A. I. Garifullin, R. M. Absaliamova, A. Dubinina, A. I. Yufanova, V. M. Smirnova, J. T. Ishbulatova, M. V. Sharabarova, E. A. Khusnutdinova, D. Safronova, A. A. Gabdullina, A. I. Aibulatov, D. R. Sitdikova
Primary hyperparathyroidism is the third most common disease of the endocrine system. It is characterized by an increase in parathyroid hormone, hypercalcemia, hypercalciuria, hypophosphatemia. Symptoms include polyuria, bone pain, weakness, and constipation. In most cases, primary hyperparathyroidism is caused by solitary parathyroid adenoma — 85%. Other causes include hyperplasia (5%), multiple adenomas (<5%), and cancer (<1%). However, particular attention in this article is paid to two causes of primary hyperparathyroidism: parathyroid adenoma and cancer, as they are of high interest both from a molecular point of view and from the clinical features of these tumors. In addition, these tumors overlap in their symptoms and signs and the diagnosis is often made only after histological examination. In total, we identified 2700 articles, of which 66 met the inclusion criteria. The 66 included studies were topical for tumor lesions of the parathyroid gland. They were held between 1997 and 2022. This review emphasizes the importance of further research of the molecular features of these diseases and, possibly, targeted treatment options, since, for example, in cancer, even with R0 resection, the risk of recurrence is high. The article also focuses on the issues of the new World Health Organization 2022 classification of tumor lesions of the parathyroid gland, which is also important for a unified study of these tumors.
{"title":"Main parathyroid tumors","authors":"A. I. Garifullin, R. M. Absaliamova, A. Dubinina, A. I. Yufanova, V. M. Smirnova, J. T. Ishbulatova, M. V. Sharabarova, E. A. Khusnutdinova, D. Safronova, A. A. Gabdullina, A. I. Aibulatov, D. R. Sitdikova","doi":"10.14341/serg12756","DOIUrl":"https://doi.org/10.14341/serg12756","url":null,"abstract":"Primary hyperparathyroidism is the third most common disease of the endocrine system. It is characterized by an increase in parathyroid hormone, hypercalcemia, hypercalciuria, hypophosphatemia. Symptoms include polyuria, bone pain, weakness, and constipation. In most cases, primary hyperparathyroidism is caused by solitary parathyroid adenoma — 85%. Other causes include hyperplasia (5%), multiple adenomas (<5%), and cancer (<1%). However, particular attention in this article is paid to two causes of primary hyperparathyroidism: parathyroid adenoma and cancer, as they are of high interest both from a molecular point of view and from the clinical features of these tumors. In addition, these tumors overlap in their symptoms and signs and the diagnosis is often made only after histological examination. In total, we identified 2700 articles, of which 66 met the inclusion criteria. The 66 included studies were topical for tumor lesions of the parathyroid gland. They were held between 1997 and 2022. This review emphasizes the importance of further research of the molecular features of these diseases and, possibly, targeted treatment options, since, for example, in cancer, even with R0 resection, the risk of recurrence is high. The article also focuses on the issues of the new World Health Organization 2022 classification of tumor lesions of the parathyroid gland, which is also important for a unified study of these tumors.","PeriodicalId":30783,"journal":{"name":"Endokrinnaia khirurgiia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47586034","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The case histories of 414 patients who were operated on for mild diseases of the thyroid gland (DTH) were retrospectively studied. The study is aimed at studying the cytological material in the preoperative period and the comparative assessment of the postoperative histological material of patients operated on for the thyroid gland. As a result of the study, it was found that the share of nodular goiter with euthyroid function (UEZ) and multinodular euthyroid goiter (MUEZ) accounts for 269 patients, which is 65%. In 87 patients (21%), diffuse-toxic goiter (DTG) and nodular toxic goiter with the formation of functional autonomy (FA) were revealed; autoimmune thyroiditis (AIT) in 58 cases (14%). All 414 patients with tonic aspiration biopsy of the thyroid gland showed good changes in the cytological material. After the diagnosis, preoperative preparation, 294 patients (71%) out of 414 underwent thyroidectmia with DTZ, FA, with MUEZ and a significant increase in thyroid gland volume. Hemityroidectomy was performed in 178 patients (29%) with one-sided nodular lesion of the thyroid gland with preserved normal hormonal background. In 94% of cases, there is a coincidence of cytological and histological studies, a benign result of a biopsy material was confirmed in 389 patients. In 6% of cases (25 patients), there is a discrepancy between cytological and histological studies.
