wenigen Jahren von manchen Enthusiasten vorhergesagt wurde.Mit den zunehmend verfügbaren Erkenntnissen aus einer Vielzahl von Projekten und Aktivitäten an Hochschulen geht es heute vorrangig nicht mehr um die Erprobung „neuer“ Ansätze mediengestützten Lernens, sondern um die (Weiter-) Entwicklung von Strukturen und Prozessen, um bestehende Ansätze auf der Basis solcher Erkenntnisse konsequent zu erweitern und die aufgezeigten Potenziale digitaler Medien in der Lehre gezielt zu nutzen. Zentrale Aufgaben werden die Umsetzung von Konzepten des Medieneinsatzes in der alltäglichen Lehre und deren dauerhafte Integration in den Hochschulalltag, in Studienrichtungen und Studiengänge.Dieser Band gibt einen Einblick in aktuelle Bemühungen an Hochschulen, diese Prozesse der Hochschulentwicklung mit und durch Medien zu gestalten. Er beinhaltet die Vorträge der GMW03 – Conference on Media in Higher Education, der 8. Jahrestagung der Gesellschaft für Medien in der Wissenschaft e.V., die vom 16.-19. September 2003 an der Universität Duisburg-Essen stattgefunden hat. (DIPF/Orig.)

If not the Virtual university then what? Co-producing e-learning and configuring its users

This paper reflects the changing notion of the Virtual University and its realization. We introduce an approach from the Sociology of Science and Technology (STS) which analyses the construction of the “student as a user” as seen through the “eyes of designers”. We ask how social relations are built into technological artefacts. In showing how socio-technical developments transcend sometimes contradict and various notions of “the student” we discuss difficulties and chances of bridging the gap between designers of e-learning-artefacts and its assumed addresses. (DIPF/Orig.)

Cirurgia endoscópica em tumores nasosinusais: experiência do IPOLFG

Introdução: Os tumores nasais são, classicamente, abordados pela via externa mas recentemente tem-se optado, também, pela via endoscópica. No entanto, em tumores localmente avançados, poderá não ser possível a remoção completa. Material e métodos: Foram analisados os processos clínicos dos 14 doentes com tumor das fossas nasais removido por via endoscópica no IPOLFG entre 2005 e 2012. Resultados: Dos 14 doentes, 8 apresentavam tumor maligno e 5 tumor benigno. Não houve preponderância de nenhum tipo histológico. 7 doentes realizaram RT adjuvante e 1 foi submetido a esvaziamento ganglionar cervical ipsilateral. Foram registadas 2 complicações cirúrgicas: 1 fístula de LCR e 1 complicação minor. Apenas 2 doentes recidivaram, recorrendo-se à via externa em 1. Conclusões: A abordagem de tumores nasais por via endoscópica é uma opção eficaz mas é necessária uma correta avaliação da extensão tumoral para decisão da via cirúrgica a utilizar, para remoção completa e obtenção de margens livres.

Ansatzpunkte für das Change-Management beim Aufbau einer Notebook-Universität

Die Einführung von Notebooks an einer Universität bringt zunächst keine grundlegende Innovation mit sich. Die Potenziale, die mit dem Einsatz von Notebooks in der Präsenzlehre verbunden sind, sind vielfältig. Der Beitrag zeigt auf, welche Vorteile der Notebook-Einsatz auf den unterschiedlichen Ebenen Individuum, Gruppe und Organisation beinhaltet. Am Beispiel des eCampus-Projektes der Universität Duisburg-Essen zeigt sich, dass dieser Mehrwert sich jedoch nicht von selbst einstellt, sondern an bestimmte Bedingungen auf den verschiedenen Ebenen geknüpft ist. Es sind Maßnahmen notwendig, um die intendierten Veränderungsprozesse in Gang zu setzen, damit Notebooks im Alltag von Lehre und Forschung verankert werden können. Dazu sind Maßnahmen in den Bereichen Infrastruktur, didaktische Reform, Personal- und Organisationsentwicklung sowie Medienproduktion und -distribution zu ergreifen und in einem angemessenen Gleichgewicht umzusetzen. (DIPF/Orig.)

Präsenzunterricht, Fernunterricht: Die Suche nach dem optimalen Mix

Bei der Beurteilung von Projekten des Swiss Virtual Campus (SVC; Virtueller Campus Schweiz, Campus Virtuel Suisse, Campus Virtuale Svizzero), eines Programms des Bundes zur Förderung der neuen Informations- und Kommunikationstechnologien in der Hochschullehre, gilt es auch auf den optimalen Mix von Präsenzunterricht und Fernunterricht zu achten. Welche Arten von Szenarien sind vorstellbar, und wie beeinflusst die Art des Szenarios die optimale Verteilung von Präsenz- und Fernunterricht? Welche technischen Hilfsmittel sind für welches Szenario sinnvoll? Der Swiss Virtual Campus ist grundsätzlich nicht als Online-Universität geplant und nicht auf Fernstudien ausgerichtet. Es ist jedoch denkbar, dass manche Projekte des Swiss Virtual Campus künftig den Weg in Fernstudienangebote finden werden, obwohl sie nicht dafür konzipiert wurden. Einige Projekte von Fachhochschulen wurden bereits als Fernstudium konzipiert. In gewissen Aspekten funktionieren sie nach anderen Regeln als für Präsenzunterricht konzipierte Kurse.(DIPF/Orig.)

