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PubMed2006

[Surgical approach for intrathoracic goiter].

OBJECTIVE: To explore the Surgical approach and management of intrathoracic goiter. METHODS: Seventy patients were operated on for thyromegaly extending to the thorax in an 15-year period at the department of Head and Neck surgery, Cancer Hospital, Chinese Academy of Medical Sciences. The median age of the 70 patients (44 women and 26 men) was 55 years, with a range of 23 to 71 years. Sixty cases were benign intrathoracic goiter and ten cases were malignancy. To help choice of operative approach, the intrathoracic goiter was divided into three types to based on chest film, computed tomography or magnetic resonance imaging and clinical symptom. I type: the inferior extremity of goiter is on the aortic arch. II type is the goiter to enter intrathoracic and portion located behind aortic arch, or the goiter enter posterior mediastinum. For III type, intrathoracic goiter intrude thoracic cavity, or accompany superior vena caval syndrome. Operative method, surgical access and treatment effect were discussed in this essay. RESULTS: A cervical incision alone was performed in 62 cases (I type 41 cases, II type 21 cases), and sternotomy in 8 (II type 3 cases, III type 5 cases). There was low morbidity and no deaths. Removal rate by cervical approach for intrathoracic benign and malignant goiter were 95% (57/60) and 50% (5/10) respectively. The Complication rate of cervical approach was significantly lower (8.1%) than that sternotomy approach (37.5%, P < 0.01). CONCLUSIONS: Most cases of intrathoracic goiter can be managed by cervical incision alone. Only a few cases, a median sternotomy approach may be needed when adhesions or an anomalous blood supply are present or carcinoma is suspected.

Adult↗
PubMed2006

Current technique for resection of mediastinal goiter.

We have developed a combined surgical technique involving traction sutures, the harmonic scalpel, and laryngeal nerve monitoring for the removal of mediastinal goiters. This technique is safe, expeditious, and effective; it minimizes the risk of blood loss or nerve injury; and it obviates the need for sternotomy. During a 4-year period, we performed this operation on 21 patients. We observed only two complications: one patient developed postoperative seroma 1 week after surgery and another experienced vocal fold paralysis after intentional sacrifice of the recurrent laryngeal nerve, which was encompassed by cancer. No other recurrent laryngeal nerve was injured. Operative blood loss was negligible, no systemic infection or permanent hypoparathyroidism was observed, and no patient required a chest tube or chest incision. Almost all patients were discharged home on postoperative day 1.

Aged↗
PubMed1991

Peak expiratory flow in the detection of retrosternal goitre.

In 24 patients where the lower border of a cervical goitre was poorly defined, the value of simple lung function tests in the prediction of the presence of a retrosternal goitre was assessed. At operation there were nine patients with retrosternal extension (Group I) and 15 without (Group II). The preoperative PEF ratio (observed to predicted) was significantly different between the two groups (P = 0.004) with a positive predictive value of 90% for a retrosternal goitre. This difference was abolished after thyroidectomy. There was a significant improvement in PEF in patients with retrosternal goitres after thyroidectomy (P less than 0.001). It is concluded that the preoperative measurement of PEF is a simple method of detecting the retrosternal extension of a cervical goitre.

Adult↗
PubMedDate not supplied

[Obstructive syndrome in laryngotracheal stenosis].

Pulmonary function studies were carried out in 13 patients in whom the diagnosis of a central (laryngeal or tracheal) stenosis was confirmed by endoscopy. Following lung function tests were performed: static lung volumes (VC, RV, TLC), FEV1.0 and FIV1.0, flow-volume loops of forced expiratory and forced inspiratory vital capacity efforts from which PEFR and PIFR, maximal expiratory (VEmx50) and maximal inspiratory flow at 50 per cent of vital capacity (VLmx50) were measured, Raw, helium mixing time and pharmacological test with acethylcholine. FIV1.0 values and flow-volume loops permitted the classification of the patients into 3 groups: 1. fixed obstruction (6 cases): decrease in about equal proportions of maximal expiratory and inspiratory flows (FEV1.0 and FIV1.0); normal FEV1.0/FIV1.0 ratio; 2. extrathoracic variable obstruction (1 case): predominant decrease in maximal inspiratory flows (FIV1.0). FEV1.0/FIV1.0 ratio is twice as normal; 3. intrathoracic variable obstruction (5 cases): exclusive or predominant reduction in maximal expiratory flows, as in COPD but with the difference that the expiratory limb of the V:V loop showed an excessive reduction in PEFR, a plateau in the midzone of the VC and a terminal portion with normal configuration. Raw was almost always increased, RV sometimes, helium mixing time was prolonged only in presence of COPD or lobar stenosis; pharmacological tests were negative in 3 out of 4 cases. Pulmonary function abnormalities did not allow a prognosis of the nature of the underlying lesion. The severity of the obstruction as evaluated by endoscopic examination was not related to the functional disturbances. In one case no functional alterations were found despite a severe tracheal stenosis.

