ABSTRACT
THE AIM: of this study was examination of laryngeal nerve injury, hypoparathyroidism, bleeding and thyroid storm frequency after thyroidectomy. MATERIAL AND METHODS: Retrospective analysis of 847 patients surgically treated from 1985 to 2004 due to thyroid cancer (77) or multinodular goiter (770). We analyzed influence of type of thyroidectomy, diagnosis and reoperation on complication rates. Statistical analysis was performed with Chi2 or Fisher exact test. RESULTS: Unilateral lobectomy was performed in 195 cases (23%)--total unilateral lobectomy in 51% of patients and partial or subtotal lobectomy in rest of them. Bilateral lobectomy was performed in 652 patients--in 20% of cases it was total thyroidectomy and partial or subtotal thyroidectomy in 524 of patients. There was no mortality in operative or postoperative period. Wound exploration due to bleeding was performed in 3 cases (0,4%) and thyroid storm was noticed in 1,6% of all patients. Unilateral permanent laryngeal nerve injury was in 2,1% of patients, in one patient it was permanent bilateral nerve injury and unilateral temporary nerve injury in 3,2%. We noticed statistically significant differences in permanent and temporary nerve injury between total and partial thyroidectomy groups (7,0% vs 1,3% and 8.6% vs 2,2%; p < 0,005) and after primary operation and reoperation groups (8,9% vs 1,7% and 6,7% vs 2,9; p < 0,005). Permanent and temporary recurrent laryngeal nerve injury rates after total thyroidectomy due to cancer or multinodular goiter were not significant (7,8% vs 5,9% and 9,1% vs 7,8%; p = 0,72). Temporary hypoparathyroidism was noticed in 34 cases (4%) and permanent in one case. Again temporary hypoparathyroidism was significantly higher after total thyroidectomy compared to partial (18,0% vs 2,1%; p < 0,005) and after reoperation (17,8% vs 3,2%; p < 0,005). There were no differences in hypoparathyroidism rates after total thyroidectomy due to cancer or multinodular goiter (20,8% vs 13,7%; p = 0,35). RESULTS: Recurrent laryngeal nerve injury and hypoparathyroidism are most common complications after thyroid surgery. Total thyroidectomy and reoperation are risk factors of recurrent laryngeal nerve injury and hypoparathyroidism.
Subject(s)
Hypoparathyroidism/etiology , Recurrent Laryngeal Nerve Injuries , Thyroidectomy/adverse effects , Thyroidectomy/methods , Vocal Cord Paralysis/etiology , Adult , Aged , Chi-Square Distribution , Female , Goiter, Nodular/surgery , Humans , Hypoparathyroidism/epidemiology , Male , Middle Aged , Poland/epidemiology , Reoperation/statistics & numerical data , Retrospective Studies , Risk Factors , Thyroid Neoplasms/surgery , Thyroidectomy/statistics & numerical data , Vocal Cord Paralysis/epidemiologyABSTRACT
We present case report of primary hyperparathyroidism treated surgically as well as a review of literature concerning this subject. The disease of not well known etiology presents with elevated parathormon levels and hypercalcemia. Primary hyperparathyroidism which states 85% percent of all kinds of hyperparathyroidism is usually parathyroid adenoma, in 11-15% glandular hyperplasia and in 1-4% parathyroid cancer. Clinical symptoms are muscle weakness and fatigue, nephrolithiasis, occasionally peptic ulcers, pancreatitis, hypertension. Laboratory test reveal increased level of PTH, hypercalcemia, elevated alkaline phosphatase levels and decreased phosphorus levels. Diagnostic imaging techniques such as ultrasonography, MRI or CT have sensitivity about 52-75%. Highest sensitivity in localization of ectopic parathyroid adenoma has sestamibi scintigraphy with technetium-99. Skeleton x-rays show typical changes in distal parts of bones and osteopenia. Treatment of choice is surgical excision of adenoma. Normalization of PTH and calcium levels after surgery and improvement of renal, musculoskeletal and circulatory system function could be achieved in 95%. Most common complications are recurrent laryngeal nerve injury, hypo- or hyperparathyroidism, bleeding or stridor.
Subject(s)
Adenoma/diagnosis , Adenoma/surgery , Hyperparathyroidism, Primary/diagnosis , Hyperparathyroidism, Primary/surgery , Parathyroid Neoplasms/diagnosis , Parathyroid Neoplasms/surgery , Adenoma/complications , Adult , Calcium/blood , Female , Humans , Hyperparathyroidism, Primary/etiology , Parathyroid Neoplasms/complications , Phosphorus/blood , Treatment OutcomeABSTRACT
OBJECTIVE: Efficacy of modified radical neck dissection in treatment of laryngeal cancer with node positive neck. PATIENTS AND METHODS: Retrospective analysis of 311 patients treated with modified radical (86) or radical (225) neck dissection. Recurrence rates, local and regional, after both operations and 5-year disease free survival (Kaplan-Meier method) were analyzed. RESULTS: Regional recurrence rates in N1 group after MRND were 3% and 13% after RND. In N2 group 13% and 16% respectively. 5-year survival after MRND in N1 group was 73% compared with 60% after RND. In N2 group 5-year survival was 56% and 47%. CONCLUSION: We consider MRND as effective treatment method of node positive neck in N1 and N2 stage compared to RND with less morbidity.
