117 research outputs found
Surgical anatomy and neurophysiology of the vagus nerve (VN) for standardised intraoperative neuromonitoring (IONM) of the inferior laryngeal nerve (ILN) during thyroidectomy
No full textBackground: Standardisation of the intraoperative neuromonitoring (IONM) technique is a fundamental aspect in monitored thyroid surgery. Vagal nerve (VN) stimulation is essential for problem solving, recognition of any inferior laryngeal nerve (ILN) lesions and prediction of ILN post-operative function. Issues that have been overlooked in the literature, particularly in terms of prospective approaches, are the topographic relationship of the VN with the carotid and jugular vessels as well as the neurophysiology of the VN and ILN that have been studied, with a prospective approach, in patients with various thyroid diseases.
Methods: Cooperation with the Human Morphology Department resulted in the completion of a dedicated anatomy report, with the clear objective of providing a detailed anatomic and neurophysiologic description of the VN (n = 263).
Results: VN identification and stimulation was feasible in all cases and did not result in increased morbidity or operative time. Most VNs lay on the posterior region of the carotid ship (73%), i.e. the P position in accordance with our model. Mean amplitudes of EMG signals obtained from VN stimulation were 750 ± 279 μV, lower than those obtained with direct INL stimulation (1,086 ± 349 μV).
Conclusion: A better understanding of the variability in the VN may be useful not only to minimise complications but also to guarantee an accurate IONM
Defining relational contracting from the Wittgenstein family-resemblance philosophy
No full textAuthor name used in this publication: John F.Y. Yeung2011-2012 > Academic research: refereed > Publication in refereed journalAccepted ManuscriptPublishedGreen (AAM
Implementation of systematic neuromonitoring training for thyroid surgery
No full textNeural monitoring is increasingly applied to thyroid surgery and yet few surgeons have received formal training in intraoperative neuromonitoring (IONM). Standardized application of neural monitoring is an expected outcome of formal training programs in IONM. This study was designed to document a systematic training course that focuses on standardized state-of-art IONM knowledge. Seventeen 1-day courses were organized by the Department of Surgical Sciences, University of Insubria Medical School (Varese-Como, Italy), between 2009-2010. The course included didactic and practical training sessions. Some specific steps and checklist identified for courses included: knowledge of IONM technology and troubleshooting algorithms; IONM anesthetic perspectives, standards of IONM equipment set up and technique. A total of 75 trainees completed a questionnaire after completion of the respective courses. Questions probed demographic data, operative IONM experience and evaluation of course content. Data gathered showed that 97% of participants had no prior experience with the standardized approach of IONM technique (i.e. stimulation of the vagal nerve). The most useful parts of the course were judged to be (a) algorithms for perioperative IONM problem solving (30%), (b) live surgery with hands-on training (25%), (c) standardization of IONM technique (25%), and (d) IONM equipment set-up (20%). Poor reimbursement for hospital thyroid procedures is the main reason of limitation of IONM technology. The course offered participants novel knowledge and training and gave participants a systematic and standard approach to IONM technique
Calcifications in thyroid nodules identified on preoperative computed tomography : patterns and clinocal significance
No full textBackground: The purpose of this study was to evaluate the patterns and clinical importance of calcifications in thyroid nodules identified on preoperative computed tomography (CT). Methods: CT of 383 patients undergoing thyroid operations were reevaluated to identify thyroid calcification. A novel classification for thyroid calcifications on CT images was applied. The prevalence and patterns of calcification were classified, analyzed, and correlated with clinical and histopathologic findings. Results: Of the 383 patients, 135 (35.2%) had intrathyroidal calcifications identified on CT. Among these 135 patients, 65 (48%) were found to have thyroid cancer on definitive histopathology. The incidence of cancer was greater in calcified nodules (48%) than in noncalcified nodules (20%; P <.001). According to the calcification patterns, 2 of 9 (22%) nodules with peripheral calcification, 11 of 52 (21%) nodules with coarse calcification, 18 of 31 (58%) nodules with a single punctate calcification, and 34 of 43 (79%) nodules with multiple punctate calcifications were malignant. In the subset of 42 patients who presented with a solitary calcified nodule, 35 (83%) were found to have cancer. In addition, the incidence of lymph node metastases is greater in malignant nodules with calcification than in those without (48% vs 25%; P =.01). Conclusion: Thyroid calcification found on preoperative CT may represent an increased risk for thyroid malignancy. When the pattern shows multiple punctate calcification or the calcification is noted within a solitary nodule, the risk of malignancy is high in this study
Risk ranking and analysis in target cost contracts : empirical evidence from the construction industry
No full textAuthor name used in this publication: Patrick T.I. LamAuthor name used in this publication: John F.Y. Yeung2011-2012 > Academic research: refereed > Publication in refereed journalAccepted ManuscriptPublishedGreen (AAM
Trachway video intubating stylet allows for optimization of electromyographic endotracheal tube placement for monitored thyroidectomy
No full textBackground: Endotracheal tube-based surface electrodes are now commonly applied to measure evoked electromyographic (EMG) response of the vocal cord during monitored thyroidectomy. The aim of the study was to determine the incidence of difficult intubation and to assess the effectiveness of using video-assisted intubating stylet (Trachway) for EMG tube placement in patients undergoing monitored thyroidectomy.
