scholarly journals SURGICAL PREVENTION AND TREATMENT OF POSTOPERATIVE HYPOPARATHYROIDISM IN PATIENTS OPERATED ON THYROID GLAND

2020 ◽  
pp. 128-134
Author(s):  
A. Ya. Pasko
Keyword(s):  
Thyroid Gland ◽  
Blood Supply ◽  
Postoperative Period ◽  
Parathyroid Glands ◽  
Antioxidant Therapy ◽  
Fatty Tissue ◽  
Group I ◽  
Postoperative Hypoparathyroidism ◽  
Prevention And Treatment ◽  
Surgical Prevention

Abstract. Thyroid gland (TG) diseases are among the most common and occupy the second place in the structure of endocrine system diseases after diabetes mellitus. The main method of TG disease treatment remains the surgical one. With the increase in the incidence of various forms of TG pathology, the number of surgeries increases including the ones performed at non-specialized in-patient facilities leading to an increase in the frequency of postoperative complications. One of the most common specific complications after surgeries on TG is postoperative hypoparathyroidism (PHPT). It occupies a special place considering the severity of manifestations and the difficulty in prevention. It is usually caused by trauma or parathyroid glands (PTG) removal, their blood supply disturbance, as well as the development of fibrosis at the surgery site in the long term. Therefore, the improvement of existing technologies and the development of new approaches to surgeries in case of TG diseases are relevant today. The most common method of postoperative hypoparathyroidism (PHPT) surgical prevention is precision nature of surgical manipulations with careful adhering to tactical and technical requirements for the operator: identify parathyroid glands (PTG) timely, mobilize gently, and keep their blood supply. However, it is often impossible to keep PTG intact structurally and without ischemia due to the small sizes of PTG and their vessels, anatomical and embryological features of these organs localization, the consistency and color similarity with fatty tissue, lymph nodes. The objective of the research was to develop and evaluate the algorithm of prevention and treatment of postoperative hypoparathyroidism (PHPT) based on determining parathyroid glands (PTG) viability and the use of antihypoxant-antioxidant therapy in the postoperative period. The research was based on the results of a comprehensive examination and treatment of 60 patients who were operated for thyroid gland diseases. The patients underwent inpatient treatment at the surgical department of Ivano-Frankivsk Central City Clinical Hospital and Ivano-Frankivsk Regional Oncology Center from 2017 to 2020. We proposed an algorithm for surgical prevention and treatment of PHPT during thyroid gland surgeries which consisted in the following. We performed a visual assessment of PTG intraoperatively and evaluated each gland from 0 to 3 points according to the degree of its viability affection. If the gland was evaluated at 0-2 points, we left it, since there was a high probability of maintaining its function. If it was evaluated at 3 points, its autotransplantation was performed. Cytoflavin drug was applied in a dose of 10 ml per 200 0.9% NaCl intravenously once a day during 7 days in the postoperative period for the purpose of antihypoxant-antioxidant therapy. 2 groups of patients were formed in order to evaluate the effectiveness of the algorithm. Each group consisted of 30 people. Patients of Group I underwent surgery on thyroid gland according to generally accepted rules. Patients of Group II underwent interventions according to the above-mentioned algorithm. The use of our proposed algorithm (intraoperative assessment of PTG viability and antihypoxant-antioxidant therapy in the postoperative period) significantly reduces the frequency of permanent PHP justifying indications to its application.

scholarly journals SURGERY OF THYROID GLAND: OBJECTS AND UNSOLVED PROBLEMS

2015 ◽  
Vol 174 (1) ◽  
pp. 73-74 ◽  
Author(s):  
O. F. Bezrukov
Keyword(s):  
Thyroid Gland ◽  
Postoperative Period ◽  
Early Postoperative Period ◽  
Parathyroid Glands ◽  
Bleeding Prophylaxis ◽  
Damage Prevention