{"title":"Cytology as a reliable method of verifying the diagnosis at the preoperative stage","authors":"G. R. Aizetullova, V. Osipov","doi":"10.14341/serg12770","DOIUrl":"https://doi.org/10.14341/serg12770","url":null,"abstract":"The case histories of 414 patients who were operated on for mild diseases of the thyroid gland (DTH) were retrospectively studied. The study is aimed at studying the cytological material in the preoperative period and the comparative assessment of the postoperative histological material of patients operated on for the thyroid gland. As a result of the study, it was found that the share of nodular goiter with euthyroid function (UEZ) and multinodular euthyroid goiter (MUEZ) accounts for 269 patients, which is 65%. In 87 patients (21%), diffuse-toxic goiter (DTG) and nodular toxic goiter with the formation of functional autonomy (FA) were revealed; autoimmune thyroiditis (AIT) in 58 cases (14%). All 414 patients with tonic aspiration biopsy of the thyroid gland showed good changes in the cytological material. After the diagnosis, preoperative preparation, 294 patients (71%) out of 414 underwent thyroidectmia with DTZ, FA, with MUEZ and a significant increase in thyroid gland volume. Hemityroidectomy was performed in 178 patients (29%) with one-sided nodular lesion of the thyroid gland with preserved normal hormonal background. In 94% of cases, there is a coincidence of cytological and histological studies, a benign result of a biopsy material was confirmed in 389 patients. In 6% of cases (25 patients), there is a discrepancy between cytological and histological studies.","PeriodicalId":30783,"journal":{"name":"Endokrinnaia khirurgiia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48819368","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background. One of the most common complications during thyroid surgery after hypoparathyroidism is a violation of the mobility of the vocal folds - paresis or paralysis of the larynx. The incidence of damage to the recurrent laryngeal nerves during primary surgical interventions can vary from 1 to 30%. Intraoperative neuromonitoring is the most effective method to reduce the amount of damage to the laryngeal nerves during surgical interventions on the thyroid and parathyroid glands. Assessment of the state of the vocal cords in the preoperative and postoperative period is crucial. In the preoperative period, this helps establish baseline characteristics and identify pre-existing laryngeal paresis, while postoperative early identification of vocal cord paresis helps develop a rapid treatment plan. Indirect laryngoscopy is still considered the reference standard for vocal cord examination. The main advantage is the ability to visualize the vocal cords in 99% of cases. However, this is an invasive procedure that can be painful and uncomfortable for patients, and increases medical costs and lead time.Materials and methods. The results of intraoperative neuromonitoring were analyzed in 25 patients who underwent total thyroidectomy according to indications (diffuse nodular non-toxic goiter — 17 patients (68%), diffuse nodular toxic goiter — 4 patients (16%), autoimmune thyroiditis, diffuse — nodular form — 4 patients (16%)), from September 2021 to February 2022. The patients’ age ranged from 18 to 73 years. There were 23 women (92%), men — 2 (8%). In the study, a C2 neuromonitor (InoMed, Germany), an electrode for EMG recording on an endotracheal tube, and a bipolar forked stimulating probe were used. To assess the mobility of the vocal folds, all patients underwent percutaneous ultrasonography before and after thyroid surgery.Results and discussion. In 20 patients (80%) before surgery on transcutaneous ultrasound of the larynx, the visualization of the structures of the larynx was good (grade 4-5), in 2 male patients (8%), the visualization of the structures of the larynx was satisfactory (grade 3), in 3 women (older than 45 years (12%)) — visualization of the structures of the larynx was satisfactory (grade 3), in all 25 patients (100%) — complete or normal symmetrical movement of the vocal folds (grade I). During the performance of precision extrafascial thyroidectomy in 3 patients (12%), a decrease in the amplitude of oscillations was recorded during stimulation of the left recurrent laryngeal nerve and the left vagus nerve, in order to prevent bilateral paresis of the larynx, it was decided to confine ourselves to hemithyroidectomy followed by a staged right-sided hemithyroidectomy. A day after the performed left-sided hemithyroidectomy, percutaneous ultrasound of the larynx in 2 patients showed a violation of the mobility of the vocal fold on the left (grade II), in 1 patient — symmetrical movement of the vocal folds (grade I) — a false positive
{"title":"The advantage of the combined use of intraoperative neuromonitoring and percutaneous ultrasonography of the larynx as a screening for postoperative vocal cord paresis","authors":"E. K. Baychorov, D. A. Kazeev, N. A. Uzdenov","doi":"10.14341/serg12766","DOIUrl":"https://doi.org/10.14341/serg12766","url":null,"abstract":"Background. One of the most common complications during thyroid surgery after hypoparathyroidism is a violation of the mobility of the vocal folds - paresis or paralysis of the larynx. The incidence of damage to the recurrent laryngeal nerves during primary surgical interventions can vary from 1 to 30%. Intraoperative neuromonitoring is the most effective method to reduce the amount of damage to the laryngeal nerves during surgical interventions on the thyroid and parathyroid glands. Assessment of the state of the vocal cords in the preoperative and postoperative period is crucial. In the preoperative period, this helps establish baseline characteristics and identify pre-existing laryngeal paresis, while postoperative early identification of vocal cord paresis helps develop a rapid treatment plan. Indirect laryngoscopy is still considered the reference standard for vocal cord examination. The main advantage is the ability to visualize the vocal cords in 99% of cases. However, this is an invasive procedure that can be painful and uncomfortable