1,721,014 research outputs found
Voice and swallowing changes after thyroidectomy in patients without inferior laryngeal nerve injuries
No full textBACKGROUND:
We performed a prospective analysis on voice and swallowing alterations following total thyroidectomy (TT), in the absence of recurrent nerve injury.
METHODS:
Patients aged 21 to 65 years undergoing TT, in the absence of laryngeal/pulmonary disease, previous neck surgery, or malignant diseases, were subjected to videostrobolaryngoscopy (VSL), acoustic voice analysis (AVA), and maximum phonation time (MPT) tests preoperatively and 3 months postoperatively. Voice impairment scores (VIS) and swallowing impairment scores (SIS) were obtained preoperatively, and at 1 week, 1 month, and 3 months postoperatively.
RESULTS:
Among the 127 selected patients, 39 completed the postoperative evaluation. No recurrent nerve injury was observed during the postoperative VSL in any of the patients. Preoperative and postoperative AVA and MPT scores did not differ significantly. The mean postoperative VIS was significantly higher than the preoperative VIS at 1 week and 1 month after TT (13.7 and 9.6 vs 4.4, respectively; P < .05) but not 3 months after TT (6.7). The mean SIS was higher than the preoperative SIS at 1 week, 1 month, and 3 months after TT (10.3, 6.0, and 2.8 vs 0.5, respectively; P < .05).
CONCLUSIONS:
Physicians should inform patients that transient voice and swallowing symptoms may occur following total thyroidectomy, and our data suggest mild symptoms may occur in the majority of operated patients
Noninvasive adrenal imaging in hyperaldosteronism: is it accurate for correctly identifying patients who should be selected for surgery?
No full textBACKGROUND AND AIMS: The most common causes of hyperaldosteronism (HA) are
bilateral idiopathic hyperaldosteronism (IHA), aldosterone-producing adenoma
(APA), and unilateral primary adrenal hyperplasia (PAH). We evaluated if
non-invasive preoperative imaging studies are able to reliably differentiate
these causes of hyperaldosteronism.
METHODS: The medical records of 50 consecutive patients with HA were reviewed.
Follow up was obtained by outpatient consultation or phone contact.
RESULTS: Thirty-five patients (70%) underwent successful adrenalectomy for APA,
basing on the computed tomography (CT) scan results only. All these patients were
biochemically cured. The remaining 15 patients underwent dexamethasone
suppression adrenal cortical scintiscan (ACS) because of equivocal or
inconclusive CT scan. In 11 of these patients, ACS showed a bilateral uptake,
suggesting IHA. They were followed-up. In the remaining four patients, ACS showed
a unilateral uptake. These patients underwent adrenalectomy. Final histology
showed APA in three patients and PAH in one. They were biochemically cured.
Sensitivity of combined non-invasive imaging procedures (CT and ACS) in detecting
histologically proven and biochemically cured APA and PAH was 100%.
CONCLUSION: Non-invasive adrenal imaging studies are accurate in distinguishing
between IHA and APA/PAH. Invasive diagnostic tests (adrenal venous sampling)
should be indicated only when they do not conclusively localize hypersecretion
Papillary thyroid microcarcinoma: extrathyroidal extension, lymph node metastases and risk factors for recurrence in a high prevalence of goiter area
No full textBACKGROUND. Papillary thyroid microcarcinoma (PTMC) is diagnosed with increasing frequency. Since risk factors for an aggressive clinical behavior have not been clearly delineated, the best therapeutic option and follow up protocol for PTMC have not been established yet, especially in case of incidental diagnosis after partial thyroidectomy for benign disease. We reviewed our series of patients with PMTC to determine risk factors for recurrence in a high prevalence of goiter area.
METHODS. The medical records of all the patients who underwent total thyroidectomy (TT) with a final pathology report of PTMC between October 2002 and June 2007 were reviewed. Demographic, clinical and pathological characteristics were registered. PTMC was defined as a papillary thyroid carcinoma 10 mm in diameter. Follow up evaluation was obtained by outpatients consultation and/or telephone interview. Patients who completed follow up evaluation were included in this study.
