Does corticosteroid have any beneficial effect on voice change after thyroidectomy?

Voice alteration is one of the most common complications after thyroidectomy. It has a serious effect on social communication and economic and psychosocial status of patients. It has been hypothesized that inflammation and edema in the surgery site has a major role in voice change after thyroidectomy. This randomized clinical trial study was design to evaluate the effect of a single preoperative dose of steroid on voice change after thyroidectomy. This is a prospective randomized clinical trial with registration no. IRCT201106306925N. From all definitive candidates for total thyroidectomy, eligible patients were selected after exclusion of 12 criteria. Selected cases were randomly allocated to two groups. One group received intravenous dexamethasone preoperatively. Other group received placebo. Voice change was evaluated by Voice Impairment Score (VIS) postoperatively. Sixty-four patients were entered in the study and divided into two groups (dexamethasone and placebo). VIS was significantly different at the first day after surgery between dexamethasone (five) and controls (13; P < 0.001). This difference was seen after 7 days but without statistically significance (one vs three; P = 0.397). VIS score significantly decreased on the seventh day related to the first day (P < 0.001) in both groups. There were no significant dexamethasone complications in either group. Preoperative dexamethasone may decrease voice change after thyroidectomy.

Diagnostic values of ultrasound and the Modified Alvarado Scoring System in acute appendicitis.

BACKGROUND: Making the diagnosis of acute appendicitis is difficult, and is important for preventing perforation of the appendix and negative appendectomy results. Ultrasound and clinical scoring systems are very helpful in making the diagnosis. Ultrasound is non-invasive, available and cost-effective, and can accomplish more than CT scans. However, there is no certainty about its effect on the clinical outcomes of patients, and it is operator dependent. Counting the neutrophils as a parameter of the Alvarado Scale is not routine in many laboratories, so we decided to evaluate the diagnostic value of the Modified Alvarado Scaling System (MASS) by omitting the neutrophil count and ultrasonography. METHODS: After ethical approval of methodology in Tehran University of Medical Sciences ethical committee, we collected the data. During 9 months, 75 patients with right lower quadrant pain were enrolled in the study, and underwent abdominal ultrasonography and appendectomy, with pathological evaluation of the appendix. The MASS score was calculated for these patients and compared with pathology results. RESULTS: Fifty-five male and 20 female patients were assessed. Of these patients 89.3% had acute appendicitis. The sensitivity, specificity, PPV, NPV and accuracy rate of ultrasonography was 71.2%, 83.3%, 97.4%, 25% and 72.4%, respectively. By taking a cutoff point of 7 for the MASS score, a sensitivity of 65.7%, specificity of 37.5%, PPV of 89.8%, NPV of 11.5% and accuracy of 62.7% were calculated. Using the cutoff point of 6, a sensitivity of 85.1%, specificity of 25%, PPV of 90.5%, NPV of 16.7% and accuracy of 78.7% were obtained. CONCLUSION: Ultrasound provides reliable findings for helping to diagnose acute appendicitis in our hospital. A cutoff point of 6 for the MASS score will yield more sensitivity and a better diagnosis of appendicitis, though with an increase in negative appendectomy.

Parathyroid adenoma Localization.

BACKGROUND: Bilateral neck exploration is the gold standard for parathyroid adenoma localization in primary hyperparathyroidism. But surgeons do not have adequate experience for accurate surgical exploration and new methods are developed for surgery like unilateral exploration and minimally invasive surgery, thus, preoperative localization could reduces time and stress in surgical performance. METHOD: 80 patients with documented primary hyperparathyroidism and with raised serum calcium and parathyroid hormone (PTH) were selected. The results of ultrasonographic localization for each patient were compared with findings of surgery and 99m technetium sestamibi scintigraphy. Also variables such as preoperative serum calcium, PTH level and adenoma weight were compared between patients who had localized and non-localized adenoma with ultrasonography or Sestamibi scan. The data was compared with student's t-test. RESULTS: In a prospective diagnostic tests accuracy study, 80 patients with primary hyperparathyroidism were enrolled. Ultrasonography images detected enlarged parathyroid glands in 61 of 80 patients (76.3%) with sensitivity of 83.5% and positive predictive value (PPV) of 89.7%. Sestamibi scintigraphy detected adenoma in 63 patients (78.8%) with sensitivity of 85% and PPV of 91.3%. There was no significant deference between ultrasonography and scintigraphy in localization of adenomas. Both ultrasonography and scintigraphy used for determining localization, and they located 73 adenomas (91.3%) with sensitivity of 97.3% and PPV of 93.5%. CONCLUSION: Ultrasonography as an accurate method for localization of enlarged parathyroid glands in primary hyperparathyroidism, is comparable in overall utility with sestamibi scintigraphy. This study suggests a strategy for initial testing with one method, followed by the alternate imaging test if the first test happens to be negative.

Distribution of solitary parathyroid adenoma over the parathyroid glands and its surgical management.

