Evaluation of the Learning Curve for Intraoperative Neural Monitoring of the Recurrent Laryngeal Nerves in Thyroid Surgery*

2015 ◽  
Vol 86 (12) ◽  
Author(s):  
Krzysztof Pragacz ◽  
Marcin Barczyński
Keyword(s):  
Learning Curve ◽  
Thyroid Surgery ◽  
Predictive Value ◽  
Postoperative Function ◽  
Laryngeal Nerves ◽  
Technical Errors ◽  
Group I ◽  
Group Ii ◽  
Recurrent Laryngeal Nerves ◽  
Neural Monitoring

AbstractIntraoperative neuromonitoring facilitates identification of the recurrent laryngeal nerves (RLN) and allows for predicting their postoperative function. Nevertheless, the outcome of thyroid surgery monitoring is affected by both the experience of the operator and his mastering of the technique.was the assessment of the learning curve for intraoperative RLN neuromonitoring.. The prospective analysis included 100 consecutive thyroid operations performed by a single surgeon during implementation of RLN neuromonitoring in a district surgical ward in Staszów. RLN neuromonitoring was performed in keeping with the recommendations of the International Neural Monitoring Study Group using a C2 NerveMonitor (Inomed, Germany). The outcomes of initial 50 procedures (group I: 08/2012-07/2013) were compared with the results of subsequent 50 operations (group II: 08/2013-07/2014). The evaluation included demographic and intraoperative data along with predictive value of the method and complications.. In group II as compared to group I, a significant reduction of operative time was noted (102.1±19.4 vs 109.9±19; p=0.045), along with an increased percentage of identified RLNs (99% vs 89.2%; p=0.006), a decreased percentage of correction-requiring technical errors (8% vs 24%; p=0.029), an improved negative predictive (99% vs 89.3%; p<0.001) and positive value (75% vs 55.6%; p<0.001), as well as a decreased percentage of RLN injuries (3% vs 14%; p=0.006).. Mastering the technique of intraoperative RLN neuromonitoring in thyroid surgery requires the surgeon to perform independently approximately 50 monitored procedures, what allows for achieving the predictive value of the method that is comparable to outcomes published by referral centers.

scholarly journals Identifying Recurrent Laryngeal Nerve in Thyroid Surgery Using Relationship with Superior Parathyroid Gland and Tubercle of Zuckerkandl

2015 ◽  
Vol 23 (3) ◽  
pp. 99-103
Author(s):  
Somesh Mozumder ◽  
Shirish Dubey ◽  
Aniruddha Dam ◽  
Anup Kumar Bhowmick
Keyword(s):  
Prospective Study ◽  
Recurrent Laryngeal Nerve ◽  
Parathyroid Gland ◽  
Thyroid Surgery ◽  
Intimate Relationship ◽  
Laryngeal Nerve ◽  
Laryngeal Nerves ◽  
Recurrent Laryngeal Nerves ◽  
A Prospective Study ◽  
Relationship Of

Introduction: Recurrent laryngeal nerves (RLN) are particularly prone to injury during thyroid surgeries due to its intimate relationship and proximity with the gland. Zuckerkandl’s tubercle (ZT) helps in preserving RLN intra operative. Material and Methods: A prospective study for identifying RLN in thyroid surgery using relationship with superior parathyroid gland and tubercle of Zuckerkandl was conducted on 50 thyroidectomy patients between August 2013 and February 2014. Results: In all cases ZT was identified. Temporary paralysis of RLN was seen in 3 (6%) cases and permanent paralysis in 2 (4%) of cases. Discussion: The site of greatest risk during thyroidectomy to the RLN is in the last 2-3 cm extralaryngeal course of the nerve. Relationship of recurrent laryngeal nerve with superior parathyroid gland and tubercle of Zukerkandl (ZT) is known. Conclusion: Use of ZT and superior parathyroids as a landmark allows safe dissection of RLN.

scholarly journals Value of ST- Segment Depression with T-Wave Inversion in Lateral Leads I, aVL, V4-V6 in Diagnosing the Left Main or Left Main Equivalent Coronary Artery Disease

2017 ◽  
Vol 9 (2) ◽  
pp. 135-141
Author(s):  
Sambhu Kumar Mallick ◽  
Mahboob Ali ◽  
Amal Kumar Chowdhury
Keyword(s):  
Coronary Artery ◽  
Predictive Value ◽  
Left Main ◽  
Stenotic Lesion ◽  
Coronary Syndrome ◽  
T Wave ◽  
Wave Inversion ◽  
Group I ◽  
St Segment ◽  
Group Ii