for patients, and increases medical costs and lead time.Materials and methods. The results of intraoperative neuromonitoring were analyzed in 25 patients who underwent total thyroidectomy according to indications (diffuse nodular non-toxic goiter — 17 patients (68%), diffuse nodular toxic goiter — 4 patients (16%), autoimmune thyroiditis, diffuse — nodular form — 4 patients (16%)), from September 2021 to February 2022. The patients’ age ranged from 18 to 73 years. There were 23 women (92%), men — 2 (8%). In the study, a C2 neuromonitor (InoMed, Germany), an electrode for EMG recording on an endotracheal tube, and a bipolar forked stimulating probe were used. To assess the mobility of the vocal folds, all patients underwent percutaneous ultrasonography before and after thyroid surgery.Results and discussion. In 20 patients (80%) before surgery on transcutaneous ultrasound of the larynx, the visualization of the structures of the larynx was good (grade 4-5), in 2 male patients (8%), the visualization of the structures of the larynx was satisfactory (grade 3), in 3 women (older than 45 years (12%)) — visualization of the structures of the larynx was satisfactory (grade 3), in all 25 patients (100%) — complete or normal symmetrical movement of the vocal folds (grade I). During the performance of precision extrafascial thyroidectomy in 3 patients (12%), a decrease in the amplitude of oscillations was recorded during stimulation of the left recurrent laryngeal nerve and the left vagus nerve, in order to prevent bilateral paresis of the larynx, it was decided to confine ourselves to hemithyroidectomy followed by a staged right-sided hemithyroidectomy. A day after the performed left-sided hemithyroidectomy, percutaneous ultrasound of the larynx in 2 patients showed a violation of the mobility of the vocal fold on the left (grade II), in 1 patient — symmetrical movement of the vocal folds (grade I) — a false positive","PeriodicalId":30783,"journal":{"name":"Endokrinnaia khirurgiia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49599209","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. V. Gostimskiy, Z. Matveeva, A. Romanchishen, I. V. Karpatskiy, A. Kuzmichev, S. Peredereev, D. V. Makharoblishvili
Background. Primary hyperparathyroidism (PHPT) is a rare pathology in pediatric and adolescent patients. Collection, analysis and generalization of the literature data and experience of the leading clinics allow to develop unified, statistically substantiated approaches to diagnostics and surgical treatment of this group of patients.Material and methods. The article presents a retrospective analysis of 17 cases of PHPT in children and adolescents aged from 6 to 18 years operated on in the department of Surgery of St.-Petersburg State Pediatric Medical University in the period from 1973 till 2021. Among those operated there were 10 girls and 7 boys, the M:F ratio was 1:1.4. The mean age of the patients was 12,9±0,71 years.Results and discussion. The main criteria of the disease diagnosis were elevated blood calcium and parathormone levels, excessive urinary calcium secretion. Manifest forms of the disease were diagnosed in 10 (58,8%) of 17 children. In 3 (17,6%) cases the parathyroid neoplasms were accompanied neither by clinical, nor laboratory manifestations of the disease and were regarded as incidentalomas. Another 4 (23.5%) patients had only laboratory changes (hypercalcemia and hyperparathyrinaemia) that manifested themselves preoperatively. These observations were referred to the asymptomatic form of PHPT.In 7 (41.2%) cases parathyroid adenomas were found and removed during surgeries for various thyroid diseases (thyroid cancer in 5 cases, diffuse toxic goiter in 1 case). An incidental finding of parathyroid adenoma was during prophylactic thyroidectomy for Sipple syndrome.A radioisotope method proved to be the most informative way to localize parathyroid tumors.Conclusion. The diagnosis of the disease in manifest sporadic cases does not differ from that in adults. Genetic study is indicated in the presence of a family history of multiple involvement of the parathyroid glands. Surgical treatment with removal of parathyroid tumor is the main method, which allows to achieve complete recovery.
{"title":"Features of the diagnosis of primary hyperparathyroidism in children","authors":"A. V. Gostimskiy, Z. Matveeva, A. Romanchishen, I. V. Karpatskiy, A. Kuzmichev, S. Peredereev, D. V. Makharoblishvili","doi":"10.14341/serg12758","DOIUrl":"https://doi.org/10.14341/serg12758","url":null,"abstract":"Background. Primary hyperparathyroidism (PHPT) is a rare pathology in pediatric and adolescent patients. Collection, analysis and generalization of the literature data and experience of the leading clinics allow to develop unified, statistically substantiated approaches to diagnostics and surgical treatment of this group of patients.Material and methods. The article presents a retrospective analysis of 17 cases of PHPT in children and adolescents aged from 6 to 18 years operated on in the department of Surgery of St.-Petersburg State Pediatric Medical University in the period from 1973 till 2021. Among those operated there were 10 girls and 7 boys, the M:F ratio was 1:1.4. The mean age of the patients was 12,9±0,71 years.Results and discussion. The main criteria of the disease diagnosis were elevated blood calcium and parathormone levels, excessive urinary calcium secretion. Manifest forms of the disease were diagnosed in 10 (58,8%) of 17 children. In 3 (17,6%) cases the parathyroid neoplasms were accompanied neither by clinical, nor laboratory manifestations of the disease and were regarded as incidentalomas. Another 4 (23.5%) patients had only laboratory changes (hypercalcemia and hyperparathyrinaemia) that manifested themselves preoperatively. These observations were referred to the asymptomatic form of PHPT.In 7 (41.2%) cases parathyroid adenomas were found and removed during surgeries for various thyroid diseases (thyroid cancer in 5 cases, diffuse toxic goiter in 1 case). An incidental finding of parathyroid adenoma was during prophylactic thyroidectomy for Sipple syndrome.A