scholarly journals Current Practice of Surgery for Benign Goitre—An Analysis of the Prospective DGAV StuDoQ|Thyroid Registry

2019 ◽  
Vol 8 (4) ◽  
pp. 477 ◽  
Author(s):  
Detlef Bartsch ◽  
Cornelia Dotzenrath ◽  
Christian Vorländer ◽  
Andreas Zielke ◽  
Theresia Weber ◽  
...  
Keyword(s):  
Postoperative Bleeding ◽  
Parathyroid Tissue ◽  
Surgical Techniques ◽  
Major Complication ◽  
Needle Aspiration ◽  
Perioperative Outcomes ◽  
Recurrent Nerve ◽  
Indications For Surgery ◽  
Recurrent Nerve Palsy ◽  
Postoperative Hypoparathyroidism

Background: To evaluate the current indications, resection strategies and short-term outcomes of surgery for benign goitre in a country with endemic goitre. Methods: Data of patients who underwent surgery for benign goitre were retrieved from the prospective StuDoQ/Thyroid registry and retrospectively analysed regarding the patient’s demographics, indications for surgery, surgical procedures, histology, and perioperative outcomes. Results: In a 15-month period, 12,888 patients from 83 departments underwent thyroid resections for benign conditions. Main indications for surgery were exclusion of malignancy (68%), compression symptoms (20.7%) and hyperthyroidism (9.7%). Preoperative fine needle aspiration cytology was performed in only 12.2% of patients with the indication “exclusion of malignancy”. Thyroidectomy (49.8%) or hemithyroidectomy (36.9%) were performed in 86.7% of patients. Minimally invasive or alternative surgical techniques were applied in only 2.2%. Intraoperative neuromonitoring was used in 98.4% of procedures, in 97.5% of patients at least one parathyroid gland was visualized, and in 15.3% of patients parathyroid tissue was autografted, respectively. The rates of unilateral and bilateral transient recurrent nerve palsy were 3.6% and 0.07% of nerves at risk, the rate of transitory hypoparathyroidism was 15.3%. The rates of postoperative bleeding and wound infections requiring reoperation were 1.4% and 0.07%, respectively. Conclusions: The indication “exclusion of malignancy” is made too liberally, and there is a strong attitude to perform complete thyroid resections. Postoperative hypoparathyroidism is the major complication after surgery for benign thyroid disease, thus requiring more awareness.

scholarly journals Surgery of the Thyroid Gland

1997 ◽  
Vol 40 (3) ◽  
pp. 71-74
Author(s):  
Jan Vokurka ◽  
Stanislava Jakoubková ◽  
Jaroslav Růžička
Keyword(s):  
Thyroid Gland ◽  
Surgical Technique ◽  
Total Thyroidectomy ◽  
Nerve Palsy ◽  
Diagnostic Procedure ◽  
Postoperative Bleeding ◽  
Blood Transfusions ◽  
Recurrent Nerve ◽  
Recurrent Nerve Palsy ◽  
Laryngeal Recurrent Nerve

Since the year 1987 to 1996 all kinds of thyroid surgeries were performed at the ENT Department. Altogether 604 patients underwent 655 surgeries. Total lobectomy or total thyroidectomy represented the most common procedures. Due to a gentle surgical technique, which we call ãpreparationÒ, good results were achieved in the morbidity of laryngeal recurrent nerve (permanent palsy in 0.6%), and in perioperative or postoperative bleeding (0.3% of wound revisions, 0.5% of blood transfusions). Postoperative hypoparythyroidism was found in 4.7% patients. There is no correlation between postoperative hoarseness and laryngeal recurrent nerve palsy. Laryngeal endoscopy immediately after surgery is the most valuable diagnostic procedure.

scholarly journals Surgical technique for revision surgery of cervical artificial disc replacements

2017 ◽  
Vol 42 (videosuppl1) ◽  
pp. V3 ◽  
Author(s):  
Julia Onken ◽  
Bernhard Meyer ◽  
Peter Vajkoczy
Keyword(s):  
Revision Surgery ◽  
Surgical Techniques ◽  
Patient Positioning ◽  
Fusion Rate ◽  
Recurrent Nerve ◽  
Artificial Disc ◽  
Surgical Experience ◽  
Recurrent Nerve Palsy ◽  
Initial Surgery ◽  
Short Time

