Wyniki wyszukiwania - Biblioteka Nauki

1

The Tendency to Increase of Extensive Thyroidectomies - Many Years' Experience of Endocrinological Surgery Department

100%

Dadan J. , Nowacka A. , Nowacka-Ejsmont J.

Polish Journal of Surgery

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2010

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tom 82

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nr 1

12-15

EN

The aim of the study was to evaluate the extent of thyreoidectomy in given years from 1993 to 2006 with the estimation of the occurrence of different types of neoplasmatic lesions in thyroid gland.Material and methods. The study included 3477 patients that underwent thyreoidectomy for nodular disease in above-mentioned period. The data were analyzed in reference to the extent of resection and the type of thyroid nodule.Results. Subtotal resections predominated and constituted 64.82% of all performed thyreoidectomies. The study showed a gradual increase in the number of total resections, from 14.86% in 1993-1996 to 27.33% in 2004-2006. The majority of removed glands revealed defects of almost total nodular degeneration. There was a significant increase in the number of papillary cancer in analyzed period.Conclusions. The profile of thyroid nodules underwent changes pointing out the higher frequency of thyroid cancer in recent years, what affected increased necessity of performing total thyreoidectomies. The more frequent stated total nodular degeneration and radicalization of thyroidectomies may be associated with an observed tendency to prolonged conservative treatment.

2

Evaluation of the Learning Curve for Intraoperative Neural Monitoring of the Recurrent Laryngeal Nerves in Thyroid Surgery*

80%

Pragacz K. , Barczyński M.

Polish Journal of Surgery

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2015

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tom 86

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nr 12

584-593

EN

Intraoperative neuromonitoring facilitates identification of the recurrent laryngeal nerves (RLN) and allows for predicting their postoperative function. Nevertheless, the outcome of thyroid surgery monitoring is affected by both the experience of the operator and his mastering of the technique. The aim of the study was the assessment of the learning curve for intraoperative RLN neuromonitoring. Material and methods. The prospective analysis included 100 consecutive thyroid operations performed by a single surgeon during implementation of RLN neuromonitoring in a district surgical ward in Staszów. RLN neuromonitoring was performed in keeping with the recommendations of the International Neural Monitoring Study Group using a C2 NerveMonitor (Inomed, Germany). The outcomes of initial 50 procedures (group I: 08/2012-07/2013) were compared with the results of subsequent 50 operations (group II: 08/2013-07/2014). The evaluation included demographic and intraoperative data along with predictive value of the method and complications. Results. In group II as compared to group I, a significant reduction of operative time was noted (102.1±19.4 vs 109.9±19; p=0.045), along with an increased percentage of identified RLNs (99% vs 89.2%; p=0.006), a decreased percentage of correction-requiring technical errors (8% vs 24%; p=0.029), an improved negative predictive (99% vs 89.3%; p<0.001) and positive value (75% vs 55.6%; p<0.001), as well as a decreased percentage of RLN injuries (3% vs 14%; p=0.006). Conclusions. Mastering the technique of intraoperative RLN neuromonitoring in thyroid surgery requires the surgeon to perform independently approximately 50 monitored procedures, what allows for achieving the predictive value of the method that is comparable to outcomes published by referral centers.

3

Intrathoracic Thyroid Goiters

80%

Jabłoński S. , Wawrzycki M. , Brocki M. , Filgus M. , Kordiak J.