radioisotope method proved to be the most informative way to localize parathyroid tumors.Conclusion. The diagnosis of the disease in manifest sporadic cases does not differ from that in adults. Genetic study is indicated in the presence of a family history of multiple involvement of the parathyroid glands. Surgical treatment with removal of parathyroid tumor is the main method, which allows to achieve complete recovery. ","PeriodicalId":30783,"journal":{"name":"Endokrinnaia khirurgiia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41858126","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background. Modern methods of topical diagnostics have high accuracy and can determine the morphological structure of the adrenal tumor with high probability before surgery, but none of them has 100% sensitivity and specificity. Contrast-enhanced computed tomography is most commonly used by clinicians. The criteria for the malignancy of an adrenal tumor determined by this method continue to be discussed.The aim is to evaluate the effectiveness of contrast-enhanced computed tomography in the preoperative diagnosis of adrenal tumors and to analyze errors.Materials and methods. Contrast-enhanced computed tomography was performed in 69 patients with adrenal tumors. After morphological examination of the removed tumors, the effectiveness of preoperative diagnostics was evaluated with the determination of sensitivity and specificity of the method. If the pre- and postoperative diagnosis did not match, the causes of errors were analyzed.Results. The attenuation on unenhanced CT in adenomas ranged from 5 to 36 HU, in adrenocortical cancer — from 26 to 80 HU, in pheochromocytomas — from 25 to 99 HU. The attenuation of adenomas on unenhanced CT was significantly less than with pheochromocytomas (p=0.005) and adrenocortical cancer (p=0.012). In the venous phase, no significant differences were found, and in the delayed phase, the attenuation of adenomas was also significantly less than in malignant tumors (p=0.008, p=0.008). The median of absolute percent contrast washout in adenomas was 85%, in pheochromocytes — 59%, in adrenocortical cancer — 57%. When comparing the diagnosis before and after surgery, its non-coincidence was found in 8 cases (10.39%). Two patients (2.59%) with small tumors (diameter of 15 mm) were diagnosed with adenoma in combination with pheochromocytoma and adenoma before surgery. After morphological examination, the diagnosis was changed to adrenocortical cancer in combination with adenoma and «mute» pheochromocytoma.Conclusion. The sensitivity and specificity of contrast-enhanced CT in the diagnosis of adenomas was 95.61% and 94.82%, pheochromocytomas — 95% and 95.08%, adrenocortical cancer — 92.31 and 98.48%. Diagnostic errors of «mute» pheochromocytoma and adrenocortical cancer occurred with small sizes (15 mm) of adrenal tumors.
{"title":"Computed tomography in the differential diagnosis of adrenal tumors","authors":"L. Kotelnikova, Yu. V. Zhizhilev","doi":"10.14341/serg12761","DOIUrl":"https://doi.org/10.14341/serg12761","url":null,"abstract":"Background. Modern methods of topical diagnostics have high accuracy and can determine the morphological structure of the adrenal tumor with high probability before surgery, but none of them has 100% sensitivity and specificity. Contrast-enhanced computed tomography is most commonly used by clinicians. The criteria for the malignancy of an adrenal tumor determined by this method continue to be discussed.The aim is to evaluate the effectiveness of contrast-enhanced computed tomography in the preoperative diagnosis of adrenal tumors and to analyze errors.Materials and methods. Contrast-enhanced computed tomography was performed in 69 patients with adrenal tumors. After morphological examination of the removed tumors, the effectiveness of preoperative diagnostics was evaluated with the determination of sensitivity and specificity of the method. If the pre- and postoperative diagnosis did not match, the causes of errors were analyzed.Results. The attenuation on unenhanced CT in adenomas ranged from 5 to 36 HU, in adrenocortical cancer — from 26 to 80 HU, in pheochromocytomas — from 25 to 99 HU. The attenuation of adenomas on unenhanced CT was significantly less than with pheochromocytomas (p=0.005) and adrenocortical cancer (p=0.012). In the venous phase, no significant differences were found, and in the delayed phase, the attenuation of adenomas was also significantly less than in malignant tumors (p=0.008, p=0.008). The median of absolute percent contrast washout in adenomas was 85%, in pheochromocytes — 59%, in adrenocortical cancer — 57%. When comparing the diagnosis before and after surgery, its non-coincidence was found in 8 cases (10.39%). Two patients (2.59%) with small tumors (diameter of 15 mm) were diagnosed with adenoma in combination with pheochromocytoma and adenoma before surgery. After morphological examination, the diagnosis was changed to adrenocortical cancer in combination with adenoma and «mute» pheochromocytoma.Conclusion. The sensitivity and specificity of contrast-enhanced CT in the diagnosis of adenomas was 95.61% and 94.82%, pheochromocytomas — 95% and 95.08%, adrenocortical cancer — 92.31 and 98.48%. Diagnostic errors of «mute» pheochromocytoma and adrenocortical cancer occurred with small sizes (15 mm) of adrenal tumors.","PeriodicalId":30783,"journal":{"name":"Endokrinnaia khirurgiia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41686040","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Retrospective analysis of treatment outcomes of 65 patients with purulent-necrotic forms of diabetic foot: group I (35 patients), who received integrated treatment using laser therapy, group II (30 patients), who received traditional treatment. It was established that the use of laser therapy in these patients compared to traditional therapy allows reducing the duration of the inflammatory reaction in tissues (from 6-8 days to 4-5 days), and subsequently to the appearance of granulations on day 7-8 and marginal epithelization by the end of 10 days, which leads to a reduction in the length of treatment.
