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PubMed1979

[Surgery of endotheracic struma].

Most cases of endothoracic struma should be considered as systemic illnesses that require thoracic surgery. Concerning cervicoendothoracic borderline cases, the same point of view is advocated, e.g., struma endothoracica falsa and vera alliata. With reference to 38 cases of true and 34 cases of false endothoracic struma, the authors summarize and discuss: 1) their experiences in diagnosis, 2) various routes of access, 3) special thoracic closure techniques, and 4) specific surgical methods on the tumor itself.

Diagnosis, Differential↗
PubMed1995

[Spiral computed tomography of the trachea. Study technique and possible clinical applications].

This work was aimed at optimizing the spiral CT technique in studying the trachea to obtain multiplanar reconstructions with high diagnostic yield. The authors tried to identify an image reconstruction technique, on both the coronal and the sagittal planes, to visualize the whole trachea on a single image in each patient. Twenty patients, 15 with pathologic tracheal involvement and 5 with pulmonary lesions with no tracheal involvement, were examined with a Somatom Plus CT unit (spiral technique: 120 kV, 210 mA, 5-mm slices, 5-mm/s table feed and 24-s scanning time). Multiplanar reconstructions were obtained on the oblique plane, identified by three axial reference scans at different levels. The whole trachea was reconstructed on a single image in 100% of cases on the coronal plane and in 95% of cases on the sagittal plane. Image quality was good in 16 patients and acceptable in 4. The authors stress the value of spiral CT multiplanar images when the reconstruction plane lies in the tracheal lumen on both the coronal and the sagittal planes.

Cysts↗
PubMed1994

Chorea due to hyperthyroidism in old age. A case report.

The authors discuss the case of an elderly female patient with thyrotoxicosis and chorea. T3 and T4 serum values were high. Since the chorea disappeared with euthyroidism but reappeared whenever there was a further increase in T3 and T4, its relationship on hyperthyroidism and its reversibility are clearly demonstrated. The chorea therefore appears to be another clinical condition present in hyperthyroidism.

Aged↗
PubMed1994

[Intrathoracic goiter. Diagnostic aspects, surgical complications and permanent sequelae].

During the course of 1151 thyroidectomies performed during an 11-year period, 195 patients were found to have intrathoracic goitre. Centre experience of operating this disease and the usefulness of applied diagnostic methods are analysed. The sensitivity of physical examination (palpation), technetium scintigraphy and chest roentgenogram is respectively 52%, 33% and 65%, while specificity is respectively 99%, 98% and 95%. These three methods together ensure the diagnosis in 82% of the patients. Positive predictive values are respectively 95%, 78%, and 72%, while negative predictive values are found to be 91%, 89%, and 93%. Frequency of permanent unilateral vocal cord paresis is 2.5%, no cases of bilateral recurrent nerve damage occurred. The frequency of unilateral vocal cord paresis is found to be 1.4%, if nerves of risk are considered. The incidence of hypocalcemia requiring permanent treatment reaches 2%. Intrathoracic goitre can be treated surgically with an only slightly elevated risk for surgical complications and permanent sequelae, especially when performed in the elective phase and within the frame of centre facilities. Intrathoracic components can nearly always (97%) be reached through cervical incision.

Adult↗
PubMed1994

[Surgical treatment of large goiters extending into the retrosternal space].

The authors describe the characteristics of primary and secondary goitres reaching as far as the retrosternal space. 154 operations of retrosternal goitres during a five-year period account for 16.7% of all operations of the thyroid gland. The great majority (97.4%) of operations was made from a cervical approach. The authors express also their opinion on sternotomies in these operations; the reasons comprise also extensive goitres which cannot be removed across the upper thoracic aperture where the orientation on the position of major blood vessels is poor, when local invasion of the tumour into the neighbouring tissues is suspected, in some reoperations or when it is necessary to explore the mediastinum to differentiate other lesions. The very rare thoracotomic approach is reserved for large retrosternal goitres located in the posterior mediastinum.

Female↗
PubMed1994

[Value of pedicled myoplasty in the treatment of severe mediastinitis. A case report].

Sternotomy is the approach of choice for cardiac surgery. Mediastinitis is a rare complication of median sternotomy with high morbidity and mortality. We describe a case of severe mediastinitis occurring after median sternotomy performed in a patient presenting diving goiter. Two-stage irrigation/drainage was unsuccessful. This failure led to opening of the chest and coverage with a pediculated flap using the grand pectoralis muscle. This stratagem allowed complete healing. This case provides an opportunity to discuss the different surgical techniques used to treat severe mediastinitis and to emphasize the value of muscle flaps in the management of recalcitrant median sternotomy wounds.

Drainage↗
PubMed1993

[Cervico-mediastinal goitre. Analysis of preoperative clinical symptoms].

