Abstract:
Effects of exertion on hormone secretion SIR,-We have already reported changes in plasma cortisol, testosterone, growth hormone, renin activity, and serum osmolality in a group of Finnish sportsmen who ran a non- competitive marathon over the classical course in Athens in October 1973.1-Asthese data suggested a correlation between physical fitness and changes in hormone profiles we investigated a similar group of nine amateurObjective To study the relationship between the thyroidectomy patterns and injury of the recurrent laryngeal nerve (RLN) in patients with benign thyroid neoplasms. Methods Five hundred eighty and six patients with benign thyroid neoplasms were treated by surgery from January 1995 to December 2002. There were 153 males and 433 females, ranging in age from 15 to 65 years old. In 486 patients, subtotal thyroidectomy was 356, partial thyroidectomy 152 and neoplasm resection alone 78. The factors of paralysis of RLN were analyzed. Results Injury incidence of RLN was 5.80 % (34 / 586) in all surgery patients. The rate of paralysis of RLN was higher in subtotal thyroidectomy (88.24 %, 30/34) than that in partial thyroidectomy (11.76 %, 4 / 34) (P 0.05). Conclusion The incidence of injury of RLN is related with the patterns of thyroidectomy. The incidence of injury of RLN is highest in subtotal thyroidectomy patients.The anatomy of RLN and identification in the procedure of thyroidectomy would be avoid to the paralysis of RLN.
Subtotal thyroidectomy
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Objective To compare the incidence of recurrent laryngeal nerve (RLN) injury in thyroidectomy with or without exposing RLN. Methods Records of 704 patients in our hospital undergoing thyroidectomy were retrospectively studied, among whom 472 patients underwent thyroidectomy with RLN being exposed and 232 underwent thyroidectomy without RLN being exposed. Results The incidence of RLN temporary damage and permanent damage in RLN exposed group was 1.49% (7/472) and 0, while it was 6. 03% (14/232)and 2. 16%(5/232) in the non-exposed group. There was statistic difference between the two groups in terms of permanent injury incidence and operation duration (P ＜ 0. 01). Conclusions Although the operation duration was prolonged in RLN exposure group, RLN exposure during operation is very helpful to prevent recurrent laryngeal nerve injury. Therefore, it's necessary to expose RLN during operation in sub-total thyroidectomy and total thyroidectomy.
Key words:
Thyroidectomy; Recurrent laryngeal nerve damage; Thyroid diseases
Nerve Injury
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Objective:To study the methods of exposure of recurrent laryngeal nerve(RLN) in the opration of thyroid neoplasms and its effect in preventing the damage of RLN.Methods:Three hundreds and ninty sides subtotal or total thyroidectomy were performed on 252 patients with the exposure of RLN in the last 3 years.Results:Only 4 of all cases occurred transient RLN paralysis.The RLN paralysis rate was 1.03% in this series.Conclusion:The exposure of RLN in thyroidectomy can efficiently prevent permanent RLN paralysis.
Laryngeal paralysis
Vocal Cord Paralysis
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Objective To investigate the value of monitoring the recurrent laryngeal nerve(RLN) by laryngeal electromyography in thyroidectomy.Methods 46 patients(27 cases wih carcinoma,6 with multiple adenoma and 13 with nodal goiters) were treated by total thyroidectomy(36 cases),subtotal thyroidectomy(6 cases) or hemithyroidectomy(4 cases).NIM-Neuro 3.0 electromyography monitor system was used and the electromagnetic signals from the vagus nerve and RLN were obtained before and after operation.RLN palsy rates were assessed.Results One of 44 patients with preoperative normal bilateral vocal cord function had temporory RLN palsy who recovered in 2 months and none of permanent RLN palsy or voice change occured.2 patients with preoperative PLN palsy had not the contralateral vocal cord disfunction postoperatively.Conclusion Real time intraoperative neuromonitoring is helpful for quick identification and protection of RLN in thyroidectomy,especially in total thyroidectomy and re-operation.
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Background: The world health organization estimates that worldwide 2 billion people still have iodine deficiency Objectives: Is to make comparison between the effect of identification of recurrent laryngeal nerve (RLN) and non-identification of the nerve on incidence of recurrent laryngeal nerve injury (RLNI) in different thyroidectomy procedures.
Type of the study: cross –sectional study.
Methods: 132 patients with goiters underwent thyroidectomy .Identification of RLN visually by exposure were done for agroup of them and non-identification of the nerves for the other group. The outcomes of RLNI in the two groupsanalyzed statistically for the effect of Identification of RLN on decreasing the incidence of the nerveinjury .The benefits of identification of RLN evaluated in each procedure ofthyroidectomy which were total thyroidectomy (TT), near totalthyroidectomy (NTT), and subtotal thyroidectomy (STT).Patients were followed up monthly for 6 months by indirect laryngoscopy for mobility of the vocal cords.