{"title":"Laser technologies in the treatment of patients with purulent-necrotic forms of diabetic foot","authors":"Y. Lutsenko, V. B. Akhrameev, A. B. Matiytsiv","doi":"10.14341/serg12762","DOIUrl":"https://doi.org/10.14341/serg12762","url":null,"abstract":"Retrospective analysis of treatment outcomes of 65 patients with purulent-necrotic forms of diabetic foot: group I (35 patients), who received integrated treatment using laser therapy, group II (30 patients), who received traditional treatment. It was established that the use of laser therapy in these patients compared to traditional therapy allows reducing the duration of the inflammatory reaction in tissues (from 6-8 days to 4-5 days), and subsequently to the appearance of granulations on day 7-8 and marginal epithelization by the end of 10 days, which leads to a reduction in the length of treatment.","PeriodicalId":30783,"journal":{"name":"Endokrinnaia khirurgiia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45907160","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
BACKGROUND: More than 30,000 surgical interventions on the thyroid gland are performed annually in the Russian Federation. Surgeons are developing methods for the prevention of various postoperative complications, and therefore operations on this organ are considered relatively safe. Currently, there is no unequivocal effective method to prevent postoperative hypoparathyroidism. This complication is often recorded and can threaten the life and health of the patient, which is contrary to the concept of safe surgery.AIM: To evaluate the effectiveness of intraoperative ICG angiography and intrathyroidal injection of brilliant green for the prevention of postoperative hypoparathyroidism.MATERIALS AND METHODS: 143 thyroidectomies were performed. The patients were divided into 3 groups: intraoperative angiography was used in 24 cases, brilliant green was injected to identify the parathyroid glands in 58 cases, visual assessment of the preservation of the parathyroid glands was used in 61 case. Calcium levels were measured in all patients included in the study before and after surgery.RESULTS: Serum calcium levels in the pre- and postoperative period: 2.37±0.14 and 2.27±0.17 in group 1, and 2.38±0.16 and 2.21±0.16 in group 2, 2.39±0.17 and 2.18±0.19 in group 3. Hypocalcemia in the postoperative period was significantly higher in the group with a visual assessment of the parathyroid glands relative to the first two groups. Differences between calcium levels in the postoperative period in groups 2 and 3 were significant with a probability of more than 99% (p<0.01). Significant differences (≥95%) in calcium levels in the postoperative period between groups 1 and 2 (p < 0.05) were obtained. Serum PTH levels in the postoperative period: 6,2±0,4 in group 1, 5,6±0,57 in group 2, 3,5±0,32 in group 3. Differences between PTH levels in the postoperative period in groups 1 and 3 were significant with a probability of more than 99% (p<0.01). Significant differences (≥95%) in PTH levels in the postoperative period between groups 2 and 3 (p < 0.05) were obtained.CONCLUSION: ICG angiography and brilliant green intrathyroidal injection are safe methods for identifying and preserving the parathyroid glands. The high level of hypocalcemia in group 3 indicates the need to search for new techniques in endocrine surgery in order to improve the safety of patients undergoing surgical treatment of thyroid pathology.
{"title":"Safe thyroid surgery: comparison effectiveness of ICG angiography and intrathyroidal brilliant green injection for the prevention of postoperative hypoparathyroidism","authors":"S. D. Somova, K. Vabalayte, A. Romanchishen","doi":"10.14341/serg12757","DOIUrl":"https://doi.org/10.14341/serg12757","url":null,"abstract":"BACKGROUND: More than 30,000 surgical interventions on the thyroid gland are performed annually in the Russian Federation. Surgeons are developing methods for the prevention of various postoperative complications, and therefore operations on this organ are considered relatively safe. Currently, there is no unequivocal effective method to prevent postoperative hypoparathyroidism. This complication is often recorded and can threaten the life and health of the patient, which is contrary to the concept of safe surgery.AIM: To evaluate the effectiveness of intraoperative ICG angiography and intrathyroidal injection of brilliant green for the prevention of postoperative hypoparathyroidism.MATERIALS AND METHODS: 143 thyroidectomies were performed. The patients were divided into 3 groups: intraoperative angiography was used in 24 cases, brilliant green was injected to identify the parathyroid glands in 58 cases, visual assessment of the preservation of the parathyroid glands was used in 61 case. Calcium levels were measured in all patients included in the study before and after surgery.RESULTS: Serum calcium levels in the pre- and postoperative period: 2.37±0.14 and 2.27±0.17 in group 1, and 2.38±0.16 and 2.21±0.16 in group 2, 2.39±0.17 and 2.18±0.19 in group 3. Hypocalcemia in the postoperative period was significantly higher in the group with a visual assessment of the parathyroid glands relative to the first two groups. Differences between calcium levels in the postoperative period in groups 2 and 3 were significant with a probability of more than 99% (p<0.01). Significant differences (≥95%) in calcium levels in the postoperative period between groups 1 and 2 (p < 0.05) were obtained. Serum PTH levels in the postoperative period: 6,2±0,4 in group 1, 5,6±0,57 