OBJECTIVE: To determine the distribution of solitary parathyroid adenoma over the parathyroid glands in a group of patients with primary hyperparathyroidism Design: A case-series. PLACE AND DURATION OF STUDY: Departments of Surgery and Pathology at Shariati Hospital, Tehran, Iran, between the years 1981 and 2003. PATIENTS AND METHODS: A retrospective review of surgery reports of 118 patients with primary hyperparathyroidism was performed. All of the patients had solitary parathyroid adenoma and the anatomical location of each adenoma was clearly defined during operation. Serum calcium, phosphorus and parathormone levels along with clinical characteristics were also included. RESULTS: The distribution of adenomas over the superior and inferior parathyroid glands showed a significant higher incidence of adenoma in the lower parathyroids (p < 0.001). The right to left distribution of adenomas was not significant (p=0.4). CONCLUSION: Surgical exploration for primary hyperparathyroidism should be initiated from the lower parathyroid glands provided that pre-operative localization scans are not helpful.

Are biochemical values predictive of adenoma's weight in primary hyperparathyroidism?

BACKGROUND: Preoperative laboratory findings may carry some predictive value about the size of the abnormal parathyroid tissue that needs to be removed in primary hyperparathyroidism. METHODS: In a retrospective study from 1988 to 2003, records of 71 patients with parathyroid adenoma were reviewed. The correlation between preoperative serum calcium, phosphate and parathyroid hormone (PTH) with adenoma's weight was analysed separately. RESULTS: There was a significant correlation between preoperative serum PTH and calcium with adenoma's weight (P < 0.001 and P = 0.03, respectively). The correlation between preoperative serum phosphate and adenoma's weight was not significant (P = 0.1). CONCLUSION: Preoperative PTH level cannot be used as a definite guide to the parathyroid adenoma's weight. Large parathyroid adenomas seem to secrete less PTH per unit weight than small adenomas. Calcium and phosphate do not seem to be of much value in predicting adenoma's weight in primary hyperparathyroidism.

Primary hyperparathyroidism: a review of 177 cases.

BACKGROUND: We designed a comprehensive study to explore different aspects of primary hyperparathyroidism in a series of Iranian patients. Our study aimed to elucidate the demographic, pathologic, biochemical, and surgical findings of these patients. MATERIAL/METHODS: In a retrospective study from 1981 to 2003, we reviewed records of 177 patients operated on with the diagnosis of primary hyperparathyroidism in Shariati Hospital. Patients with secondary or tertiary hyperparathyroidism and those being re-operated were excluded. RESULTS: 88.1% of the lesions were adenoma, 9.6% hyperplasia, and 1 case proved to be carcinoma. In 1.7% of patients, no pathologic gland(s) were found. The majority of patients were female (female-to-male ratio: 5.5) and their mean age was 41.9+/-13.6 years. Most of the patients (77.6%) had mild hypercalcemia, and the mean calcium level was 11.2+/-0.8 mg/dl prior to surgery. Patients with hyperplasia had lower calcium levels than patients with adenoma 24 hours post-operation, with mean calcium levels of 8.1+/-1.2 mg/dl versus 9.03+/-1.2 mg/dl, respectively (p=0.02). Mean weight of adenomas was 4.1 gram (range 0.8-25 g). Adenomas were mostly (74%) located in lower parathyroid glands and 6.3% of them were ectopic. CONCLUSIONS: Primary hyperparathyroidism should be expected at younger ages in Iran. Parathyroid hyperplasia in a patient should alert the surgeon of the higher risk of postoperative hypocalcemia.

Diagnostic value of frozen section examination in thyroid nodule--surgery at the Shariati Hospital (1997-2000).

INTRODUCTION: There is controversy regarding the use and accuracy of frozen section (FS) in managing thyroid nodules. We compared the diagnostic value of FS with that of permanent histopathology examination and fine needle aspiration (FNA). MATERIALS AND METHODS: Permanent, FS, and FNA sample reports were compared in 214 patients between 1997 and 2000. FS, FNA, and permanent pathology (gold standard) results were compared using McNemar's test. RESULTS: 160 women and 54 men (mean age: 42.3 +/- 5.4 yr) took part in the study; 163 patients (76%) had benign and 51 (24%) malignant lesions; 76% of our thyroid cancer cases were papillary, 13.5% follicular, 6% medullary carcinoma, 4% Hürthle cell carcinoma, and 0.5% anaplastic carcinoma. FNA yielded definite results in 150 patients (sensitivity 72%, specificity 96%, and precision 90%). In 64 patients with equivocal FNA, FS was performed (sensitivity 36%, specificity 73%, and precision 85%). The observed difference between FNA and FS was not statistically significant. DISCUSSION: When FNA results are inconclusive, FS does not provide any further information. In suspected cases of papillary, undifferentiated, or medullary carcinomas, FS can confirm FNA findings and guide surgical therapy.