This study aims to provide insight into the etiology and frequency of swallowing complications that arise after thyroidectomy and to outline the available diagnostic procedures by revising the ...existing literature on this topic. We conducted a bibliographic search using the electronic database MEDLINE/PubMed to identify all relevant articles and 44 studies were included in the review out of a total of 218 published articles. Dysphagia after thyroid surgery is a common postoperative complication which, in the short- or long-term, significantly affects patient life quality. There is no standard diagnostic protocol for thyroidectomy-related swallowing impairment. Among the reviewed studies, 8 questionnaires and 12 instrumental diagnostic tools were used to identify swallowing difficulties related to thyroid surgery. The Swallowing Impairment Index (SIS-6) was the most-used questionnaire. Fiberoptic endoscopy is a standard diagnostic tool performed prior and after thyroid surgery, primarily to identify changes in vocal fold mobility. Although instrumental findings usually reveal non-specific alterations of swallowing; swallowing videofluoroscopy and esophageal manometry can be the most helpful tools in further management of thyroidectomy dysphagia. In patients with thyroidectomy-related swallowing difficulties and suspected laryngopharyngeal reflux, 24-hour MII-pH metry should be performed.
The early-stage diagnosis of papillary thyroid cancer (PTC) has significantly increased in incidence worldwide without any beneficial impact on survival. In order to improve the risk assessment in ...PTC, we have conducted a retrospective study in which we analyzed the BRAF V600E mutation and CPSF2 protein expression as prognostic markers on archival tissue samples of 49 patients without (control group) and 97 patients with (study group) PTC metastases in the cervical lymph nodes at the time of initial diagnosis. Our aim was to correlate the BRAF V600E mutation and the expression of CPSF2 protein with the clinical and pathological features of PTC. The expression of CPSF2 protein was evaluated via immunohistochemistry and graded semi-quantitatively. The presence of the BRAF V600E mutation was determined via real-time polymerase chain reac-tion (PCR). CPSF2 protein < 3+ intensity expression was correlated with more frequent recurrences (Fisher-Freeman-Halton exact test; p = 0.010; 95% CI: 1.26−22.03), and patients who presented with the BRAF V600E mutation and CPSF2 protein expression < 3+ intensity had shorter disease-free survival (log-rank test; 105.0 months vs. 146.6 months; p < 0.001; HR 8.32, 95% CI: 2.91−23.83), whereas patients with PTC who had CPSF2 expression 3+ had longer disease-free survival in correlation with other lower intensity expressions of CPSF2 protein (log-rank test; 139.7 months vs. 129.6 months; p = 0.008). The multivariate analysis showed that younger patients with CPSF2 protein expression <3+ and the BRAF V600E mutation are at an increased risk for recurrence and require more intensive monitoring (Cox proportional hazards regression model; X2 = 17.5, df = 10, p = 0.025). Our results correlate the BRAF V600E mutation and CPSF2 protein expression with recurrence and disease-free survival as relevant prognostic factors for PTC.
Autologous fat vocal fold augmentation is a widespread surgical procedure that aims to repair glottal incompetence in patients with unilateral vocal fold paralysis (UVFP). However, there are some ...concerns in the literature about the long-term results of this technique. At the ENT Department of the Zagreb University Hospital Centre, this technique has been in use for more than 15 years, and a retrospective medical chart review was conducted from June 2005 to November 2019. Overall, 78 patients with UVFP met the inclusion criteria for enrolment in the study. All patients underwent at least one preoperative and two postoperative voice assessments, one early (within 3 months from surgery) and one late (at least 1 year after surgery). All tested voice outcome parameters (maximum phonation time (MPT), jitter, shimmer, noise-to-harmonic ratio (NHR)) significantly improved after surgery, both early and late postoperatively (p<0.001). The reoperation rate was only 10.3% (8/78), with the majority of patients in our series experiencing long-term benefits from this surgical procedure. According to the results of our study, autologous fat vocal fold augmentation appears to be a highly useful and effective surgical technique with long-lasting results in the majority of patients suffering from UVFP.