in group 2, 3,5±0,32 in group 3. Differences between PTH levels in the postoperative period in groups 1 and 3 were significant with a probability of more than 99% (p<0.01). Significant differences (≥95%) in PTH levels in the postoperative period between groups 2 and 3 (p < 0.05) were obtained.CONCLUSION: ICG angiography and brilliant green intrathyroidal injection are safe methods for identifying and preserving the parathyroid glands. The high level of hypocalcemia in group 3 indicates the need to search for new techniques in endocrine surgery in order to improve the safety of patients undergoing surgical treatment of thyroid pathology.","PeriodicalId":30783,"journal":{"name":"Endokrinnaia khirurgiia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46711094","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background. The relevance of endoscopic interventions on the thyroid and parathyroid glands is beyond doubt, and this explains the interest in this promising choice of surgical approach both among surgeons and patients who want to avoid a scar on the neck.Aim. To evaluate the first results of own endoscopic interventions in patients with diseases of the thyroid and parathyroid glands.Materials and methods. In the Research Institute of KCH N 1 named after prof. S.V. Ochapovsky from December 2020 to April 2022, 23 hemithyroidectomies and 8 paraadenomectomies were performed using endoscopic techniques for benign neoplasms of the thyroid and parathyroid glands. All patients in the preoperative period underwent ultrasound, TAPB + CI (for thyroid pathology), and the hormonal background was studied. Indications for endoscopic hemithyroidectomy in 18 cases were colloid goiter, in 5 cases — follicular adenoma. The indication for endoscopic paraadenomectomy in all cases was primary hyperparathyroidism. We used endoscopic three-port axillary-mammary gas access. Under the ETN, an incision was made along the outer edge of the pectoralis major muscle (m. pectoralis major). Carbon dioxide was injected into the pancreas using a Verish needle. A 5 mm port was inserted along the edge of the areola. Another 10 mm trocar was installed at the attachment points (m. pectoralis major).Results. The average operation time was 190.4 minutes for endoscopic hemithyroidectomy and 78.6 minutes for endoscopic paraadenomectomy. With the increase in the number of performed operations, there was a decrease in the duration of surgical interventions. In two cases in patients after hemithyroidectomy, seromas up to 20 ml in volume were noted in the postoperative period, which required puncture interventions (once).Conclusion. Endoscopic interventions on the thyroid and parathyroid glands from axillary access are a safe method of surgical intervention, and the cosmetic result is an indisputable advantage of this method.
背景内镜干预甲状腺和甲状旁腺的相关性是毋庸置疑的，这解释了外科医生和希望避免颈部疤痕的患者对这种有前景的手术方法的兴趣。目标评估甲状腺和甲状旁腺疾病患者内镜干预的首次结果。材料和方法。2020年12月至2022年4月，在以S.V.Ochapovsky教授命名的KCH N 1研究所，使用内镜技术对甲状腺和甲状旁腺的良性肿瘤进行了23例半甲状腺切除术和8例腺旁切除术。术前对所有患者进行了超声检查，TAPB+CI（用于甲状腺病理），并对激素背景进行了研究。内镜下甲状腺半切除术的适应证为胶体甲状腺肿18例，滤泡腺瘤5例。所有病例的内镜下腺旁切除术的指征均为原发性甲状旁腺功能亢进。我们使用了内窥镜三口腋窝乳腺气体通道。在ETN下，沿着胸大肌（胸大肌）的外缘切开。使用Verish针头将二氧化碳注入胰腺。沿着乳晕的边缘插入一个5毫米的口。在附着点（胸大肌）安装另一个10mm套管针。结果：内窥镜半甲状腺切除术的平均手术时间为190.4分钟，内窥镜腺旁切除术的手术时间为78.6分钟。随着手术次数的增加，手术干预的持续时间也有所缩短。在两例甲状腺半切除术后的患者中，术后发现体积高达20ml的浆膜瘤，需要穿刺干预（一次）。结论：从腋窝对甲状腺和甲状旁腺进行内镜干预是一种安全的手术干预方法，美容效果是该方法无可争议的优势。
{"title":"Transaxillary hemithyroidectomy and parathyroidectomy: mastering the technique","authors":"Yu. S. Bondarenko, D. Salikhov, A. Petrovsky","doi":"10.14341/serg12768","DOIUrl":"https://doi.org/10.14341/serg12768","url":null,"abstract":"Background. The relevance of endoscopic interventions on the thyroid and parathyroid glands is beyond doubt, and this explains the interest in this promising choice of surgical approach both among surgeons and patients who want to avoid a scar on the neck.Aim. To evaluate the first results of own endoscopic interventions in patients with diseases of the thyroid and parathyroid glands.Materials and methods. In the Research Institute of KCH N 1 named after prof. S.V. Ochapovsky from December 2020 to April 2022, 23 hemithyroidectomies and 8 paraadenomectomies were performed using endoscopic techniques for benign neoplasms of the thyroid and parathyroid glands. All patients in the preoperative period underwent ultrasound, TAPB + CI (for thyroid pathology), and the hormonal background was studied. Indications for endoscopic hemithyroidectomy in 18 cases were colloid goiter, in 5 cases — follicular adenoma. The indication for endoscopic paraadenomectomy in all cases was primary hyperparathyroidism. We used endoscopic three-port axillary-mammary gas access. Under the ETN, an incision was made along the outer edge of the pectoralis major muscle (m. pectoralis major). Carbon dioxide was injected into the pancreas using a Verish needle. A 5 mm port was inserted along the edge of the areola. Another 10 mm trocar was installed at the attachment points (m. pectoralis major).Results. The average operation time was 190.4 minutes for endoscopic hemithyroidectomy and 78.6 minutes for endoscopic paraadenomectomy. With the increase in the number of performed operations, there was a decrease in the duration of surgical interventions. In two cases in patients after hemithyroidectomy, seromas up to 20 ml in volume were noted in the postoperative period, which required puncture interventions (once).Conclusion. Endoscopic interventions on the thyroid and parathyroid glands from axillary access are a safe method of surgical intervention, and the cosmetic result is an indisputable advantage of this method.","PeriodicalId":30783,"journal":{"name":"Endokrinnaia khirurgiia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41894779","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. I. Garayeva, E. V. Nikolaev, L. T. Khabibullina, S. Styazhkina
