Ectopic parathyroid adenoma located inside the hypoglossal nerve.

BACKGROUND: Intraneural parathyroid adenomas are extremely rare, with only 9 cases of intravagal adenomas reported. We report the first case of an ectopic parathyroid adenoma located within the hypoglossal nerve. METHODS AND RESULTS: A 62-year-old woman presented with a palpable nodule in the right submandibular area, reduced bone mass, and elevated calcium and parathormone levels. Preoperative investigation with neck ultrasound and MRI did not provide a definitive diagnosis, whereas sestamibi scan showed slightly increased radiotracer accumulation in the same area. Intraoperatively, the right hypoglossal nerve was found to course through the lesion and, despite the attempt to salvage it, most of its fibers were transected. Histopathology confirmed the presence of a parathyroid adenoma inside the trunk of a nerve. Postoperatively, calcium and parathormone levels decreased but right hypoglossal nerve paresis was noted. CONCLUSION: This unique case emphasizes the variability of parathyroid anatomy and the difficulties faced by the surgeon when treating this disease process.

Risk factors influencing conversion of laparoscopic to open cholecystectomy.

BACKGROUND: Conversion of laparoscopic to open cholecystectomy is required in certain cases for the safe completion of the operation. Some factors contribute more to the need for conversion. METHODS: Over a 13-year period, the laparoscopic cholecystectomy procedure was attempted in 1263 patients whose mean age was 54 years and 28% being male. The conversion was necessary in 98 cases whose mean age was 60 years, with 42% being male. All data were studied retrospectively. Six factors were examined statistically for a possible correlation with the conversion rate, as well as the trend of it over time. RESULTS: The main reason for conversion was the unclear anatomy owing to previous inflammation, followed by bleeding and choledocholithiasis suspicion, gallbladder carcinoma, bile duct injury, or spilled gallstones. The overall conversion rate was 7.75%. It was significantly increased in males (11.6%) and the elderly (12.4 %), gallbladder inflammation (29%), and morbid obesity (50%). Conversion rate did not change significantly in the first half period (8.1%) of the study, the second half-period (7.6%), in patients with diabetes mellitus (6.7%), or hematological disorders (6%). CONCLUSIONS: The risk for the conversion of laparoscopic cholecystectomy increases significantly in males, the elderly, obese patients, and when inflammation is present. This observation remains unchanged over time. Diabetes mellitus and hematologic disorders do not predispose in a higher risk for conversion.

Efficacy and safety of ultrasonically activated shears in thyroid surgery.

BACKGROUND: The purpose of this prospective study is to evaluate the efficacy of ultrasonically activated shears (UAS) in hemostasis as well as its safety in regard to complications in thyroid surgery. METHODS: Three hundred patients who had undergone surgery on the thyroid gland were divided into 2 groups of 150 patients each. Hemostasis as well as division of blood vessels and thyroid tissue were performed with the use of UAS in the first group and by conventional ligations in the second group. RESULTS: The use of UAS resulted in as much as a 39.7% reduction in the operative time of the total thyroidectomy and a 30.8% reduction of the lobectomy (p < .001). However, there was no important difference in the postoperative blood loss in either the temporary hypoparathyroidism or the paresis of recurrent laryngeal nerves. CONCLUSIONS: The use of UAS in thyroid surgery is a safe method for hemostasis, as well as for the division of blood vessels and thyroid tissue. It leads to the reduction of the total operative time without serious complications.

Changes in coagulation and fibrinolysis during laparoscopic cholecystectomy.

BACKGROUND: The influence of laparoscopic cholecystectomy on coagulation and fibrinolysis is debatable. There have been a few but controversial studies and the need for routine antithrombotic prophylaxis is unclear. MATERIALS AND METHODS: In this prospective study we investigated changes in coagulation and fibrinolysis parameters in laparoscopic cholecystectomy. Blood samples taken before, during, and after surgery from 38 consecutive patients were analyzed. Measured parameters included the international normalized ratio, prothrombin time, partial thromboplastin time, antithrombin III activity, platelet count, mean platelet volume, fibrinogen, and D-dimers. RESULTS: Statistically significant changes included increased perioperative international normalized ratio and D-dimers, and postoperative antithrombin III, fibrinogen, and D-dimers, as well as decreased perioperative antithrombin III and fibrinogen and postoperative international normalized ratio, platelet count, and mean platelet volume. Values of partial thromboplastin time had no statistically significant changes. CONCLUSION: Reduced coagulation activity and increased fibrinolytic activity occur during and after laparoscopic cholecystectomy.