Background: Critical stenosis in the proximal part of the left anterior descending, severe 3 vessel disease and left main stem stenosis have all been recognized as clinical conditions complicated by a high incidence of large infarction, pump failure, arrhythmias and sudden death in patients with acute coronary syndrome (ACS). As many effective treatment modes are available currently, early recognition of those circumstances is crucial for appropriate management.Methods: this observational study was carried out at the Department of Cardiology, National Institute of Cardiovascular Disease (NICVD), Dhaka. Patients (30 patients) with NSTEACS having ST-segment depression with T-wave inversion maximally in leads I,avL,V4-V6 were considered as cases (Group I) and those (30 patients) with ST-segment depression without T-wave inversion in lateral leads were controls (Group II). Coronary angiogram (CAG) was done during in-hospital stay.Results: In present study, it was evident that among group I patients, 43.3% had stenotic lesion in left main artery (LM) and 26.67% in LM equivalent coronary artery (LME CA), whereas had no stenotic lesion in LM and 3.33% had LME CA lesion in group II patients. Low cost, widely available ECG criteria is supposed to be useful predictor of left main or left main equivalent coronary artery obstruction (Sensitivity=95%, Specificity= 76%, Positive predictive value= 70.0% and Negative predictive value= 97.0%) and high ST–segment changes score (>18 mm (100%) &/or ³10mm (80%) was an additive predictor of LM or LMECA lesion.Conclusion: Maximum ST- segment depression with T-wave inversion in the lateral leads I, aVL, V4-V6 on admission ECG can predict the critical LM or LMECA obstruction in patients with NSTEACS. It can help to provide prompt and appropriate management earlier to reduce the mortality & morbidity.Cardiovasc. j. 2017; 9(2): 135-141

scholarly journals Pulmonary embolism in patients with chronic hypoxemia

2010 ◽  
Vol 63 (7-8) ◽  
pp. 492-496 ◽  
Author(s):  
Lidija Ristic ◽  
Milan Rancic ◽  
Tatjana Pejcic
Keyword(s):  
Pulmonary Embolism ◽  
Pulmonary Artery ◽  
Predictive Value ◽  
Diagnostic Study ◽  
Diagnostic Strategy ◽  
Radiological Findings ◽  
Group I ◽  
Perfusion Scan ◽  
Group Ii ◽  
Chronic Hypoxemia

Introduction. The aim of this prospective, originally designed, clinical - diagnostic study including 200 chronic hypoxemic patients was to assess the possibility of implementation of noninvasive diagnostic strategy and to investigate the incidence of pulmonary embolism and parameters of diagnostic accuracy of radiological findings according to Shintz criteria, echocardiography, lung perfusion scanning according to PIOPED criteria. Material and methods. The study included 200 chronic hypoxemic patients divided into 2 groups, the group I consisting of 42 women and 58 men and the group II consisting of 48 women and 52 men. Results and conclusion. Out of 200 hypoxemic patients, 49 patients (24.5%) were found to have pulmonary embolism. In the group I of 100 patients (42 women and 58 men) with chronic hypoxemia and secondary erythrocytosis the diagnosis of pulmonary embolism was confirmed in 39%, that being statistically significantly different (p<0.001) from 100 patients (48 women and 52 men) in the group II with chronic hypoxemia without secondary erythrocytosis, where pulmonary embolism was found in 10% of the patients. The predictive value was positive for direct radiological signs in 92.3% of patients in the group I for PTE, for indirect ones in 74.35%, and in the group II it was positive for direct radiological signs in 60% and for indirect ones in 90%. The predictive value of perfusion scan was positive in 59% of the group I and in only 22% of the group II. The predictive value for high pressure in the pulmonary artery was positive in 93.7% of the group I and in 66.6% of the group II. The following were found to be a variable predictor: hypoxemia, enlargement of the pulmonary artery, peripheral oligemia and elevation of diaphragm. Logistic regression according to backward - conditional method showed that the chronic hypoxemic patients with secondary erythrocytosis, who had radiological sign of peripheral oligemia - Westermark sign, had 2.286 times higher probability of having pulmonary embolism than similar patients without this sign.

