ABSTRACT
Tinnitus is a phantom perception of sound in the absence of overt acoustic stimulation. The focus of our attention is a combined therapy of tinnitus. In this prospective study (2013-2014) we evaluated the data of normal-hearing patients with tinnitus treated with various treatment modalities. In Group 1 we evaluated the data of 84 patients/124 ears after six weeks of treatment with betahistine dihydrochloride (72 mg). In Group 2, we evaluated the data of 36 patients/ 55 ears unimproved from Group 1 who were then treated for six weeks with hyperbaric oxygen (HBO2) therapy combined with gingko biloba extract (120 mg). In Group 1, tinnitus disappeared in 9.7%, alleviated in 18.5% and improved overall in 28.2%. Average intensity of tinnitus before/after treatment was 37 decibels (dB)/33 dB. Tinnitus intensities after treatment are statistically significantly lower (p = 0.001) than the values before treatment. In Group 2 tinnitus disappeared in 5.4%, 36.4% achieved alleviation, and 41.8% showed overall improvement. The average intensity of tinnitus before/after treatment was 41dB/ 38dB. The values of tinnitus intensity after combined therapy are statistically significantly lower (p = 0.046). We have shown that both methods treatment of tinnitus are statistically significant. HBO2therapy was recommended for the general public.
Subject(s)
Betahistine/therapeutic use , Hearing , Hyperbaric Oxygenation , Plant Extracts/therapeutic use , Tinnitus/therapy , Vasodilator Agents/therapeutic use , Adult , Aged , Combined Modality Therapy/methods , Female , Ginkgo biloba , Humans , Male , Middle Aged , Prospective Studies , Severity of Illness IndexABSTRACT
BACKGROUND: The purpose of this study was to evaluate preoperative features, surgical details, and postoperative findings related to the identification of parathyroid glands and to establish the relationship between identification of parathyroid glands and postoperative hypocalcemia. METHODS: Seven hundred eighty-eight total thyroidectomies performed between January 2002 and April 2012 by a single surgeon were studied. To evaluate the impact of parathyroid glands identification on study variables, patients were stratified into 2 study groups: group 1 with 0 to 2 parathyroid glands identified and group 2 with 3 to 4 parathyroid glands identified. RESULTS: Multivariate analysis identified younger age (p = .007), female sex (p = .001), and no usage of the Biclamp hemostatic technique (p < .001) related to the higher number of parathyroid glands identified. Univariate analysis revealed a higher incidence of temporary hypocalcemia (p = .015) and permanent hypoparathyroidism (p = .040) in group 2 than in group 1. CONCLUSION: Identification of a higher number of parathyroid glands is associated with a higher incidence of postoperative temporary hypocalcemia and permanent hypoparathyroidism.
Subject(s)
Hypocalcemia/physiopathology , Parathyroid Glands/surgery , Parathyroidectomy/methods , Thyroidectomy/methods , Adult , Age Factors , Aged , Aged, 80 and over , Analysis of Variance , Cohort Studies , Dissection , Female , Humans , Hypocalcemia/etiology , Incidence , Logistic Models , Male , Middle Aged , Monitoring, Intraoperative/methods , Multivariate Analysis , Parathyroid Glands/abnormalities , Parathyroidectomy/adverse effects , Postoperative Complications/epidemiology , Postoperative Complications/physiopathology , Prognosis , Retrospective Studies , Risk Assessment , Sex Factors , Statistics, Nonparametric , Thyroidectomy/adverse effects , Treatment Outcome , Young AdultABSTRACT
OBJECTIVE: To identify incidence, preoperative features, surgical factors, and postoperative events of incidental parathyroidectomy (IP) during thyroidectomy. STUDY DESIGN: A total of 1068 consecutive patients who underwent thyroidectomy performed by a single surgeon between January 2003 and April 2012 were enrolled in retrospective study with prospectively collected data. SETTING: University hospital. SUBJECTS AND METHODS: To assess the impact of IP on study variables, patients were stratified into 2 study groups: IP group and non-IP group. Univariate and multivariate analyses identified significant correlates of IP. RESULTS: In all, 5.4% patients experienced IP. Significant difference (P < .001) was in incidence of temporary hypocalcemia between IP group (36.2%) and non-IP group (16.8%). Multivariable logistic regression model identified total thyroidectomy (odds ratio 3.937, 95% confidence interval [CI] 1.462-10.601, P = .007) and Graves' disease (odds ratio 2.192, 95% CI 1.157-4.158, P = .016) as risk-adjusted factors associated with IP. Multivariate analysis of repeated measures identified statistically significant difference of repeated total calcium level (P < .001) and ionized calcium level (P = .020) between study groups. CONCLUSION: IP during thyroidectomy might be potential complication. Total thyroidectomy, Graves' disease, longer operation time, and identification 3 and more parathyroid glands seemed to be predictive factors for IP. IP is significantly associated with temporary hypocalcemia, but not with permanent hypoparathyroidism.
Subject(s)
Neck Dissection/methods , Parathyroidectomy , Thyroid Diseases/surgery , Thyroidectomy , Adult , Aged , Czech Republic/epidemiology , Female , Humans , Incidence , Incidental Findings , Male , Middle Aged , Postoperative Complications/epidemiology , Retrospective Studies , Treatment OutcomeABSTRACT
Metastases in the thyroid gland are very rare. Even the rarer are sarcoma metastases. A 52-year-old woman was referred to our department for evaluation of a nodule in the right lobe of the thyroid gland. She had a history dermatosarcoma of the abdominal wall with known metastasis in the lung. Clinically she had neck pain and worsened swallowing. Objective assessment (ultrasound, computed tomography, and magnetic resonance) indicated a voluminous right lobe nodule with mechanical syndrome, and a fine-needle aspiration biopsy revealed a very suspicious malignant finding. After surgery, the diagnosis was metastasis of dermatofibrosarcoma protuberans. Subsequent treatment was radio- and chemotherapy.
