[Comparison of the frequency of recurrent laryngeal nerve injury with and without exploration of the nerve in thyroidectomy]

Surgeons are not willing to participate in thyroid surgeries due to dangerous, although rare, complications of the procedure. Post thyroidectomy complications are divided in early and late onset; hypocalcemia, bleeding, thyroid storm and recurrent laryngeal nerve [RLN] injury are the most important ones. This study was performed to compare the frequency of recurrent laryngeal nerve injury with and without nerve exploration in the thyroidectomy operation. In this Cohort study, we evaluated 566 cases underwent thyroidectomy during about 6 years [2005-2011] in two centers, Bahonar and Afzalipour hospitals, in Kerman, Iran. A total of 566 patients, 124 men [21.9%] and 442 women [78.1%] with the mean age of 40.26 years and the mean hospitalization period of 3.35 days were evaluated. 382 patients [67.5%] underwent total or subtotal thyroidectomy and 184 [32.5%] underwent lobectomy and isthmectomy. 124 patients [21.9%] had malignant and 442 [78.1%] had benign lesions. The most common found malignancy was papillary thyroid carcinoma [PTC], where as the most found benign lesion was multinodular guiter [MNG]. Recurrent laryngeal nerve exploration was done for 337 patients [59/5%]. Totally, 6 cases [1.1%] showed Recurrent laryngeal nerve injury [1 in exploration and 5 in non exploration group] from which, 4 had permanent hoarseness and 2 had permanent dysphonia. Also, malignancy and radical neck dissection had significant effect on nerve injury but re-operation and unilateral or bilateral surgery had not. Recurrent laryngeal nerve identification and exploration decreased the incidence of nerve injury significantly. We believe that recurrent laryngeal nerve identification and exploration during thyroidectomy is the best procedure to decrease the risk of nerve injury

[ case report of gastrointestinal bleeding due to gastric lipoma]

Benign Gastric tumors are rare and generally account for less than 10% of all stomach tumors. Gastric lipoma is a rare tumor that constitutes approximately 3% of all benign tumors of the stomach and mainly is seen as a submucosal mass. Most gastric lipoma are asymptomatic and are found accidentally. Occasionally they can cause symptoms such as gastrointestinal bleeding, obstruction, abdominal pain and intussuception. CT scan and endoscopy are helpful in diagnosis. The main modality of treatment is surgery. Diagnosis is confirmed by histology. In this article, a patient with weakness, fatigue, and melena complaints is presented. On gastric endoscopy a yellowish submucosal mass was seen in antrum. Abdominal CT scan disclosed a mass with fat density resembling lipoma. The patient underwent surgery and diagnosis of lipoma was confirmed by histology. Although gastric lipoma is rare, it should be considered in the assessment and differential diagnosis of hemorrhagic submucosal masses in the stomach