scholarly journals The Recurrent Laryngeal Nerve in Relation to the Inferior Thyroid Artery in Adult Filipino Cadavers

2011 ◽  
Vol 26 (2) ◽  
pp. 13-17 ◽  
Author(s):  
Jacob S. Matubis ◽  
Karen June P. Dumlao ◽  
Ryner Jose C. Carrillo
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Thyroid Surgery ◽  
Anatomical Variations ◽  
The Philippines ◽  
Laryngeal Nerve ◽  
Inferior Thyroid Artery ◽  
Laryngeal Nerves ◽  
Recurrent Laryngeal Nerves ◽  
The Right ◽  
Relationship Of

Objective: To describe the anatomic relationship of the recurrent laryngeal nerve and the inferior thyroid artery in adult cadavers in the Philippines and to compare the proportions of these anatomic relationships with those reported in the foreign literature. Methods: Study design: Descriptive, cross-sectional Setting: University of the Philippines College of Medicine Anatomy Laboratory Subjects: Fifty-four (54)  preserved cadavers (108 sides) dissected within a period from June 2008 to Aug 2010. The anatomy and position of both  the right and the left recurrent laryngeal nerves (RLN) and inferior thyroid arteries (ITA) were noted. The RLN was further classified into 2 variations: non-branching or branching prior to insertion at the cricothyroid joint, under the inferior constrictor muscle.  The ITA was also classified into non-branching and branching.  The results were compared to two foreign studies using a Z-test for two proportions. Results: Fifty four (54) cadavers (108) sides were dissected. Among the  cadavers, both the recurrent laryngeal nerves and inferior thyroid arteries had a maximum of two branches although both the RLNs and ITAs for both the right and left sides were mostly non-branching. The right side of one cadaver was noted to have both a branching RLN and a branching ITA. There were no non-recurrent laryngeal nerves seen among the 54 cadavers. For both left and right sides, the RLN was mostly dorsal to the ITA. Branching RLNs was mostly dorsal to a non-branching ITAs. Most of the non-branching RLNs were dorsal to the ITAs. Non-branching RLNs were usually dorsal to the ITA.               The local patterns of the course of the RLN in relation to the ITA approximates those of Chinese where there is predominance of the RLN dorsal to the ITA  but differs from those of Brazilians where the RLN is usually between ITA branches.    Conclusion: There are multiple anatomical variations with regards to the relationship of the RLN and the ITA. The anatomic variation among Asians may be different from Brazilians. The surgeon’s knowledge of the possible various configurations of the RLN and ITA should be able to help in identification and preservation of the RLN and prevention of complications in thyroid surgery. Keywords: recurrent laryngeal nerve, inferior thyroid  artery, thyroid surgery, Filipino cadavers, anatomical variations

Concomitant Diagnosis of Fibromyalgia and Ankylosing Spondylitis: Relation to Clinical Features and Plasma Pentraxin -3 Level.

2021 ◽  
Vol 17 ◽  
Author(s):  
Eman Baraka ◽  
Mona Balata ◽  
Shereen Ahmed ◽  
Mona El-Blbehisy ◽  
Enas Elattar
Keyword(s):  
Ankylosing Spondylitis ◽  
Disease Activity ◽  
Clinical Features ◽  
Predictive Value ◽  
Disease Duration ◽  
Rapid Screening ◽  
Disease Assessment ◽  
Group I ◽  
Diagnostic Certainty ◽  
Group Ii

