scholarly journals Continuous Intraoperative Nerve Monitoring in Thyroid Surgery: Can Amplitude Be a Standardized Parameter?

2021 ◽  
Vol 12 ◽  
Author(s):  
Sara Mazzone ◽  
Adelaide Esposito ◽  
Vittorio Giacomarra
Keyword(s):  
Vocal Cord ◽  
Vocal Cord Paralysis ◽  
Initial Amplitude ◽  
Nerve Monitoring ◽  
Absolute Value ◽  
Reduction Group ◽  
Group 3 ◽  
Group 2 ◽  
Intraoperative Nerve Monitoring ◽  
Group 1

The objective of this study is to evaluate electromyographic waveforms related to vagus monitoring. We collected data from patients undergoing thyroidectomy with CIONM, regardless of vocal cord response amplitude initially measured. We divided data of 193 nerves into three groups, according to initial amplitude value: ≥500 µV (Group 1,110 pt.), between 100 and 500 µV (Group 2, 79 pt.), and <100 µV (Group 3, 4 pt.). ROC curve showed a high diagnostic accuracy of final amplitude absolute value in vocal cord paralysis detection in both groups (89 and 86%). An increase of vocal cord paralysis risk was associated with progressive amplitude reduction (Group 1: OR=1.05, CI=1.02–1.09, p=0.001; Group 2: OR=1.05, CI=1.02–1.08, p=0.002). Cut-off values for amplitude reduction with optimal sensitivity and specificity were −77% in Group 1 and −15% in Group 2. In Group 3 signals showed an amplitude <100 µV for all monitoring, with no loss of a recognizable signal and normal postoperative cordal functionality. The use of a strict amplitude signal cut-off value ≥500 µV could be too restrictive. Also, signal with baseline amplitude <500 µV may be considered equally adequate. Setting the alarm for a reduction of 77% in patients with initial amplitude ≥500 µV and of 15% for those <500 µV could make monitoring safe and an effective aid for surgeons. In conclusion, there are cases in which initial amplitude is lower than that considered as adequate by current literature but with well recognizable and stable EMG waveforms. How those cases should be approached and what should the surgeon’s attitude be are a matter of discussion.

Intraoperative Nerve Monitoring and Vocal Cord Paralysis: Controlling Bias

2015 ◽  
Vol 220 (5) ◽  
pp. 973-974
Author(s):  
Thomas K. Chung ◽  
Eben L. Rosenthal ◽  
John R. Porterfield ◽  
William R. Carroll ◽  
Joshua Richman ◽  
...  
Keyword(s):  
Vocal Cord ◽  
Vocal Cord Paralysis ◽  
Nerve Monitoring ◽  
Intraoperative Nerve Monitoring

scholarly journals Laryngopharyngeal Reflux in Hypertrophic Laryngeal Diseases

2020 ◽  
pp. 014556132095323
Author(s):  
Honglei Han ◽  
Qiuping Lyu ◽  
Jianhui Zhao
Keyword(s):  
Vocal Cord ◽  
Laryngeal Carcinoma ◽  
Laryngopharyngeal Reflux ◽  
Laryngeal Diseases ◽  
Male Preponderance ◽  
Group 3 ◽  
Group 2 ◽  
The Relationship ◽  
Group 1