OBJECTIVECervical artificial disc replacement (C-ADR) is a widely used procedure with low risk at implantation. Few cases have been reported about the surgical techniques of C-ADR revision. The authors describe their surgical experience with the explantation of a Galileo C-ADR.METHODSRevision surgery was performed in a 58-year-old patient. Patient positioning and surgical opening techniques were performed as appropriate for anterior cervical decompression.RESULTSRevision surgery via the initial anterior approach was successful following an atraumatic removal of the implant. Fusion of the C5–6 segment was performed without complications.CONCLUSIONSIn general, the authors observed recurrent nerve palsy and malpositioning of the revised implant in C-ADR revision surgery. Problems with implant removal did not occur because the fusion rate was low due to the short time between initial surgery and C-ADR revision surgery.The video can be found here: https://youtu.be/32CUEDquinc.

Operative and Technical Complications of Vagus Nerve Stimulator Implantation

2010 ◽  
Vol 67 (suppl_2) ◽  
pp. ons489-ons494 ◽  
Author(s):  
Sebastian Spuck ◽  
Volker Tronnier ◽  
Iren Orosz ◽  
Rainer Schönweiler ◽  
Abolgassem Sepehrnia ◽  
...  
Keyword(s):  
Vagus Nerve ◽  
Refractory Epilepsy ◽  
Late Onset ◽  
Major Complication ◽  
Fracture Dislocation ◽  
Recurrent Nerve ◽  
Technical Problems ◽  
Recurrent Nerve Palsy ◽  
Cardiac Symptoms ◽  
Technical Complications

ABSTRACT BACKGROUND: The treatment of refractory epilepsy by vagus nerve stimulation (VNS) is a well-established therapy option for patients not suitable for epilepsy surgery and therapy refractory depressions. OBJECTIVE: To analyze surgical and technical complications after implantation of left-sided VNS in patients with therapy-refractory epilepsy and depression. METHODS: One hundred five patients receiving a VNS or VNS-related operations (n = 118) from 1999 to 2008 were investigated retrospectively. RESULTS: At the time of operation, 84 patients were younger than 18 years, with a mean age of 10.5 years. Twenty (19%) patients had technical problems or complications. In 6 (5.7%) patients these problems were caused by the operation. The device was removed in 8 cases. The range of surgically and technically induced complications included electrode fractures, early and late onset of deep wound infections, transient vocal cord palsy, cardiac arrhythmia under test stimulation, electrode malfunction, and posttraumatic dysfunction of the stimulator. CONCLUSION: VNS therapy is combined with a wide spread of possible complications. Technical problems are to be expected, including electrode fracture, dislocation, and generator malfunction. The major complication in younger patients is the electrode fracture, which might be induced by growth during adolescence. Surgically induced complications of VNS implantation are comparably low. Cardiac symptoms and recurrent nerve palsy need to be taken into consideration.

Diagnostic accuracy and complication rate of image-guided percutaneous transthoracic needle lung biopsy for subsolid pulmonary nodules: a systematic review and meta-analysis

2021 ◽  
Author(s):  
Junghoon Kim ◽  
Choong Guen Chee ◽  
Jungheum Cho ◽  
Youngjune Kim ◽  
Min A Yoon
Keyword(s):  
Diagnostic Accuracy ◽  
Complication Rate ◽  
Needle Biopsy ◽  
Meta Analysis ◽  
Pulmonary Nodules ◽  
Major Complication ◽  
Needle Aspiration ◽  
Fine Needle ◽  
Major Complication Rate ◽  
Higher Sensitivity

Objectives: To determine the diagnostic accuracy and complication rate of percutaneous transthoracic needle biopsy (PTNB) for subsolid pulmonary nodules and sources of heterogeneity among reported results. Methods: We searched PubMed, EMBASE, and Cochrane libraries (until November 7, 2020) for studies measuring the diagnostic accuracy of PTNB for subsolid pulmonary nodules. Pooled sensitivity and specificity of PTNB were calculated using a bivariate random-effects model. Bivariate meta-regression analyses were performed to identify sources of heterogeneity. Pooled overall and major complication rates were calculated. Results: We included 744 biopsies from 685 patients (12 studies). The pooled sensitivity and specificity of PTNB for subsolid nodules were 90% (95% confidence interval [CI]: 85–94%) and 99% (95% CI: 92–100%), respectively. Mean age above 65 years was the only covariate significantly associated with higher sensitivity (93% vs  85%, p = 0.04). Core needle biopsy showed marginally higher sensitivity than fine-needle aspiration (93% vs  83%, p = 0.07). Pooled overall and major complication rate of PTNB were 43% (95% CI: 25–62%) and 0.1% (95% CI: 0–0.4%), respectively. Major complication rate was not different between fine-needle aspiration and core needle biopsy groups (p = 0.25). Conclusion: PTNB had acceptable performance and a low major complication rate in diagnosing subsolid pulmonary nodules. The only significant source of heterogeneity in reported sensitivities was a mean age above 65 years. Advances in knowledge: This is the first meta-analysis attempting to systemically determine the cause of heterogeneity in the diagnostic accuracy and complication rate of PTNB for subsolid pulmonary nodules.

