Influence of neural monitoring during thyroid surgery on nerve integrity and postoperative vocal function.

BACKGROUND: Integrity of the recurrent laryngeal nerve (RLN) and the external branch of the superior laryngeal nerve (EBSLN) can be checked by intraoperative nerve monitoring (IONM) after visualization. The aim of this study was to determine the prevalence and nature of voice dysfunction following thyroid surgery with routine IONM. METHODS: Thyroidectomies were performed with routine division of strap muscles and nerve monitoring to confirm integrity of the RLN and EBSLN following dissection. Patients were assessed for vocal function before surgery and at 1 and 3 months after operation. Assessment included use of the Voice Handicap Index (VHI) 10, maximum phonation time, fundamental frequency, pitch range, harmonic to noise ratio, cepstral peak prominence and smoothed cepstral peak prominence. RESULTS: A total of 172 nerves at risk were analysed in 102 consecutive patients undergoing elective thyroid surgery. In 23·3 per cent of EBSLNs and 0·6 per cent of RLNs nerve identification required the assistance of IONM in addition to visualization. Nerve integrity was confirmed during surgery for 98·8 per cent of EBSLNs and 98·3 per cent of RLNs. There were no differences between preoperative and postoperative VHI-10 scores. Acoustic voice assessment showed small changes in maximum phonation time at 1 and 3 months after surgery. CONCLUSION: Where there is routine division of strap muscles, thyroidectomy using nerve monitoring confirmation of RLN and EBSLN function following dissection results in no clinically significant voice change.

Sphenopalatine foramen: endoscopic approach with bony landmarks.

OBJECTIVE: To establish whether nasal bony landmarks on computed tomography could be utilised reliably in endoscopic approaches to the sphenopalatine foramen. METHODS: A prospective analysis of 102 consecutive helical computed tomography scans of the paranasal sinuses was carried out by 2 senior ENT surgeons. Distances from the sphenopalatine foramen to endoscopically palpable bony landmarks were measured. RESULTS: There were a total of 102 patients (45 females and 57 males), with a mean age of 62 years. The mean distance from the posterior fontanelle to the sphenopalatine foramen was 14.1 mm (standard deviation = 2.13). The average vertical distance of the sphenopalatine foramen opening from the bony attachment of the inferior turbinate was 14.13 mm. There were no statistically significant differences between any of these measurements (foramen width p-value = 0.714, distance from fontanelle p-value = 0.43 and distance from inferior turbinate p-value = 0.48). CONCLUSION: Determination of reliable bony landmarks is clinically useful in endoscopic surgery and can aid identification of the sphenopalatine foramen. The inferior turbinate concha and posterior fontanelle may be used as reliable computed tomography landmarks for endoscopic approaches to the sphenopalatine foramen.

Cough after laryngeal herpes zoster: a new aspect of post-herpetic sensory disturbance.

OBJECTIVE: Although neurogenic cough is increasingly recognised, its pathophysiology remains obscure. We describe two cases of chronic cough following laryngeal herpes zoster, a rarely described manifestation of varicella-zoster virus reactivation, and suggest that this may be analogous to post-herpetic neuralgia. The same mechanisms may cause both phenomena. CASE REPORTS: We describe two cases of chronic cough persisting for more than three months following an acute attack of laryngeal herpes zoster. CONCLUSION: Neuronal damage by varicella-zoster virus results in irritable nociceptors and deafferentation, mechanisms known to cause post-herpetic neuralgia. When the vagus nerve is affected, as in laryngeal herpes zoster, the result may be a chronic cough. Similar damage may underlie chronic neurogenic cough in other contexts.

Identification of tristetraprolin as a factor that modulates the stability of the TAFI transcript through binding to the 3'-untranslated region.

BACKGROUND: Thrombin-activatable fibrinolysis inhibitor (TAFI) is a basic carboxypeptidase zymogen encoded by the human gene CPB2. TAFI constitutes a molecular link between coagulation and fibrinolysis, and between coagulation and inflammation. The 3'-untranslated region (UTR) of the human CPB2 mRNA plays a key role in regulating CPB2 mRNA abundance, but the exact mechanisms that mediate this regulation are largely unexplored. OBJECTIVES: To pinpoint cis-acting elements in the CPB2 3'-UTR that act as stability determinants and to identify protein factors binding to these sites. METHODS: We constructed a series of plasmids encoding mRNAs containing rabbit ß-globin sequences (as a reporter) fused to sequences of the CPB2 3'-UTR (encompassing 5' and internal deletions). These plasmids were transfected into HepG2 (human hepatoma) cells and the stability of the fusion transcripts measured. We performed a series of gel mobility shift analyses using RNA probes encompassing putative (in)stability elements. RESULTS: We identified one element conferring stability and three elements conferring instability. Supershift assays identified the protein bound to the site between the second and third polyadenylation sites as tristetraprolin (TTP). Mutation of the TTP site abolished TTP binding in gel mobility shift assays and also stabilized ß-globin/CPB2 fusion transcripts. TTP knockdown stabilized the fusion transcript containing the TTP site, but not a fusion transcript in which this site was mutated. CONCLUSIONS: Our findings are indicative of a role for TTP in constitutive, and perhaps regulated, control of CPB2 mRNA stability and hence abundance.

