PREDICTORS OF MULTIFOCAL PAPILLARY THYROID CANCER. DO THEY EXIST?

The aim of this study is to analyze and identify the main predictors that may indicate multifocal growth of PTC. Materials and methods: The main and control groups included patients with the category of malignant multifocal process T1-3mN0Mx (n=109) and unifocal T1-T3N0Mx (n=50) respectively, who underwent thyroidectomy with lymphadenectomy.Ultrasound characteristics of the nodes, tissue changes of the thyroid gland were taken into account. Results: Fibrous changes can be considered as one of the risk factors of the presence of additional PTC lesion. Discussion: There is no unambiguity in the definition of predictors of multifocal PTC growth. Conclusions: No clear predictors of multifocal PTC have been identified. It is advisable to improve the quality of ultrasound, to focus on single-focus PTC in patients with fibrinous changes in the thyroid gland at normal levels of TSH.

[The change of objective parameters of voice after laryngeal reinnervation].

Possibilities and late results of nonselective surgical reinnervation, using formation of primary or deferred anastomosis of n. laryngeal recurrence (NLR) with one of cervical peripheral nerves (proximal fragment of NLR, the main branch of cervical loop - ansa cervicalis, nerve-donor) in a one-sided laryngeal paralysis, were studied up. Preoperatively and postoperatively the indirect laryngoscopy, videolaryngoscopy, the voice spectral analysis (main frequency, intensity and the rate harmonics-noise RHN, maximal period of phonation--MPP) were accomplished, subjective selfestimation by a patient of the voice quality (VHI-30) was done. Anastomosis with NLR was formatted in 95 patients, including 53--with cervical loop, in 34 - NLR - NLR, 8 - NLR - nerve donor). Postoperative follow-up have constituted (12 +/- 1.8) mo at average, the period up to occurrence of the first indirect signs of laryngeal reinnervation- (4.5 +/- 2.9) mo, were observed in all the patients: occurrence of the vocal plica tone, reduction of the vocal fissure dimensions while phonation (peculiarly in anastomosis of NLR with cervical loop)--from (2.25 +/- 0.86) to (0.35 +/- 0.17) mm. In accordance to data of acoustic analysis, reinnervation is mostly effective in anastomosing of NLR with cervical loop, RHN increased from (12 +/- 3.7) to (24 +/- 2.4) (see symbol) MPP--from (7 +/- 1.22) to (16 +/- 3.52) c (p < 0.01). Improvement in all subgroups of the main group was noted while performing analysis of subjective psychosocial selfestimation of the voice formation.

[Autoplasty of recurrent laryngeal nerve in the thyroid gland surgery].

Efficacy of autoplasty of recurrent laryngeal nerve (RLN) for laryngeal reinnervation in surgery of differentiated cancer of thyroid gland was studied. Prospectively 8 patients were examined, in whom laryngeal reinnervation, using the RLN autoplasty, for the abduction laryngeal paralysis was done. The examination was performed before and after the operation, it included videolaryngoscopy, acoustic analysis and the patient's self-estimation of psychosocial consequences of the voice-formation disturbance. Improvement of a vocal cords spacious positioning was noted in 38% patients, and was confirmed by trustworthy improvement of the voice-formating parameters after the operation, comparing with a preoperative state. In 72% patients the vocal aperture closure was incomplete and the voice-formation parameters trustworthy differed from such in patients of a control group. When the intact alternative nerves-donors for laryngeal reinnervation are present (distal stump of PLN, ipsilateral and contralateral main branch of cervical loop) the RLN autoplasty performance must be maximally postponed because of low efficacy of such method of surgical laryngeal reinnervation.

[Complications after therapeutic dissection of the neck in the treatment of differentiated thyroid gland cancer].

There were analyzed retrospectively 1078 patients, operated on for differentiated cancer of thyroidal gland (DCTHG) in 2009-2012 yrs in the Centre, who have had following surgical complications: the injury of the X, XI, XII cranial nerves pairs, of the motor and sensitive branches of cervical and brachial plexuses, lymphorrhea, hypoparathyrosis and hematoma of the neck. In 868 patients the primary operations were performed, 304 - were operated for the recurrent forms. In 271 patients (the comparison group) thyroidectomy was performed, in 884 (the main group)--thyroidectomy and different kinds of the neck dissection, in 121--the operation was done, using neuromonitoring. Therapeutic dissection of the neck--the central and lateral one, as well as primary and repeated, may be performed relatively safely in patients, suffering DCTHG. In reoperations the rate of injury of the X, XI, XII cranial nerves pairs, of the motor and sensitive branches of cervical and brachial plexuses is increasing. Application of intraoperative electroneuromonitoring for identification of peripheral nerves permits to lower the neurotrauma occurrence.

[Larynx reinnervation by the main branch of ansa cervicalis use in the thyroid surgery in cases of unilateral vocal fold paralysis].

The effectiveness of laryngeal reinnervation by anza cervicalis abduction in the treatment of unilateral vocal fold paralysis in thyroid surgery was study. The prospectively examined 11 patients with abduction paralysis of the larynx, which were treated by ipsilateral anastomosis of anza cervicalis main branch to the distal stump of the recurrent laryngeal nerve were performed. The survey was conducted on the pre- and postoperative stages and included videolaryngoscopy, acoustic analysis, and patient self-assessment of voice. Average follow-up was (2.98 +/- 1.04) years. The use of videolaryngoscopy showed significant improvement of the spatial positioning of the vocal folds in the postoperative period and acoustical parameters. Laryngeal reinnervation by anza cervicalis is an effective treatment for laryngeal paralysis related to operations on the thyroid gland and laryngeal function can be improve to almost normal of the spoken voice parameters and the basic functions of the larynx.

[Reinnervation of larynx in surgical treatment of invasive thyroidal gland cancer].

The possibilities and efficacy of performance of simultant operations for invasive thyroid gland cancer in initial neuropathic laryngeal stenosis and dysphonic syndrome, aimed at minimization of the residual volume of thyroid gland tissue and surgical laryngeal reinnervation, were studied. The results of laryngeal surgical reinnervation, in accordance to data of videolaryngoscopy, aerodynamical and spectral analysis of the voice, self estimation of the vocal disorders impact on the patients quality of life were analyzed. Postoperatively in all the patients the improvement of phonation and quality of life was noted. Primary neurorhaphia of recurrent laryngeal nerve secures restoration of normal or nearly normal talkative voice due to restoration of the tone and volume of m. cricoarytenoideus lateralis and m. thyroarytenoideus on the side of affection and may be effectively applied for correction of consequences of laryngeal neuropathic paralysis in surgical treatment of the thyroid gland cancer.

[Treatment and monitoring of patients with differentiated cancer of thyroid gland]. / Lechenie i monitoring bol'nykh s differentsirovannym rakom shchitovidnoi zhelezy.

There were examined 200 patients aged from 19 to 77 years with differentiated cancer of the thyroid gland (TG). The combined treatment, which included performance of operation, radioiodine therapy and hormonotherapy, was conducted to all the patients. Total and maximum subtotal TG resection was performed in 90% patients, nonradical operation--in 10%, 23% patients were reoperated. Postoperative monitoring according to chart was done with application of dynamic scintigraphy and determination of the thyroglobuline level in the blood serum. The TG residual tissue (RT) was revealed in 61% patients and in 39%--the cancer metastases in the lymphatic nodes. RT of TG was eliminated in 86.8% patients after the first radioiodine therapy course conduction in middle remedial activity (2.79 +/- 0.11) GBq, the metastases devitalization--in 67.9% in middle remedial activity (4.07 +/- 0.12) GBq.