The author considers the problems for surgeons such as maintenance of trachea and the esophagus integrity, bleeding prophylaxis, damage prevention of recurrent nerves and parathyroid glands. The article proposed the measures of the edematous syndrome prevention in early postoperative period.

scholarly journals Postoperative Hypoparathyroidism in Thyroid Surgery: Anatomic-Surgical Mapping of the Parathyroids and Implications for Thyroid Surgery

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Florian Burger ◽  
Helga Fritsch ◽  
Marit Zwierzina ◽  
Rupert Prommegger ◽  
Marko Konschake
Keyword(s):  
Thyroid Gland ◽  
Coordinate System ◽  
Blood Supply ◽  
Thyroid Surgery ◽  
Laryngeal Nerve ◽  
Superior Thyroid Artery ◽  
Cartesian Coordinate System ◽  
Inferior Laryngeal Nerve ◽  
Postoperative Hypoparathyroidism ◽  
Cartesian Coordinate

Abstract Hypoparathyroidism remains one of the most common complications in thyroid surgery. This study aims for an improved understanding of the complexity of the blood supply and the localisation of the parathyroids compared to the two most important intraoperative landmarks: the inferior laryngeal nerve (ILN) and Zuckerkandl’s tubercle (ZT). We examined 103 laryngeal compounds to classify the blood supply and the localisation of the parathyroids. For intraoperative localisation we defined a Cartesian coordinate system with the ZT plane as x-axis and the course of the inferior laryngeal nerve as y-axis. The inferior thyroid artery (ITA) mainly supplies the parathyroids, whereas the superior thyroid artery provides a backup supply. It must be pointed out that 8.2% of parathyroids receive their blood directly from the thyroid gland. 73.5% of all parathyroids lie within 1 cm of the ILN and 1 cm cranial and 2.5 cm caudal to the ZT plane. Our described perimeters mark the most crucial areas during surgery and provide the surgeon with an anatomic mapping showing areas of special carefulness needed. One should keep bearing in mind all possible blood supply types of the parathyroids and therefore all branches should be handled with care.

scholarly journals AUTO- AND ISOTRANSPLANTATION, IN DOGS, OF THE PARATHYROID GLANDULES

1909 ◽  
Vol 11 (1) ◽  
pp. 175-199 ◽  
Author(s):  
W. S. Halsted
Keyword(s):  
Thyroid Gland ◽  
Blood Supply ◽  
Present State ◽  
Human Subject ◽  
Parathyroid Tissue ◽  
Good Health ◽  
Rectus Abdominis ◽  
Parathyroid Glands ◽  
Complete Excision ◽  
The Creation

1. The autotransplantation of parathyroid glandules into the thyroid gland and behind the musculus rectus abdominis has been successful in sixty-one per cent. of the cases in which a deficiency greater than one-half has been created. 2. In no instance has the autotransplantation succeeded without the creation of such deficiency. 3. Isotransplantation has been uniformly unsuccessful. 4. Parathyroid tissue transplanted in excess of what is urgently required by the organism has not lived. 5. One parathyroid autograft may suffice to maintain the animal in good health and spirits for many months and possibly for years. 6. Excised or deprived of their blood supply in the course of operation upon the human subject, parathyroid glands should, in the present state of our knowledge, be grafted, and probably into the thyroid gland. 7. Complete excision of the thyroid lobes in dogs may be well borne for a year or more. The myxœdema which usually has manifested itself within a few weeks has not increased after the first few months. May it subsequently diminish with the hypertrophy of accessory thyroids? 8. Parathyroid tissue is essential to the life of dogs, as has been conclusively proved by the result of excision of the sole, sustaining graft. There may be found, perhaps, in our experiments, explanation of the fact observed by others (Enderlen, Payr) that, when transplanted, thyroid preserves its integrity less well than parathyroid tissue. In the instances recorded the amount of thyroid gland excised may have been insufficient to make possible the fullest success of the transplantation; and particularly so when we consider the extent of the hypertrophy of which the thyroid gland seems capable.