Polish Journal of Surgery

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2010

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tom 82

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nr 2

69-76

EN

In this article, the difficulties in treatment of 18 patients with intrathoracic thyroid goiters were discussed.The aim of the study were: defining the etiology and symptomology of goiters within the chest in the own material, conducting the analysis of the diagnostic efficiency, the evaluation of the early results of surgery and postoperative complications.Material and methods. The research material included 18 patients with intarhoracic thyroid goiters after surgical treatment (mediastinal goiters, ectopic goiters). The cases of retrosternal goiters were not analyzed. There was carried out the retrospective analysis of the medical documentation of goiters etiology, the frequency of dominating clinical symptoms, value of diagnostic methods, early effects of surgical treatment and postoperative complications.Results. In the years 2004-2008, operations were performed on 14 women and 4 men with intrathoracic goiters, aged from 34 to 82. The average age of patients was 51.1. The etiology of intrathoracic thyroid goiters were as follows: thyroid goiters (struma nodosa) - 55%, adenoma and thyroid goiters - 17%, thyroid cancer (ca papillare) and thyroid goiters - 11%, ectopic thyroid gland - 11%, thyroid goiters and thyroid inflammation - 6%. The majority of the material were cases of a cervico-mediastinal thyroid gland, only 2 patients were diagnosed with an ectopic thyroid gland located in the mediastinum with no connection with the cervical thyroid. The local symptoms of compression on intrathoracic organs were mostly observed in the clinical picture, 22% of patients were asymptomatic. The diagnostic process included the estimation of the hormonal state and the radiology localised methods among which helical computer tomography was the most valuable. In order to estimate endotracheal intubation conditions 11 patients (61%) underwent brochofiberoscopy. The following accesses were used in the treatment: cervical - 3 cases, partial sternotomy - 11, longitudinal sternotomy - 2, thoracotomy - 1, combined thoracotomy with cervicotomy - 1. Good treatment results were obtained in all cases. The following complications were noted: a permanent paralysis of the laryngeal nerve - 1 case (6%), hypoparathyroidism - 1 (6%).Conclusions. Thyroid goiters situated inside the chest are a rarely met pathology which may cause serious difficulties in surgical treatment. Patients with this illness require a thorough preparation for the treatment including balancing hormonal perturbations, preventing intubation difficulties and access to the necessary quality of a diagnostics wit purpose of planning the most optimal surgical access and avoiding serious perioperative complications.

4

Analysis of the Analgesic Effect of Metamizole Sodium in Patients Operated on for Goitre

80%

Srebrzyński A. , Ziółkowski R. , Płużańska K. , Kaczka K. , Kuzdak K. , Pomorski L.

Polish Journal of Surgery

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2008

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tom 80

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nr 5

263-270

EN

The aim of the study was to evaluate the analgesic effect of metamizole sodium administered intravenously during the day after surgery in patients operated on for nodular goitre - using the 11-point NAS scale (Numeric Analog Scale).Material and methods. The study was comprised of 114 patients who had undergone surgery for nontoxic: 84 (73.7%) or toxic: 30 (26.3%) nodular goitre. The goitre size, according to the WHO classification ranged between III and I° (2). I° goitre was found in 31 (27%) patients, II° goitre - in 46 (40.4%) patients and III° goitre - in 37 (32.4%) patients. The age of patients ranged between 22 and 75 years (median 53, IQR 43-61). The goitre was localized in the neck in 103 (90.4%) patients and it partially reached the superior aperture of the thorax with its lower poles in 11 (9.6%) patients. Patients with coexisting diseases such as diabetes mellitus or peripheral neuropathy were excluded from the study. Patients were randomly assigned to 4 groups. Group I included 38 subjects in whom metamizole sodium was applied at a dose of 1 g intravenously every 6 hours for a day after surgery; the first dose was administered at the moment of surgical wound closure. Group II included 37 patients in whom metamizole sodium was applied according to the above-mentioned regimen and, additionally the surgical wound was injected with 10 ml of bupivacaine 0.25%. Group III consisted of 36 patients in whom 1 g of metamizole was first administered intravenously thirty minutes before surgery and the subsequent doses were systematically repeated at time intervals of 6 hours (preemptive analgesia), avoiding buvacaine wound infiltration. Group IV included 40 patients in whom ketoprophen was administered intravenously at a dose of 0.1 g every 6 hours for a day after the procedure. Surgical wounds were not injected with buvacaine in these patients, similarly as in groups III and I. In case of severe pain patients could additionally receive morphine 1 mg on-demand.Results. Pain intensity was analyzed every 6 hours on NAS scale and pain scores ranged from 1 to 5.5. At all time points, the highest pain intensity scores were found in patients who received metamizole as monotherapy (group I) or ketoprofen (group IV), while the lowest were found in the groups where surgical wound was additionally injected with bupivacaine solution (group II) or additional metamizole dose was used before the procedure (group III). Patients from group II rated their pain intensity as slightly higher or similar to that in group III (statistically insiginficant). Similarly patients from group I had pain scores slightly higher or similar to scores reported in group IV (statistically insiginficant).Conclusions. 1. The most intense pain was observed during the first 12 hours after thyroid surgery. 2. Administration of metamizole sodium according to the regimen that was applied in groups II and III provided sufficient analgesia. 3. Infiltration of the surgical wound with buvacaine or administration of an additional dose of metamizole sodium prior to the surgery (preemptive analgesia) results in postoperative pain relief and allows avoiding demand for opioid analgetics.

