Amyloid Goiter: A Case Report and Review of the Literature.

Amyloid goiter is a very rare manifestation of amyloidosis. Here, we describe the case of a 40-year-old male, who presented with upper airway obstructive symptoms including hoarseness and breathing difficulty, to highlight the clinical and pathological features of secondary amyloidosis of the thyroid gland and the difficulties in making a preoperative diagnosis. The patient had previously been wounded in the war in Bosnia, which resulted in the right kidney being surgically removed. Further, he had undergone two surgical interventions on both hips due to osteomyelitis and was on a chronic dialysis program due to a progressively poor left kidney function that had eventually resulted in complete loss of renal function. Thyroid function tests were normal, and the patient clinically was euthyroid; biochemical investigations were within normal limits. Results from sonography, computed tomography scan of the neck, scintigraphy and fine-needle aspiration cytology were nondiagnostic. Therefore, a thyroid biopsy was carried out, and amyloid deposits were found. After preoperative work-up, total thyroidectomy was performed with no complications. We conclude that amyloid goiter may have no major impact on thyroid function even when a substantial amount of amyloid has replaced the normal thyroid parenchyma, as was the case in our patient. Amyloid goiter should be suspected in all patients with a progressive, rapidly growing bilateral thyroid enlargement with concomitant inflammatory processes or in patients undergoing hemodialysis treatment.

Fine Needle Aspiration Cytology and Thyroglobulin Antibodies in Preoperative Diagnosis of Thyroid Malignancy.

INTRODUCTION: Most important in the evaluation of thyroid thyroid disease is to differentiate a disease that is treated medically from a disease that requires surgical treatment. In preoperative differentiation of a malignant from a benign lesion are used different diagnostic methods (US, scintigraphy, FNAC, MRI). AIM: The aim of the study was to determine the diagnostic value of fine needle aspiration cytology (FNAC) and serum thyroglobulin antibodies (TgAb) values in individual cytological categories. METHODS: The prospective study included 100 patients with scintigraphic cold thyroid nodules divided into two groups. The first group consisted of 50 patients with histopathological verified benign nodules and the second group of 50 patients with histopathological verified benign nodules. Demographic datas, FNAC findings, TgAb levels and final histopathological findings were recorded. FNAC with ultrasound (US) guidance was performed by the so-called Free hand technique. TgAtb values were estimated by the radio-immunity assay (RIA) method. RESULTS: In patients with histopathological findings of a benign nodule, 20 patients had a cytological finding of a colloidal nodule, 18 patients had a cellular nodule, 12 had a finding of follicular neoplasm. In patients with a histopathological finding of the malignant nodule, 9 patients had a cytological finding of a colloidal nodule, 8 had a cellular nodule, 21 follicular neoplasm and 12 patients had cancer. FNAC had a sensitivity of 66%, specificity of 76%, a positive predictive value of 73%, a negative predictive value of 69%. The highest preoperative serum TgAb values were in patients with cytologic findings of cancer, and the lowest in the cellular nodule. CONCLUSION: The finding of FNAC together with serum TgAb values contributes to better diagnosis and selection of patients requiring surgery.

Impact of Preoperative Anxiety in Patients on Hemodynamic Changes and a Dose of Anesthetic During Induction of Anesthesia.

OBJECTIVES: Each surgical patient is preoperatively, intraoperatively and postoperatively exposed to stress. The aim of this study was to determine the existence of preoperative anxiety, and to determine its impact on hemodynamic parameters (blood pressure, heart rate) in patients and dose of anesthetics during induction of anesthesia. METHODS: A prospective clinical study conducted at the Department of Anesthesiology and Reanimation and Surgery Clinic of University Clinical Center Tuzla (UCC) in the period May 2012. to January 2015. The 80 patients were analyzed which were planned for and done an elective cholecystectomy surgery or herniectomy surgical intervention. Preoperative anxiety was measured with the help of Spielberg test and evaluation of depth of anesthesia was performed with BIS monitoring. RESULTS: The results showed that all patients had some degree of preoperative manifest anxiety. Average values of mean arterial pressure, preoperatively and after the induction of general anesthesia, differed for 15,4 mm/Hg, but were not observed significant association between Spielberg score and differences in blood pressure. Preoperative anxiety is a significant predictor of administered dose of anesthetic. Each additional score on Spielberg scale reduces the dose of anesthetic for 0,304 mg/kgTT. CONCLUSION: Adequate assessment of preoperative anxiety and undertaking of certain steps to reduce it can assist in accurately determining the required dosage of anesthetic for the introduction of general anesthesia.

