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At least 127 records · Page 7Linked to original sources
PubMed2004

Kinetics of intraoperative fluorescence diagnosis of parathyroid glands.

OBJECTIVE: Identification of parathyroid glands is often a challenge even for experienced surgeons. The feasibility and efficacy of fluorescence diagnosis for localization of parathyroids has already been proven in an experimental setting. In preparation for a clinical application of this technique in patients undergoing surgery for hyperparathyroidism, we evaluated the kinetics of fluorescence diagnosis. DESIGN AND METHODS: Fifty rats were randomized into eight groups with different photosensitization parameters using the photosensitizer aminolevulinic acid (ALA): a peritoneal lavage was performed with either 1.5 or 3.0% ALA solution and the induced photosensitization times varied from 0.5, 1 and 2 to 4 h. Under special fluorescence illumination, D-light, the exposed operative site with thyroid, parathyroid glands and neck muscles was examined. The identified parathyroid glands were studied according to fluorescence intensity by spectrometric measurement and compared with surrounding tissue. RESULTS: Photosensitizer accumulation in parathyroid glands, indirectly measured by spectrometry, was up to 3.2 times higher than in thyroid and 2.6 times higher than in muscle tissue (2 h photosensitization with 3.0% ALA). Using 1.5% ALA, the optimum fluorescence intensity and ratio/contrast was slightly lower (parathyroid-to-thyroid ratio x 3.0, parathyroid-to-muscle ratio x 1.9) but was reached earlier (1 h) and hence considered as the parameter of choice for a clinical application. CONCLUSIONS: In future clinical application, intraoperative fluorescence diagnosis is expected to increase the ease of identification of atypically located or supernumeric glands. In combination with preoperative diagnostics, this may result in reduced operation time and avoidance of persistent hypercalcaemia.

Aminolevulinic Acid↗
PubMed2001

Clinical features and therapeutic outcomes of 65 patients with acromegaly at Tokyo Women's Medical University.

OBJECTIVE: The purpose of this study was to survey the clinical characteristics, complications, and therapeutic outcome in patients with acromegaly. PATIENTS AND METHODS: The clinical features of 65 patients with acromegaly (31 males, 34 females; mean age: 50+/-2 yr.) who were admitted to Tokyo Women's Medical University between 1990 and 1999 were analyzed retrospectively from medical records. RESULTS: The retrospective analysis revealed that the diagnosis of acromegaly was preceded by approximately 8.1+/-1.1 years of signs and symptoms of the disease. Forty-six of the 65 patients (71%) had macroadenomas, 16 (25%) had microadenomas, and the remaining three had empty sella. The rate of biochemical cure or remission was 81% for microadenoma (13/16), 64% for macroadenoma without extrasellar extension (9/14), and 13% for macroadenoma with cavernous sinus extension (2/15). Eighteen (28%) patients had impaired glucose tolerance (IGT) and 32 (49%) had diabetes mellitus (DM). After treatment for acromegaly, glucose metabolism was analyzed again in 38 patients, and it improved in 26 patients with IGT or DM. Twenty-five of 65 patients (38%) had hypertension. Of 26 patients who underwent barium enema or colonoscopy, 10 had colonic polyps and 4 had colon cancer. CONCLUSION: This study suggests that long-term excessive growth hormone (GH) secretion causes many complications. Therefore, awareness of the early symptoms and signs of acromegaly and long-term careful management of complications, along with therapy to reduce serum GH/insulin-like growth factor (IGF)-I levels, are important for patients with acromegaly.

Acromegaly↗
PubMedDate not supplied

Prevalence of differentiated thyroid cancer in 810 cases of surgically treated goiter in Yemen.

BACKGROUND: In 1990, the World Health Organization (WHO) suggested that severe iodine deficiency exists in Yemen. Therefore, we looked at the prevalence of differentiated thyroid goiter in 810 cases consecutively treated by surgery for goiter. METHODS: This was a retrospective study of 810 surgically operated cases of goiter over a 5-year period (1999-2003). All cases were evaluated on H&E stained sections from embedded, 10% buffered formalin fixed tissue blocks. Special stains and immunohistochemical analysis were done in Yemen and abroad. Most patients were older than 20 years of age and were from the high altitude areas (2000 to 2600 meters above sea level), where iodine deficiency disorders (IDD) are well documented. RESULTS: In the 810 cases, 729 (90%) were females and the remaining 81 (10%) were males, with female-to-male ratio of 9:1. Differentiated thyroid cancer (DTC) was found in 170 (21%) cases, including 148 (86.4%) females and 22 (13.6%) males. Nearly 60% of the cases were in the age group of 21-40 years. Papillary carcinoma was the most common type of DTC (164 cases, 96.5%). CONCLUSIONS: In a Yemeni population, which has a high prevalence of iodine deficiency, 21% of patients operated on for nodular goiter without pre-operative fine needle aspiration biopsy had thyroid cancer, mostly of the papillary type. In this study, males and elderly patients with goiter had a higher chance of having malignancy.