5

Local Anesthesia in Thyroid Surgery - Own Experience and Literature Review

80%

Banasiewicz T. , Meissner W. , Pyda P. , Wierzbicki T. , Biczysko M. , Głyda M. , Iwanik K. , Drews M.

Polish Journal of Surgery

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2011

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tom 83

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nr 5

264-270

EN

The local anesthesia in thyroid surgery is rarely used, only in selected patients. Majority of centers performing thyroid surgery with local anesthesia have possibility to convert to the general anesthesia.The aim of the study was to present our experiences with partial thyroidectomy under local anesthesia performed in 49 consecutive subjects in the Central African Republic (bilateral subtotal strumectomy, total resection of the one lobe, subtotal resection of the one lobe).Material and methods. All admitted patients with clinically significant goiter were accepted for surgical treatment. For infiltration anesthesia 1% lignocaine was used. Because of the shortage of medical resources, potential conversion to the general anesthesia was impossible. Before the operation patients had received an oral sedation and antibiotic. In 16 patients general anesthesia was used, in other 33 it was impossible.Results. Subtotal bilateral thyroidectomy was performed in 37 patients, 12 patients underwent lobectomy or partial lobectomy of the affected portion of the gland. There were no intraoperative and postoperative complications noticed in the reported group, including complications related to laryngeal nerve injury. The mean duration of the procedure was 127 minutes and mean medical follow-up was 3 days. General condition of all patients on the day of discharge from hospital was good.Conclusions. Surgery for goiter under local anesthesia may be a safe alternative where general anesthesia is not available or contraindicated for medical reasons. The infiltration anesthesia is simple to perform and reduces the number of complications potentially occurred at the C2-C4 neck plexus block.

6

Clinical and Metabolic Changes Following Complicated Thyroid Resection Procedures

80%

Sławeta N. , Głuszek S. , Heciak J.

Polish Journal of Surgery

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2013

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tom 85

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nr 5

235-246

EN

Clinical and metabolic consequences of complicated thyroid resection procedures are rarely an object of complex analysis, and teams participating in treatment may have a very limited knowledge of them. The aim of the study was to assess clinical and metabolic consequences of complicated thyroid surgical procedures. Material and methods. In the years 2002-2007, 756 patients underwent surgery due to non-neoplastic thyroid diseases. Sixty-nine (9.1%) patients experienced complications manifesting as vocal cord paralysis and/or hypoparathyroidism. Follow-up examination was conducted in a group of 42 persons, which amounted to 61% of patients who experienced complications following thyroid surgical procedures. Follow-up examination, comprising assessment of morphotic blood elements, electrolyte, lipid and parathormone blood concentrations, thyroid hormone activity, respiratory function, vocal cord mobility, bone mineralization and ultrasound examination of the pocket left after thyroid resection, was conducted after the mean period of 43 months following surgery. Results. In the analyzed group, no significant differences in plasma electrolyte content were found (sodium, potassium, magnesium, calcium and phosphorus ions). In the group of patients with chronic hypoparathyroidism, no hypophosphatemia was observed, and there were no reports of concomitant nephrolithiasis or cataract. Increased cholesterol concentration was observed in the group of patients with chronic hypoparathyroidism and without hypoparathyroidism (p = 0.07). In 35% of patients with chronic vocal cord paralysis, abnormal results of spirometry tests were obtained. In the group of patients with chronic hypoparathyroidism, densitometry examination revealed higher T-score values compared with patients with transient hypoparathyroidism and vocal cord paralysis (p = 0.07). No bone mineralization disorders manifesting as pathological fractures were noted. Conclusions. The knowledge of clinical and metabolic consequences of complicated thyroid surgical procedures, due to their complexity, may be very limited among the members of both surgical teams and teams involved in management of complications. Development of a complication following thyroid surgery may be associated with significant homeostasis disorders, especially as regards calcium-phosphate metabolism, the skeletal system and the respiratory system. Such disorders can manifest long after the disease onset, only properly intensified and long-term management allows limitation of their extent.