Plantar Fibromatosis: A Review of Primary and Recurrent Surgical Treatment

1995 ◽  
Vol 16 (9) ◽  
pp. 548-551 ◽  
Author(s):  
Keith L. Wapner ◽  
Prodromos A. Ververeli ◽  
John H. Moore ◽  
Paul J. Hecht ◽  
Carl E. Becker ◽  
...  
Keyword(s):  
Surgical Techniques ◽  
Major Complication ◽  
Primary Group ◽  
Split Thickness Skin Graft ◽  
Consecutive Series ◽  
Revision Procedure ◽  
Thickness Skin ◽  
Plantar Fibromatosis ◽  
Revision Operations

Plantar fibromatosis can be quite disabling to the patient, as well as a technical challenge to the surgeon. Patients who undergo previous local excisions and in whom aggressive recurrences develop are difficult to manage successfully. We present a consecutive series of five primary procedures on patients with painful plantar fibroma and seven revision operations on patients with recurrent plantar fibroma. The average follow-up was 47 months (range, 22–66 months) in the primary group and 40 months (range, 21–78 months) in the revision group. The overall results were satisfactory in four of the five primary operations, with only one recurrence. In the revision group, five of seven results were satisfactory with no recurrences. The major complication that led to unsatisfactory results was the development of a postoperative neuroma. In this article, we outline our present surgical techniques of wide primary excision and a staged revision procedure with delayed split-thickness skin graft closure. These techniques can be used successfully to manage this disabling, progressive disease.

scholarly journals SUN-934 A Rare Case of Hyperparathyroidism - Parathyroid Carcinoma, Atypical Adenoma, or Both?

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Petra Krutilova ◽  
Harjyot Sandhu ◽  
Michael Salim ◽  
Janice L Gilden ◽  
Paula Butler
Keyword(s):  
Parathyroid Carcinoma ◽  
Rare Case ◽  
Parathyroid Tissue ◽  
Needle Aspiration ◽  
Mitotic Rate ◽  
Fluid Replacement ◽  
Cancer Center ◽  
Subtotal Parathyroidectomy ◽  
History Of ◽  
The Right

Abstract Introduction: Parathyroid carcinoma (PC) is a rare endocrine malignancy. It accounts for <1% cases of primary hyperparathyroidism (PHPT). We present a rare case of concurrent PC and atypical parathyroid adenoma (PA). Case presentation: A 72-year-old woman presented with 1-week history of generalized weakness, confusion, and auditory hallucinations. Her medical history was significant for PHPT known for 5 years, CAD and CHF. The patient appeared mildly volume depleted and was tachycardic (105/min). The rest of her physical exam was unremarkable. Calcium (Ca) was 15.1 mg/dL (8.4–10.2 mg/dL) and intact PTH 451.9 pg/mL (12–88 pg/mL). Her condition improved with aggressive fluid replacement, pamidronate, and cinacalcet. A sestamibi scan revealed increased uptake of bilateral parathyroid tissue. Fine needle aspiration (FNA) revealed PA. Surgical treatment was postponed for control of cardiac comorbidities. One month later, she presented again with symptomatic hypercalcemia. Her Ca was 16.1 md/dL and PTH 761.5 pg/mL. Initial medical management was followed by subtotal parathyroidectomy – three masses were removed (one on the right and two on the left). Final pathology revealed PC within the left parathyroid, the others were consistent with hypercellular parathyroid tissue. One month later, the patient underwent left hemithyroidectomy, right parathyroidectomy, and central neck dissection. PTH level dropped to 2.4 pg/mL and Ca level was 7.6 mg/dL after surgery. She was discharged home on Ca and vitamin D supplements. Pathology was sent to a referral cancer center and revealed PC vs. atypical PA within the right parathyroid. Discussion: PC is a rare endocrine malignancy. Further, there are not many cases of synchronous PC and PA or multifocal PC. Diagnosing PC preoperatively is challenging since it shares overlapping characteristics with PA. Patients with malignancy commonly present with larger tumor size, higher level of Ca (>14.6 mg/dL), and PTH (5-fold higher than the upper limit of normal). Our patient had a history of multiple admissions due to symptomatic HC. She had no palpable neck masses on exam. Her initial FNA was consistent with PA. Hence, we presumed that her hypercalcemia was caused by PA. Establishing a definitive diagnosis of PC by frozen sections intraoperatively is difficult. Histopathologic findings of atypical cells, high mitotic rate, and cellular invasions can suggest the diagnosis, though they are often negative. Even postoperatively, pathologists often disagree on cytologic interpretation. However, differentiating PA and PC is important since earlier and more aggressive treatment is needed to reduce the morbidity and mortality in case of malignancy.