Objectives: To evaluate the characteristics of laryngopharyngeal reflux (LPR) in patients with different hypertrophic laryngeal diseases and to explore the relationship between LPR and these diseases. Methods: A retrospective analysis was performed. The clinical data of 154 patients were collected. According to their diagnoses, patients were divided into 3 groups. Group 1 included 49 patients with vocal cord polyps. Group 2 contained 52 patients with vocal cord leukoplakia. Group 3 included 53 patients with laryngeal carcinoma. The reflux symptom indexes (RSIs), reflux finding scores (RFSs), and Ryan scores of all patients were evaluated and compared. Results: Patients with vocal cord polyps were the youngest of the 3 groups, and those with laryngeal carcinoma were the oldest. A male preponderance emerged in each group. In total, 128 patients (83.12%) had positive RSI/RFS values and 60 (60/146, 41.1%) patients had positive Ryan scores. The positive RSI/RFS rates of both groups 1 and 2 (89.80% and 92.16%, respectively) were significantly higher than that of group 3 (69.81%). Moreover, the positive Ryan score rates in both groups 1 and 2 (39.58% and 53.85%, respectively) were significantly higher than that of group 3 (28.26%). Conclusions: Laryngopharyngeal reflux occurs in many patients with vocal cord polyps, vocal cord leukoplakia, and vocal cord carcinoma, indicating that LPR may be important in the pathogenesis of these diseases. Laryngopharyngeal reflux occurs more common in patients with vocal cord polyps and leukoplakia and less common in those with laryngeal carcinoma, suggesting the role of LPR on these diseases may be different.

scholarly journals Impact of COVID-19 pandemic on the incidence of otitis media with effusion in adults and children: a multicenter study

2021 ◽  
Author(s):  
Giannicola Iannella ◽  
Giuseppe Magliulo ◽  
Jerome R. Lechien ◽  
Antonino Maniaci ◽  
Tiziano Perrone ◽  
...  
Keyword(s):  
Otitis Media ◽  
Positive Impact ◽  
Otitis Media With Effusion ◽  
Social Changes ◽  
Absolute Value ◽  
Adults And Children ◽  
Group 3 ◽  
Group 2 ◽  
Continuous Use ◽  
Group 1

Abstract Purpose To compare and analyze the incidence of otitis media with effusion (OME), before and during the COVID-19-related pandemic period, to evaluate the effects of the social changes (lockdown, continuous use of facial masks, social distancing, reduction of social activities) in the OME incidence in children and adults. Methods The number of diagnosed OME in e five referral centers, between 1 March 2018 and 1 March 2021, has been reviewed and collected. To estimate the reduction of OME incidence in children and adults during the COVID-19 pandemic period the OME incidence in three period of time were evaluated and compared: group 1—patients with OME diagnosis achieved between 1/03/2018 and 01/03/2019 (not pandemic period). Group 2—patients with OME diagnosis achieved between 1/03/2019 and 1/03/2020 (not pandemic period). Group 3—patients with OME diagnosis achieved between 1/03/2020 and 1/03/2021 (COVID-19 pandemic period). Results In the non-pandemic periods (group 1 and 2), the incidence of OME in the five referral centers considered was similar, with 482 and 555 diagnosed cases, respectively. In contrast, the OME incidence in the same centers, during the pandemic period (group 3) was clearly reduced with a lower total number of 177 cases of OME estimated. Percentage variation in OME incidence between the first non-pandemic year considered (group 1) and the pandemic period (group 3) was—63, 3%, with an absolute value decrease value of—305 cases. Similarly, comparing the second non-pandemic year (group 2) and the pandemic year (group 3) the percentage variation of OME incidence was—68, 1% with an absolute value of—305 cases decreased. Conclusions Our findings showed a lower incidence of OME during the pandemic period compared with 2 previous non pandemic years. The drastic restrictive anti-contagion measures taken by the Italian government to contain the spread of COVID-19 could have had a positive impact on the lower OME incidence during the last pandemic year.

scholarly journals Advantages of the experience of navigation when starting manual total knee arthroplasty