Aim. A clinical case of a non-functioning tumor of the adrenal gland, its diagnosis and treatment.Materials and Methods. Histological preparations were stained with hematoxylin and eosin, photographed at 200 magnification.Results. Adrenal cysts are benign neoplasms that are hormonally inactive and can be asymptomatic for a long time. They are often discovered incidentally during an ultrasound or CT scan. Prior to the improvement of diagnostic methods, formations such as adrenal cysts were extremely rare. To date, there is a trend towards a steady increase in the frequency of adrenal tumors detected incidentally and is about 6–10%. Hormonally inactive adrenal tumors usually do not require surgery, but there are clinical situations in which surgery is necessary. As an example of a disease, a clinical case is given below.Patient P., 39 years old, was hospitalized in the urology department from 12/13/2021 to 12/24/2021 with a diagnosis: D35.0 Benign neoplasm of the adrenal gland (cyst of the left adrenal gland). Upon admission, there were complaints of aching pain in the left lumbar region.He considers himself ill for several years, was treated for another disease, an ultrasound in 2018 accidentally revealed a neoplasm of the adrenal gland on the left. At the last ultrasound control, an active growth of the neoplasm was detected, for this reason he was sent for surgical treatment to the urological department of RCH 1.Surgery was performed in the hospital by laparoscopic excision of a cyst of the left adrenal gland under endotracheal anesthesia. The adrenal gland was sent for post-mortem examination, the results are presented below.The wall of the cystic formation is represented by cells of the cortical layer of the adrenal gland, corresponding to the cells of the glomerular zone. The cells are large with abundant light cytoplasm and a monomorphic nucleus. In the wall of cyst there are foci of hemorrhages and accumulations of hemosiderin pigment. Outside, the cystic formation is surrounded by a fibrous capsule.Conclusion. This paper presents an analysis of a large adrenal cyst. It is important to pay attention to the fact that this incidentaloma was asymptomatic, without any clinical signs and hormonal activity. Incidentalomas are often «silent», so it is extremely difficult to identify them, but the likelihood of degeneration into a malignant tumor is high.
{"title":"Clinical case: large cystic mass of the left adrenal gland","authors":"A. I. Garayeva, E. V. Nikolaev, L. T. Khabibullina, S. Styazhkina","doi":"10.14341/serg12760","DOIUrl":"https://doi.org/10.14341/serg12760","url":null,"abstract":"Aim. A clinical case of a non-functioning tumor of the adrenal gland, its diagnosis and treatment.Materials and Methods. Histological preparations were stained with hematoxylin and eosin, photographed at 200 magnification.Results. Adrenal cysts are benign neoplasms that are hormonally inactive and can be asymptomatic for a long time. They are often discovered incidentally during an ultrasound or CT scan. Prior to the improvement of diagnostic methods, formations such as adrenal cysts were extremely rare. To date, there is a trend towards a steady increase in the frequency of adrenal tumors detected incidentally and is about 6–10%. Hormonally inactive adrenal tumors usually do not require surgery, but there are clinical situations in which surgery is necessary. As an example of a disease, a clinical case is given below.Patient P., 39 years old, was hospitalized in the urology department from 12/13/2021 to 12/24/2021 with a diagnosis: D35.0 Benign neoplasm of the adrenal gland (cyst of the left adrenal gland). Upon admission, there were complaints of aching pain in the left lumbar region.He considers himself ill for several years, was treated for another disease, an ultrasound in 2018 accidentally revealed a neoplasm of the adrenal gland on the left. At the last ultrasound control, an active growth of the neoplasm was detected, for this reason he was sent for surgical treatment to the urological department of RCH 1.Surgery was performed in the hospital by laparoscopic excision of a cyst of the left adrenal gland under endotracheal anesthesia. The adrenal gland was sent for post-mortem examination, the results are presented below.The wall of the cystic formation is represented by cells of the cortical layer of the adrenal gland, corresponding to the cells of the glomerular zone. The cells are large with abundant light cytoplasm and a monomorphic nucleus. In the wall of cyst there are foci of hemorrhages and accumulations of hemosiderin pigment. Outside, the cystic formation is surrounded by a fibrous capsule.Conclusion. This paper presents an analysis of a large adrenal cyst. It is important to pay attention to the fact that this incidentaloma was asymptomatic, without any clinical signs and hormonal activity. Incidentalomas are often «silent», so it is extremely difficult to identify them, but the likelihood of degeneration into a malignant tumor is high.","PeriodicalId":30783,"journal":{"name":"Endokrinnaia khirurgiia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46407914","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
E. H. Gadzhieva, T. Geliashvili, M. O. Goncharov, A. Pronin, A. Krylov, V. S. Ilyakov, A. V. Parnas
