Swallowing disorders after thyroidectomy: a systematic review and meta-analysis.

PURPOSE: Swallowing disorders following thyroidectomy are common, even after surgery without confirmed complications. The purpose of the current systematic review is to investigate the prevalence of dysphagia at various time points after thyroidectomy, at the whole spectrum of it (total/partial, open/endoscopic, for benign/malignant disease). METHODS: The literature available at PubMed, SciELO and Cochrane Library databases was reviewed, according to PRISMA guidelines, using the terms "dysphagia", "swallowing disorder", "deglutition disorder", "thyroidectomy" and "thyroid surgery" in the appropriate combinations. A quantitative synthesis of the results followed. RESULTS: The systematic review of the literature resulted in 35 articles, which met the inclusion criteria and were analyzed regarding their type, sample, follow-up and results regarding post-thyroidectomy dysphagia in multiple follow-up times. A significant increase of swallowing impairment compared to baseline was recorded shortly after surgery. Dysphagia reverted to pre-operative levels 2-3 months later. Dysphagia continued to be reported in a significantly lower proportion of patients, even 1 year after surgery. No significant difference was noticed between open and endoscopic thyroid surgery at 2-3 months post-surgery. CONCLUSIONS: The swallowing disorders reported after thyroidectomy should be expected, but are not always detectable through objective methods. This should not lead to underestimation of symptoms, since the patients' quality of life is negatively affected by the symptomatology.

Emulsifiers from Partially Composted Olive Waste.

Partial (one month) composting of solid olive processing waste is shown to produce extractable emulsifiers. Size exclusion chromatography (SEC) and Fourier-transform infra-red spectroscopy (FTIR) show that these consist of polysaccharides and proteins from the composted waste. Aqueous extraction at pH 5, pH 7, and pH 9 all yield extracts rich in oligosacchrides and oligopeptides which derive from the break-down of the macromolecules under composting, with the extract obtained at pH 5 being the richer in such components. Fourier-transform infra-red (FTIR) spectroscopy also confirms that these materials consist of proteinic and poly/oligosaccharidic populations. These materials can emulsify stable oil-in-water emulsions at pH 3 for a few days, while the same emulsions collapse in less than 24 h at pH 7. Confocal microscopy and droplet size distribution data suggest that Ostwald ripening, rather than coalescence, is the major course of emulsion instability. The above point to a short-process alternative to full composting in producing a high added value product from solid olive processing waste.