7

Early predictors of post – thyroidectomy hypoparathyroidism

70%

Sieniawski K. , Kaczka K. , Paduszyńska K. , Fendler W. , Tomasik B. , Pomorski L.

Polish Journal of Surgery

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2016

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tom 88(6)

540-555

EN

Thyroid surgery is the most commonly performed procedure in the field of endocrine surgery. Studies are still ongoing on the development of a single algorithm for diagnosis and care of patients at risk of postoperative hypoparathyroidism. The aim of the study was to determine the biochemical marker that would allow the most accurate diagnosis of patient groups at risk of developing hypoparathyroidism and to identify risk factors for this disorder. Material and methods. The prospective study included 142 consecutive patients undergoing total thyroidectomy for benign goiter from January 1st 2014 to December 31st 2015. Serum intact parathyroid hormone (iPTH), total calcium (Ca), phosphate (P), and magnesium (Mg) levels have been measured preoperatively and at 1, 6, 24, and 48 h postoperatively. Results. Clinical symptoms of hypoparathyroidism developed in 25 (17.6%) of 142 patients. The best diagnostic accuracy for hypoparathyroidism based on ROC curves was obtained for iPTH at 6h (AUC 0.942; 95% CI: 0.866-1.000, p<0.001) and its percentage change from baseline ΔiPTH at 6h (AUC 0.930; 95% CI: 0.858-1.000, p<0.001). In an multivariate analysis, the preoperative Ca level higher by 0.1 mmol/l, and iPTH level higher by 0.1 pmol/l were associated with a lower risk of hypoparathyroidism, by 68% (p=0.012) and 61% (p=0.007), respectively. A 1% decline in iPTH from baseline increased the risk of hypoparathyroidism by 15% (p<0.001). Conclusions. The most reliable markers indicating a high risk of postoperative hypoparathyroidism are the decline in ΔiPTH at 6h by > 65% or iPTH level at 6h <1.57 pmol /l. A postoperative decline in iPTH levels is an independent risk factor for the development of hypoparathyroidism. Preoperative higher concentrations of Ca and iPTH are protective factors for the development of this disorder.

8

Glove failure in elective thyroid surgery: A prospective randomized study

60%

Timler D. , Kusiński M. , Iltchev P. , Szarpak Ł. , Śliwczyński A. , Kuzdak K. , Marczak M.

International Journal of Occupational Medicine and Environmental Health

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2015

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tom 28

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nr 3

499-505

EN

Objectives To analyze perforation rate in sterile gloves used by surgeons in the operating theatre of the Department of Endocrinological and General Surgery of Medical University of Lodz. Material and Methods Randomized and controlled trial. This study analyses the incidents of tears in sterile surgical gloves used by surgeons during operations on 3 types of thyroid diseases according to the 10th revision of International Statistical Classification of Diseases and Related Health Problems (ICD-10) codes. Nine hundred seventy-two pairs (sets) of gloves were collected from 321 surgical procedures. All gloves were tested immediately following surgery using the water leak test (EN455-1) to detect leakage. Results Glove perforation was detected in 89 of 972 glove sets (9.2%). Statistically relevant more often glove tears occurred in operator than the 1st assistant (p < 0.001). The sites of perforation were localized mostly on the middle finger of the non-dominant hand (22.5%), and the non-dominant ring finger (17.9%). Conclusions This study has proved that the role performed by the surgeon during the procedure (operator, 1st assistant) has significant influence on the risk of glove perforations. Nearly 90% of glove perforations are unnoticed during surgery.

9

Przydatność kamery termowizyjnej w ocenie urazu termicznego powstałego podczas tyroidektomii wykonywanej z użyciem noża ultradźwiękowego - doniesienie wstępne

60%

Dedecjus M. , Kałużna K. , Stróżyk G. , Kusińska R. , Drews-Peszyński C. , Brzeziński J.