OSA-18 survey in evaluation of sleep-disordered breathing in children with adenotonsillar hypertrophy.

BACKGROUND/AIM: The aim of this study was to estimate the quality of life (QOL) in children with sleep-disordered breathing (SDB) before and after adenoidectomy and before and after adenotonsillectomy using the OSA-18 survey. SETTING AND DESIGN: The prospective study included sixty children with symptoms of SDB caused by enlarged adenoids or tonsils, of both sexes, aged 3-12 years, consecutively admitted into the ENT Clinic in Tuzla, for adenoidectomy or adenotonsillectomy. METHODS: Patients were divided in two subgroups: thirty patients who underwent adenoidectomy and thirty patients who underwent adenotonsillectomy. Parents or caregivers completed the OSA-18 survey before surgery and 5 weeks after surgery. For statistical analysis was used Student's t-test of pared samples. The values p < 0.05 were accepted as significant. RESULTS: Mean total score before adenoidectomy was 3.44 (SD = 0.77) and after surgery was 1.30 (SD = 0.46).Mean total score before adenotonsillectomy was 3.69 (SD = 0.80), after surgery was 1.22 (SD = 0.27). The difference between preoperative and postoperative scores in both subgroups of patients was significant (p < 0.01). CONCLUSION: Adenoidectomy and adenotonsillectomy improve QOL in children with SDB, which is caused by adenotonsillar hypertrophy. The OSA-18 survey is a useful tool for the selection of children for surgery with SDB caused by adenotonsillar hypertrophy and to assess quality of life after surgery.

[Quality of life in children with obstructive sleep apnea after adenotonsillectomy]. / Kvalitet ivota u djece sa opstruktivnim nocnim apneama nakon adenotonzilektomije.

UNLABELLED: Obstructive sleep apnea (OSA) caused by enlarged tonsils and adenoids is common in pediatric population. The prevalence of pediatric obstructive sleep apnea syndrome has been estimated to be between 1% and 3% in preschool and school-aged children. The aim of this study was to examine quality of life in children before and after adenotonsillectomy. SUBJECTS AND METHODS: This study was prospective and it was carried out in the period from mid-November 2005 to end-June 2006. Specific exclusion criteria were: no existing of OSA, neuromuscular disorders, constitutional maxillofacial anomalies, septal deviation, mental retardation, obesity (BMI > 30). Anamnesis was taken from parents or caregiver, each child was examined from ENT specialist, Pediatar and Anestesiolog. The adenoid size was estimated by palpation or/and X-ray examination of nasopharynx. The tonsils size was estimated by Brodsky scala. OSA-18 quality of life survey was used to estimate improvement of quality of life after adenotonsillectomy. The children that had asserted symptoms of OSA by OSA-18 quality of life survey, were analyzed by this survey 5 weeks after surgery. The results before and after surgery were compared. The adenotonsillectomy was done with standard operation technique at our ENT department (cold dissection using termocauter), and comprehends removal palatinal tonsils and adenoids, that are removed by adenotom with uniform anestesiology protocol. RESULTS: At 13 patients (43.3%) undergone adenotonsillectomy, OSA had a small impact on quality of life, at 11 (36.7) patients had a moderate impact and at 6 (20%) patients had large impact. Statistical significant improvement of quality of life after adenotonsillectomy was found in all domains using OSA-18-QOL survey: sleep disturbance (P < 0.0001), physical suffering (P < 0.0001), emotional distress (P < 0.0001), daytime problems (P = 0.0081) and caregiver concerns (P < 0.0001). The mean OSA-18-QOL total change score showed significant improvement of quality of life in patients suffering from OSA who undergone adenotonsillectomy. CONCLUSION: Adenotonsillectomy improves quality of life in children suffering from OSA caused by adenotonsillar hypertrophy.