Management of Substernal and Intrathoracic Goiters

1986 ◽  
Vol 94 (3) ◽  
pp. 282-287 ◽  
Author(s):  
Hyun T. Cho ◽  
Jason P. Cohen ◽  
Max L. Som
Keyword(s):  
Preoperative Evaluation ◽  
Surgical Removal ◽  
Team Approach ◽  
Vascular Compression ◽  
Intrathoracic Goiter ◽  
Transcervical Approach ◽  
Respiratory Embarrassment ◽  
Selection Of Patients ◽  
Mediastinal Goiter ◽  
Selection Of

Goiters that descend into the mediastinum can cause respiratory embarrassment, dysphagia, vascular compression, vocal cord paralysis, and sudden death. Although many such goiters remain clinically silent, their ability to produce sudden and unpredictable respiratory distress is well known. The condition was not considered uncommon in the first half of the twentieth century; some authors reported series of hundreds of thyroidectomies for Intrathoracic goiter. Though seen less frequently today, the only effective treatment for mediastinal goiter is surgical removal. We report our experience with the management of 70 consecutive patients with substernal or intrathoracic goiters. The clinical presentation, preoperative evaluation, operative technique, and results and complications of therapy are discussed. Consideration is also given to the pathogenesis of Intrathoracic extension. The transcervical approach for resection is emphasized—even goiters extending to the aortic arch were safely removed without requiring sternotomy. A multidlsciplinary team approach, including the surgeon, anesthesiologist, and endocrinologist, is essential. Because of more conservative trends in the selection of patients for thyroidectomy, the Incidence of mediastinal goiter may be increasing.

scholarly journals Primary Intrathoracic Goiter

2009 ◽  
Vol 1 (1) ◽  
pp. 43-46
Author(s):  
Dorin T Colibaseanu ◽  
Jon A van Heerden ◽  
David R Farley ◽  
Stephen D Cassivi
Keyword(s):  
Differential Diagnosis ◽  
Thyroid Gland ◽  
Surgical Resection ◽  
Mediastinal Mass ◽  
Treatment Options ◽  
Radiographic Imaging ◽  
Intrathoracic Goiter ◽  
Transcervical Approach ◽  
Substernal Goiter ◽  
Mediastinal Goiter

ABSTRACT The differential diagnosis of a middle mediastinal mass is fairly broad. Though relatively rare, the diagnosis of primary intrathoracic goiter is a clinically important consideration that should not be overlooked. The nature of this clinical entity and its diagnostic implications are discussed. Relevant radiographic imaging is evaluated demonstrating the key findings. Indications for intervening and treatment options are reviewed. Specifically, the presence of a growing substernal goiter in an otherwise fit patient is generally an indication for surgical resection. The nature of a primary intrathoracic goiter usually obviates the more common transcervical approach since by definition the mediastinal goiter is discontinuous with the cervical thyroid gland. Other transthoracic approaches are therefore necessary.

Combined Use of Subdural and Intracerebral Electrodes in Preoperative Evaluation of Epilepsy

Neurosurgery ◽  
1990 ◽  
Vol 26 (1) ◽  
pp. 93-101 ◽  
Author(s):  
C. W. M. van Veelen ◽  
R. M. Chr. Debets ◽  
A. C. van Huffelen ◽  
W. van Emde Boas ◽  
C. D. Binnie ◽  
...  
Keyword(s):  
Preoperative Evaluation ◽  
Epileptogenic Zone ◽  
Partial Seizures ◽  
Complex Partial Seizures ◽  
Depth Electrodes ◽  
Combined Use ◽  
Intracranial Recording ◽  
Burr Holes ◽  
Selection Of Patients ◽  
Selection Of

Abstract For intracranial recording of partial seizures considered to originate from one of the temporal or frontal lobes, the team in the Utrecht Academic Hospital has used subdural, multicontact, flexible electrodes since 1972. These are introduced through bilateral, frontocentral trephine holes and are manipulated under fluoroscopy to cover most of the cerebral convexity. It became evident that in many patients, additional placements to record from intracerebral structures were indispensable. Therefore, using the same trephine holes, an additional 2 to 4 depth electrodes were stereotactically implanted in the mesial temporal and/or frontal structures, as appropriate. An extensive intra- and extracerebral spatial representation of the epileptogenic zone was thus obtained. We report here the methods for manufacturing and applying these electrodes and our clinical experience with 28 patients. The results obtained so far stress the value of combining subdural and depth electroencephalographic monitoring in the presurgical selection of patients suffering from medically refractory complex partial seizures. By miniaturizing the electrodes, extensive areas of the brain can be investigated without craniotomy or multiple burr holes. (Neurosurgery 26:93-101, 1990)

