Vol 9, No 4 (2015)

Clinical practice
Is it advisable to perform preoperativelaryngoscopy in all patients due to undergo the thyroid and parathyroid surgery?Analysis of 5172 preoperative laryngoscopies
Makarin V.A., Uspenskaya A.A., Timofeeva N.I., Sleptсov I.V., Semenov A.A., Chernikov R.A., Chinchuk I.K., Karelina U.V., Novokshonov K.U., Fedorov E.A., Malugov Y.N., Rusakov V.F., Kniazeva P.S., Malkov V.A., Pridvigkina T.S., Valdina E.A., Fedotov Y.N., Bubnov A.N.
Abstract

Given the yearly growth of thyroid and parathyroid surgery, diagnosis of such serious complications as paresis of the larynx is still relevant today. Endoscopic laryngoscopy is the main method of controlling laryngeal function. The timely detection of violations of this function in the postoperative period allows for patients to be sent to specialists quickly for treatment. Nonetheless, the role of laryngoscopies in the preoperative period has not been precisely recognized. The main contentious issue has become the need to perform preoperative laryngoscopies on all patients due to undergo operations on the thyroid or parathyroid glands.For this paper, we analyzed 5172 consecutive endoscopic laryngoscopies. The role of preoperative laryngoscopy when planning surgery on the thyroid or parathyroid glands was determined.

Aim: to evaluate the feasibility of performing routine laryngoscopies on patients due to undergo surgery for diseases of the thyroid and parathyroid glands.

Materials and Methods

This paper presents an analysis of the results of preoperative laryngoscopy on 5172 patients who underwent surgical procedures on the thyroid and parathyroid glands.

Results

Preoperative one-sided paresis of the larynx was detected in 12 (0.23%) of the 5172 patients. Patients did not exhibit bilateral paresis of the larynx.

Conclusions

Preoperative paresis of the larynx is rare, and performing routine endoscopic laryngoscopies on all patients due to undergo thyroid or parathyroid gland operations is not appropriate.

Endocrine Surgery. 2015;9(4):5-11
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Modified quick parathyroid hormone test in surgery of primary hyperparathyroidism
Sleptsov I.V., Vybornova N.B., Chernikov R.A., Semenov A.A., Timofeeva N.I., Chinchuk I.K., Makarin V.A., Novokshonov K.Y., Fedorov E.A., Uspenskaya A.A., Karelina J.V., Malyugov Y.N., Nikulin M.O., Belov A.V., Bahtijarova A.R., Bubnov A.N., Fedotov Y.N.
Abstract

Aim.

The aim of the current study was the improvement of intraoperative quick parathyroid hormone (PTH) test, enabling to receive the results in a shorter period of time and to reduce the cost of the test, comparing with the existing methods.

Methods.

404 consecutive patients with primary hyperparathyroidism (PHPT) were included in the study. All patients were subjected to selective parathyroidectomy – by traditional or videoassisted technique. We performed two parathyroid tests – traditional and modified – in each patient. Blood was taken a) before skin incision, b) before cutting the parathyroid adenoma vessels and c) in 10 minutes after cutting the parathyroid adenoma vessels. We used immunochemiluminescent analyzer DiaSorin Liaison. Modified test for parathyroid hormone differed in the duration of reagents incubation – two times shorter than in traditional method, resulting in immune reaction break before plateau occurrence. The statistical analysis of the results was performed using Microsoft Excel 2010.

Results.

With 50% cut-off level for PTH level fall (between the maximal level – before operation or before cutting parathyroid adenoma vessels – and the level in 10 minutes after cutting the adenoma vessels), the sensitivity, specificity, positive predictive value and negative predictive value for modified test reached 92.73%, 60.00%, 97.81% and 30.00%, accordingly, comparing with 95.84%, 55.00%, 97.62% and 40.74% for conventional method. Cut-off level change to 40% improved the results of modified test application, and increased its sensitivity and negative predictive value (97.14%; 50.00%; 97.40%; 47.62%).

Conclusions.

2 times reduction of incubation time with cut-off level change to 40% allowed to cut the duration of intraoperative test for parathyroid hormone by half, and to improve diagnostic accuracy of the test, and at the same time to preserve low cost of the test.

Endocrine Surgery. 2015;9(4):12-21
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Clinical Case
Thyrolipoma. Clinical case
Isaev P.A., Siomin D.Y., Rumiantsev P.O., Polkin V.V., Ilyin A.A., Dvinskyh N.Y., Medvedev V.S.
Abstract

Thyrolipomas are rare benign neoplasms composed of mature adipose tissue and glandular elements. The most common clinical manifestation is a slowly enlarging neck mass. If thyroid fine-needle aspiration biopsy discloses a mixed population of adipocytes and follicular cells, the possibility of an adenolipoma should be considered in the differential diagnosis. Complete surgical excision is curative and the prognosis is favorable. We report a case of a 59 year-old female, with a recent diagnosis of multinodular goitre. The diagnosis of thyrolipoma was only possible after surgery, performed because of a suspicious fine-needle aspiration biopsy. We also briefly discuss the clinic and diagnosis of this entity.

Endocrine Surgery. 2015;9(4):22-25
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Clinical case of rare neuroendocrine tumor of pancreas - proinsulinoma
Volkova N.I., Porksheyan M.I., Kanaeva S.A., Shytova Y.S., Beltsevitch D.G., Egorov V.I., Petrov R.V.
Abstract

Proinsulinoma is very rare neuroendocrine tumor of pancreas with proinsulin activity. Today there is no data about its true prevalence and occurrence within the syndrome of Multiple Endocrine Neoplasia (MEN) type 1. We have found no one clinical cases of the disease in available domestic literature, but only few clinical cases in foreign literature. Actually the management of patients with proinsulinoma is unknown, because such clinical guidelines are absent. Therefore, it is essential to describe particularly every new case of this neuroendocrine tumor in order to obtain sufficient data about proinsulinoma, because it is unclear whether the following management of such patients is correct or not. The clinical case of patient with proinsulinoma is described in the article. Atypical clinical presentation of hypoglycemia is reported. All stages of diagnostic research with main errors, the disputed key issues of follow up are discussed in detail, especially differential diagnosis of hypoglycemia in real clinical practice, screening of syndrome of MEN type 1 and the protocol of further observation.

Endocrine Surgery. 2015;9(4):26-31
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Well-differentiated thyroid cancer disclosed during pregnancy. Management experience
Ilyin A.A., Rumyantsev P.O., Derbugov D.N., Semin D.N., Severskaya N.V., Isaev P.A., Vasilkov S.V., Medvedev V.S., Polkin V.V.
Abstract

Thyroid cancer have the second place as malignancy detectable during pregnancy. Disclose of thyroid cancer during pregnancy raises many questions among endocrinologists, oncologists and obstetricians. Our aim was to analyze the results of delayed treatment in 15 women with differentiated thyroid cancer diagnosed during pregnancy. Our experience shows that in absence of progression of locally advanced differentiated thyroid cancer during pregnancy the observation tactics with deferred surgical treatment after delivery is reasonable, which is not worsening early and late results of delayed treatment.

Endocrine Surgery. 2015;9(4):32-38
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