Totalna laringektomija je kirurško odstranjenje cijelog larinksa i indicirana je u bolesnika s uznapredovalim karcinomima larinksa. Metode rehabilitacije glasa nakon totalne laringektomije jesu ...korištenje elektrolarinksa kao izvora glasa te usvajanje ezofagealnog ili traheoezofagealnog govora pomoću govorne proteze, pri čemu sluznica faringoezofagealnog segmenta služi kao generator glasa. Akustička analiza alaringealnog glasa danas predstavlja zlatni standard u procjeni kvalitete glasa laringektomiranih bolesnika. Nažalost, standardnim dijagnostičkim postupkom videostroboskopijom koja se koristi u vizualnoj analizi sluzničkog vala na glasnicama nije moguće prikazati i analizirati vibracije faringoezofagealnog segmenta laringektomiranih bolesnika pri fonaciji. Stoga je tek kliničkom upotrebom ultrabrze videoendoskopije omogućeno proučavanje morfologije sluznice faringoezofagealnog segmenta. Pregledom dosadašnje literature dali smo detaljan uvid u primjenu ultrabrze videoendoskopije u analizi fonatornog gibanja sluznice faringoezofagealnog segmenta u laringektomiranih bolesnika.
Despite prolonged survival and better quality of life as compared to dialysis, kidney transplantation frequently presents with a complex set of medical issues that require intensive management to ...protect graft function. Metabolic acidosis has an impact on several metabolic complications such as mineral and muscle metabolism, nutritional status and anemia. It may also have an effect on graft function, possibly through the stimulation of adaptive mechanisms aimed at maintaining acid-base homeostasis. We investigated current practice in the evaluation of metabolic acidosis at one of the largest transplant centers in the Eurotransplant region. Adult renal transplant recipients having received allograft from January 2011 to August 2012 were included in the investigation. We recorded the frequency of measuring the parameters of venous blood gas analysis, as well as creatinine and urea levels, creatinine clearance, proteinuria, calcium, phosphate and potassium blood levels, body mass index and the time spent on dialysis prior to kidney transplantation. Out of 203 patients who had received renal allograft at our institution during the observed period, 191 (124 males and 67 females, age range from 18 to 77 years) were enrolled in the study. Of these, only 92 (48.167%) patients had parameters of venous blood gas analysis measured at some time after kidney transplantation. Acid-base status was determined more often in males (77 males vs. 22 females, p = 0.001). Patients with pH/blood gas analysis performed were found to have significantly higher creatinine and urea levels and significantly lower creatinine clearance (p < 0.001 both). Serum calcium levels were also significantly lower in this group of patients (p < 0.001). Metabolic acidosis is a very important clinical issue that needs to be monitored in every transplant recipient. Its effects on graft function, nutritional status, anemia and bone mass are complex but can be successfully managed. Our study showed metabolic acidosis to be linked with significantly higher creatinine and urea levels, decreased creatinine clearance and lower calcium levels. Nevertheless, metabolic acidosis still stays a highly underestimated problem among nephrologists dealing with transplant recipients. We suggest regular determination of the acid-base status in renal transplant recipients.
Vocal Cord Paralysis and Parathyroid Cyst Đanić, Davorin; Fuštar Preradović, Ljubica; Jović, Rajko ...
Southeastern European Medical Journal,
07/2017, Letnik:
1, Številka:
1
Journal Article
Recenzirano
Odprti dostop
Aim: Parathyroid gland lesions are an extremely rare clinical entity, mostly manifesting as adenoma and hyperplasia, rarely as parathyroid cysts, and most infrequently as carcinoma. Parathyroid cysts ...are frequently asymptomatic lesions of the neck and the superior mediastinum with only 300 cases reported in the literature. Symptomatic parathyroid cysts are very rare. Vocal cord paralysis due to recurrent laryngeal nerve dysfunction may herald the presence of neck and mediastinal disease including a variety of neoplastic, inflammatory and vascular conditions. The aim of this report is to describe their clinical presentation, diagnostic procedures, and therapeutic approaches. The objective of the study was to assess the presence of vocal cord paralysis and recurrent laryngeal nerve dysfunction, as well as their association in patients with recurrent laryngeal nerve.
Methods. We performed a 12-year departmental review of parathyroid lesions and parathyroid cysts. Retrospective analysis of clinical data on 20630 unselected patients submitted to thyroid gland and neck ultrasonography yielded 149 (0.007%) patients with parathyroid lesions, six (0.0003%) of them with parathyroid cysts. A comprehensive review of the literature revealed 18 patients with vocal cord paralysis and parathyroid cysts.