Adolescent↗
PubMed1999

Retrosternal (intrathoracic) goitre--diagnosis and surgical treatment.

For a period of 12 years (1987-1998) 2033 patients underwent surgical treatment of the thyroids in the surgical clinics of the Higher Medical Institute in Plovdiv. Retrosternal or intrathoracic goitre was found in 29 patients (p +/- Sp = 1.43 +/- 0.26%). Of these, seven were males and 22 females all aged 32 to 76 years. Twenty two of the patients were euthyroid and seven hyperthyroid (75.9 +/- 7.9% and 24.1 +/- 7.8%, respectively). Compression of adjacent organs was detected in 19 of the patients (65.5 +/- 8.8%) (P < 0.05). X-ray, ultrasonography, scintigraphy (gamma-chamber), computed tomography, and in cases of voice disorders, direct laryngoscopy were used in making the diagnosis. All patients underwent surgical treatment. Cervical collar incision was suitable in 27 patients and in one patient longitudinal sternotomy was used and in other, who had deep posterior mediastinal goitre, Hart's method of combined thoracotomy and cervicotomy was required. The weight of the resected glands varied from 50 to 1500 g. The results obtained are discussed in terms of the incidence, type, and site of the retrosternal (intrathoracic) goitre, capabilities of the contemporary methods of diagnostics, surgical necessities, surgical approach and compared with literature data.

Adult↗
PubMed1997

[Surgery of substernal thyroid goiter].

A retrospective study on 87 substernal thyroid nodules operated between 1965 and 1994 was made. Among them 73.6% were goiters, 14.9% adenoma and 11.5% malignancy. Resection via cervical collar incision was performed in 70% of all cases, sternotomy in 16% and thoracotomy in 14%. A cervical collar incision was adequate in 91% of 43 cases after 1985, only one goiter was completed by sternotomy. Morbidity rate of complications was 41.4%, while the rate of recurrent laryngeal nerve paralysis was 20.7%. Surgery via cervical collar incision for all retrosternal thyroid nodules was advised and sternotomy or thoracotomy are suggested.

Adenocarcinoma, Follicular↗
PubMed1998

[Surgical treatment of insulinomas with observations on six cases in one year].

Insulinomas are among the endocrine pancreatic tumors most commonly met with. Regardless of their small proportion compared to other tumors of the digestive system, they give rise to pressing surgical problems on account of a number of reasons, namely: 1) early clinical diagnosis and undertaking opportune operative management in those presenting benign neoplasms, even in oligosymptomatic cases, 2) exact topical preoperative diagnosis using echography, CAT, MRI, angiography and the like; 3) intraoperative identification of the tumor/tumors in the event of multiple involvement, and choice of the most adequate operative approach, 4) intra- and postoperative monitoring of the blood sugar levels and appropriate insulin therapy prescription. Over the period Jan/Oct 1997, six patients presenting clinical, laboratory and instrumental evidence of insulinomas are subjected to operation in Department of General and Operative Surgery of the Medical University-Sofia. The basic principles with a reference to preoperative topical diagnosis and surgical tactics adopted, as well as postoperative care and monitoring of hyperglycemia developing as the result of surgery, are thoroughly discussed. Good immediate and long-term postoperative results are recorded in all six patients.

Bulgaria↗
PubMed2001

The diagnosis and surgical management of diseases of the adrenal glands.

The authors present their own experience in the diagnosis and management of adrenal tumours and cysts. During the years 1980-2000, 74 patients were underwent surgical treatment. Of this group, 23 had Cushing's syndrome, 19 phaeochromocytomas, 4 Conn's syndrome, 2 virilising tumours, 2 adenocarcinomas, 2 ganglioneuromas, 7 adrenal cysts, 8 adenomas, 3 adenocortical carcinomas, 2 nodular hypertrophies, 1 myelolipoma and 1 liposarcoma. Treatment was effective in 73 (98.6%) of patients. We recommend the transperitoneal approach which allows the visual evaluation of both adrenals and extra adrenal tissue. We regard surgical intervention as being the only effective method of treating adrenal tumours.

Adrenal Gland Diseases↗
PubMed2002

[Surgical treatment of pheochromocytoma--personal experience].