2020 ◽  
Vol 28 (1) ◽  
pp. 230949902090339
Author(s):  
Suk Kyoon Song ◽  
Cheol Hwan Ryu ◽  
Won-Kee Choi
Keyword(s):  
Operative Time ◽  
Absolute Error ◽  
Early Years ◽  
Absolute Value ◽  
Experienced Surgeon ◽  
Median Error ◽  
Total Knee ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Purpose: To evaluate how the accuracy of coronal-plane bone cutting and operative time may be affected by the experience of navigated total knee replacement (TKR) in starters of manual TKR. Methods: We analyzed 30 cases of navigated TKR performed in the early years (group 1), 30 consecutive cases of navigated TKR performed after experiencing more than 100 cases of navigated TKR (group 2), and the initial 30 consecutive cases of manual TKR (group 3). Postoperative mechanical hip-knee-ankle (mHKA) angle, mechanical medial proximal tibial angle (mMPTA), and mechanical lateral distal femoral angle (mLDFA) were measured. Bone cutting was aimed at mHKA angle of 0°, mMPTA of 90°, and mLDFA of 90°. We have set the tolerance of absolute value of errors in mHKA angle, mMPTA and mLDFA as 0 ± 3°. Comparative analysis of tourniquet times have been performed. Results: Postoperative absolute error values of mHKA angle, mMPTA, and mLDFA were 2.78 ± 3.53°, 1.06 ± 1.91°, and 1.44 ± 1.90° in group 1; 1.18 ± 1.32°, 1.20 ± 1.49°, and 0.98 ± 1.09° in group 2; and 2.11 ± 2.49°, 1.35 ± 0.62°, and 1.92 ± 2.85° in group 3. Tourniquet times were 67.50 ± 21.50 min in group 1, while group 2 and group 3 showed tourniquet times of 51.87 ± 12.00 and 52.00 ± 15.00 min, respectively. Conclusion: In starters of manual TKR, previous experience of performing navigated TKR may help the error values during femoral and tibial bone cutting to fall within the values similar to the median error value of navigated TKR. It may also help to reduce the operative time of manual TKR similar to the operative time of and experienced surgeon with over 100 cases of navigated TKR.

scholarly journals Should intraoperative nerve monitoring be used routinely in primary thyroid surgeries?

2019 ◽  
Vol 36 (2) ◽  
Author(s):  
Murat Akıcı ◽  
Murat Çilekar ◽  
Sezgin Yılmaz ◽  
Yüksel Arıkan
Keyword(s):  
Nerve Monitoring ◽  
Creative Commons ◽  
Thyroid Pathology ◽  
Primary Surgery ◽  
Significant Difference ◽  
Transient Paralysis ◽  
Group 2 ◽  
Intraoperative Nerve Monitoring ◽  
Benign Thyroid ◽  
Group 1

Objective: This study presents the effects of intraoperative nerve monitoring on RLN injuries in patients who underwent primary surgery for benign thyroid pathology. Methods: We retrospectively evaluated the data of 273 patients who had primary thyroidectomy due to benign thyroid pathology between January 2012 and July 2017. The patients were classified into two groups. Group-1 consists of patients whose nerves were monitored. We separated the patients whose nerves were not monitored into Group-2. Results: There were 140 and 133 patients in Groups 1 and 2, respectively. Regarding the age, gender and surgical indication between the groups, statistically significant difference was not found (P > 0.05). In Group-1, transient paralysis developed in four patients (2.9%). The permanent paralysis developed in one patient (0.7%). In Group-2, transient paralysis developed in nine patients (6.8%). The permanent paralysis developed in four patients (3%). When the groups were evaluated, there was statistically significant difference in terms of transient and permanent paralysis (P=0.01, P =0.001, respectively). Conclusions: In view of the negative effects of RLN injury on the patient, we think that intraoperative nerve monitoring should be used routinely in benign thyroid surgeries. doi: https://doi.org/10.12669/pjms.36.2.1054 How to cite this:Akici M, Cilekar M, Yilmaz S, Arikan Y. Should intraoperative nerve monitoring be used routinely in primary thyroid surgeries? Pak J Med Sci. 2020;36(2):---------. doi: https://doi.org/10.12669/pjms.36.2.1054 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

In-vivo evaluation of the effect of cyanoacrylate on prosthetic vascular graft infection – does cyanoacrylate increase the severity of infection?

