Vol 10, No 2 (2016)

Clinical lecture
Intraoperative neuromonitoring in thyroid and parathyroid surgery: indications and method
Makarin V.A., Uspenskaya A.A., Alekseev M.A., Gorskaya N.A., Slepstov I.V., Chernikov R.A., Fedotov J.N., Timofeeva N.I., Semenov A.A., Malugov J.N., Bubnov A.N.

Intraoperative neuromonitoring finds widespread application in thyroid and parathyroid surgery, as a preventive method against laryngeal nerves injuries. Today it is possible to monitor the laryngeal nerve function in real time during an operation. In this article based on experience of 1065 thyroid and parathyroid operations with intraoperative neuromonitoring, we describe in details the procedure of intraoperative neuromonitoring of laryngeal nerves: features of anaesthesia, endotracheal tube position, algorythm of trouble shooting in case of loss of electromyographical sygnal. Besides that, there is an explanation of electromyographical indices, such as: signal amplitude, latency, threshold, LOS (loss of signal); there are main literature sources on this problem.

Endocrine Surgery. 2016;10(2):5-17
Adrenal imaging: what the clinician should be informed on?
Volkova N.I., Porksheyan M.S.

Nowadays there is a “pandemic” of so-called adrenal incidentalomas. The frequency of detection of incidentalomas is around 4–6% in general population and 9–13% among the patients with diagnosed oncological diseases. It is obvious that it will be increasing because of the development of methods of visualization and improving of their availability. In most cases there is possiblle to establish exact diagnosis by means of using of modern devices of computed tomography (CT) and magnetic resonance imaging (MRI) with standardized study protocols for adrenal glands. Thus, radiologists play the key role in determining of the adrenal gland tumor nature and, consequently, further management of patients.

However, in real clinical practice there is another situation. On the one hand, study protocols are often not followed and, as a consequence, the conclusions of radiologists are either primitive descriptive such as “formation of the right adrenal gland 3 cm”, or illiterate. On the other hand, even when the description is correct, in most cases the clinicians do not know which method of visualization should be chosen, the advantages over other methods and how to interpret the description and conclusion.

Because of high prevalence of incidentalomas and current situation, it is necessary that physicians have basic knowledge of adrenal visualization and should be well versed in the capabilities of different visualization methods.

The article provides, firstly, the review of modern data on opportunities of CT, MRI and PET in differential diagnostics of adrenal lesions, secondly, the description of evidence-based protocols for study adrenals, and, thirdly, critical review of techniques that shouldn't be used nowadays.

Endocrine Surgery. 2016;10(2):18-28
Clinical practice
Radioiodine therapy activity 550 MBq of I131 in thyrotoxicosis patients
Sheremeta M.S., Degtyarev M.V., Rumiantsev P.O.

Background. Radioiodine therapy (RIT) is an alternative method to surgical treatment used in the treatment of hyperthyroidism (Graves’ disease or solitary/multinodular toxic goiter (STG/MTG) etiology). However, treatment protocol doesn’t exist.

Aim. To evaluate the outcomes of the I131 treatment in hyperthyroidism using the standard dose (550 Mbq), and to explore the factors that influence the outcome of treatment.

Methods. We studied 38 patients (35 women and 3 men) with hyperthyroidism. Each patient was carried I131 RIT in a dose of 550 Mbq. Patients were randomized 2 group – patients with Graves' disease and patients with a solitary/multinodular toxic goiter. Antithyroid drugs withdraw was usually conducted for 7–14 days prior to RIT. Follow-up period ranged from 6 to 8 months, the average was 6.6 ± 0.4 months.

Results. Six months after the RIT 23 patients (61%) reached hypothyroidism, 7 patients (18%) was observed euthyroidism, thyrotoxicosis stayed in 8 patients (21%). In patients with Graves&apos; disease onset hypothyroidism were more likely (75% vs 35.7%, p < 0.001). Thus at STG/MTG achieve euthyrosis percentage was higher (28.6% vs 12.5%). Predictors of a positive outcome of the treatment are: less thyroid size (<30 ml for women, <40 ml for men) and younger age (under 35 years old). Statistical significance in influencing the outcome of treatment by disease duration, level of stimulating antibodies against thyrotropin receptors have not been identified.

Conclusions. Fixed activity of 550 MBq I131 has a different efficacy in the treatment of hyperthyroidism in patients with Graves’ disease and STG/MTG. In addition, on treatment results affect patient age and the size of the thyroid gland, which should be considered during planning RIT. In order to improve the effectiveness of radioiodine therapy of hyperthyroidism requires personalization tactics of treatment based on clinical factors, as well as the use of in vivo dosimetry planning when therapeutic activity calculating.

Endocrine Surgery. 2016;10(2):29-33
Comparison of adrenal tumor treatment results by different volume of surgical interventions.
Semenov D.J., Pankova P.A., Osmanov Z.K., Chausova V.G., Farafonova U.V.

In recent years detection of various adrenal tumors has increased greatly. Total adrenalectomy remains the standart of surgical managment for adrenal tumors, although, the vast majority of these tumors turn out to be benign on the routine histological examination. Performing organ-sparing surgery would allow to avoid hormone insufficiency after total adrenalectomy.

Aim: to compare results of adrenal tumors treatment by different volume of surgical interventions.

Materials and methods. We evaluated the short-term results of 237 patients treatment with various adrenal tumors. Total adrenalectomy were performed on 206 cases, 31 patients undergone adrenal resection. There were analyzed intraoperative and postoperative complications, assessed the hormonal status of the patients, depending on the extent of surgical treatment. Besides, the long-term results were evaluated in 141 patients underwent total adrenalectomy and 30 patients after organ-sparing surgery. Moreover, we analyzed the percentage of recurrenses, assessed the hormonal status of the patients and the effectiveness of treatment.

Results. Performing the organ-sparing operations doesn&apos;t increase the risk of intraoperative complications. In all patients with hormone-active tumors we found decline of pathologically increased hormone levels and trend to regress of clinical manifestations of the disease in early postoperative period. We found no difference in local recurrences in both groups, and its occurrence did not exceed 3.33%. Refractory postoperative adrenal insufficiency was observed only in corticosteroma patients in spite of surgery volume. In case of both side adrenal tumors there was no need in replacement therapy after total adrenalectomy from there one side and resection from the other.

Conclusions. In cases of adrenal tumor performing organ-sparing operations is advisable, if there are no preoperative sings of malignancy.

Endocrine Surgery. 2016;10(2):34-43

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