Methods: Medical records were collected from consecutive patients undergoing thyroid surgery before and after implementation of the protocol. A total of 748 patients intubated with EMG tube for monitored thyroidectomy by the same team were enrolled in this study. Patient allocation was based on intubation technique either conventional direct laryngoscopy (n=336) or Trachway (n=412). The intubation difficulty was assessed and analyzed.
Results: The overall incidence of difficult intubation was 4.4%. Incidence of difficult intubation was significantly lower in patients with the Trachway procedure (2.7%) than direct laryngoscopy (6.5%, P=0.01). The incidence of "unable to intubate" (>3 attempts, or change airway device or anesthesiologist) also significantly reduced from 2.3% to 0.5% after introduction of the Trachway intubating stylet (P=0.02).
Conclusions: We conclude that the incidence of difficult intubation was significantly lower with Trachway than direct laryngoscopy. The Trachway video-intubating stylet is useful and helpful to reduce EMG tube intubation difficulty for monitored thyroidectomy
The Elizabethan and Jacobean two-part play: a study of the composition and structure of dramatic sequels
No full textThis thesis dexamines for the first time the origin and development of the multi-part play in English between the years 1587 and 1630. After Tamburlaine, dramatic sequels become a regular feature of the professional theatre, and figure significantly in the early careers of Shakespeare and Marston as well as that of Marlowe. More than one hundred separate plays, extant and lost, are considered for evidence of composition, performance, publication, and literary and theatrical relationship. The plays are grouped according to genre, but at the same time a continuing chronological development is revealed. Many of the multi-part plays were unanticipated by the author, sequels appearing in response to popular success; others, especially among the Histories, were deliberately conceived in two or more parts. Nevertheless, in both categories, verbal and structural cross-references exist which can indicate intellectual consistency even where the original circumstances of performance made this difficult to perceive. From the general considerations, some specific conclusions emerge: many of the problems of 1 Henry VI are explained with reference to other planned sequences influenced by Tamburlaine; Munday's Huntington plays are shown to have an ingenious design in an extended rehearsal framework; new reasons are given for the derivation of 1 Hieronimo from an earlier sequel to Kyd's revenge tragedy; the structure of Chapman's Byron plays yields new evidence of their textual history; and Dekker's 2 The Honest Whore is profitably discussed in relation to Shakespeare's treatment of Hal in 2 Henry IV. In an essay comparing the composition and structure of sequels, it is suggested that they have an unrecognized significance to the growth and achievement of English Renaissance drama
Productie van trimethylolpropaan
No full textDocument uit de collectie Chemische ProcestechnologieDelftChemTechApplied Science
Laryngeal neural monitoring during pediatric thyroid cancer surgery—is transcartilage recording a preferable method?
No full textThe use of transcartilage (TC) intraoperative neuromonitoring (IONM) in a pediatric population has not been reported. This study evaluated the feasibility and the benefit of using TC-IONM for thyroid cancer surgery in a pediatric population. This retrospective single-center study enrolled 33 pediatric patients who had received an IONM-assisted thyroidectomy. Demographic characteristics, standardized IONM laryngeal examinations and stimulation information (L1-V1-R1-R2-V2-L2) were compared between endotracheal tube (ET) and TC methods. In the 15 cancer patients (30 nerves), TC-IONM provided significant higher electromyography (EMG) amplitude (p < 0.001), signal stability (lower V1/V2 signal correlation, r = 0.955 vs. r = 0.484, p = 0.004), signal quality (higher ratio of V1 or V2 amplitude <500μV, 0.0% vs. 43.8%, p = 0.005) and lower R1-R2p change (7.1% vs. 37.5%, p = 0.049) compared to ET-IONM. In the 18 benign patients (28 nerves), TCIONM provided significantly higher EMG amplitude (p < 0.001), signal stability (r = 0.945 vs. r = 0.746, p = 0.0324) and non-significant higher signal quality and R1-R2p change. This report is the first to discuss the use of TC-IONM in pediatric thyroid surgery. In contrast with ET-IONM, TCIONM had superior amplitude, stability and quality of EMG signals, which greatly facilitates the meticulous recurrent laryngeal nerve dissection in pediatric thyroidectomies. The TC-IONM method can be considered a feasible, effective and preferable method of monitored thyroidectomy in pediatric thyroid cancer
Vagal nerve stimulation without dissecting the carotid sheath during intraoperative neuromonitoring of the recurrent laryngeal nerve in thyroid surgery
No full textBackground: Vagal nerve stimulation (VNS) has been recommended as a routine procedure during intraoperative neuromonitoring (IONM) of the recurrent laryngeal nerve (RLN). However, many surgeons have been discouraged from performing VNS because of the need for opening the carotid sheath. The purpose of this study was to investigate the feasibility and reliability of VNS without carotid sheath dissection. Methods: Two hundred twenty patients with 376 nerves at risk were enrolled in this study. VNS without nerve exposure during IONM was applied by simply pressing a ball-tip stimulator on the space between the carotid artery and jugular vein. Results: VNS without nerve exposure was feasible in all cases and did not result in any morbidity. All VNS signals were successfully obtained within 30 minutes of the start of the operation and all showed a clear and reliable laryngeal electromyography (EMG) response that was similar to that from the conventional method in which nerve exposure for VNS is applied. Conclusions: VNS without dissecting the carotid sheath is feasible and reliable, rendering it a simple, safe, and surgeon-friendly procedure during IONM
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