VASA ◽  
2020 ◽  
Vol 49 (4) ◽  
pp. 281-284
Author(s):  
Atıf Yolgosteren ◽  
Gencehan Kumtepe ◽  
Melda Payaslioglu ◽  
Cuneyt Ozakin
Keyword(s):  
Vascular Graft ◽  
Graft Infection ◽  
Vascular Graft Infection ◽  
Group 4 ◽  
Significant Difference ◽  
Group 3 ◽  
Group 2 ◽  
Prosthetic Vascular Graft Infection ◽  
Group 1

Summary. Background: Prosthetic vascular graft infection (PVGI) is a complication with high mortality. Cyanoacrylate (CA) is an adhesive which has been used in a number of surgical procedures. In this in-vivo study, we aimed to evaluate the relationship between PVGI and CA. Materials and methods: Thirty-two rats were equally divided into four groups. Pouch was formed on back of rats until deep fascia. In group 1, vascular graft with polyethyleneterephthalate (PET) was placed into pouch. In group 2, MRSA strain with a density of 1 ml 0.5 MacFarland was injected into pouch. In group 3, 1 cm 2 vascular graft with PET piece was placed into pouch and MRSA strain with a density of 1 ml 0.5 MacFarland was injected. In group 4, 1 cm 2 vascular graft with PET piece impregnated with N-butyl cyanoacrylate-based adhesive was placed and MRSA strain with a density of 1 ml 0.5 MacFarland was injected. All rats were scarified in 96th hour, culture samples were taken where intervention was performed and were evaluated microbiologically. Bacteria reproducing in each group were numerically evaluated based on colony-forming unit (CFU/ml) and compared by taking their average. Results: MRSA reproduction of 0 CFU/ml in group 1, of 1410 CFU/ml in group 2, of 180 200 CFU/ml in group 3 and of 625 300 CFU/ml in group 4 was present. A statistically significant difference was present between group 1 and group 4 (p < 0.01), between group 2 and group 4 (p < 0.01), between group 3 and group 4 (p < 0.05). In terms of reproduction, no statistically significant difference was found in group 1, group 2, group 3 in themselves. Conclusions: We observed that the rate of infection increased in the cyanoacyrylate group where cyanoacrylate was used. We think that surgeon should be more careful in using CA in vascular surgery.

Abnormal Haemostasis and Blood Viscosity in Malignant Hypertension

1984 ◽  
Vol 52 (03) ◽  
pp. 253-255 ◽  
Author(s):  
C Isles ◽  
G D O Lowe ◽  
B M Rankin ◽  
C D Forbes ◽  
N Lucie ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Blood Viscosity ◽  
Renal Damage ◽  
Antithrombin Iii ◽  
Plasma Viscosity ◽  
Malignant Hypertension ◽  
Fibrin Deposition ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

SummaryWe have previously shown abnormalities of haemostasis suggestive of intravascular coagulation in patients with malignant hypertension, a condition associated with retinopathy and renal fibrin deposition. To determine whether such abnormalities are specific to malignant hypertension, we have measured several haemostatic and haemorheological variables in 18 patients with malignant hypertension (Group 1), 18 matched healthy controls (Group 2), and 18 patients with non-malignant hypertension (Group 3) matched for renal pathology, blood pressure and serum creatinine with Group 1. Both Groups 1 and 3 had increased mean levels of fibrinogen, factor VIIIc, beta-thrombo- globulin, plasma viscosity and blood viscosity (corrected for haematocrit); and decreased mean levels of haematocrit, antithrombin III and platelet count. Mean levels of fast antiplasmin and alpha2-macroglobulin were elevated in Group 1 but not in Group 3. We conclude that most blood abnormalities are not specific to malignant hypertension; are also present in patients with non-malignant hypertension who have similar levels of blood pressure and renal damage; and might result from renal damage as well as promoting further renal damage by enhancing fibrin deposition. However increased levels of fibrinolytic inhibitors in malignant hypertension merit further investigation in relation to removal of renal fibrin.

Sign in / Sign up

Export Citation Format

Share Document