Riedel's Thyroiditis. A Clinical Review.

Riedel`s thyroiditis is a rare disease with an unknown etiology, which is characterized by replacement of the thyroid gland tissue with a fibrous connective tissue, the main characteristic sign is the stony-hard texture of the gland, extending to the surrounding structures (trachea, esophagus, blood vessels and nerves). Dense adhesion causes clinical symptoms of tracheal compression, such as shortness of breath, hoarseness, coughing and dyspnoea. Regarding functional activity, both euthyroidism and thyrotoxicosis with the subsequent development of hypothyroidism can be observed. A difficult preoperative diagnosis allows only to suspect this disease, as well as differentiate it with some aggressive forms of cancer, and therefore the final diagnosis is possible only after histological and immunohistochemical examinations of postoperative material. The conservative treatment (mainly glucocorticoid drugs) and surgical intervention can be applied. It is necessary to be meticulous about the choice of a treatment method, taking into account the firmly adhesion with surrounding structures and a high risk of complications of surgical treatment of the thyroid gland. This case report describes a patient with a confirmed morphological diagnosis of Riedelapos;s thyroiditis after thyroidectomy. The peculiarity of this case is a clear positive correlation of the occurrence of subfebrile fever with the onset of the disease and its resolution after surgical treatment and a 11-month follow-up period.

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Surgical treatment of diffuse toxic goiter and the possibility of predicting its results

Problems of Endocrinology ◽

10.14341/probl11863 ◽

2000 ◽

Vol 46 (4) ◽

pp. 34-38

Author(s):

M. I. Balabolkin ◽

P. S. Vetshev ◽

N. A. Petunina ◽

L. V. Trukhina

Keyword(s):

Surgical Treatment ◽

Western Europe ◽

Clinical Symptoms ◽

Low Frequency ◽

Treatment Method ◽

Antithyroid Drugs ◽

Minimal Risk ◽

Cancer Breast ◽

The Usa ◽

Toxic Goiter

Most of the most respected researchers in the field of thyroidology agree that the ideal treatment for diffuse toxic goiter (DTZ) should ensure the rapid elimination of the clinical symptoms of thyrotoxicosis and be accompanied by a minimal risk of complications for the patient [1, 2, 7]. Unfortunately, at present, clinical practice does not have a treatment method that fully meets these requirements. The choice of treatment method for DTZ is largely determined by the commitment of specialists and their experience in the application of a particular treatment method, the characteristics of national endocrinological and surgical schools, the capabilities of a particular medical institution, as well as the sex, age of the patient, options for the clinical course of the disease, the patient’s wishes and some others factors. It can be noted that the recommendations given by experts in Europe, the USA and Japan are different. Conservative therapy with antithyroid drugs is quite widespread in European countries, but the low frequency of achieving stable remission of the disease does not satisfy endocrinologists [1,5, 32, 40, 42]. Radioactive iodine therapy, which is widely used in the USA and Western Europe, which is a rather effective method of treating DTZ, over time leads to the development of hypothyroidism in almost all patients [16, 20], it is also necessary to take into account the risk of developing thyroid cancer, breast, infertility and severe osteoporosis in women in the premenopausal period [10, 13, 18, 19]. Surgical treatment occupies a significant place in the treatment of DTZ, providing the patient with the most rapid achievement of the euthyroid state, however, like any surgical intervention, it is accompanied by a number of characteristic complications [2, 46]. Nevertheless, in Japan, thyroidectomy is considered the main treatment for DTZ.

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Case Report: A Rare Association of Diffuse Thyroid Lipomatosis with Amyloid Deposition

European Thyroid Journal ◽

10.1159/000518444 ◽

2021 ◽

pp. 1-5

Author(s):

Daniela Rodrigues Cavaco ◽

Ana Alves Rafael ◽

Rafael Cabrera ◽

Helena Vilar ◽

Valeriano Leite

Keyword(s):

Thyroid Gland ◽

Fatty Infiltration ◽

Rare Condition ◽

Final Diagnosis ◽

Amyloid Deposition ◽

Unknown Etiology ◽

Diffuse Infiltration ◽

Microscopic Appearance ◽

Diffuse Goiter ◽

History Of

Diffuse thyroid lipomatosis is a rare histopathological condition of unknown etiology, characterized by diffuse fatty infiltration of the thyroid stroma, which can result in diffuse goiter with compressive symptoms. We report a case of a 46-year-old man with 1-year history of progressive goiter enlargement with compressive symptoms. Imaging studies revealed multiple coalescent nodules. The patient underwent surgery, and the microscopic appearance revealed a diffuse infiltration of thyroid stroma by mature adipose tissue with associated amyloid deposition. A final diagnosis of diffuse lipomatosis of the thyroid gland was established. This patient represents one of the few reported cases of diffuse lipomatosis with coexisting deposition of amyloid protein of the thyroid gland and contributes to the better understanding of this extremely rare condition.

