Non-recurrent inferior laryngeal nerve: case report and review of the literature.

Total thyroidectomy is nowadays the operation of choice in the majority of endocrine surgery centers, whether the pathology is benign or malignant. To obtain good results, a thorough knowledge of local anatomy and a profound respect for hemostasis are necessary. Routine, at least visual, identification of the inferior laryngeal nerve (ILN) is considered gold standard and is strongly recommended. Surgeons are generally aware of the variations the nerve can have, especially on the right side. Although very rare, one such variation, with possible great impact on outcomes, is the non-recurrent route of the nerve. We present the case of a middle-aged woman with a multinodular goiter scheduled for elective surgery. During total thyroidectomy, on the right side, we were not able to find the inferior laryngeal nerve in its usual position, using the customary anatomical landmarks. Instead, we encountered it emerging directly from the right vagus nerve, at a rather right angle and entering the larynx as a unique non-bifurcating nerve. Thus, it could be spared from any injury and protected, although it could have been easily confounded with a vascular structure, given its transverse course.We think it is never overmuch to repeat that the routine identification and exposure of the inferior laryngeal nerve is a must for the thyroid surgeon in order to safely preserve its integrity.

Laparoscopic myomectomy.

Uterine leiomyoma is the most common benign tumour occurring in women in the reproductive age. It is typically found during the middle and later reproductive years. The prevalence quoted in literature ranges from 20-50% based on post mortem studies. The symptoms usually reported by women with fibroids are the following: abnormal gynaecologic haemorrhage, chronic pelvic pain, dyspareunia, as well as urinary and bowel symptoms, urinary frequency or retention and, in some cases, infertility. During pregnancy, premature labor might be caused, interfering with the position of the fetus or abortion could be induced. However, only 30% of the women develop symptoms, most of them being asymptomatic. It was proved that the factors that can cause fibroids are the following: genetic, hormonal, and growth factors, especially transforming the growth factor beta (TGFb)-related cellular changes. As diagnosis tools, studies are revealing that ultrasound has been shown to be an insufficient method of myoma mapping, and magnetic resonance imaging should be preferred for surgical therapy planning. The contour of the endometrial cavity is delineated by using trans vaginal ultrasound and saline infusion hysterosonography, but hysteroscopy is the gold standard to evaluate the uterine cavity.

Effect of short-term lithium carbonate administration in hyperthyroidism, with or without associated ophthalmopathy.

The study was carried out on 21 female hyperthyroid patients aged 22-53 years, with or without associated ophthalmopathy, admitted to the Endocrinology ward of the 1st Medical Clinic of the Craiova County Hospital, Romania, between 1983 and 1985. Administration of lithium carbonate was proceeded and followed by radioimmunoassay (RIA) determinations of T3 and T4 and measurement of Achilles' reflex (AR). Two regimens were employed. The first comprised ten patients receiving doses of 500 mg/day lithium carbonate and the second 11 patients who had an associated ophthalmopathy and who received 250 mg/day lithium carbonate and 30 mg/day carbimazole. Lithium administration was discontinued after 4 weeks. The results of the therapy suggest a possible intervention of lithium carbonate in the process of blocking the biosynthesis of thyroid hormones and/or its regulating processes, with concomitant improvement of the clinical status, much more in the patients without ophthalmopathy.

Investigation of thermic transition and renaturation of high polymerized DNA extracted from thyroid nodule.

The study was carried out on 16 cases of mixed thyroid hypertrophy in which total or partial thyroidectomy was performed. Fragments collected intraoperatively from the thyroid nodule were used for extraction of high polymerized DNA. At the same time with quantitative evaluation of DNA, RNA and proteins were also assayed. The thermic transition mean temperature of the DNA extracted from the thyroid nodule is compared to other standards (DNA-HP-standard, calf thymus DNA, normal leukocytic DNA) and the thermic transition curves are presented. Hyperchromicity after thermic denaturation and renaturation is analysed and expressed in per cent values.