Self-Retaining Retractor Widox® for Thyroid Surgeries: Technical Note.

During a thyroidectomy, perfect exposure of the vascular nerve structures, parathyroid gland, trachea, larynx, esophagus, and lymphnodes is crucial to facilitate the surgeon in the meticulous dissection. WIDOX® (MOSS Spa, Lesa, Italy) is an atraumatic self-retaining thyroidectomy retractor specifically designed for thyroid surgeries with an octagonal shape and six retractors (Fig. 1). It is a sterile, single-use device which keeps the surgical wound and the neck muscles retracted allowing the proper exposure of the operatory field. The device substitutes the manual retractors held by the surgeon's assistants. In our institute, we started using the self-retaining retractor WIDOX® from May 2015 for a total of 50 patients. From our preliminary experience, the self-retaining retractor WIDOX® is simple and practical and can be adapted to each patient. The use of energy-based devices and the neuromonitoring is not prevented by the presence of this retractor.

Continuous Intraoperative Neuromonitoring (C-IONM) Technique with the Automatic Periodic Stimulating (APS) Accessory for Conventional and Endoscopic Thyroid Surgery.

One of the most important trends in intraoperative neural monitoring (IONM) in thyroid surgery is currently the real-time monitoring of the vagus nerve (VN) in order to prevent recurrent laryngeal nerve (RLN) iatrogenic damages. Notably, continuous intraoperative neuromonitoring (C-IONM) seems to be superior to intermitted intraoperative neural monitoring (I-IONM) because it enhances standardization by permanent vagus nerve (VN) stimulation, and it provides entire and constant RLN function monitoring as the surgeon dissects and removes the thyroid gland. It also has to be highlighted that the surgical maneuvers for the automatic periodic stimulating (APS) placement must be accurate and standardized in order to avoid a potential iatrogenic morbidity on the VN function. We recommend the experienced surgeon be very careful in each step, with cautious dissection. With this review article we provide a comprehensive analyses of C-IONM technique with the APS accessory for conventional and endoscopic thyroid surgery.

Endovascular repair of a celiac trunk aneurysm with a new multilayer stent.

Operative treatment of celiac trunk aneurysms has traditionally involved open repair using simple ligation, interposition graft, resection, and direct repair or antegrade bypass from the aorta; recently, endovascular techniques have been proposed in selected cases. We report a 60-year-old man presenting with a celiac trunk aneurysm that we treated with a new multilayer stent with the aim of preserving the parent vessels arising from the aneurysm. Computed tomography angiography at the 12-month follow-up visit confirmed the patency of the stents, the complete thrombosis of the sac without impairment of the main branches, and the regular perfusion of the liver and spleen.

Twenty-year experience of femoral artery aneurysms.

BACKGROUND: The purpose of this experience was to define patient characteristics, aneurysm anatomy and presentation, types of utilized repair options, and temporal changes over 2 decades in the management of femoral artery aneurysms (FAAs). METHODS: Between January 1988 and December 2009, 27 patients with a total of 35 true FAAs were analyzed. Histologic examination was obtained for all the operated FAAs. Postoperative follow-up included clinical and radiologic examinations every 6 months in the first year and once per year thereafter. RESULTS: There were 25 men; mean age was 65 ± 19 years. Aneurysms involved the common femoral artery in 20 cases (57%), the superficial femoral artery in 9 cases (26%), and the profunda femoris artery in 6 cases (17%). Seven patients (26%) had bilateral aneurysms, and 13 patients (48%) had additional aneurysms. Overall, 10 FAAs (29%) were symptomatic. Mean aneurysm diameter was 46 ± 19 mm. Three patients with four aneurysms were not operated on, and 31 aneurysms were finally operated on. Intensive care unit admission was never needed and hospital mortality was not registered. Major complications occurred in 3 cases (3 of 31; 8.5%) only. Amputations were never performed. Mean follow-up was 56 ± 49 months. No graft thrombosed and only a late (6 months) anastomotic pseudoaneurysm was detected and treated with an endograft. Patients' survival was 93% ± 0.5% at 6 months, 88.6% ± 0.6% at 1 year, and 77.6% ± 1.2% at 5 years. CONCLUSION: FAAs have been uncommon and rarely isolated lesions. Surgical repair offered good results either in elective or urgent settings.

Shortening hospital stay for thyroid surgery.

The number of outpatient surgical procedures performed in hospitals, increases daily. In some countries, such as Italy, outpatient operations outnumber inpatient operations. The incidence of thyroid disorders and, in particular, the cancer forms, has been increasing sharply for many years in several countries. Even if thyroid surgery is performed with low morbidity, no mortality and short operation time, some potentially lethal complications are strong arguments against shortening of hospital stay. The purpose of this review is to examine the relevant updated published results on the outcome measures that can be used to assess the quality of shortstay surgery for thyroid disease with well-controlled trials. We discuss the special ethical and legal issues that this thyroid surgery raises. Searches were last updated in May 2007.

A Giant-Cell Lesion with Cellular Cannibalism in the Mandible: Case Report and Review of Brown Tumors in Hyperparathyroidism.

A small radiolucent area in the mandible was discovered in a 58-year-old woman with no oral complaints. The patient's history included only hypertension. The lesion was considered as an inflammatory cyst and was enucleated. Three months later, a CT revealed the presence of a cyst-like lesion in the mandible with thin expanded buccal cortical plate, localized erosion, and a polylobate appearance on the lingual aspect of the cortical plate. The histological diagnosis of the lesion was central giant-cell granuloma (CGCG). The lesion was thoroughly enucleated. Nevertheless, another X-ray carried out six months later revealed multiple bilateral osteolytic areas throughout the jaw. In addition, widespread cortical plate erosion was observed, as well as signs of root resorption and periodontal enlargement. There was no sign of neurological involvement, although the nerves appeared to be dislocated. After full blood chemistry analysis and detailed collection of radiographs, the final diagnosis was brown tumors in primary hyperparathyroidism. This case report demonstrates how dental clinicians may be the first-line specialists who identify a complex systemic disease before other clinicians. Finally, it highlights the role of cellular cannibalism in predicting the clinical aggressiveness of brown tumors as well as in other giant-cell lesions.