Vol 10, No 3 (2016)

Clinical practice
Ultrasonography of the larynx for diagnosis of the vocal folds mobility impairment
Vetshev P.S., Yankin P.L., Zhivotov V.A., Poddubnyi E.I., Drozzin A.Y., Bondarev N.S., Korol V.V., Maady A.S., Vasilev I.V., Alekseev K.I., Osipov A.S., Apostolidi K.G., Savchuk O.V., Shirokova N.V., Krastyn E.A., Balan B.A.

Purpose. To study a possibility of performance and diagnostic accuracy of ultrasonography (US) of a larynx in identification of motility disorders of VF (vocal folds) in comparison with the laryngoscope which is traditionally applied for this purpose.

Materials and methods. According to the objectives of the study, two patient groups were formed. In first group of patients (n = 466) we studied acceptability of ultrasonografy to discriminate various laryngeal structures. In second group of patient (n = 432) we evaluated the diagnostic accuracy of ultrasonography in point of detection of vocal muscles paresis.

Results. Laryngeal structures were available to examination by ultrasound (without taking in account age and sex) in 92.7% of patients. Two patterns have been identified in the course of this part of the study: deterioration of visibility of the vocal folds with increasing patient age and better visibility of the vocal folds in women than in men. According to the comparative analysis, ultrasonography accuracy rate (in those patients who had had clearly visible vocal folds during ultrasonography) did not differ from that during videolaryngoscopy.

Conclusion. During the conducted research it was found that the US of the larynx is an effective and perspective method for detection of a paresis of VF with sensitivity and specificity 93,55% and 100% respectively. Among those patients who' VF are available to ultrasound evaluation the accuracy of method is comparable with a videolaryngoscopy and can be used with success in daily work of units of endocrine surgery.

Endocrine Surgery. 2016;10(3):5-14
Loss of signal during intraoperative neuromonitoring of laryngeal nerves as a predictor of postoperative larynx paresis: Analysis of 1065 consequetive thyroid and parathyroid operations. Surgeons' algorythm (tactics)
Makarin V.A., Uspenskaya A.A., Semenov A.A., Timofeeva N.I., Chernikov R.A., Slepcov I.V., Chinchuk I.K., Karelina Y.V., Novokshonov K.Y., Fedorov E.A., Malyugov Y.N., Rusakov V.F., Sablin I.V., Gorskaya N.A., Denisenkova V.N., Ostanina Y.V., Krasnov L.M., Fedotov Y.N., Bubnov A.N.

During thyroid and parathyroid operations performed with laryngeal nerves neuromonitoring, a segmental or global loss of signal may occur. The most frequent cause of loss of signal – is tension of thyroid gland tissue and at the same time tension of the laryngeal nerves. There is no consensus if this complication arises regarding surgeon’s actions.

Aim. Evaluation of predictive value of loss of signal during IONM regarding larynx paresis in postoperative period, and algorithm suggestion in case of loss of signal develops.

Materials and methods. 1065 patients were operated on thyroid and parathyroid glands with neuromonitoring of laryngeal nerves. Neuromonitore C2 (Inomed, Emmendingen, Germany) was used. We evaluated frequency of loss of signal, described types of loss of signal, showed sensitivity and specificity of loss of signal and development of postoperative larynx paresis.

Results. Loss of signal developed in 32 (1,9%) patients. More frequently loss of signal was detected at left side (p=0,01, χ2 = 4,2 OR=2,9). Sensitivity (Se)  of loss of signal and postoperative larynx paresis development reached 59,2%, specificity – 99,7% (Sp), positive predicitive value (PPV) – 91,4%, negative predictive value (NPV) – 97,8%. There are no statistically reliable differences in recovery periods of larynx function depending on type of loss of signal (segmental or global) (p=0,5).

Conclusions. In most cases loss of electromyographical signal indicates injury of laryngeal nerves during operation on thyroid and parathyroid glands. When there is loss of signal in case of bilateral thyroid gland disease it is reasonable to make a decision to stop operation to prevent development of bilateral larynx paresis.
Endocrine Surgery. 2016;10(3):15-24
Clinical Case
Laparoscopic distal pancreatectomy in 16 years girl with insulinoma
Sokolov Y.Y., Melikyan M.A., Karpachev S.A., Druzhinin V.R., Tashirova E.A., Brovin D.N., Danilenko O.S.

We present a clinical case of insulinoma in 16 years-old girl. The patient complained about episodes of loss of consciousness, followed by retrograde amnesia and accompanied by weakness and dizziness. The patient was transferred to the Department of Endocrinology, where hypoglycemia was detected (2.0-2.5 mmol/l). Topical diagnosis of insulinoma was evidentiated with the help of radiological methods - multislice CT and contrast-enhanced MRI, which revealed an oval tumor 12x10 mm. The molecular genetic analysis of MEN1 gene was performed – no mutations were revealed. Prescribed Proglikem (diazoxide) therapy (100 mg / day) on pre-operative period was effective, patient`s glycemia values stabilized. Further the laparoscopic distal pancreatectomy with tumor removal was performed. After the surgery we achieved stable euglycemia. On microscopic and immunohistochemical studies pancreatic neuroendocrine tumor G1 was confirmed. The discussion presents data on the epidemiology, diagnosis and surgical treatment of insulinomas in children and adults.

Endocrine Surgery. 2016;10(3):26-32
Letter to the Editor
TI-RADS: to be or not to be. Polemic notes from the Eurasian Forum on thyroid cancer
Borsukov A.V.

Experts discussing about problems of ultrasound diagnostics of thyroid cancer in the format of TI-RADS and cytological Bethesda classification results at the Eurasian Forum of thyroid cancer are presented.

Endocrine Surgery. 2016;10(3):33-36
In memory of Arian P. Kalinin

On October 28 2016 after a long illness Arian P. Kalinin died. He was an outstanding Russian scientist, surgeon, endocrinologist, doctor of medical sciences, professor, corresponding member of the Russian Academy of Medical Sciences, Honored Worker of Science, Professor Emeritus of 12 medical universities and research institutes (4 of them in various countries of CIS).

Endocrine Surgery. 2016;10(3):37-38

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