Nonsurgical Management of Small and Intracanalicular Acoustic Tumors

Neurosurgery ◽  
1985 ◽  
Vol 16 (6) ◽  
pp. 801-803 ◽  
Author(s):  
Craig W. Clark ◽  
William H. Moretz ◽  
James D. Acker ◽  
Gale L. Gardner ◽  
Frank Eggers ◽  
...  
Keyword(s):  
Small Group ◽  
Management Strategy ◽  
Nonoperative Management ◽  
Surgical Removal ◽  
Nonsurgical Management ◽  
Selection Of Patients ◽  
Selection Of

Abstract Although surgical removal is generally regarded as the management strategy of choice for acoustic tumors, there remains a small group of patients usually with small or intracanalicular tumors in whom nonoperative management may be a desirable alternative to operation. The authors present a series of six such cases and discuss criteria that may aid in the selection of patients suitable for initial nonoperative management.

scholarly journals Complications of Circumcision

2011 ◽  
Vol 11 ◽  
pp. 2458-2468 ◽  
Author(s):  
Aaron J. Krill ◽  
Lane S. Palmer ◽  
Jeffrey S. Palmer
Keyword(s):  
Health Care ◽  
Preoperative Evaluation ◽  
The United States ◽  
Safe Procedure ◽  
Significant Cost ◽  
Proper Selection ◽  
Significant Percentage ◽  
Bleeding History ◽  
Selection Of Patients ◽  
Selection Of

In the United States, circumcision is a commonly performed procedure. It is a relatively safe procedure with a low overall complication rate. Most complications are minor and can be managed easily. Though uncommon, complications of circumcision do represent a significant percentage of cases seen by pediatric urologists. Often they require surgical correction that results in a significant cost to the health care system. Severe complications are quite rare, but death has been reported as a result in some cases. A thorough and complete preoperative evaluation, focusing on bleeding history and birth history, is imperative. Proper selection of patients based on age and anatomic considerations as well as proper sterile surgical technique are critical to prevent future circumcision-related adverse events.

scholarly journals Trichophagia and Trichobezoar: Case Report

2012 ◽  
Vol 8 (1) ◽  
pp. 43-45 ◽  
Author(s):  
Santos Tiago ◽  
Madeira Nuno ◽  
Alcafache João ◽  
Vicente Carla ◽  
Molinar Gonçalo ◽  
...  
Keyword(s):  
Case Report ◽  
Impulse Control ◽  
Surgical Removal ◽  
Gastric Cavity ◽  
Rapunzel Syndrome ◽  
Surgical Data ◽  
Surgical Condition ◽  
Selection Of Patients ◽  
Selection Of

Objective:Trichobezoar consists of a compact mass of hair occupying the gastric cavity to a various extent. When the trichobezoar extends past the duodenum it is better referred to as Rapunzel Syndrome. Although trichobezoars are well described in terms of surgical diagnostic and procedure, there are only but very scarce reports on psychiatric literature, usually associated with trichotillomania. The authors present a clinical case of trichobezoar and discuss the most relevant aspects concerning this entity.Methods:Presentation of psychiatric and surgical data concerning the case report. Previously reported cases are also mentioned.Results:Report of a 27-year-old female patient with a trichobezoar submitted to surgical removal, with a prior intervention 4 years before also due to trichobezoar, and with unknown psychiatric antecedents or follow-up.Conclusions:A trichobezoar represents a serious surgical condition. It is important to consider such diagnosis in face of suggestive symptoms, even if signs of trichotillomania are not present. The discrepancies between the prevalence of trichotillomania and trichobezoars due to trichophagia may be due to issues related to self-selection of patients and symptom severity. Such issues may also be important in the study of impulsive-compulsive spectrum models and to their relevance to impulse control disorders.

Selection of patients for portal-systemic shunts

JAMA ◽  
1966 ◽  
Vol 196 (12) ◽  
pp. 1039-1044 ◽  
Author(s):  
R. E. Hermann
Keyword(s):  
Selection Of Patients ◽  
Selection Of

Perioperative acute internal carotid thrombosis after general surgery

2020 ◽  
Vol 99 (3) ◽  
pp. 136-140
Keyword(s):  
Cardiac Surgery ◽  
Internal Carotid ◽  
Right Hemicolectomy ◽  
Diagnostic Assessment ◽  
Left Carotid Artery ◽  
Perioperative Stroke ◽  
Internal Carotid Occlusion ◽  
Acute Brain Ischemia ◽  
Selection Of Patients ◽  
Selection Of

Introduction: The average incidence of perioperative stroke during major non-cardiac surgery is less than 1%, suggesting that it is rarely a major problem for the vast majority of patients. Methods: In our paper we present a 46-year-old patient undergoing acute right hemicolectomy who developed right-sided hemiparesis in the perioperative setting. Immediate CTAg examination showed an ischemic stroke in the left hemisphere as a result of left internal carotid thrombosis. A surgical procedure to recanalize the left carotid artery was performed 14 hours from the onset of neurological symptomatology and the neurological deficit gradually recovered fully. Conclusion: Our case report supports studies showing that a thorough diagnostic assessment allows the selection of patients who may benefit from urgent revascularization of acute internal carotid occlusion during the phase of acute brain ischemia.

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