scholarly journals Loss of signal during intraoperative neuromonitoring of laryngeal nerves as a predictor of postoperative larynx paresis: Analysis of 1065 consequetive thyroid and parathyroid operations. Surgeons' algorythm (tactics)

2017 ◽  
Vol 10 (3) ◽  
pp. 15-24
Author(s):  
Viktor A. Makarin ◽  
Anna A. Uspenskaya ◽  
Arseniy A. Semenov ◽  
Natalia I. Timofeeva ◽  
Roman A. Chernikov ◽  
...  
Keyword(s):  
Thyroid Gland ◽  
Negative Predictive Value ◽  
Sensitivity And Specificity ◽  
Postoperative Period ◽  
Predictive Value ◽  
Intraoperative Neuromonitoring ◽  
Parathyroid Glands ◽  
Laryngeal Nerves ◽  
Gland Tissue ◽  
Thyroid Gland Tissue

During thyroid and parathyroid operations performed with laryngeal nerves neuromonitoring, a segmental or global loss of signal may occur. The most frequent cause of loss of signal – is tension of thyroid gland tissue and at the same time tension of the laryngeal nerves. There is no consensus if this complication arises regarding surgeon’s actions.Aim. Evaluation of predictive value of loss of signal during IONM regarding larynx paresis in postoperative period, and algorithm suggestion in case of loss of signal develops.Materials and methods. 1065 patients were operated on thyroid and parathyroid glands with neuromonitoring of laryngeal nerves. Neuromonitore C2 (Inomed, Emmendingen, Germany) was used. We evaluated frequency of loss of signal, described types of loss of signal, showed sensitivity and specificity of loss of signal and development of postoperative larynx paresis.Results. Loss of signal developed in 32 (1,9%) patients. More frequently loss of signal was detected at left side (p=0,01, χ2 = 4,2 OR=2,9). Sensitivity (Se)  of loss of signal and postoperative larynx paresis development reached 59,2%, specificity – 99,7% (Sp), positive predicitive value (PPV) – 91,4%, negative predictive value (NPV) – 97,8%. There are no statistically reliable differences in recovery periods of larynx function depending on type of loss of signal (segmental or global) (p=0,5).Conclusions. In most cases loss of electromyographical signal indicates injury of laryngeal nerves during operation on thyroid and parathyroid glands. When there is loss of signal in case of bilateral thyroid gland disease it is reasonable to make a decision to stop operation to prevent development of bilateral larynx paresis.

Topography and blood supply of the thyroid and parathyroid glands of wild animals

2018 ◽  
pp. 73-79
Author(s):  
A. Senchik ◽  
◽  
N. Trush ◽  
G. Gavrilova ◽  
I. Sayapina ◽  
...  
Keyword(s):  
Blood Supply ◽  
Parathyroid Glands ◽  
Wild Animals

Effect of Silver Nitrate Application on the Success of Endoscopic Dacryocystorhinostomy

2021 ◽  
pp. 194589242110427
Author(s):  
Yaser S. Çetin ◽  
Ramazan Akın ◽  
Ufuk Düzenli ◽  
Mahfuz Turan ◽  
Nazım Bozan
Keyword(s):  
Silver Nitrate ◽  
Success Rate ◽  
Postoperative Period ◽  
Revision Surgery ◽  
Granuloma Formation ◽  
Stent Insertion ◽  
Group Iii ◽  
Group I ◽  
Significant Difference ◽  
Silicone Stent