Adult↗
PubMed1991

[The criteria for choosing the surgical approach to cervicomediastinal goiters].

The retrospective analysis of a series of 350 cases of intrathoracic goiters, out of a total of 5,000 thyroid operations derived from the joined case records of the 3rd General Surgery Institute (Director: Prof. G. Di Matteo) and the 8th Chair of Surgical Pathology (Director: Prof. F.P. Campana), has induced the authors to reconsider the surgical approach to this pathology on the basis of anatomo-surgical factors.

Goiter, Substernal↗
PubMed1990

[Struma with euthyroidism ].

A total of 75-85% of thyroid operations are performed on euthyroid goiters; 70% of them are bilateral. Ultrasonography is the most important preoperatively examination. But even lobes classified as normal should be inspected carefully during operations: nodules were found in so called "normal" lobes in 22%. All nodules have to be resected, and attention must be paid to retrosternal and retrovisceral parts. Identification of recurrent nerves and parathyroid glands is necessary. Recurrent goiters should be prepared intercapsularly. In our own 3049 cases of euthyroid goiters 2.4% had early recurrent nerve paralysis, 3.9% retrosternal and 6.6% recurrent goiters.

Euthyroid Sick Syndromes↗
PubMed1991

[Tracheal injury caused by intubation for compressive endothoracic goiter].

The tube cannot pass along the marked curve of the trachea, which is displaced by a large goiter extending into the posterior mediastinum. The trachea is perforated in a low thoracic location. Tracheal suture and exeresis of the goiter are performed through sternotomia. This serious accident seems to be exceptional. Can it be predicted?

Aged↗
PubMed1990

[The superior vena cava syndrome secondary to a benign intrathoracic goiter: a case report and review of the literature].

The clinical case of a female patient suffering a benign retrosternal goitre which first appeared as a superior vena cava syndrome, is presented. After confirming the diagnosis with an intrathoracic CT scan, a subtotal bilateral thyroidectomy was performed resulting in a complete remission of the clinical picture. A literature review is performed commenting on some clinical, diagnostic and therapeutical aspects.

Aged↗
PubMed1990

[Experience of the malignant complete intrathoracic goiter: discussion on 13 cases of Japan].

A 56-year-old woman was found to have a mediastinal mass on routine examination. Chest X-ray, CT scan, MRI and superior vena cavography showed a right upper mediastinal tumor invading the SVC. And it was diagnosed malignant intrathoracic goiter by histological examination by percutaneous needle biopsy. On thoracotomy and mediastinotomy, the tumor located only in the right upper mediastinum and had no relation to the cervical thyroid gland. Histological examination revealed papillary adenocarcinoma. We reported a malignant complete intrathoracic goiter and added discussion on another 12 cases seen in Japanese literature.

Adenocarcinoma, Papillary↗
PubMed1990

[Two cases of mediastinal goiter with progressive deviation of the trachea by its growth and their thyroid hormone values in the fluid of the cystic lesions].

We reported two operated cases (a 35-year-old male and 52-year-old male) of mediastinal goiter accompanied by marked tracheal deviation. The two patients did not have any clinical symptoms. CT, MRI, ultrasonography and angiography finding of the two cases are presented. Fluid was obtained from the cystic lesions by ultrasonically guided needle aspiration. The levels of thyroid hormones (T3, T4) in the fluid were not high in comparison with serum levels. Surgical resection was performed on the 35-year-old male case by collar incision and on the 52-year-old male case by median sternotomy.

Adenoma↗
PubMed1990

[Intrathoracic goiter. Apropos of 36 cases].

This article is concerned with 36 cases of plunging goiters responding to Eschapasse and Merlier definition. The frequency of plunging goiters is 5.2%, women are predominating with 96% and the average of age is 45 years. In 34%, these goiters gave rise to fow symptoms, while there was mediastinal complication in the others cases. Paraclinic investigations are limited to a face and profile pulmonary roentgenographies, and scintigraphy of the thyroid. In the treatment, cervicotomy proved to the completely satisfactory to removal of all the goiters and there were no need to sternotomy or thoracotomy. The pathology revealed two malignant tumors. Post operative evolution was uneventful except one death in the 10th post operative day by pulmonary emboli.

Adult↗
PubMed1990

[Mediastinal goiters. A clinical case series].

The paper described the treatment of a series of 47 mediastinal goitres. The importance of a thorough preoperative assessment of the lesion and of careful planning of the operative technique are underlined. Cervical collar incision provided adequate exposure in most patients. The Authors conclude that surgical treatment should be recommended in all cases.

Adult↗