[Effectiveness and results of intraoperative neuromonitoring in thyroid surgery. Statement of the Interdisciplinary Study Group on Intraoperative Neuromonitoring of Thyroid Surgery]. / Zuverlässigkeit und Konsequenzen des intraoperativen Neuromonitorings in der Schilddrüsenchirurgie. Stellungnahme der "Interdisziplinären Studiengruppe Intraoperatives Neuromonitoring Schilddrüsenchirurgie"

Intraoperative neuromonitoring (IONM) has yielded an increasing effect on thyroid surgery. During IONM, the recurrent laryngeal nerve is stimulated electrically and an acoustically transformed electromyographic signal is derived via either a needle electrode placed in the vocalis muscle or an electrode adjusted to the intubation tube. The IONM is used for identifying and predicting the function of the recurrent laryngeal nerve. Especially under difficult anatomic conditions, IONM has proven a valuable tool for identification of recurrent laryngeal nerves. This can lead to decreased occurrence of nerve palsy rates, as shown in numerous studies. The reliability of the IONM signal (defined as the correlation between intraoperative signal interpretation and postoperative vocal cord function) is reflected by a specificity as high as 98.2%, as shown by German multicenter studies. Thus, normal vocal cord function could be demonstrated postoperatively in over 98.2% of patients with intraoperatively unchanged neuromonitoring signals. If the neuromonitoring signal changed during operation, 39% of the patients suffered from transient vocal cord immobility and 12% had permanent loss of vocal cord function.

[Not all vocal cord failure following thyroid surgery is recurrent paresis due to damage during operation. Statement of the German Interdisciplinary Study Group on Intraoperative Neuromonitoring of Thyroid Surgery concerning recurring paresis due to intubation]. / Nicht jeder Stimmlippenstillstand nach Schilddrüsenoperation ist eine chirurgischbedingte Rekurrensparese. Stellungnahme der "Interdisziplinären Studiengruppe Intraoperatives Neuromonitoring Schilddrüsenchirurgie" zur Problematik intubationsbedingter Rekurrensparesen.

Since the phoniatrician H. Bauer described the first case of recurrent laryngeal nerve palsy most likely caused by intubation some 45 years ago, several case reports have been published. However, systematic analyses regarding the frequency of recurrent laryngeal nerve palsies due to intubation are scarce, and none of them has used the proper methods to demonstrate clearly that such a mechanism exists. Currently available data justify the assumption that not every recurrent laryngeal nerve palsy following thyroid surgery is due to the operation itself and that the damage caused by intubation, however, may only account for a minority of these cases. The differential diagnosis of postoperative recurrent laryngeal nerve palsy requires the use of specific tools which go beyond simple laryngoscopy and include stroboscopy as well as intra- and extralaryngeal electromyography. A partial palsy of recurrent laryngeal nerve due to intubation would be associated with severe dysphonia or aphonia, not with dyspnea because of the typical intermediate position of the paralyzed vocal folds with a normal electromyographic function of the cricothyroid muscle. The use of these methods to identify the nature of postoperative recurrent laryngeal nerve palsy is recommended in cases of regular intraoperative neuromonitoring but postoperatively impaired function of the vocal cords.

[Preventive total thyroidectomy in children with MEN IIa syndrome]. / Prophylaktische totale Thyreoidektomie bei Kindern mit MEN IIa-Syndrom.

Three children of MEN IIa-families underwent a prophylactic total thyroidectomy (at the age of 4, 7 and 8 years). Pathologic examination showed a bilateral C-cell-hyperplasia in each case. The annual follow-up of the physically and mentally well-developing children so far showed normal calcitonin provocative testing. Members of risk families should undergo a screening program as early as possible.

[Results of a comparative study of MR, CT and sonography of patients with primary hyperparathyroidism]. / Ergebnisse einer Vergleichsstudie von MR, CT und Sonographie bei Patienten mit primärem Hyperparathyreoidismus.

Twenty-three patients with primary hyperparathyroidism were examined by MR, CT and sonography in order to localise the parathyroid adenoma. In twenty patients, surgery was performed and the findings confirmed histologically. Fifteen patients had an adenoma in a parathyroid and in three, the adenoma was in the mediastinum. In one patient there was hyperplasia of all parathyroids. Accuracy of MR was 98%, of CT 98% and sonography 94% in previously unoperated patients and is therefore similar for these methods. This is also true for previously operated patients (four) where MR was 88% accurate, CT 83% and sonography 91%. In sixteen patients without previous operation, MR had the highest sensitivity with 79%. In previously operated patients, the sensitivity of MR and sonography was equal, with 67%, and CT was similar with 66%, MR was able to differentiate adenomas by the specific measurements of T1 and T2.

[The incidence of squinting in school beginners in Hamburg (author's transl)]. / Schielhäufigkeit bei Hamburger Schulanfängern.

In 830 children medically examined at the time of beginning school 20% showed conditions which needed treatment or correction. From these children half had never been in ophthalmological treatment. We found a squint in 52 children (6.3%), and from these, 9 (17.3% of the squinters) showed microstrabismus. One squinter in five had never started ophthalmological treatment. Out of the non-squinting children, however, 15 out of 778 (1.9%) had amblyopia (6/12 or worse visual acuity). In 4 cases an organic condition was the cause of the reduced visual acuity. Among the squinters amblyopia was commoner--23 out of 52 cases (44.2%). From these 4 showed bilateral amblyopia.