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Surgical treatment of 125 cases with congenital diaphragmatic eventration in a single institution

10.21203/rs.3.rs-35679/v1 ◽

2020 ◽

Author(s):

Shengliang Zhao ◽

Zhengxia Pan ◽

Yonggang Li ◽

Yong An ◽

Lu Zhao ◽

...

Keyword(s):

Surgical Treatment ◽

Open Surgery ◽

Clinical Symptoms ◽

Clinical Manifestations ◽

Operation Time ◽

Treatment Method ◽

Diaphragmatic Eventration ◽

Time To Peak ◽

Surgical Methods ◽

Better Than

Abstract Background:This study sought to investigate the clinical characteristics of congenital diaphragmatic eventration (CDE) and to compare the efficacy of thoracoscopy and traditional open surgery in infants with congenital diaphragmatic eventration.Methods: We retrospectively analyzed the clinical data of 125 children with CDE(90 boys, 35girls; median age:12.2 months, range 1h-7years;body mass1.99-28.5kg,median body mass 7.87±4.40kg) admitted to our hospital in recent 10years,and statistically analyzed their clinical manifestations and surgical methods. Results:108 children in this group underwent surgery, of which 67 underwent open surgery and 41 underwent thoracoscopic diaphragmatic Plication.107 patients recovered well postoperatively, except for 1 patient with hiatal hernia died of respiratory distress after surgery.Followed up for 1-9.5 years,107 patients had significantly improved preoperative symptoms.Eleven of the 17 children who did not undergo surgical treatment did not see a significant decrease in diaphragm position after 1-6 years of follow-up.In the thoracoscopy group, the lung function values of 13 children before operation and 3 year after operation was compared. The difference in percent of expiratory time to peak tidal time (tPTEF%tE) and percentage of tidal volume to peak tidal expiratory flow(VPEF%VE) was significant (P<0.05).In the thoracoscopy group, the index data on the operation time, intraoperative blood loss, chest drainage time, postoperative mechanical ventilation time, postoperative hospital stay and postoperative CCU admission time were better than those in the open group.The difference between the two groups was statistically significant (P＜0.05). Conclusions: Clinical symptoms of congenital diaphragmatic eventration varied in severity. Patients with severe symptoms should be operated early. All kinds of surgical methods can achieve better results.The clinical symptoms of children after diaphragm Plication operation are better than those before operation.We believe that the continuous suture of barbed wire thread applied to thoracoscopy diaphragm Plication surgery has quick operation time, less trauma, and quick recovery should be the preferred treatment method for infants with congenital diaphragmatic eventration.

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Surgical treatment of transmissible venereal tumor (sticker sarcoma)

10.33109/bjvmjj2020case1 ◽

2020 ◽

Vol 18 (1) ◽

Author(s):

Bougherara Hithem ◽

Boukhechem Saïd ◽

Aguezlane Abdelaziz ◽

Benelhadj Khouloud ◽

Aissi Adel

Keyword(s):

Surgical Treatment ◽

Cancer Cells ◽

Treatment Method ◽

High Rate ◽

Surgical Removal ◽

Characteristic Appearance ◽

Recurrent Tumors ◽

External Genital Organs

Background: Sticker sarcoma, also called venereal sarcoma or venereal lymphosarcomatosis, is a tumor of the external genital organs in females and males. In male animals the penis and foreskin (prepuce) are affected, in the female, it happens in vagina (vagina) and labia (vulva). The diagnosis of sticker sarcoma is based on the chronic discharge, the typical locations and the characteristic appearance of the tumor. Methods: We have relied on the treatment method on the complete surgical removal of all cancer cells that we can access. Results: After surgery, we notice recurrent tumors about six months after surgical treatment, indicating the need for other treatments in addition to surgery. Conclusion: Although spontaneous regressions of sticker sarcoma are documented (with permanent immunity), chemotherapy is the treatment of choice today. Irradiation should also be effective. If the tumor is only removed surgically, there is a high rate of recurrence, and this is what happened with the case that we treated, as the tumor reappeared after less than six months.

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Incidence, characteristics, determinants and prognostic impact of recurrent syncope

European Heart Journal ◽

10.1093/ehjci/ehaa946.0700 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

T Zimmermann ◽

J Du Fay De Lavallaz ◽

T Nestelberger ◽

D Gualandro ◽

P Badertscher ◽

...