Subject(s)
Laryngeal Neoplasms/surgery , Neck Dissection/methods , Female , Humans , Male , Middle Aged , Neoplasm Recurrence, Local , Neoplasm Staging , Retrospective Studies , Survival Analysis , Treatment OutcomeABSTRACT
OBJECTIVE: Impact of extracapsular spread upon survival and recurrence rates in patients with laryngeal cancer. MATERIAL AND METHODS: Retrospective analysis of 309 patients with pathologically confirmed regional metastases with and without extracapsular spread (144 and 165 patients respectively). To examine impact of clinical variables upon treatment outcomes we used logistic regression (logit) and Kaplan-Meier method to calculate 5-years disease free survival. RESULTS: Extracapsular spread significantly reduced 5-years survival (40% vs 77%; p = 0.005) and increased regional recurrence rates (33% vs 12%; p = 0.0001). CONCLUSION: Authors suggest use of radiotherapy after neck dissection in presence of extracapsular spread.
Subject(s)
Laryngeal Neoplasms/pathology , Lymph Nodes/pathology , Disease-Free Survival , Female , Humans , Incidence , Lymphatic Metastasis , Male , Middle Aged , Neoplasm Recurrence, Local/epidemiology , Neoplasm Staging , Retrospective Studies , Risk FactorsABSTRACT
OBJECTIVE: Efficacy of salvage surgery after radiotherapy failure in patients with laryngeal cancer. MATERIAL AND METHODS: Retrospective analysis of 121 patients treated in our clinic between 1980 and 2003 (supraglottis--86 patients, glottis--35). In 70% of patients T-stage was T3 and T4 and regional metastases were present in 56% of cases. We performed statistical analysis of recurrence rates and 5-years survival according to Kaplan-Meier method. RESULTS: Glottic localization (p = 0.02) and extracapsular spread (p = 0.03) were significant factors of final outcome. Local and regional stage was not significant factor of recurrence. Disease free 5-year survival was 53%. CONCLUSION: Salvage surgery is a reasonable method that could save about 50% of patients after radiotherapy failure.
Subject(s)
Laryngeal Neoplasms/radiotherapy , Laryngeal Neoplasms/surgery , Neoplasm Recurrence, Local/surgery , Salvage Therapy , Adult , Aged , Female , Humans , Male , Middle Aged , Neoplasm Recurrence, Local/mortality , Neoplasm Staging , Prognosis , Retrospective Studies , Salvage Therapy/methods , Survival Analysis , Treatment FailureABSTRACT
Authors present surgical procedure for treatment of tracheostomal stenosis after laryngectomy with use of 7th rib cartilage. Procedure is simple, almost without morbidity, provides good ventilatory and cosmetic results and helps in learning esophageal speech.
Subject(s)
Cartilage/transplantation , Constriction, Pathologic/surgery , Tracheostomy/adverse effects , Humans , Male , Middle Aged , Treatment OutcomeABSTRACT
INTRODUCTION: Authors present four cases of acute suppurative thyroiditis treated in our department. Initial symptoms are similar to acute pharyngitis or laryngitis but could end in fulminant course that could be life threatening. MATERIAL AND METHODS: We present etiology, clinical symptoms and accessory exams as well as new treatment methods. RESULTS: All four patients were cured. In one case pharmacological treatment was sufficient. In second case the patient needed intubation due to stridor. In third one after pharmacological treatment we performed partial thyroidectomy. In last case patient with thyroid abscess needed urgent thyroidectomy due to retropharyngeal and mediastinal multiple abscesses. CONCLUSIONS: Acute suppurative thyroiditis needs hospitalisation. Some patients needed surgical intervention due to life threatening course.
Subject(s)
Laryngitis/complications , Thyroiditis, Suppurative/diagnosis , Thyroiditis, Suppurative/etiology , Adult , Aged , Female , Humans , Laryngitis/diagnostic imaging , Middle Aged , Thyroid Gland/diagnostic imaging , Thyroid Gland/surgery , Thyroidectomy , Thyroiditis, Suppurative/surgery , Tomography, X-Ray ComputedABSTRACT
We present 3 cases of Kuttner tumour (or chronic sclerosing sialadenitis of submandibular gland) all treated by surgery. In one case we report bilateral involvement. The disease was first described by Kuttner more than 100 years ago. In the new WHO Classification of tumour-like lesions of the Salivary Glands (1992) Kuttner tumour is classified as a distinct clinicopathologic entity. We also present a review of the literature about etiology, pathogenesis, differential diagnosis and treatment of this disease.