ABSTRACT
The "difficult thyroidectomies" (DT) are motivated by several factors that, alone or in association with each other, make surgery more laborious and increase the related risks. Topographical, technical and anatomical criteria have been used by us to classify DT with a view to illustrating specific problems and suggesting appropriate strategies. According to topographical criteria we considered mediastinal goiter and resurgery; according to technical criteria we considered the presence of auto-immune thyroiditis and locally advanced malignancies; on the basis of anatomical criteria, we considered the presence of "non recurrent" laryngeal nerve and of a pre-operatory vocal cord palsy.
Subject(s)
Goiter, Substernal/surgery , Thyroidectomy/methods , Thyroiditis, Autoimmune/surgery , Humans , Recurrent Laryngeal Nerve Injuries/etiology , Reoperation , Risk Factors , Thyroidectomy/adverse effectsSubject(s)
Thyroid Gland/surgery , Thyroidectomy/methods , Elective Surgical Procedures/methods , Humans , Hypoparathyroidism/prevention & control , Intraoperative Complications/prevention & control , Minimally Invasive Surgical Procedures/methods , Neck Muscles/surgery , Neoplasm Recurrence, Local/surgery , Postoperative Complications/prevention & control , Recurrent Laryngeal Nerve Injuries/prevention & control , Reoperation , Thyroid Neoplasms/surgeryABSTRACT
AIM: To review and to update the management protocols in thyroid surgery proposed two years ago by 1st Consensus Conference called on the topic by the Italian Association of Endocrine Surgery Units (UEC Club). METHOD: The 2nd Consensus Conference took place November 30, 2008 in Pisa within the framework of the 7th National Congress of the UEC Club. A selected board of endocrinologists and endocrine surgeons (chairmans: Paolo Miccoli and Aldo Pinchera; speaker: Lodovico Rosato) examined the individual chapters and submitted the consensus text for the approval of several experts. This plain and concise text provides the rationale of the thyroid patient management and wants to be the most complete possible tool for the physicians and other professionals in the field. CONCLUSIONS: The diagnostic, therapeutic and healthcare management protocols in thyroid surgery approved by the 2nd Consensus Conference are officially those proposed by the Italian Association of Endocrine Surgery Units (UEC Club) and are subject to review by two years.
Subject(s)
Patient Care Management , Thyroid Diseases/diagnosis , Thyroid Diseases/surgery , Thyroidectomy , Clinical Protocols , Humans , Italy , Patient Discharge , Risk Factors , Societies, Medical , Thyroid Diseases/therapy , Thyroidectomy/adverse effects , Thyroidectomy/methodsABSTRACT
AIM: The aim of the study was to draw up a management protocol in parathyroid surgery promoted by the Italian Association of Endocrine Surgery Units (UEC Club), based on the guidelines of the main international scientific societies and shared by the experts and applied by the operators in the sector. METHODS AND CONSENSUS: The management protocols, already presented in 2003, on the occasion of the current review were examined by the 1st Consensus Conference called on the topic by the Italian Association of Endocrine Surgery Units (UEC). The Conference comprised two distinct sessions, the first in November 2006 within the framework of the 5th National Congress of the UEC Club in Verona, and the second in September 2007 within the framework of the 10th Multidisciplinary Scanno Prize Meeting. A selected board of endocrinologists and endocrine surgeons examined the individual chapters and submitted the consensus text for the approval of several experts. CONCLUSIONS: The diagnostic, therapeutic and healthcare management protocols in parathyroid surgery approved by the 1st Consensus Conference are officially those proposed by the Italian Association of Endocrine Surgery Units (UEC Club) and are subject to review by October, 2009.
Subject(s)
Parathyroid Glands/pathology , Parathyroid Glands/surgery , Parathyroid Neoplasms/diagnosis , Parathyroid Neoplasms/surgery , Patient Care Management , Delivery of Health Care , Humans , Italy , Parathyroid Diseases/diagnosis , Parathyroid Diseases/surgery , Societies, MedicalABSTRACT
Aim of the work is the in vitro evaluation of normal and tumoral thyroid tissue relaxation times, in order to obtain useful information for MR Imaging in vivo. Water proton high-resolution MR spectra, together with T1 and T2 relaxation times, have been measured in normal and tumoral thyroid tissues. The longitudinal relaxation time T1 was particularly sensitive to pathologic tissue: significant differences (mean: 243 ms) were observed between normal and tumoral tissues, which is a useful finding for the successful application of MR techniques to the detection of tumors in the thyroid gland. The average T1 relaxation time, for each class of examined tumors, correlates qualitatively with the degree of malignancy. On the contrary, the transverse relaxation time T2 was insensitive to pathologic changes in the tissues. The analysis of water proton spectra showed the overall Free Induction Decay constant T2 to allow an easier discrimination than T2 between normal and pathologic thyroid tissue. Thus, T1-weighted sequences probably provide better discrimination than T2-weighted scans in the evaluation of normal and tumoral thyroid tissues.