Keyword(s):

Patient Characteristics ◽

Coronary Intervention ◽

Final Diagnosis ◽

Major Adverse Cardiovascular Events ◽

Unknown Etiology ◽

Funding Source ◽

Prognostic Impact ◽

Lasso Regression ◽

Recurrence Rates ◽

Increased Risk

Abstract Background The incidence, characteristics, determinants, and prognostic impact of recurrent syncope are largely unknown, causing uncertainty for both patients and physicians. Methods We characterized recurrent syncope including sex-specific aspects and its impact on death and major adverse cardiovascular events (MACE) in a large prospective international multicenter study enrolling patients ≥40 years presenting with syncope to the emergency department (ED). Syncope etiology was centrally adjudicated by two independent and blinded cardiologists using all information becoming available during syncope work-up and 12-month follow-up. MACE were defined as a composite of all-cause death, acute myocardial infarction, surgical or percutaneous coronary intervention, life-threatening arrhythmia including cardiac arrest, pacemaker or implantable cardioverter defibrillator implantation, valve intervention, heart-failure, gastrointestinal bleeding or other bleeding requiring transfusion, intracranial hemorrhage, ischemic stroke or transient ischemic attack, sepsis and pulmonary embolism. Results Incidence of recurrent syncope among 1790 patients was 20% (95%-confidence interval (CI) 18% to 22%) within 24 months. Patients with an adjudicated final diagnosis of cardiac syncope (hazard ratio (HR) 1.50, 95%-CI 1.11 to 2.01) or syncope of unknown etiology even after central adjudication (HR 2.11, 95%-CI 1.54 to 2.89) had an increased risk for syncope recurrence (Figure). LASSO regression fit on all patient information available early in the ED identified more than three previous episodes of syncope as the only independent predictor for recurrent syncope (HR 2.13, 95%-CI 1.64 to 2.75). Recurrent syncope within the first 12 months after the index event carried an increased risk for all-cause death (HR 1.59, 95%-CI 1.06 to 2.38) and MACE (HR 2.24, 95%-CI 1.67 to 3.01), whereas recurrences after 12 months did not have a significant impact on outcome measures. Conclusion Recurrence rates of syncope are substantial and vary depending on syncope etiology. There seem to be no reliable patient characteristics available early on the ED that allow for the prediction of recurrent syncope with only a history of more than three previous syncope being associated with a higher risk for future recurrences. Importantly, recurrent syncope within the first 12 months carries an increased risk for death and MACE. Figure 1 Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): Swiss National Science Foundation, Swiss Heart Foundation

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The accuracy of initial diagnoses in coma: an observational study in 835 patients with non-traumatic disorder of consciousness

Scandinavian Journal of Trauma Resuscitation and Emergency Medicine ◽

10.1186/s13049-020-00822-w ◽

2021 ◽

Vol 29 (1) ◽

Author(s):

Maximilian Lutz ◽

Martin Möckel ◽

Tobias Lindner ◽

Christoph J. Ploner ◽

Mischa Braun ◽

...

Keyword(s):

Emergency Care ◽

Final Diagnosis ◽

Class I ◽

Prehospital Emergency Care ◽

Unknown Etiology ◽

Care Providers ◽

Cohen’S Kappa ◽

Disorder Of Consciousness ◽

Cohen's Kappa ◽

Suspected Diagnosis

Abstract Background Management of patients with coma of unknown etiology (CUE) is a major challenge in most emergency departments (EDs). CUE is associated with a high mortality and a wide variety of pathologies that require differential therapies. A suspected diagnosis issued by pre-hospital emergency care providers often drives the first approach to these patients. We aim to determine the accuracy and value of the initial diagnostic hypothesis in patients with CUE. Methods Consecutive ED patients presenting with CUE were prospectively enrolled. We obtained the suspected diagnoses or working hypotheses from standardized reports given by prehospital emergency care providers, both paramedics and emergency physicians. Suspected and final diagnoses were classified into I) acute primary brain lesions, II) primary brain pathologies without acute lesions and III) pathologies that affected the brain secondarily. We compared suspected and final diagnosis with percent agreement and Cohen’s Kappa including sub-group analyses for paramedics and physicians. Furthermore, we tested the value of suspected and final diagnoses as predictors for mortality with binary logistic regression models. Results Overall, suspected and final diagnoses matched in 62% of 835 enrolled patients. Cohen’s Kappa showed a value of κ = .415 (95% CI .361–.469, p < .005). There was no relevant difference in diagnostic accuracy between paramedics and physicians. Suspected diagnoses did not significantly interact with in-hospital mortality (e.g., suspected class I: OR .982, 95% CI .518–1.836) while final diagnoses interacted strongly (e.g., final class I: OR 5.425, 95% CI 3.409–8.633). Conclusion In cases of CUE, the suspected diagnosis is unreliable, regardless of different pre-hospital care providers’ qualifications. It is not an appropriate decision-making tool as it neither sufficiently predicts the final diagnosis nor detects the especially critical comatose patient. To avoid the risk of mistriage and unnecessarily delayed therapy, we advocate for a standardized diagnostic work-up for all CUE patients that should be triggered by the emergency symptom alone and not by any suspected diagnosis.