Background: Ankylosing spondylitis (AS) is a chronic systemic inflammatory rheumatic disease that specifically affects the spine and sacroiliac joint. AS diagnosis is often delayed in the clinical practice and this delay may cause the patients to miss the chance of early treatment. Fibromyalgia (FM) is a frequently encountered clinical syndrome, fibromyalgianess is a term used when patients who are diagnosed with inflammatory arthropathies met the criteria for FM syndrome as shown in rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), Sjogren syndrome, and AS. Objectives: We aimed primarily to assess the frequency of concomitant diagnosis FM syndrome in AS patients and to study its impact on clinical disease aspects. Secondary, our aim extended as a preliminary pilot study to assess the PTX-3 as a potential marker for the diagnosis of FM syndrome in AS patients. Methods: Plasma PTX-3 in 61 AS patients was compared to 60 matched controls. FM was diagnosed by FM Rapid Screening Tool. Bath AS disease activity index (BASDAI) and AS disease assessment score using C- reactive protein (ASDAS-CRP), Bath AS functional impairment index (BASFI), Bath AS metrology index (BASMI), AS quality of life (ASQoL) scale, Beck Depression Inventory, and Bath AS Radiology Index (BASRI) were assessed. Results: The patients were categorized into two groups according to the concomitant diagnosis of FM syndrome. Group I included 14 (22.9%) AS patients who fulfilled the clinical diagnosis of FM syndrome. Group II included 47 (77.1%) patients without FM syndrome. AS patients with FM (Group I) had significantly(p<0.001) increased an average of ages, disease duration, diagnostic delay of AS, switching of bDMARDs, morning stiffness duration, ASDAS-CRP, BASFI, ASQoL score, BASDAI (p=0.008), and BDI score (p=0.005) compared to AS patients without FM (Group II). PTX-3 levels were significantly (p<0.001) higher in Group I (p<0.001) (median, 0.23; IQR, 0.15-0.41 ng/ml) than Group II (median, 0.13; IQR, 0.035-0.21ng/ml) which showed no significant differences (p>0.05) compared to the controls. PTX-3 levels had significant positive correlations (p<0.05) with disease duration, BASFI, and ASQOl. Age, female sex, switch of biologic, ASDAS -CRP, and PTX-3 were significant predictors of FM in AS patients. Conclusion: These results indicate that concomitant FM is a significant problem in patients with AS and its presence is associated with higher disease activity, impaired function as well as an overall negative impact on QoL. Easy scanning of suspicious cases of FM with FiRST questionnaire can be done in daily practice. PTX-3 is more or less accurate as the clinical features to improve the diagnostic certainty of FM in the presence of AS with a proven sensitivity of 62.3%, a specificity of 90 %, a positive predictive value of 82.75%, and a negative predictive value of 73.9%.

scholarly journals Efficacy of Intraoperative Neural Monitoring (IONM) in Thyroid Surgery: the Learning Curve

2018 ◽  
Vol 11 (2) ◽  
pp. 130 ◽  
Author(s):  
Min Kyu Kwak ◽  
Song Jae Lee ◽  
Chang Myeon Song ◽  
Yong Bae Ji ◽  
Kyung Tae
Keyword(s):  
Learning Curve ◽  
Thyroid Surgery ◽  
Neural Monitoring

scholarly journals Anatomical Variations in Recurrent Laryngeal Nerves in Thyroid Surgery

2020 ◽  
pp. 014556132092756 ◽  
Author(s):  
Chuanchang Yin ◽  
Bin Song ◽  
Xiaoyan Wang
Keyword(s):  
Thyroid Surgery ◽  
Vocal Cord Paralysis ◽  
Anatomical Variation ◽  
Anatomical Variations ◽  
Laryngeal Nerve ◽  
Laryngeal Nerves ◽  
Original Direction ◽  
Nonrecurrent Laryngeal Nerve ◽  
Recurrent Laryngeal Nerves ◽  
The Right

Objective: To study terminal bifurcation of recurrent laryngeal nerves (RLNs) with original direction to larynx entry and to decrease the risk of vocal cord paralysis in thyroid patients. Methods: The RLNs of 294 patients (482 sides) were dissected according to the branches into the larynx, and the original direction of each RLN trunk in thyroid surgery was recorded. Results: (1) About 30.9% of the RLNs gave off multiple branches into the larynx. (2) Two and 3 branches of RLNs into the larynx were found in 25.5% and 5.4% of the cases, respectively. (3) In 0.4% or 2 cases, the RLN trunk combined with the inferior branch of the vagus nerve. (4) Nonrecurrent laryngeal nerve appeared in 2 cases. (5) On the left side, 68.0%, 25.6%, and 6.4% of cases were found with 1, 2, and 3 bifurcations of RLN to larynx entry, respectively. On the right side, 69.8%, 25.8%, and 4.4% cases were identified with 1, 2, and 3 bifurcations of RLN to larynx entry, respectively. (6) The combining dissection approach was proved as successful and safe for protecting the RLN with no permanent RLN paresis. Conclusions: Because of the anatomical variation in RLNs with extralaryngeal bifurcation, it is necessary to increase the awareness of surgeons about these variations so as to protect bifurcated nerves in thyroid surgery.

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