Vocal Cord Paralysis and Parathyroid Cyst Đanić, Davorin; Fuštar Preradović, Ljubica; Jović, Rajko ...
Southeastern European Medical Journal,
07/2017, Letnik:
1, Številka:
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Journal Article
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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.
Lyme borreliosis is a vector-borne infectious disease characterized by three disease stages. In the areas endemic for borreliosis, every acute facial palsy indicates serologic testing and implies ...specific approach to the disease. Th e aim of the study was to identify and confirm the value of acoustic refl ex and House-Brackman (HB) grading scale as prognostic indicators of facial palsy in neuroborreliosis. Th e study included 176 patients with acute facial palsy divided into three groups based on serologic testing: borreliosis, Bell's palsy, and facial palsy caused by herpes simplex virus type 1 (HSV-1). Study patients underwent baseline audiometry with tympanometry and acoustic reflex, whereas current state of facial palsy was assessed by the HB scale. Subsequently, the same tests were obtained on three occasions, i.e. in week 3, 6 and 12 of presentation. Th e patients diagnosed with borreliosis, Bell's palsy and HSV-1 differed according to the time to acoustic refl ex recovery, which took longest time in patients with borreliosis. Th ese patients had the highest percentage of suprastapedial lesions at all time points and recovery was achieved later as compared with the other two diagnoses. Th e mean score on the HB scale declined with time, also at a slower rate in borreliosis patients. Th e prognosis of acoustic refl ex and facial palsy recovery according to HB scale was not associated with the length of elapsed time. The results obtained in the present study strongly confirmed the role of acoustic reflex and HB grading scale as prognostic indicators of facial palsy in neuroborreliosis.
Parathyroid cysts (PCs) account for less than 1% of all parathyroid lesions and are most commonly located along thyroid lobes, rarely at ectopic sites. PCs are important because they can pose a ...differential diagnostic challenge against other cystic formations of the neck. PCs can be functional (elevated serum parathyroid hormone level) and nonfunctional. Four cases of nonfunctional PCs are presented. All four female patients underwent physical examination and ultrasonography of the neck with ultrasound-guided fine-needle aspiration biopsy (UG-FNA). The material thus obtained was stained by the standard May-Grünwald-Giemsa method. Parathyroid hormone level was determined in aspirate and serum, along with serum levels of total calcium, inorganic phosphates. In two asymptomatic patients, remission occurred after initial aspiration biopsy; one patient had compression syndrome with vocal cord paresis that required surgical treatment; and one patient had cyst recurrence that was surgically removed. Cystic neck masses can pose a major differential diagnostic problem considering different approach, treatment method, and preoperative and postoperative follow up. Surgical treatment is necessary in case of functional and large nonfunctional PCs (due to compression syndrome), whereas individualized therapeutic approach is used in case of small nonfunctional PCs. Ultrasonography with UG-FNA, cytologic analysis of the material obtained, and determination of parathyroid hormone level in aspirate and serum are crucial for making an accurate diagnosis.
Expression of polySia is associated with metastatic dissemination and progression of various malignant diseases. In particular, it may contribute to tumorigenesis by a negative modulatory effect on ...cellular signaling cascades responsible for cellular migration, differentiation and proliferation. In this study, we investigated the expression of polySia in primary metastatic and non-metastatic laryngeal squamous cell carcinoma (LSCC) tumor tissues and its potential impact on the LSCC progression.
The expression of polySia in metastatic and non-metastatic primary laryngeal squamous cell carcinoma (LSCC) tumor biopsy specimens was investigated by immunohistochemistry, while the expression of polysialyltransferase IV (ST8SiaIV)(), fibroblast growth factor receptor 1 (FGFR1), extracellular signal regulated kinases 1 and 2 (Erk 1/2) and c-Raf was tested in metastatic and non-metastatic primary tumor tissues (including the corresponding non-tumor control tissues) by Western blot analysis.
The expression of polySia was detected in LSCC biopsies specimens with generally stronger immunoreactivity in non-metastatic tumor LSCC sections and in histologically undifferentiated tumors. Also, increased polySia expression was observed in adjacent histologically unaltered laryngeal tumor-associated tissue of the metastatic sections. In addition, we provide an evidence of increased polysialyltransferase IV (ST8SiaIV) expression, involved in polySia synthesis in both metastatic and non-metastatic primary tumors which is accompanied by decreased levels of FGFR1, Erk 1/2 and c-Raf.