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Surgical treatment of metastatic disease in the thyroid gland

Journal of Surgical Oncology ◽

10.1002/jso.2930170104 ◽

1981 ◽

Vol 17 (1) ◽

pp. 15-23 ◽

Cited By ~ 55

Author(s):

Mats Ericsson ◽

Ander Biörklund ◽

Ebbe Cederquist ◽

Stig Ingemansson ◽

Måns Åkerman

Keyword(s):

Surgical Treatment ◽

Thyroid Gland ◽

Metastatic Disease

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DISC HERNIA - DIFFERENTIAL DIAGNOSTICS, OPTION OF PSEUDOTUMOROUS FLOW

Vestnik ◽

10.53065/kaznmu.2021.34.13.018 ◽

2021 ◽

pp. 97-101

Author(s):

М.А. Алиев ◽

М.Ж. Мирзабаев ◽

В.С. Караваев

Keyword(s):

Clinical Medicine ◽

Clinical Symptoms ◽

Final Diagnosis ◽

Herniated Disc ◽

General Definition ◽

Differential Diagnostics ◽

Common Disease ◽

Physical And Mental Health ◽

Imaging Results ◽

Definition Of

Грыжа диска (ГД) является распространенным заболеванием и наносит большой вред как физическому, так и психическому здоровью пациентов, страдающих этим заболеванием. Главным этиологическим фактором заболевания служит дегенерация диска. В настоящее время общее определение грыжи межпозвонкового диска в клинической медицине довольно запутанно. В настоящее время общее определение грыжи межпозвонкового диска в клинической медицине довольно запутанно. Окончательный диагноз ГД основывается на совокупности анамнеза, клинических симптомов и результатах визуализации. Herniated disc is a common disease and causes great harm to both the physical and mental health of patients suffering from this disease. The main etiological factor of the disease is disc degeneration. Currently, the general definition of a herniated disc in clinical medicine is quite confusing. Currently, the general definition of a herniated disc in clinical medicine is quite confusing. The final diagnosis of HD is based on a combination of anamnesis, clinical symptoms, and imaging results.

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Differential diagnosis of chiasmal-cellular cyst

Vestnik nevrologii, psihiatrii i nejrohirurgii (Bulletin of Neurology, Psychiatry and Neurosurgery) ◽

10.33920/med-01-2008-05 ◽

2020 ◽

pp. 47-59

Author(s):

Nikita Sergeevich Puzakov ◽

Vladislav Yurievich Cherebillo ◽

Ilya Aleksandrovich Tregubenko ◽

Evgeniy Igorevich Kozak ◽

Yuliya Igorevna Ryumina

Keyword(s):

Surgical Treatment ◽

Pituitary Adenomas ◽

Comparison Group ◽

Clinical Symptoms ◽

Differential Diagnostics ◽

Diagnostic Features ◽

Accurate Preoperative Diagnosis ◽

Colloid Cysts ◽

Surgical Tactics ◽

Cellular Area

The clinical symptoms of chiasmal-cellular formations are similar, which significantly complicates its differential diagnostics. The differential diagnostics of chiasmal-cellular cysts, which include colloid cysts, arachnoid cysts, Rathke’s pouch cysts, epidermoid and dermoid cysts, is especially difficult. Nevertheless, an accurate preoperative differential diagnostics of chiasmal-cellular cysts is an important stage of preparation for surgical treatment, which allows determining the surgical tactics in advance, because each group of chiasmal-cellular cysts has its own features of surgical treatment, which significantly reduce the number of complications and minimize the number of recurrences. This study intended to improve the efficiency of diagnostics of the chiasmal-cellular cysts by determining the criteria for its differential diagnostics. 94 patients with chiasmal-cellular cysts and pituitary adenomas were examined and treated in the period of 2009 and 2018 for this purpose. As the most frequent pathology of the chiasmal-cellular area, pituitary adenomas were selected as a comparison group due to the fact that it is often necessary to differentiate chiasmal-cellular cysts with this pathology. Patients were divided into 5 groups according to the nosology of the disease. Clinical picture, laboratory analysis and MRI data were studied in each group. Statistical analysis and comparison of the data obtained among all groups were performed, and it allowed to determine the distinctive diagnostic features incidental to each group. It is possible to make an accurate preoperative diagnosis based on the specific features of differential diagnostics.

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