UNLABELLED: The first description of the adrenal gland dates since 1563 by Eustachius in a study "Opscula anatomica". Despite earlier recognition of the presence of adrenals and division into cortex and medulla, the precise observations of Addison appeared in 1855 that the essential role of these glands was recognized in patients who died with adrenal destruction secondary to tuberculosis. Frankel first described a medulary adrenal tumour in 1886. In 1912 the pathologist Pick formulated the descriptive term pheochromocytoma. The first surgical removal of pheochromocytoma in Europe was performed by Rouks in 1926 and by Mayo in USA in 1927. The work of the later had greater impact. For a long period of time the Military Medical Academy is involved in clinical diagnosis and management of adrenal tumours. The first description of diagnosed pheochromocytoma was by Professor Ratibor Mitshitsh. The first surgical removal of pheochromocytoma in the Military Medical academy and in Yugoslavia was performed by Professor Isidor Papo. Over the period January 1974-December 2001, 268 patients with tumours of adrenal origin(93 patients/34.7%/had pheochromocytoma) underwent surgical treatment in the Military Medical Academy. Of our particular interest was the relation between the surgical approach to pheochromocytoma and the incidence and severe intraoperative and immediate postoperative complications. Although numerous studies favorise transabdominal and thoracic approach, our experience in flank approach is very favorable. By the lateral high intercostal approach above the eleventh costae we operated on 67 (72%) patients with only one (1.5%) major complication--cardiac arrest. With successful reanimation the patient survived. The transperitoneal approach was performed in 21 (22%) cases and we had 7 (33.1%) severe complications: one lethal outcome, cardiac arrest, injury of the aorta, injury of the VCI, postoperative bleeding that required relaparatomy and two splenectomies. The lethal outcome was the result of nonidentified ectopic retropancreatic pheochromocytoma that was not identified preoperatively and intraoperatively. At that time ultrasound, CT and MRI were not available. By transthoracic and posterior approach we operated on a small number of pheochromocytomas. DISSCUSSION: We analysed the advantages and disadvantages of some surgical approaches and our experience in these methods of management of pheochromocytoma and other adrenal tumours; we confirmed multiple advantages of flank intercostal approach above the eleventh costae compared to other approaches. This approach is simple, extrapleural and extraperitoneal. It offers a broad surgical field with the adrenal in its centre which permits an atraumatic operation with little risk of complications. CONCLUSIONS: The flank intercostal approach above the eleventh costae is indicated(option of choice) in unilateral pheochromocytoma and other unilateral adrenal tumours. The transabdominal approach is indicated in cases of bilateral pheochromocytomas, in cases of abdominal localization of ectopic pheochromocytomas, in tumours which involve the VCl and most of the left renal vein, and in patients with extremely large adrenal tumours. The thoracic approach is indicated in intrathoracic ectopic pheochromocytomas.

Adrenal Gland Neoplasms↗
PubMed1999

[Anatomic variations of the ostiomeatal complex and their correlation with chronic sinusitis: CT evaluation].

OBJECTIVE: To explore the relationship between anatomic variations in the ostiomeatal complex (OMC) and chronic sinusitis. METHODS: Coronal plane CT scans of the paranasal sinuses showing the ostiomeatal complex including the middle turbinate, uncinate, ethmoid bulla, agger nasi and Haller cell were analyzed in 297 individuals (594 sides). Statistical analyses were carried out with SPSS 5.0. RESULTS: There were 81.14% of OMC noted to have at least one variation. The anatomic variations included paradoxical curvature of the middle turbinate (13.97%), the pneumatized middle turbinate (34.85%), uncinate hyperplasia(19.36%), deviation of uncinate (45.27%), large ethmoidal bulla (30.30%), large agger nasi (0.70%) and Haller cell (1.00%). The correlation between variations and chronic sinusitis was significant (P < 0.01). CONCLUSION: The occurrence of OMC variation is common. The variations may be one of the causes of chronic sinusitis. Therefore, properly handling the variations was important in the endoscopic sinus surgery.

Adolescent↗
PubMed1999

[Management of middle turbinates in endoscopic sinus surgery].

OBJECTIVE: To explore the relationship between the partial middle turbinectomy and the prognosis. METHODS: Forty patients with nasal polyp and sinusitis were chosen. The partially middle turbinate was removed on one side and preserved on the opposite side. The time of postoperative debridement for nasal cavity, synechia of nasal cavity, and olfactory changes were assessed. RESULTS: The time of postoperative debridement of nasal cavity in patients with partial endonasal middle turbinectomy was shorter than those with preservation of middle turbinate (P < 0.01). There was no synechia in cases with partial middle turbinectomy and 12 cases of synechia in cases with preservation of middle turbinate. There was not difference about olfactory change in both sides. CONCLUSION: The partial middle turbinectomy in the endoscopic sinus surgery may be good for the prognosis of patients.

Adult↗