Voice changes after thyroidectomy: role of external laryngeal nerve

To evaluate a technique to protect the external laryngeal nerve during thyroidectomy.Randomized controlled trial. Patients randomized into group A or B using closed envelops method. Alexandria university hospital is a teaching hospital. It is the referral center serving seven million people. Forty four consecutive patients admitted to Alexandria university hospital for thyroidectomy. Fourpatients had voice abnormalities on preoperative voice analysis. They were excluded. All patients underwent thyroidectomy. Group A had conventional mass ligature of the superior poleof thyroid gland while group B had individual ligation of the branches of the superior thyroid artery afteridentification of the external laryngeal nerve whenever possible. Abnormal readings on postoperative voice analysis and abnormal electromyogram of thecricothyroid muscles. Observers performing voice analysis tests were blinded as regards patient group. Postoperativeelectromyography of the cricothyroid revealed signs of nerve injury in five patients of group A but none in groupB. Multi-dimensional voice program, fundamental frequency range, fundamental frequency and maximum pressurelevel all showed significant postoperative change in group A but not of those in group B [level of confidence95%].Identification of external laryngeal nerve and/or ligation of the terminal branches of the superiorthyroid vessels seems to help prevent external laryngeal nerve injury

A randomized study of the safety and efficacy of reused angioplasty balloon catheters.

BACKGROUND: To lower costs, many centers around the world utilize previously used, resterilized balloon catheters to perform coronary angioplasty There are no controlled trials regarding their safety and efficacy. METHODS AND RESULTS: We performed the first randomized, double-blind, controlled, single-center clinical trial comparing the safety (clinical success) and efficacy (angiographic success) of reused versus new coronary angioplasty balloon catheters. A total of 377 procedures were included, 178 in the reused catheter arm and 199 in the new catheter arm. There were no significant differences in clinical or lesion characteristics among the two arms. The incidence of first balloon failure in the reused catheter arm was similar to that of the new catheter arm (12 cases [7%] v. 10 cases [5%], respectively). The angiographic success rate was also similar-176 cases (98.9%) in the reused catheter arm and 196 cases (98.5%) in the new catheter arm. The number of balloon catheters used per lesion, amount of contrast, and procedural and fluoroscopy time were similar in the two arms. At 30 days, the incidence of major adverse cardiac events was similar in both arms, 8 cases (4.5%) in the reused catheter arm and 10 cases (5%) in the new catheter arm. The incidence of fever was also similar. CONCLUSIONS: When performing coronary angioplasty, reused catheters are as effective (similar angiographic success) and safe (similar clinical success) as new catheters.

Preoperative chemo-radiotherapy in the initially unresectable rectal cancer

Seventeen patients with initially unresectable adenocarcinoma of the rectum were treated by preoperative chemo-radiotherapy. Radiation treatment was given for 4000 cGy at 200 cGy per day, 5 days a week to the primary tumor and pelvic lymph nodes. Concomitantly chemotherapy in the form of 5-fluorouracil, 1000 mg/m 2 bolus injection, was given on days 1-4 of radiotherapy. The same chemotherapy dose was repeated on days 29-32 of treatment. Surgical exploration was performed 4-6 weeks after irradiation. Lower abdominal resection with colo-anal anastomosis was done in eight cases and abdomino-perineal resection in six cases. Twelve cases were found to have mobile tumors and two patients found to have tethered lesions. Carcino-embryonic antigen [CEA] as a tumor marker returned back to normal levels in 11 out of 12 cases one month after surgery. Treatment was tolerable in all cases. Eight patients had sphincter preservation by this combined modality of treatment