Results: Parathyroid adenoma were present in 97/149 (0.65%) and hyperplasia in 46/149 (0.30%) patients with parathyroid lesions. Parathyroid cysts were present only in six of 149 (0.04%) patients with parathyroid lesions. Five patients had asymptomatic nonfunctional parathyroid cysts, with vocal cord paralysis diagnosed in one female patient. In the 19 patients with parathyroid cysts and vocal cord paralysis reported in the literature (including the patient reported here), nine and ten patients had parathyroid cysts localized in the neck and mediastinum, respectively. Mediastinal cysts were twofold greater than those localized on the neck, while left recurrent laryngeal nerve dysfunction was recorded in 80% of cases. Cyst removal resulted in recurrent laryngeal nerve functional recovery in two-thirds of patients.
Conclusion: Parathyroid cysts are rare, mostly asymptomatic pathologic lesions of parathyroid glands that should be taken into consideration in patients with hyperparathyroidism or vocal cord paresis.
Purpose
It has been shown that the reflux of the gastric content to the proximal oesophagus influences incidence of voice prosthesis (VP) complications in laryngectomized patients. We conducted ...prospective randomised study to investigate the relationship between pepsin concentration in saliva and occurrence of VP complications before and after 3 months of proton pump inhibitor (PPI) therapy.
Methods
60 laryngectomized patients with VP and 30 controls were included in the study. Saliva samples were collected in the morning and concentration of pepsin were measured by Human Pepsin (PG) ELISA kit. Thirty-Four (57%) patients reported one or more VP complication and were randomised in two groups, with and without PPI therapy, 40 mg pantoprazole per day for 3 months.
Results
Patients who had longer time since last VP change had higher incidence of periprosthetic and transprosthetic leakage and Candida colonisation. Pepsin was found in all saliva samples. Median saliva pepsin concentration level did not significantly differ between laryngectomized patients and control subjects, or between patients with and without VP complications, and there was no correlation between saliva pepsin concentration levels and type of VP complication. After 3 months therapy, there was no difference in median saliva pepsin level or incidence of VP complication between patients with and without PPI therapy.
Conclusion
Although reflux was proposed to be associated with VP complications and pepsin was proven as a most sensitive and specific marker of EER, we did not find any statistically significant correlation between pepsin levels and occurrence of VP complications. A 3 months 40 mg pantoprazole therapy was ineffective in reduction of VP complications in our study group.
Pregledom recentne literature prikazali smo nove spoznaje u patofiziologiji, simptomatologiji, dijagnostičkim i terapijskim metodama zbrinjavanja bolesnika s laringofaringealnim refluksom (LPR-om). ...Iako se broj istraživanja LPR-a značajno povećao posljednjih nekoliko godina, i dalje ne postoje zlatni standardi niti standardizirani protokoli dijagnosticiranja i liječenja LPR-a te je neophodan interdisciplinarni pristup u rješavanju ove problematike. Upitnici za samoprocjenu težine simptoma i skale kliničkih znakova trebali bi uključivati i simptome i znakove gastroezofagealne refluksne bolesti i respiratornog sustava, a objektivna dijagnostika trebala bi se temeljiti na lako dostupnom i jednostavnom testu određivanja razine koncentracije pepsina u slini. Nejasne slučajeve treba uputiti na daljnju dijagnostičku obradu: višekanalnu impendaciju s pH-metrijom, koja omogućuje određivanje tipa refluksa (kiselinski, mješoviti i nekiselinski) te provođenje personalizirane terapije. Prema najnovijim spoznajama kod blagih oblika bolesti primjena bihevioralnih mjera bila bi metoda izbora liječenja. Kod umjerenih i teških oblika lijek izbora ili kombinacija lijekova ovisi o tipu refluksa. Medikamentnu terapiju treba provoditi minimalno osam tjedana, a optimalno tri mjeseca, nakon čega slijede kontrolni pregledi i revizija simptoma i kliničkih nalaza te u slučaju značajnog poboljšanja smanjivanje medikamentne terapije, a u slučaju blagog poboljšanja pojačanje doze i produljenje terapije dodatna tri mjeseca. U slučajevima bez promjene ili eventualnog pogoršanja bolesnike treba uputiti na dodatnu gastroenterološku obradu i eventualno kirurško liječenje. Preporučuje se strogo pridržavanje bihevioralnih mjera, dok se dugotrajna primjena inhibitora protonske pumpe ne preporučuje s obzirom na dokazane brojne nuspojave lijeka.
This report presents a case of an exceptionallyrare primary Natural Killer/T cell (NK/T) lymphomaof the right paranasal frontal and ethmoidsinuses in a patient treated previously for rightside ...chronic sinusitis. It highlighted the importanceof adequate tissue biopsy and patohistologicalexamination in patients with chronic sinusitisor orbital cellulitis that fail to respond totraditional management.
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