[Surgical treatment of goiter at a central hospital. A consecutive adjustment after changes in the organization, strategy and surgical techniques]. / Kirurgisk behandling af struma på et centralsygehus. En konsekutiv opgørelse efter aendringer i organisation, strategi og kirurgisk teknik.

The aim of the study was to analyze the frequency of complications following thyroid gland surgery in a surgical department of a district hospital. Since the results of the department were last evaluated in 1988, changes in surgical strategy and operative techniques have been introduced. Hemithyroidectomy with resection of the glandular isthmus is now the least comprehensive operation performed, and at all operations the recurrent laryngeal nerve is identified and exposed. One hundred and twenty-five operations were carried out over a five years period. Half of the patients were operated for non-toxic nodular goitre, and 24 patients for thyrotoxicosis. Of 23 patients with a scintigraphically "cold" nodule, four turned out to have carcinoma. The frequency of permanent complications were 0.8% (hypoparathyroidism in one patient). Transient hypoparathyroidism was seen in 2%, and in four patients (3%) transient unilateral nerve palsy developed. No cases of permanent or bilateral vocal cord paralysis were found. Remaining complications were haemorrhage (2%) and one patient with a complication not related to surgery (0.8%). The departments results have improved significantly since 1988, and it is concluded that uncomplicated thyroid gland surgery may safely be performed at a district hospital.

Longitudinal pulmonary function changes in pigeon breeders.

We studied 15 subjects (14 men and one woman; seven symptomatic and eight asymptomatic) at three- to four-year intervals from 1967 through 1985 (18 years) to determine if continued pigeon antigen exposure in these groups was associated with a decline in pulmonary function greater than expected in healthy individuals. We collected immunologic studies at the initial visit, performed sequential pulmonary function studies and obtained chest radiographs. After compensating for the normal changes expected with increasing age, we found the declines in FVC, FEV1, and Dsb in the symptomatic group were nearly four times greater than expected. There was no significant difference in the decline of pulmonary function between asymptomatic subjects and the normal predicted declines with increasing age. We conclude that, if an individual has episodes of acute hypersensitivity pneumonitis, long-term exposure to pigeon antigens will result in an accelerated decline in pulmonary function.

Pigeon breeders' disease--a prevalence study and review.

Among fifty-three Salt Lake City, Utah area pigeon fanciers, 21% were found to have the clinical picture of pigeon breeders' disease. This is a much higher frequency than has been observed previously. Abnormal spirometry and increased skin reactivity to pigeon sera were found more often, statistically significantly, in symptomatic than in exposed asymptomatic fanciers. Pigeon breeders' disease is associated with a variety of abnormal findings; skin test, precipitins, pulmonary function changes and radiographic derangements; but unfortunately none of these are diagnostic. Pigeon breeders' disease is best identified by clinical criteria.