Results: 132 patients underwent thyroidectomy,258 RLNswere at risk, 124 nerves were identified and134 nerves were not identified,1 RLN was injured in identified group, and 8 RLN were injured in non-identified group. The pvalue was (0.0393) which was significant. TT were performed for 56 patients (42.4%) and total hemi thyroidectomy(THT) for 6patients(4.5%), there were 118 RLNs at risk, 64RLNs were identified and 54 RLNs were not identified.1RLN was injured in identified group, and 7RLNs were injured in non-identifiedgroup, the pvalue was(0.023)which was significant.NTT procedure were performed for 38 patients(28.8%) , 76 RLNs were at risk. 30 RLNswere identified and none of themwas injured, 46 RLNswere not identified, 1 RLN was injured the p value was(1)which was not significant.STT were performed for 32patients(24.4%),64 RLNs were at risk. 30 RLNs were identified and 34 RLNs not identified,there was no nerve injury in both groups .
Conclusions: identification of RLN decrease incidence of RLNI in TT, while there was no significant increase of RLNI in NTT and STT when the nerve was not identified
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Objective: To determine the risk of vocal fold paralysis in patients who underwent total thyroidectomy with and without intraoperative recurrent laryngeal nerve identification.
Methods:
Study design: Retrospective cohort study
Setting: Tertiary military hospital
Population: 237 adult patients who underwent total thyroidectomy for benign lesions based on post-operative histopathology operated on by senior third or fourth year residents. Excluded were those who underwent lobectomy with isthmusectomy or reoperation/completion thyroidectomy, had intrathoracic goiters, confirmed malignancies based on post-operative histopathology, or cases wherein the RLN had to be sacrificed due to gross involvement of the nerve caused by malignancy.
Results: Group A, wherein intraoperative identification of RLN was done, had a temporary and permanent RLN injury incidence of 2.75% and 0.92% respectively. Group B, wherein intraoperative identification of RLN was not done, had a temporary and permanent RLN injury incidence of 17.19% and 12.5% respectively. Through binary linear regression, the probability of having temporary paralysis increases almost two-fold if the nerve is not identified, and the probability of having permanent paralysis increases by almost nine-fold if the nerve is not identified.
Conclusion: We recommend routine intraoperative RLN identification, which has a lower risk for temporary and permanent vocal fold paralysis when compared to non-identification of the RLN.
Keywords: cranial nerve injuries/prevention and control, recurrent laryngeal nerve injuries, thyroid neoplasms/surgery, thyroidectomy/adverse effects, vocal cord paralysis/prevention control
Vocal Cord Paralysis
Histopathology
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Objective To investigate the significance of routine exposure of recurrent laryngeal nerve (RLN)in thyroidectomy.Methods The data of consecutive 232 patients with thyroidectomies during 2009-2010 were retrospectively reviewed.All operations,either lobectomy or total thyroidectomy were performed by the same surgeons.The RLN was identified routinely during the operation.Results Totally 280 RLNs were exposed in 181 thyroid lobectomies and 51 total thyroidectomies(98.9%).Ten patients experienced post-operative hoarseness(3.6%).Seven patients were diagnosed with paralysed vocal cord post-operatively,although the RLN were identified intact during the surgeries,and their voice became normal in 2 months.Another 3 patients'RLNs were transected injured and re-anastomosed during the same procedures and their voice became normal in 4 months.Conclusions Exposing the recurrent laryngeal nerve in the thyroidectomy is an effective way to prevent permanent injury to RLN.
Key words:
Thyroidectomy; Recurrent laryngeal nerve; Nerve injury
Vocal Cord Paralysis
Recurrent nerve
Iatrogenic injury
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The nationally-recognized Susquehanna
Chorale will delight audiences of all
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Objective To compare the complication incidence rate of injury of recurrent laryngeal nerve(RLN) in thyroidectomy to dissect and not to dissect RLN.Methods Retrospective study was conducted to analyze the data of 861 patient's records in our hospital who underwent thyroidectomy.Results The temporary damage rate and permanent damage rate of RLN dissected group were 1.4% and 0;Meanwhile in not dissected group they were 5.2% and 1.0%.The differences between two groups were significant(P0.001).Conclusion To dissect recurrent laryngeal nerve in operation can prevent recurrent laryngeal nerve damage.
Nerve Injury
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