Objectives To compare the clinical outcomes of patients undergoing additional procedures in endoscopic endonasal dacryocystorhinostomy (End-DCR) surgery and discuss the factors affecting the success of End-DCR surgery in light of relevant literature. Methods The study included 155 patients who underwent End-DCR surgery in our clinic due to epiphora. This was a prospective randomized, single-blind, controlled trial. Group I (control) included 54 patients who did not undergo silicone stent insertion or silver nitrate application, group II included 51 patients who underwent silicone stent insertion only, and group III included 50 patients who underwent silver nitrate application only. Statistical analysis was performed on follow-up data regarding anatomic and functional success rates. Results Revision surgery was performed in 16 patients who developed persistent epiphora in the postoperative period, including 6 in group I, 7 in group II, and 3 in group III ( P = .4). The most common reason for revision surgery was stenosis of the neo-ostium ( n = 8), followed by granulation tissue formation ( n = 5) and synechia formation ( n = 3). Granuloma formation was the most common postoperative complication, and a significant difference was found among the groups with regard to granuloma formation ( P = .04). At postoperative month 12, the functional success rate was estimated to be 88%, 86%, and 94%, and the anatomic success rate was estimated to be 94%, 92%, and 96% in groups I, II, and III, respectively, with no significant difference, found among the 3 groups with regard to both rates ( P = .79 and P = .76, respectively). Conclusion The results indicated that stenting and silver nitrate application did not affect surgical success. Our preliminary results on silver nitrate cauterization showed that it is an effective, inexpensive, and practical method to reduce granulation formation in the postoperative period.

scholarly journals Recurrent goitrous transformation and postoperative hypothyroidism — the arguments to execution of organ-preserving thyroid sergery

2010 ◽  
Vol 9 (5) ◽  
pp. 160-164
Author(s):  
A. N. Galyan ◽  
O. S. Popov ◽  
V. I. Tikhonov ◽  
V. D. Zavadovskaya ◽  
S. N. Gasparyan ◽  
...  
Keyword(s):  
Thyroid Gland ◽  
Functional State ◽  
Postoperative Period ◽  
Thyroid Tissue ◽  
Surgical Methods

The study included 557 patients with diffuse nodular colloidal goiter and different functional state of thyroid gland after routine surgeries. In the postoperative period was diagnosed hypothyroidism and in its presence the relapse nodulation in thyroid residue. In order to prevent the development of postoperative hypothyroidism, organopreserve surgical methods of the local cryodestruction of pathologic area thyroid gland and autotransplantation of intact thyroid tissue were suggested.

scholarly journals Assessment of Relation between External Branch of Superior Laryngeal Nerve & Thyroid Gland- A Cadaveric Study

2020 ◽  
Vol 6 (2) ◽  
pp. 73-76
Author(s):  
Anurag ◽  
Vishnu Gupta
Keyword(s):  
Thyroid Gland ◽  
Cricoid Cartilage ◽  
Superior Laryngeal Nerve ◽  
Laryngeal Nerve ◽  
The Body ◽  
Superior Thyroid Artery ◽  
Group I ◽  
External Branch ◽  
The Mean ◽  
Group Ii

Background: The thyroid gland is essential for normal growth of the body. This study assessed relation of external branch of superior laryngeal nerve to the superior pole of the thyroid gland. Subjects and Methods: This study was conducted on 25 human cadavers having 50 superior thyroid poles of both genders. Cadavers were classified based on age groups, group I was those with age less than 39 years and group II cadavers were those with age more than 40 years of age. Various measurements were performed on cadavers. Results: 14 cadavers were I group I and 11 were in group II. The mean mass was 67.2 Kgs in group I and 59.5 Kgs in group II, time elapsed after death was 481.5 minutes in group I and 476.4 minutes in group II, mean height was 1.74 meters in group I and 1.69 meters in group II, mean BMI found to be 22.3 kg/m2in group I and 20.1 kg/m2in group II. Height found to be significant between both groups (P< 0.05). The mean distance from EBSLN to cranial point of the thyroid gland was 6.66 mm in group I and 8.96 mm in group II. The mean transverse distance from superior thyroid artery to EBSLN was 3.55 mm in group I and 5.12 mm side in group II. The mean distance of the crossing point between the most cranial point of the thyroid lobe was 6.40 mm in group I and 11.47 mm in group II. The mean distance from the EBSLN to the midline of the neck was 19.80 mm in group I and 18.58 mm in group II. The mean distance from the EBSLN to the midline of the neck on the most cranial point of the cricoid cartilage was 18.77 mm in group I and 17.80 mm in group II. Conclusion: Authors found variation in measurements in left and right side in both group I and group II.