Lung metastases (LM) in differentiated thyroid cancer in children occur in 7-30% of cases, 3-4 times more often than in adults. Early diagnosis of LM improves the results of radioiodine therapy and the rate of complete remissions. We present a clinical case demonstrating the specific features of LM diagnosis in children. Patient G., a 9-year-old boy, was for two years observed for excessive body weight. Ultrasound thyroid gland examination revealed multiple hypoechogenic nodules, cytologically verified papillary cancer. Computed tomography (CT) of the chest revealed subpleural foci up to 3 mm in both lungs, which were more consistent with intrapulmonary lymph nodes, but did not completely rule out metastatic lesions. A thyroidectomy with central and lateral neck dissections was performed in January 2022. Histologic examination revealed multifocal papillary cancer growth in the entire thyroid gland with Tall cell sites and metastases to multiple cervical lymph nodes. According to TNM classification (American Joint Committee on Cancer (AJCC), 8th edition), the tumor grade was considered as pT2N1bM0, stage I. Seven weeks after surgical treatment, the patient underwent whole body scintigraphy with I-123 (24 hours after I-123 injection for 50 MBq) followed by radioiodine therapy on endogenous TSH-stimulation (4 weeks of L-thyroxine withdrawal). Scintigraphy with I-123 (whole-body and SPECT/CT) did not detect iodine-accumulating tissue. However, post-therapy (72 hours after administration of 2 GBq I-131) scintigraphy (whole-body and SPECT/CT) revealed residual thyroid tissue and diffuse accumulation of I-131 in both lungs. The TSH-stimulated thyroglobulin was 118 ng/ml, and thyroglobulin antibodies were 21 IU/ml. Pathological accumulation of I-131 in the lungs in combination with the elevated thyroglobulin level and chest CT findings were regarded as LM, therefore the tumor process was restaged — pT2N1bM1, stage II and radioiodine therapy was planned to continue.Conclusion. In this clinical case, when diagnosing LM, the result of scintigraphy with I-123 was false-negative, and chest CT scan was uncertain, requiring dynamic monitoring. Scintigraphy after administration of I-131 therapeutic activity revealed LM, thereby changing further treatment strategy to continued radioiodine therapy and increasing the possibility of achieving complete disease remission. Factors associated with LM were miltifocal growth, massive neck lymph node involvement and high TSH-stimulated thyroglobulin levels.
{"title":"Radioiodine diagnosis of differentiated thyroid cancer lung metastases in children: a case report","authors":"E. H. Gadzhieva, T. Geliashvili, M. O. Goncharov, A. Pronin, A. Krylov, V. S. Ilyakov, A. V. Parnas","doi":"10.14341/serg12767","DOIUrl":"https://doi.org/10.14341/serg12767","url":null,"abstract":"Lung metastases (LM) in differentiated thyroid cancer in children occur in 7-30% of cases, 3-4 times more often than in adults. Early diagnosis of LM improves the results of radioiodine therapy and the rate of complete remissions. We present a clinical case demonstrating the specific features of LM diagnosis in children. Patient G., a 9-year-old boy, was for two years observed for excessive body weight. Ultrasound thyroid gland examination revealed multiple hypoechogenic nodules, cytologically verified papillary cancer. Computed tomography (CT) of the chest revealed subpleural foci up to 3 mm in both lungs, which were more consistent with intrapulmonary lymph nodes, but did not completely rule out metastatic lesions. A thyroidectomy with central and lateral neck dissections was performed in January 2022. Histologic examination revealed multifocal papillary cancer growth in the entire thyroid gland with Tall cell sites and metastases to multiple cervical lymph nodes. According to TNM classification (American Joint Committee on Cancer (AJCC), 8th edition), the tumor grade was considered as pT2N1bM0, stage I. Seven weeks after surgical treatment, the patient underwent whole body scintigraphy with I-123 (24 hours after I-123 injection for 50 MBq) followed by radioiodine therapy on endogenous TSH-stimulation (4 weeks of L-thyroxine withdrawal). Scintigraphy with I-123 (whole-body and SPECT/CT) did not detect iodine-accumulating tissue. However, post-therapy (72 hours after administration of 2 GBq I-131) scintigraphy (whole-body and SPECT/CT) revealed residual thyroid tissue and diffuse accumulation of I-131 in both lungs. The TSH-stimulated thyroglobulin was 118 ng/ml, and thyroglobulin antibodies were 21 IU/ml. Pathological accumulation of I-131 in the lungs in combination with the elevated thyroglobulin level and chest CT findings were regarded as LM, therefore the tumor process was restaged — pT2N1bM1, stage II and radioiodine therapy was planned to continue.Conclusion. In this clinical case, when diagnosing LM, the result of scintigraphy with I-123 was false-negative, and chest CT scan was uncertain, requiring dynamic monitoring. Scintigraphy after administration of I-131 therapeutic activity revealed LM, thereby changing further treatment strategy to continued radioiodine therapy and increasing the possibility of achieving complete disease remission. Factors associated with LM were miltifocal growth, massive neck lymph node involvement and high TSH-stimulated thyroglobulin levels.","PeriodicalId":30783,"journal":{"name":"Endokrinnaia khirurgiia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43269931","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：