Experimental study of the morphological and electromyographic characteristics of the most frequent iatrogenic lesions of the recurrent laryngeal nerves in thyroid surgery.

INTRODUCTION: Iatrogenic lesions of the recurrent laryngeal nerves remain one of the most severe and frequent complications in thyroid surgery. According to Eisele (Laryngoscope 1996;106:443) their incidence varies between 1% and 12% depending on the size of surgery. AIM: The aim of the study was to examine experimentally the type of neural lesion and the efficiency of stimulation electromyography for immediate evaluation of the recurrent laryngeal nerve function in the most common surgical traumas. MATERIAL AND METHODS: Ten clinically healthy and parasite-free male dogs of mixed breed weighing from 11 to 18 kg were used in the experiment. The injured laryngeal nerves of the experimental animals were examined histologically using Sudan III staining for myelin and Bilshovsky staining for neurofibrils. The intraoperative electromyography was performed with Neurostim 100. RESULTS: The results show severe damage both of the myelin sheath and neurofibrils in most of the surgical traumas of the nerve fiber. The electromyography of the laryngeal musculature shows complete interruption of the conduction of the action potential in all types of experimental lesions. CONCLUSION: EMG intraoperative monitoring of the laryngeal nerves appears the most effective measure to avoid the complication.

Correlations between arthroscopic findings and synovial membrane histology in patients with rheumatoid synovitis of the knee joint.

UNLABELLED: Correlation and agreement between the diagnostic results of arthroscopic and histological examinations of the synovial membrane in rheumatoid synovitis of the knee joint have been discussed in small number of studies with contradictory conclusions. AIM: The aim of the present study was to determine the correlation between the arthroscopic characteristics and histology of the synovial membrane in patients with rheumatoid arthritis and synovitis of the knee joint. METHODS: Sixty-four arthroscopies of the knee joint with guided multiple synovial biopsies were performed in patients with rheumatoid synovitis. Biopsy samples were taken under visual control from the evidently inflamed synovia in four regions of the knee joint. Arthroscopic assessment of the rheumatoid synovitis was done according the standard system of ACR including 6 criteria. The histological assessment of the synovitis met the EULAR criteria including 6 morphological variables. RESULTS: High positive correlation (r = +0.76) was established between the arthroscopic and histological assessment of the rheumatoid synovitis in the examined patients. High values were also found for the k coefficient for agreement (k = 0.70). The mean value of synovitis extent according to VAS was 43.16 mm and the mean value of intensity of the inflammatory process according to VAS was 54.31 mm. CONCLUSION: The agreement between the arthroscopic and histological diagnosis of the synovitis is in the range of high but not absolute correlation. The two methods are not contradictory and should be used concurrently in patients with chronic rheumatoid synovitis.

Recurrence of epidermoid cyst in the third ventricle. Case report.

The authors present the case of a 34-year-old man. The patients was admitted for the second time in the clinic. A year before an epidermoid cyst of the third ventricle, obstructing the two foramen Monroe and causing acute hydrocephaly, was surgically removed. In the operative intervention a cerebral fenestration of the lateral cerebral ventricle was performed and the epidermoid cyst was totally extirpated through the right foramen Monroe under operative microscope. The patient was discharged in excellent state, without complaints and neurological symptoms. The patient received attacks of severe headaches, staggering gate and double vision two months before his second admission. The neurological examination revealed paresis of left nervus abducens, staggering gait and pronounced psychic symptoms. The computed tomography of the brain revealed cystic formation, 3.4 cm in diameter, in the front part of the third cerebral ventricle. The intervention was performed after preoperative management of the patient and a cystic tumor with the histologic characteristics of an epidermoid cyst was totally extirpated under operative microscope, using the same approach as in the first operation. The patient was discharged in good state without complaints and no abnormalities detected in the neurological status.