Contralateral surgery in patients scheduled for total thyroidectomy with initial loss or absence of signal during neural monitoring.

BACKGROUND: Staged total thyroidectomy has been advised to prevent bilateral recurrent laryngeal nerve paralysis when loss of the signal from neural monitoring is observed after dissection of the initial thyroid lobe. This is supported by expert opinion but hard evidence is lacking. A lost signal can return during surgery or, even if it persists, its positive predictive value is only in the range 60-70 per cent. The aim of the present study was to investigate the clinical outcome of patients in whom total thyroidectomy was performed following loss of signal after dissection of the first thyroid lobe. METHODS: This was a prospective observational study of adult patients scheduled for neural monitoring during total thyroidectomy. The prevalence of first-side absence or loss of signal was recorded. The contralateral thyroid lobe was approached routinely. The vagus and recurrent laryngeal nerves on the first side were retested during and at the end of the contralateral procedure. RESULTS: Some 462 patients were included. Loss (32 patients) or initial absence (8) of signal at dissection of the first thyroid lobe was noted in 40 patients (8·7 per cent). Total thyroidectomy was completed in 29 patients, and a change of surgical strategy adopted in 11 patients with benign disease. At retesting, 15 of 37 initially silent nerves recovered electromyographic signal after a mean(s.d.) interval of 30(14) min. Postoperative vocal cord palsy/paresis was demonstrated in 24 of 40 patients. One patient developed a bilateral paresis that could be managed conservatively. CONCLUSION: After an absence or loss of signal of the recurrent laryngeal nerve following dissection of the first thyroid lobe, contralateral thyroidectomy can be performed safely, avoiding the expense, psychological burden and potential complications of a second procedure.

Salivary epidermal growth factor correlates with hospitalization length in rotavirus infection.

BACKGROUND: The IFI27 interferon gene expression has been found to be largely increased in rotavirus (RV)-infected patients. IFI27 gene encodes for a protein of unknown function, very recently linked to epidermal proliferation and related to the epidermal growth factor (EGF) protein. The EGF is a low-molecular-weight polypeptide that is mainly produced by submandibular and parotid glands, and it plays an important physiological role in the maintenance of oro-esophageal and gastric tissue integrity. Our aim was to determine salivary EGF levels in RV-infected patients in order to establish its potential relationship with IFI27 increased expression and EGF-mediated mucosal protection in RV infection. METHODS: We conducted a prospective comparative study using saliva samples from 27 infants infected with RV (sampled at recruitment during hospital admission and at convalescence, i.e. at least 3 months after recovery) and from 36 healthy control children. RESULTS: Median (SD) EGF salivary concentration was 777 (529) pg/ml in RV-infected group at acute phase and 356 (242) pg/m at convalescence, while it was 337 (119) pg/ml in the healthy control group. A significant association was found between EGF levels and hospitalization length of stay (P-value = 0.022; r2 = -0.63). CONCLUSIONS: The salivary levels of EGF are significantly increased during the acute phase of natural RV infection, and relate to length of hospitalization. Further assessment of this non-invasive biomarker in RV disease is warranted.

Prospective study on loss of signal on the first side during neuromonitoring of the recurrent laryngeal nerve in total thyroidectomy.

BACKGROUND: Staged thyroidectomy has been recommended when loss of the signal from intraoperative nerve monitoring is observed after first-side dissection of the recurrent laryngeal nerve. There is no high-quality evidence supporting this recommendation. In addition, it is not clear whether signal loss predicts postoperative vocal cord paralysis. METHODS: This was a prospective observational study of consecutive adult patients undergoing neuromonitored total thyroidectomy for either malignancy or multinodular goitre. The prevalence of first-side loss of signal was recorded. Surgery was completed, and vagus and laryngeal nerves on the first side were rechecked at the end of the procedure. RESULTS: Two-hundred and ninety patients were included. Loss of signal on the first side was noted in 16 procedures (5.5 per cent). Thyroidectomy was completed and, at retesting, 15 of 16 initially silent nerves recovered an electromyographic signal with a mean(s.d.) amplitude of 132(26) mcV. Mean time to recovery was 20.2 (range 10-35) min. In no patient was the signal lost on the opposite side. Only three of 15 nerves with a recovered signal were associated with transient vocal cord dysfunction. CONCLUSION: After loss of signal of the recurrent laryngeal nerve dissected initially, there was a 90 per cent chance of intraoperative signal recovery. In this setting, judicious bilateral thyroidectomy can be performed without risk of bilateral recurrent nerve paresis.

Foot-sparing postoperative compression bandage: a possible alternative to the traditional bandage.

OBJECTIVES: To verify whether a foot-sparing bandage is effective for patients who have undergone varicose vein surgery, being in the C2 class, having a normal deep venous system and actively walking. METHODS: Ninety consecutive lower legs meeting the inclusion criteria underwent treatment with an inelastic foot-sparing bandage. Patient's satisfaction, efficacy and local effects were systematically documented. RESULTS: The bandage was well tolerated and highly effective. Four of the first 20 cases experienced a slight morning oedema of the foot, which disappeared while walking. Thus, in the remaining cases we covered the foot and distal limb with a custom short tubular-shaped 'sock' providing 10 mmHg compression, only during the first 24 hours. CONCLUSION: The foot-sparing inelastic bandage is effective, cheap and tolerated by well-selected patients who have undergone varicose vein surgery.

Injury to the abdominal aorta during laparoscopic surgery: an unusual presentation.

IMPLICATIONS: Laparoscopic cholecystectomy is a very common surgical procedure, and vascular injuries account for one third of major complications during this surgery. We describe an unusual presentation of an abdominal aorta injury.

[Study of the squamous cell carcinoma (SCC) antigen in benign diseases]. / Estudio del antígeno del carcinoma de células escamosas (scc) en las enfermedades benignas.

BACKGROUND: The values of the squamous cell carcinoma (SCC) antigen in benign diseases were studied with the aim of determining false positive values in the study of epidermoid carcinomas. METHODS: Serum determinations of the SCC antigen were performed by radioimmunoanalysis with the Abbott SCC-RIA kit. The control group was made up of a total of 719 subjects of whom 317 were healthy blood donors and 402 were healthy women with normal cervicovaginal cytology. The study group was made up of 693 women with benign diseases. RESULTS: Ninety-eight point two percent of the subjects from the control group presented values under 2.5 ng/ml, therefore this value was chosen as the maximum limit of normality. Higher values than this threshold of normality were observed in 11.7% of the 34 patients with chronic disease (0.1-18.2 ng/ml) and in 57.5% of the 40 patients with chronic renal failure (0.5-6.0 ng/ml). CONCLUSIONS: In patients with chronic liver disease or chronic renal failure, the serum determination of the squamous cell carcinoma antigen loses its value as a tumor marker of epidermoid carcinomas given the risk of obtaining false positive values.