ABSTRACT
According to the modern literature, mediastinal parathyroid glands are diagnosed in 2-20% of cases. In the available Russian-language literature, there are few reports on successful resection of mediastinal parathyroid glands in impossible surgery through cervical approach. Despite the development of minimally invasive surgical approaches and their advantages, traumatic sternotomy was used in these cases. We report a successful thoracoscopic resection of mediastinal parathyroid gland in a patient with persistent hyperparathyroidism. Preoperative topical diagnosis was essential for successful surgery. Favorable postoperative outcome was confirmed by regression of symptoms and vascular calcification, as well as improved densitometric parameters in one year after surgery.
Subject(s)
Hyperparathyroidism/surgery , Parathyroid Glands/surgery , Thoracoscopy , Humans , Hyperparathyroidism/diagnosis , Mediastinum/surgery , Preoperative CareABSTRACT
The objective of the present study was to analyze the current literature concerning mechanisms underlying the development of tracheal stenosis, new methods for the treatment and prevention of this condition. The main cause behind the formation of cicatrical stenosis of trachea is believed to be long-term artificial lung ventilation whereas the principal factors responsible for the injury to the tracheal wall include the impact of the cuff and the free end of the endotracheal tube, reflux of duodenal and gastric contents, concomitant infection, and the involvement of the autoimmune component. These pathogenic factors produce morphological changes in all layers of the tracheal wall with the formation of the granulation tissue the appearance of which serves as a forerunner of irreversible changes leading to tracheal stenosis. The biomedical technologies including auto- and allo-transplantation, tissue engineering, gene and cell-based therapy are considered to be the most promising methods for the treatment and prevention of this condition likely to improve the outcome of the management of cicatrical tracheal stenosis.
Subject(s)
Cicatrix/therapy , Gastroesophageal Reflux/complications , Intubation, Intratracheal/adverse effects , Trachea/surgery , Tracheal Stenosis/therapy , Cicatrix/etiology , Cicatrix/prevention & control , Humans , Trachea/injuries , Trachea/pathology , Tracheal Stenosis/etiology , Tracheal Stenosis/prevention & controlABSTRACT
Quality of life of 89 patients with diffuse toxic goiter was analyzed before surgical intervention and at different terms after thyroidectomy or terminal subtotal resection of the thyroid gland using questionnaire SF-36. It was found that quality of life of patients with diffuse toxic goiter was lower than that of respondents without such pathology. The indices of quality of life one year after thyroidectomy (terminal subtotal resection of the thyroid gland) remained depending on the duration of the disease and complications of thyrotoxicosis, became reliably larger as compared with preoperative level due to social activity and emotional state.
Subject(s)
Graves Disease/surgery , Quality of Life , Sickness Impact Profile , Thyroid Gland/surgery , Thyroidectomy , Adult , Age Factors , Aged , Female , Graves Disease/complications , Graves Disease/metabolism , Graves Disease/pathology , Health Status , Humans , Male , Middle Aged , Postoperative Complications/physiopathology , Postoperative Complications/psychology , Postoperative Period , Preoperative Period , Surveys and Questionnaires , Thyroid Gland/pathology , Thyroid Hormones/metabolism , Thyroidectomy/adverse effects , Thyroidectomy/methods , Thyrotoxicosis/etiology , Thyrotoxicosis/metabolism , Thyrotoxicosis/psychology , Treatment OutcomeABSTRACT
Specific manifestations of postoperative laryngeal paresis observed with the use of indirect laryngoscopy are described in 53 patients subjected to the surgical treatment of diffuse toxic goiter. Laryngeal paresis was shown to develop both in the early (up to 7 days) and in the late (over 14 days) postoperative periods. The delayed form of pathology accounted for 13% of the total number of the cases of postoperative laryngeal paresis. The standard treatment of transient postoperative laryngeal paresis resulted in the complete recovery of vocal cord mobility within 1-6 months after the onset of therapy, regardless of the state of the cords at the time of diagnosis of the disease. Persistent postoperative laryngeal paresis developed by the end of the 15 month observation period. Phonation was found to be preserved in 66% of the patients in whom laryngeal paresis (unilateral abduction paresis) had been diagnosed by indirect laryngoscopy. In all the remaining patients, phonation recovered 15 months or more after surgery. The authors argue that neither the recovery nor the preservation of phonation can be a criterion for the absence of complications. Also, the outcome of surgical intervention unsupported by the results of laryngoscopy performed within 1, 6, and 15 months after the treatment does not reflect the true structure of postoperative complications.