We present for the first time the evidence for the polySia expression in LSCC biopsies specimens which suggests its potential impact on initial steps of LSCC malignant transformation.
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.
We performed a review of recent literature in order to present new insights in pathophysiology, symptomatology, diagnostics and therapy of laryngopharyngeal reflux (LPR). Although the number of LPR ...studies has increased significantly over the past few years, there are still no gold standards or standardized protocols for diagnosing and treating LPR, and an interdisciplinary approach is necessary. Questionnaires for symptom severity self-assessment and clinical signs should include both symptoms and signs of gastroesophageal reflux disease and respiratory system, and primary objective diagnostic tool should be a simple determination of the most reliable biomarker pepsin, from easily obtainable fluid, such as saliva. Unclear cases should be referred for further assessment with multichannel impedance and pH monitoring. It allows the determination of the type of reflux (acidic, mixed and non-acidic) and implementation of personalized therapy. According to the latest findings, behavioural therapy would be the method of choice in the treatment of mild forms of the LPR. In moderate and severe forms, the combination of drugs depends on the reflux type. Drug therapy should be carried out for a minimum of eight weeks, optimally three months, followed by follow-up examination and revision of symptoms and clinical findings. Significant improvement allows drug therapy reduction, while cases with slight improvement demand dosage increase and another three months of treatment. In cases without change or possible deterioration, patients should undergo additional gastroenterological work-up and potential surgical treatment. Strict adherence to behavioural measures is proposed, while long-term prescription of proton pump inhibitors is not recommended given the proven number of adverse drug reactions.
Objective: Association of altered growth factor receptors-mediated intracellular pathways and biological processes associated with extracellular matrix composition and structure in laryngeal squamous ...cell carcinoma (LSCC) were described previously. In particular, the expression and glycosylation of important extracellular matrix molecules (ECM) such as small leucine rich proteoglycan lumican, may be generally associated with disrupted extracellular matrix integrity and inflammation processes which have a role in tumour invasiveness. In this study, the relative expression of different lumican glycoforms were evaluated in primary tumour and tumour-unaffected tissue samples of ten patients with metastatic and ten non-metastatic LSCC by Western blot and 2D immunoblot analysis. Materials and methods: Tissue samples from the primary tumours and paired adjacent non-tumour tissues were surgically resected from ten untreated LSCC patients with non-metastatic disease and ten LSCC patients with lymph nodes metastases. The relative expression of different lumican glycoforms in primary tumours and paired adjacent non-tumour tissues were evaluated by Western blot and 2D immunoblot analysis. Results: Results of Western blot analysis have revealed elevated expression of the moderately glycosylated lumican form in metastatic (p<0,05) and non-metastatic primary tumour tissues in comparison with tumour unaffected tissues. In addition, moderately glycosylated form of lumican with negatively charged oligosaccharide residues in the N-glycan molecule part was exclusively determined in metastatic primary tumour tissues by 2D immunoblot analysis. Conclusion: We demonstrated elevated expression of the moderately glycosylated lumican form with negatively charged oligosaccharide residues in the N-glycan portion exclusively in primary laryngeal squamous cell carcinoma from patients with metastatic disease.
Cilj: Prijašnje su studije opisale povezanost između promijenjenih staničnih signalnih puteva posredovanih receptorima za faktore rasta i narušenog integriteta izvanstaničnog matriksa u karcinomu pločastih stanica grkljana. Izražaj i glikozilacija molekula izvanstaničnog matriksa, poput proteoglikana lumikana, može biti povezana s narušenim integritetom izvanstaničnog matriksa i upalnim procesima koji imaju važnu ulogu prilikom invazije tumora. U ovom smo radu pomoću Western blot i 2D imunoblot metoda ispitali relativni izražaj različitih glikoformi lumikana u uzorcima primarnog tumora i tumorom nezahvaćenog tkiva 10 pacijenata oboljelih od metastatskog i 10 od nemetastatskog karcinoma pločastih stanica grkljana. Materijali i metode: Uzorci tkiva primarnih tumora i pripadajućih tumorom nezahvaćenih histološki neizmijenjenih tkiva prikupljeni su tijekom kirurške resekcije 10 pacijenata oboljelih od metastatskog karcinoma i 10 od nemetastatskog karcinoma. Razina relativnog izražaja glikoformi lumikana u tkivima primarnih tumora i pripadajućim tumorom nezahvaćenim tkivima ispitana je uz pomoć Western blot i 2D imunoblot metoda. Rezultati: Rezultati Western blot analize pokazali su povećan izražaj umjereno glikozilirane forme lumikana u tkivima primarnih tumora pacijenata oboljelih od metastatske (p < 0,05) i nemetastatske bolesti u usporedbi s pripadajućim tumorom nezahvaćenim tkivima. Uz ovo, umjereno glikozilirana forma lumikana s negativno nabijenim ugljikohidratnim ostacima u N-glikanskom dijelu molekule isključivo je detektirana u tkivima metastatskog primarnih tumora pomoću 2D imunoblot analize. Zaključci: Dokazali smo povećan izražaj umjereno glikozilirane forme lumikana s negativno nabijenim oligosaharidnim ostacima u N-glikanskom dijelu isključivo u primarnom karcinomu pločastih stanica grkljana kod pacijenata s metastatskom bolesti.