scholarly journals MANAGEMENT OF ENDOCRINE DISEASE: Postsurgical hypoparathyroidism: current treatments and future prospects for parathyroid allotransplantation

2021 ◽  
Vol 184 (5) ◽  
pp. R165-R175
Author(s):  
Radu Mihai ◽  
Rajesh V Thakker
Keyword(s):  
Thyroid Surgery ◽  
Case Reports ◽  
Prospective Trial ◽  
Significant Proportion ◽  
Parathyroid Tissue ◽  
Major Complication ◽  
Neck Surgery ◽  
Parathyroid Cell ◽  
Healthcare Provision ◽  
Complex Needs

Background Permanent postsurgical hypoparathyroidism (POSH) is a major complication of anterior neck surgery in general and of thyroid surgery in particular. Depending on diagnostic criteria, up to 10% of patients undergoing bilateral thyroid surgery develop POSH. This leads to a multitude of symptoms that decrease the quality of life and burden the healthcare provision through complex needs for medication and treatment of specific complications, such as seizures and laryngospasm. Methods Narrative review of current medical treatments for POSH and of the experience accumulated with parathyroid allotransplantation. Results In most patients, POSH is controlled with regular use of calcium supplements and active vitamin D analogues but a significant proportion of patients continue to experience severe symptoms requiring repeated emergency admissions. Replacement therapy with synthetic PTH compounds (PTH1-34, Natpara® and PTH1-84, teriparatide, Forsteo®) has been assessed in multicentre trials, but the use of this medication is restricted by costs and concerns related to the risk of development of osteosarcoma. Based on recent case reports of successful allotransplantation of parathyroid tissue between siblings, there is renewed interest in this technique. Data on selection of donors, parathyroid cell preparation before allotransplantation, site and timing of transplantation, need for immunosuppression and long-term outcomes are reviewed. Conclusion A prospective trial to assess the efficacy of parathyroid allotransplantation in patients with severely symptomatic protracted post-surgical hypoparathyroidism is warranted.

scholarly journals Ptimary thyroid lymphomas and other rare thyroid tumors

2003 ◽  
Vol 50 (3) ◽  
pp. 141-146 ◽  
Author(s):  
Aleksandar Diklic ◽  
Vladan Zivaljevic ◽  
Ivan Paunovic ◽  
Ksenija Krgovic ◽  
Rastko Zivic ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Residual Tumor ◽  
Hashimoto Thyroiditis ◽  
Local Relapse ◽  
Thyroid Tumor ◽  
Recurrent Nerve ◽  
Thyroid Tumors ◽  
Treatment Frequency ◽  
Recurrent Nerve Palsy