During past decades, a considerable and debated speculation about the classification of intrathoracic goitre was more and more developing. One of the most reliable classifications we share is that considering the degree of the intrathoracic extension of the thyroid gland: i) largely intrathoracic (more than 80%), ii) partially intrathoracic (more than 50%, but less than 80%), and iii) sub-sternal goitre (more than 50% holding in the neck). Consistently with the above mentioned classification, this report deals with ninety-seven cases of completely intrathoracic goitre (64 females and 33 males, aging between 29 and 78 years). Sixty-eight patients out of these showed a goitre reaching the upper aortic border; the other 29 patients had a thyroid gland exceeding this degree of extension. Therefore the intrathoracic goitre is a not frequent thyroid disease: in our series, it represents the 3.67% of 2641 surgical interventions on the thyroid gland from January 1984 to December 1990, that is to say the 20% of the so-called plongeant goitres undergoing surgery during the same years. The aim of this survey was to study the clinical features of the intrathoracic goitre and to have a therapeutic and prognostic assessment in this thyroid disease, before the surgical intervention. To this purpose, the prodromic symptom or sign, the clinical course before surgery, the clinical examination (peculiarly about the neck) and the laboratory findings at admission, the preoperative imaging study (chest X-ray, ultrasound examination, scintiscan and tomoscan finding) were reviewed.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

[A case of recurrent mediastinal goiter (oxyphilic cell carcinoma)].

A case of recurrent mediastinal goiter (oxyphilic cell carcinoma) in a 66-year-old female was reported. 19 years ago, the patient submitted to a right-hemithyroidectomy for the oxyphilic cell adenoma. Since two months, her dyspnea gradually aggravated. On admission, abnormal mass of right upper mediastinum was shown by chest X-ray. CT scan and MRI showed a 8 cm sized right upper mediastinal tumor with tracheal compression.

Adenoma↗
PubMed1993

Surgical management of intrathoracic goiter.

Thirty-three consecutive patients of intrathoracic goiters underwent resection at the TCVGH during a nine-year period 1982-1991. The mean age of 21 men and 12 women was 65 years. Six (18 per cent) had undergone prior thyroid surgery. Thirty-one of the 33 patients were euthyroid. Thirty patients underwent transcervical approach for resection; three had cervical incision plus median sternotomy. Pathological examination revealed multinodular goiter in 31 (94 per cent) and follicular carcinoma in two (6 per cent). The mean mass of goiter was 201.25 g and the mean greatest dimension was 10 cm. Thyroidectomy is advisable in all cases of intrathoracic goiter and resection can almost invariably be performed through a transcervical approach.

Adult↗
PubMed1977

[Endothoracic goiter with retro-tracheo-esophageal migration].

A case of endothoracic goitre with crossed, left-right, retrovascular, retro-tracheo-oesophageal migration is used as the basis for pathogenetic and diagnostic discussion and for stressing the surgical importance of correct topographic and migratory classification of each form.

Female↗
PubMed1995

[Cervico-mediastinal goiters. Clinical aspects].

Among 660 cases of thyroid pathology diagnosed by the 2nd Institute of Clinical Surgery, Policlinico San Matteo, IRCCS, Pavia, during the period 1984 to 1993, 34 cases of cervical-mediastinal goiter were observed with an incidence of 5%. After a careful analysis of the main contributions to the study of cervical-mediastinal goiters, paying special attention to their classification, pathogenesis, methods of growth, and unique symptomatic manifestations, the authors focus on current radiological and instrumental studies, which are widely regarded as being useful for the diagnosis of the site and nature of this disease. They review the routes for aggressive surgery and appropriate techniques for the exeresis of the mediastinal mass. Having empasised the absolute indication for surgery the authors recommend quasi-total or total thyroidectomy as the elective form of surgery.

Adolescent↗
PubMed1996

[Intrathoracic goiters. 62 surgically treated patients].

OBJECTIVES: Intrathoracic goitres present as tumors of the upper mediastinum. Malignancy is uncommon, but sudden or progressive development often leads to compression of the trachea. We report here our experience with surgical exeresis. METHODS: From 1980 to 1995, we operated 62 patients with intrathoracic goitre. There were 23 men and 39 women (mean age 63 years). The main manifestations leading to diagnosis were dyspnea (n = 20; 32%) and identification of a mediastinal formation on routine chest x-rays (n = 19; 30%). RESULTS: Antevascular goitre was seen in 24 patients (39%) and retrovascular goitre in 38 (61%). The retrovascular goitres were located anteriorly and laterally to the trachea in 21 patients (34%) and posteriorly in 17 (27%). Simple cervicotomy was used in 57 patients (92%). Manubriotomy (n = 1) and total sternotomy (n = 4) were also required. All intrathoracic goitres removed were benign. Post-operative mortality was nul and morbidity was 11%: 2 cases of hypocalcemia and 2 tracheomalacias including 1 with recurrent nerve palsy and one with hematoma and pulmonary infection. CONCLUSION: Surgical exeresis of intrathoracic goitre is essentially required in case of respiratory distress due to compression of the trachea. Morbidity is low with simple cervicotomy.

Adult↗