Extracorporeal shock wave lithotripsy in the management of pediatric urolithiasis.

The main objective of this paper was to evaluate the efficacy and safety of the management of pediatric urolithiasis by extracorporeal shock wave lithotripsy (ESWL). Between November 1988 and July 2000, 165 renal stones, 53 ureteral stones, and 5 bladder stones were treated in 126 pediatric patients using Siemens Lithostar lithotriptor. The ESWL treatments ranging from 1 to 7 were needed per patient (mean: 2.1). One ESWL session was performed for 49.6% of stones, two for 24.6%, three for 13.0 %, four for 5.6% and > 4 for 8.2%. The success rate for renal stone units (asymptomatic fragments less than 4 mm) was 88.2%, stone-free rate was 49.0%. The stone-free rate for ureteral stone units was 87.5%, but was 75% for bladder stones. The overall results of ESWL treatment in 126 children was satisfactory: the success rate was 90.5%, stone-free rate was 51.6%, residual fragments > 4 mm were 9.5%. General anesthesia was required in 65 children (136 treatments) under the age of 10, and only in 18 children (40 treatments) in the age 11-14. Auxiliary procedures, such as double J stent and percutaneous nephrostomy (PCN) were used in 19 and 7 patients, respectively. Perirenal hematoma in one patient and hematomas in enteric wall in another one patient were the only major complications managed conservatively without consequences. Low energy lithotripsy with the Siemens Lithostar in our series of pediatric patients was safe and relatively effective.

[Indications for female sterilization in our surgical records]. / Indikacije za sterilizaciju zena na nasem operativnom materijalu.

During the period of 1970--1979 there were 303 patients sterilized by the Madlener method. Out of the them number. The highest number was delivered by caesarean section (182, 60%), and the highest number of the sterilized in the group of caesarean, section were multiparae with seven and more living children (102, 89.5%), then those with the third caesarean section (38, 76%), the fourth (3, 75%), the second (22, 10%), and the first caesarean section (17, 3.42%). Special conditions for sterilization were age, more than 30 years old, with three and more children with medical and socio-economic indications. In 21 women (40%) sterilization was performed as an additional intervention to the other laparatomies, when there was a special care about the number of living children (above three), age and medical indications. There were 3 (0,99%) failed sterilisations (one ectopic pregnancy and two in utero). The authors advocate women's free declaration for sterilization and respective legal acts.

[Comparison of the results of interruption of advanced pregnancy using prostaglandin F2-alpha and a NaCl solution]. / Uporedni rezultati prekida odmakle trudnoce prostagladinom F2-alpha i 20% rastvorom NaCl.

PIP: This article discusses the parallel results of interruption of advanced pregnancy (14-20 weeks) with Prostaglandin F2alpha (PGF2alpha) and a 20% NaCl solution. 40 mg of PGF2a was administered intraamniotically with another 20 mg administered if abortion did not occur within 24 hours. The 20% NaCl solution was given intraamniotically and without aspiration of the fetal liquid in a quantity of 200 ml in some of the patients. Likewise, with the 20% NaCl solution, an intravenous (IV) infusion of syntocyne was administered drop by drop (average dosage 0.19 Ij/minute). This procedure was carried out until abortion of the fetus took place in 1/2 of the patients, while in the second 1/2 it was performed until abortion of the placenta. The abortion was considered a failure it it did not take place within 48 hours (with administration of both agents). In 67 cases, abortion was successful with PGF2alpha. In 4 patients it failed and was terminated by induction with syntocyne. However the 20% NaCl solution and IV syntocyne infusion resulted in abortion in 71 patients. The following number of incomplete abortions was registered: 20.9% with PGF2alpha and 16.9% with hypertonic NaCl solution. The latency period was 22.21 hours with PGF2alpha and 21 hours with 20% NaCl solution. Side effects (vomiting, diarrhea, fever) were higher with the PGF2alpha. 2 cases of diffuse peritonitis were registered, each due to each one of the agents, and both patients recovered. Better results with the 20% NaCl were due to the parallel IV infusion of syntocyne. However, caution must be exercised as this utertonic may cause genital organ lesions.^ieng