Acta Bio-Optica et Informatica Medica. Inżynieria Biomedyczna

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2006

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tom Vol. 12, nr 3

162-163

PL

Noże ultradźwiękowe są wykorzystywane w wielu dyscyplinach chirurgicznych. Uważa się, że są to narzędzia bezpieczne, powodujące niewielki uraz otaczających tkanek. Jednakże liczba publikacji dotyczących tego zagadnienia jest bardzo ograniczona. Celem pracy jest ocena przydatności kamery termowizyjnej w analizie rozkładu temperatur w polu operacyjnym podczas operacji gruczołu tarczycowego. Operacje zostały przeprowadzone z użyciem noża harmonicznego (Ethicon), noża ultradźwiękowego (Olympus) oraz techniki klasycznej, z zastosowaniem koagulacji monopolamej. Porównano obrazy termiczne poła operacyjnego za pomocą analizy komputerowej. Ponadto przeprowadzono badania histologiczne uzyskanych preparatów, aby określić głębokość urazu termicznego. Wnioski: kamera termowizyjna jest bardzo użytecznym narzędziem, umożliwiającym monitorowanie temperatury tkanki zarówno podczas koagulacji, jak i resekcji tarczycy.

EN

Ultrasonic dissection is in widespread use in surgery. Ultrasound scalpels, as it is generally considered are minimally invasisv to the surrounding tissue, however the number of publications in this field is small. The aim of the present study was to evaluate the usefulness of the thermal camera in temperature mapping of tissue diuing thyroid dissection performed with use of harmonic scalpel (Ethicon), ultrasound scalpel (Olympus) and classical knot-tying technique together with monopolar coagulation. Thermal images from operating field registered during thyroidectomy were analyzed and compared. Moreover, histological examination of the tissue was performed to compare morphologic indication of thermal damage. Conclusions: In situ thermal imaging represents a powerful modality for monitoring coagulation and dissection of thyroid tissue.

10

Reoperative Surgery for Benign Thyroid Diseases

60%

Alesina P. , Rolfs T. , Walz M.

Polish Journal of Surgery

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2008

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tom 80

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nr 9

441-445

EN

The aim of the study was to present a retrospective analysis of the experience with completion thyroidectomy for benign thyroid disease in a referral centre.Material and methods. Between October 1999 and December 2007, 2353 thyroid operations were performed for benign diseases. Of these, 113 patients (12 men, 101 women; age: 25-77 years) underwent a reoperation for recurrent goitre (n=107) or recurrent Grave's disease (n=6). A bilateral resection was performed in 33 patients, a unilateral in 80 patients. The mean interval between the initial and the reoperative procedure was 14.5 years.Results. The mean operative time was 78 minutes (range: 20-210) with 68 minutes for unilateral and 96 minutes for bilateral operations. Postoperative complications consisted of transient hypoparathyroidism in 6 patients (5.3%); no patient experienced a permanent hypoparathyroidism. A transient recurrent laryngeal nerve (RLN) palsy occurred in 6 cases (4.1% of "nerves at risk") and a definitive bilateral RLN palsy was registered in a patient with a preoperative unilateral RLN palsy (0.9%). In 4 patients (3.5%) a postoperative bleeding required reoperation. No wound infection was observed. The mean postoperative hospital stay was 2.3 days. Final histology showed a thyroid cancer in 6 patients (5.3%).Conclusion. In experienced hands, reoperative thyroid surgery can be performed safely and with limited morbidity.

11

Spectral analysis the information signal in the identification of the recurrent laryngeal nerve in thyroid burgery

60%

Dyvak M. , Kasatkina N. , Pukas A. , Padletska N.

Przegląd Elektrotechniczny

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2013

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tom R. 89, nr 6

275--277

EN

The task of identification the recurrent laryngeal nerve during thyroid surgery based on spectral analysis of the information signal is presented. A method based on the nerve reaction to the stimulation of the surgical wound by the alternated current was considered.

PL

Celem autorów jest opracowanie metody identyfikacji położenia nerwu krtaniowego w czasie operacji tarczycy. Rozpatrzono metodę opartą o stymulację pola operacji przez prąd przemienny.