Abstract Background Subperiosteal orbital hematoma (SOH) is a rare finding after midface trauma, causing compartment syndrome within the orbit. It should be consideration in the differential ...diagnosis of any case of proptosis and vertical globe displacement. Patients We present two patients with SOH treated by surgical evacuation and drainage. Results In both the hematomas resolved completely and uneventfully. Conclusion Being a safe and simple method, surgical decompression combined with drainage enables complete evacuation of the blood clot and prevents possible sequelae. This method should be considered even in cases without significant visual impairment.
Summary
Background and objectives
Tonsillectomy is a very painful procedure. Pain may be severe, and patients are often unable to perform in school or eat regular food for a number of days after the ...surgery. The aim of this study was to compare the quality of life after undergoing two different surgical techniques of tonsillectomy, harmonic scalpel and classic tonsillectomy with bipolar cauterization.
Design and setting
Prospective randomized double-blind, clinical trial study conducted in the ENT Department, Dr. Josip Benčević General Hospital, Slavonski Brod, Croatia.
Patients and methods
Data were collected, according to the type of operation, on pain persistence and intensity and returning to normal eating with tonsillectomy patients during the first seven postoperative days. Group A consisted of 50 children submitted to classic tonsillectomy with bipolar cauterization, while group B included 50 children operated on using the harmonic scalpel. Data on pain intensity were obtained using pain measuring scales adjusted to children’s age (Faces scales, visual analog scale). The first day of normal oral food intake was recorded.
Results
The analysis of variance revealed that the grade of pain significantly differs by a surgical technique employed, and that it significantly varied over the first seven postoperative days. The pain was more severe after undergoing the harmonic scalpel technique and children started to eat later compared with the classic tonsillectomy.
Conclusion
The classic tonsillectomy method with bipolar cauterization is the method of choice due to lower postoperative pain levels and sooner normal eating. The quality of life is better after undergoing the classic tonsillectomy method.
Objective. Minimally invasive surgery is the method of choice in the management of hyperparathyroidism caused by parathyroid adenoma, whereas in case of parathyroid hyperplasia a radical operative ...procedure is necessary to prevent recurrence of the disease. The aim of the study was to investigate morphological and cytochemical parameters differentiating parathyroid adenoma from parathyroid hyperplasia in cytologic smears in preoperative work-up of patients with hyperparathyroidism.
Methods. Fifty parathyroid cytologic smears, preoperatively obtained by ultrasound-guided aspiration biopsy, were analyzed. Fifty parathyroid cell nuclei per smear were analyzed, and the number of nucleolar organizer region (AgNOR) was determined using SFORM software (Vamstec, Zagreb). The results obtained were compared with histopathology findings.
Results. The values of nuclear size parameters obtained by morphometric measurement revealed cells with larger nuclei and greater nuclear size diversity to be found in parathyroid adenoma, thus enabling differentiation of parathyroid hyperplasia from parathyroid adenoma in many cases. However, due to overlapping of borderline values, an attempt was made to reduce the possibility of error by determining AgNOR count and structure. The results obtained showed that neither AgNOR count, nor AgNOR classification into individual AgNOR, AgNOR clusters and annular AgNOR, had any role in differentiating parathyroid hyperplasia from parathyroid adenoma.
Conclusion. Study results showed that AgNOR count and structure cannot help in determining more clearly the border between parathyroid adenoma and hyperplasia in cytologic smears.
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