Lessons learned: Moderation und Gestaltung netzbasierter Diskussionsprozesse in Foren

Der Einsatz netzbasierter Diskussionsforen ist in vielen E-Learning-Szenarien zu finden: In ‚blended learning‘-Arrangements wird beispielsweise versucht, zwischen Präsenzsitzungen durch den Einsatz von Foren netzbasierte Diskussionsprozesse zu initiieren. Foren werden auch begleitend zur traditionellen Präsenzlehre eingesetzt, um z.B. der Besprechung von solchen Themen Raum und Zeit einzuräumen, welche in den wöchentlichen Präsenzsitzungen zu kurz kommen würden. Doch vor allem in rein virtuellen Lernszenarien spielen netzbasierte Foren eine besondere Rolle: Hier dienen sie als virtuelles Plenum der Kommunikation zwischen allen Teilnehmenden und bilden damit eine wichtige Funktion im Rahmen der Veranstaltung ab. Doch trotz dieser vielfältigen Einsatzmöglichkeiten lässt sich im Alltag der Hochschullehre immer wieder das Problem beobachten, dass Studierende die Option Foren zu nutzen nicht ausreichend aufgreifen. Oftmals werden Rolle und Aufgabe der Foren im Rahmen der gesamten Veranstaltung nicht transparent. Viele Hochschullehrende stellen sich die Frage, wie sie den Einsatz von Foren und damit die zusätzlichen Kommunikationsmöglichkeiten attraktiv gestalten können. Dieser Beitrag widmet sich diesem Problem, indem Einsatzszenarien netzbasierter Foren vorgestellt und aus den Erfahrungen mit mehreren virtuellen Konferenzen Gestaltungsoptionen und Moderationsstrategien für Foren abgeleitet werden.(DIPF/Orig.)

Volatile Blood Pressure Due To Baroreflex and Autonomic Failure

An 85-year-old male was hospitalized because of deterioration of his general condition and infection of the tracheostoma. He had had laryngectomy, bilateral neck dissection and radiation therapy for a laryngeal carcinoma 5 years earlier. Despite a good recovery, he could not get up because of a new onset of postural symptoms (dizziness, lightheadedness, collapse). Late onset of baroreflex failure and autonomic nervous system failure were diagnosed. Volatility of blood pressure (supine hypertension, upright hypotension) was treated with NaCl supplement during the day and a short-acting antihypertensive (clonidine) at night. With this regimen, the patient could walk without support.

Polymyalgia Rheumatica (PMR) Special Interest Group at OMERACT 11: outcomes of importance for patients with PMR

We worked toward developing a core outcome set for clinical research studies in polymyalgia rheumatica (PMR) by conducting (1) patient consultations using modified nominal group technique; (2) a systematic literature review of outcome measures in PMR; (3) a pilot observational study of patients presenting with untreated PMR, and further discussion with patient research partners; and (4) a qualitative focus group study of patients with PMR on the meaning of stiffness, using thematic analysis. (1) Consultations included 104 patients at 4 centers. Symptoms of PMR included pain, stiffness, fatigue, and sleep disturbance. Function, anxiety, and depression were also often mentioned. Participants expressed concerns about diagnostic delay, adverse effects of glucocorticoids, and fear of relapse. (2) In the systematic review, outcome measures previously used for PMR include pain visual analog scores (VAS), morning stiffness, blood markers, function, and quality of life; standardized effect sizes posttreatment were large. (3) Findings from the observational study indicated that asking about symptom severity at 7 AM, or "on waking," appeared more relevant to disease activity than asking about symptom severity "now" (which depended on the time of assessment). (4) Preliminary results were presented from the focus group qualitative study, encompassing broad themes of stiffness, pain, and the effect of PMR on patients' lives. It was concluded that further validation work is required before a core outcome set in PMR can be recommended. Nevertheless, the large standardized effect sizes suggest that pain VAS is likely to be satisfactory as a primary outcome measure for assessing response to initial therapy of PMR. Dissection of between-patient heterogeneity in the subsequent treatment course may require attention to comorbidity as a potential confounding factor.