scholarly journals DOES THE ASSOCIATION OF TACROLIMUS AND MYCOPHENOLATE MOFETIL CHANGE THE HEALING OF THE ABDOMINAL WALL? STUDY IN RATS SUBMITTED TO ISCHEMIA AND KIDNEY REPERFUSION

2020 ◽  
Vol 33 (4) ◽  
Author(s):  
André Luís Conde WATANABE ◽  
Jorge Eduardo Fouto MATIAS
Keyword(s):  
Mycophenolate Mofetil ◽  
Abdominal Wall ◽  
Histological Examination ◽  
Postoperative Period ◽  
Breaking Strength ◽  
Immunosuppressive Agents ◽  
Control Group ◽  
Strength Measurement ◽  
Standard Operation ◽  
Group I

ABSTRACT Background: Tacrolimus and mycophenolate mofetil are immunosuppressive agents widely used on the postoperative period of the transplants. Aim: To evaluate the influence of the association of them on the abdominal wall healing in rats. Methods: Thirty-six Wistar rats were randomly assigned in three groups of 12. On the early postoperative period, four of the control group and three of the experimental groups died. The three groups were nominated as follow: control group (GC, n=8); group I (GI, n=11, standard operation, mycophenolate mofetil and tacrolimus); group II (GII, n=10, standard operation, mycophenolate mofetil and tacrolimus). The standard operation consisted of right total nephrectomy and 20 min ischemia of the left kidney followed by reperfusion. Both NaCl 0.9% and the immunosuppressive agents were administered starting on the first postoperative day and continuing daily until the day of death on the 14th day. On the day of their deaths, two strips of the anterior abdominal wall were collected and submitted to breaking strength measurement and histological examination. Results: There were no significant differences in wound infection rates (p=0,175), in the breaking strength measurement and in the histological examination among the three groups. Conclusion: The combination of the immunosuppressive agents used in the study associated with renal ischemia and reperfusion does not interfere in the abdominal wall healing of rats.

scholarly journals Possibilities of minimally invasive treatments of hemorrhoidal disease

2018 ◽  
pp. 77-82 ◽  
Author(s):  
M. V. Abritsova
Keyword(s):  
Surgical Treatment ◽  
Minimally Invasive ◽  
Postoperative Period ◽  
Harmonic Scalpel ◽  
Hemorrhoidal Disease ◽  
Single Center ◽  
Narcotic Analgesics ◽  
Group I ◽  
Minimally Invasive Treatments ◽  
Observation Period

The article presents the results of surgical treatment of patients with stages III to IV hemorrhoids followed by an observation period of 45 days, which is designed to improve the results of surgical treatment of this category of patients. The surgical treatment methods included doppler-guided transanal hemorrhoiddearterialization with mucopexy (DDM) (Group I) and harmonic scalpel hemorrhoidectomy (HSH) (Group II). Operated patients underwent all necessary examinations according to the “per protocol” principle. Study Design: single-center controlled randomized prospective. The effectiveness of DDM was comparable to that of hemorrhoidectomy (HE), which made it possible to significantly reduce the duration of the operation (DDM 17.9 ± 6.1 min, GE 34.5 ± 10.1 min (p <0.01) ), reduce the level of pain in the postoperative period (DDM an average of 2.5 points, HE 4.8 points (p <0.01)), reduce the frequency of narcotic analgesics (DDM an average of 1.3 doses, HE an average of 6.1 doses (p <0.01)) and shorten the period of disability (DDM 14.4 ± 5.2 days, HE 30.3 ± 5.4 days (p <0.01)) patients with stages III to IV disease.

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