Primary thyroid lymphomas are rare. Surgery is seldom indicated. The aim of the study is to find out the main characteristics of primary thyroid lymphomas in our patients, indications for surgery and the possibility of treatment, frequency and characteristics of rare thyroid tumors. Method: retrospective study of 1044 patient operated for malignant thyroid tumor. Results: From 1995 to may 2003, we operated upon 15 patients with primary thyroid lymphomas, 2 men and 13 women mean age of 50.12 years (from 22 to 74 years), also one patient of age 69 with insular thyroid cancer. Reason for surgery was thyroid tumor in all, compressive disturbances in 9, among them 4 with asphyxia. Radical total thyroidectomy was performed in 4 (26.7%), whole in others some residual tumor tissue was could not be removed in spite of thyroidectomy in 3, hemithyroidectomy in 2, tumor debulking in 5 and only open biopsy was performed in one patient. There was no operative mortality, no postoperative hypocalcaemia and no recurrent nerve palsy. Histological type of tumor was Non-Hodgkin lymphoma in 13 patients, Hodgkin disease in 2 female patients of age 22 and 24. Hashimoto thyroiditis was present in 3 patients. After surgery, 13 patients were treated with chemotherapy, one patient died one month after the operation and one patient refused chemotherapy. Follow-up data are available for 9 patients and the mean follow-up period was 20 months (1-48months). Three patients died after a month, 2 and 3 years after surgery. Six patients are without local relapse. In one patient who refused chemotherapy, a year after thyroid surgery, resection of large intestine was performed because of lymphoma of the colon. Conclusion: Malignant thyroid lymphomas are rare. They present with rapidly growing thyroid tumor, compression and asphyxia. Surgery is only temporarily effective and it is necessary to start with chemo-radiotherapy as soon as possible. Rare forms of thyroid cancer have to be histological recognized in order to choose the best way of treatment.

Surgery on the Hands of Musicians with Rheumatoid Arthritis

2002 ◽  
Vol 17 (3) ◽  
pp. 121-127
Author(s):  
Nikolaus Ell
Keyword(s):  
Rheumatoid Arthritis ◽  
Operative Procedure ◽  
Surgical Techniques ◽  
Operative Therapy ◽  
Musical Instruments ◽  
Basic Knowledge ◽  
Indications For Surgery ◽  
The Right ◽  
Late Stages ◽  
Right And Left Hands

The essential requisites for successful operative treatment of hands affected by rheumatoid arthritis are a thorough knowledge of the disease and experience in the applicable specialized hand surgical techniques. In musicians, decisions about the indications for surgery, the particular technique to be used, and the disadvantages of each possible procedure require additional basic knowledge about musical instruments and how they are played. This paper provides an overview of the changes in the hand and their effects on musicians in the early stages and late stages of rheumatoid arthritis as well as the special considerations that must be taken into account for operative therapy in both the early and late stages of the disease. The choice of operative procedure is often dependent on the instrument played and may vary between the right and left hands, or even from one finger to the next. If at all possible, the anticipated results of an operation should be simulated and checked preoperatively by using static or dynamic testsplints.

scholarly journals Stent or Surgery for Malignant Low Bileduct Obstruction?

HPB Surgery ◽  
1997 ◽  
Vol 10 (3) ◽  
pp. 179-181
Author(s):  
Ingemar Ihse ◽  
Lars Hansson ◽  
Lars-Erik Hammarström ◽  
Eva Lindström
Keyword(s):  
Controlled Trial ◽  
Surgical Techniques ◽  
Outlet Obstruction ◽  
Major Complication ◽  
Late Complications ◽  
Stent Insertion ◽  
Endoscopic Stenting ◽  
Total Hospital Stay ◽  
Significant Difference ◽  
Cast Doubt

The development of non-surgical techniques for the relief of malignant low bileduct obstruction has cast doubt on the best way of relieving jaundice, particularly in patients fit for surgery whose life expectancy is more than a few weeks.We did a randomised prospective controlled trial comparing endoscopic stent insertion and surgical biliary bypass in patients with malignant low bileduct obstruction. 204 patients were randomised (surgery 103, stent 101); 3 subsequently proved to have benign disease and were excluded, leaving 101 surgical and 100 stented patients for assessment. Technical success was achieved in 94 surgical and 95 stent patients, with functional biliary decompression obtained in 92 patients in both groups. In stented patients, there was a lower procedure-related mortality (3% vs 14%, p=0.01), major complication rate (11% vs 29%, p=0.02), and median total hospital stay (20 vs 26 days, p=0.001). Recurrent jaundice occurred in 36 stented patients and 2 surgical patients. Late gastric outlet obstruction occurred in 17% of stented patients and 7% of the surgical group. Despite the early benefits of stenting there was no significant difference in overall survival between the two groups (median survival: surgical 26 weeks; stented 21 weeks; p=0.065).Endoscopic stenting and surgery are effective palliative treatments with the former having fewer early treatment-related complications and the latter fewer late complications.

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