Variação no conteúdo protéico e pigmentar em variantes cromáticas de Gracilaria domingensis nas populações naturais de Rio do Fogo-RN, BRASIL

The seaweed Gracilaria domingensis is a common species in the coast of Rio Grande do Norte. This species lives in the intertidal zone, where colour strains (red, green and brown) co-occur during the whole year. Seaweeds that live in this region are exposed to daily changes and to the rhythm of the tide. During the low tide they are exposed to dissection, hiper-or hipo-osmotic shock, high temperatures and high irradiance. The aim of this study was to analyze whether the pigment and protein content of the colour strains of G. domingensis is affected by some environmental parameters in a temporal scale. The seaweeds were collected during 10 months in the seashore of Rio do Fogo (RN). The total soluble proteins and the phycobiliprotein were extracted in phosphate buffer and the carotenoids were analyzed by a standardized method through HPLC-UV. The pigments analysis showed that phycoerithrin is the most abundant pigment in the three strains. This pigment was strongly correlated with nitrogen and the photosynthetically active radiation. Chlorophyll presented higher concentrations than carotenoids during the whole, but the ratio carotenoid/chlorophyll-a was modified by incident radiation. The most abundant carotenoid was ß-carotene and zeaxanthin, which had higher concentrations in the higher radiation months. The concentration increase of zeaxanthin in this period indicated a photoprotective response of the seaweed. The three strains presented a pigment profile that indicates different radiation tolerance profile. Our results pointed that the green strain is better adapted to high irradiance levels than the red and brown strains

Das Mobile Hardware-Praktikum

Im Rahmen der wissenschaftlichen Ausbildung sind Praktika vielerorts ein wichtiger Bestandteil der Lehre. Sie zeichnen sich im Regelfall dadurch aus, dass die Studierenden die gestellten Versuche an speziell ausgestatteten Laborplätzen durchführen, was neben extrem hohen Kosten zu einer Begrenzung der maximalen Teilnehmerzahl führt. In diesem Zusammenhang scheint es auf den ersten Blick nicht möglich, Konzepte einer Virtuellen Universität umzusetzen, da die Studierenden „vor Ort“ sein müssen. In diesem Dokument stellen wir das so genannte Mobile Hardware-Praktikum vor, das den Studierenden die Teilnahme zu jeder Zeit und von jedem beliebigen Ort aus erlaubt und dennoch ein Gefühl der Präsenz im Labor vermittelt. Gleichzeitig kann weit mehr als 100 Studierenden die Teilnahme ermöglicht werden. Erreicht wird dies durch ein speziell für diesen Zweck entwickeltes webbasiertes Learning Management System in Kombination mit Hardware-Komponenten, die einem voll ausgestatteten Labor-Arbeitsplatz entsprechen und den Teilnehmern für die Zeit des Praktikums auf Leihbasis zur Verfügung gestellt werden. Die Experimente werden von den teilnehmenden Gruppen in Eigenregie gelöst und elektronisch abgegeben. Die Bewertung erfolgt ebenfalls elektronisch.(DIPF/Orig.)

Kollaboratives Lernen mit WikiWikiWebs

WikiWikiWebs sind ein asynchrones webbasiertes Kommunikationsinstrument, das vergleichbar mit Diskussionsforen, Weblogs und anderen CSCW1-Umgebungen in verschiedenen Szenarien einsetzbar ist. Es basiert auf zwei zentralen Prinzipien: „Jeder kann jeden Text ändern“ und „Strukturen entstehen bottom-up durch Verlinkung.“ Als Lernumgebungen können WikiWikiWebs zentrale Kommunikationsplattformen für asynchrone, ortsverteilte Veranstaltungen sein oder veranstaltungsbegleitend die Kommunikation über die Präsenzveranstaltungen hinaus ausdehnen. Idealerweise verändern WikiWikiWebs die Textproduktion hin zu einem kooperativen Prozess, der selbst organisierendes Lernen in Arbeitsgruppen begünstigt. Anhand von drei Anwendungsszenarien werden Bedingungen und Möglichkeiten eines solchen Lernens diskutiert. Die Ergebnisse zeigen, dass WikiWikiWebs kollaboratives Lernen und Arbeiten unter geeigneten Einsatzbedingungen ermöglichen, aber nicht von selbst herbeiführen.(DIPF/Orig.)

Teaching by chat

This paper discusses some didactical aspects of chat usage for instructional purposes. Areas covered range from the choice of course type and student group for using chats, to the preparation and moderation of chats, and discussing how to manage both troublemaking students and systems. In February 1998 I was the chair of a committee at my previous university that was authoring a recommendation list about the Internet to the president of the school. One of our recommendations was to eliminate the IRC server (Internet Relay Chat), since it was only causing traffic and was just being used for games. We stated that we could not envision a use for chatting either for research or for instructional purposes. Five years later here I am: teaching 4 of my 5 courses by way of chat. There has been an enormous growth in the use of chat-based instruction, but also quite a lot of problems encountered. Much of the available literature addresses technical problems, or discusses chats from an educational psychology perspective. This paper will address ten of the didactical issues in chat-based instruction, summarizing the experiences that I have made in many years of chat experience (DIPF/Orig.)