RESULTS. Among a series of 2220 patients who underwent thyroidectomy for a thyroid carcinoma, 1029 had a PTMC. Among them, 965 underwent TT and were included. Follow up evaluation was completed in 200 patients. There were 40 males and 160 females, with a mean age of 49.4 years (range 11-81). Diagnosis was incidental in 175 patients (87.5%). PTMC were larger than 5mm in 145 patients (72.5%) and multifocal in 88 (44%). Extracapsular spread (ECS) was present in 41 cases (20.5%), node metastases in 20 (10%) and distant metastases in 2 (1%). Loco-regional recurrence was observed in 43 cases (21.5%). Patients with ECS were significantly younger (43.4 Vs 51.0 years) (P<0.005) and had more frequently a multifocal disease (24/41 Vs 63/159) (P<0.05). Patients with node metastases were significantly younger (36.7 Vs 51.0 years) (P<0.005), more frequently males (8/20 Vs 32/180) (P<0.05) and had more frequently a pT3 tumor (12/20 Vs 29/180) (P<0.001). Risk factors for recurrence were male sex, multifocal disease, ECS and node metastases at diagnosis (P<0.05). Lesion size <5mm was not associated with a lower rate of ECS, node metastases and recurrence.
CONCLUSIONS. Incidental diagnosis of PTMC is frequent in a high prevalence of goiter area. PMTC showed variable aggressiveness, independent from tumor size. The extent of surgery, the need for radio-iodine ablation and follow up protocol should be based on prognostic parameters, such as gender, multifocality, ECS and node metastases at diagnosis, as for larger tumors
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Nonpalpable breast lesions. Diagnostic and therapeutic considerations
No full textThe early detection of breast cancer is of primary importance, as one method which many reduce the unacceptably high mortality rate associated with this disease. In fact, it is well stated that the most concrete possibility of therapeutic success in the treatment of breast cancer is represented by early treatment, while the disease is still localized. Then a screening program is necessary in asymptomatic women, to diagnose the disease as early as possible even in case of non palpable lesion. Mammography is nowadays the most specific and sensitive investigation for clinically occult breast cancer. In this study we searched for mammographic findings with the best predictive value for cancer and we tested the most careful techniques for preoperative localization and surgical biopsy of nonpalpable breast lesions. Seventy-one asymptomatic women (age range: 31-76 years, mean: 53.6) underwent stereotaxic needle localization to perform surgical biopsy of mammographically suspicious but nonpalpable breast lesions. Mammographic findings were classified as: a) well defined and smooth bordered opacities (11.3% of cases); b) poorly defined, irregular, spiculated and stellate opacities (32.4% of cases); c) lowly suspicious microcalcifications, larger, rounder, fewer in number (19.7% of cases); d) highly suspicious microcalcifications, with irregularities on shape, density and size described as clustered and polymorphic (36.6% of cases). Cancer was found in 22 cases (31%); 12 of those (54.5%) were associated with highly suspicious microcalcifications, 10 of those (45.5%) were associated with stellate and poorly defined opacities. On the contrary, all cases of lowly suspicious microcalcifications and all cases of well defined opacities resulted histologically benign lesions; fibrocystic disease accounted for more than half of these. Other findings included fibroadenomas, cysts, ductal or lobular hyperplasia. Fourteen of the cancers (63,6%) were 1 cm or less in diameter and all the others were less than 2 cm; sixteen of the cancers (72.7%) had negative axillary lymph nodes. However the rate of detection of cancer should be significantly improved, beacuse the positive predictive value of mammography currently is not very high. With the increasing specificity of mammographic findings, more strict criteria in the selection of patients undergoing breast biopsy will found, so that surgery must be performed only in very highly suspicious mammographic lesions, decreasing the unnecessary overall biopsy cost. Then, in these cases, stereotaxic technique for hook-wire needle guided biopsy can be very useful in detecting small, early and do potentially curable breast cancer
”Parathyroid Hormone Level 4 Hours after Surgery and Post-Thyroidectomy hypocalcemia: A Critical Appraisal”
No full textENT Function in a 14-Days Guinness Scuba Dive.
No full textScuba diving is known to affect the rhino-pharyngo-tubaric district (RPT unit). The aim of the study was to document function modifications of the RPT unit in 6 Italian divers (3 men and 3 women) who lived for 14 days consecutively at a depth of 8-10 m, breathing air (21% oxygen) at a pressure ranging between 1.8 and 2 ATA. RPT and inner ear assessment were carried out before the dive (TIME 0) and 24 h (TIME 1) after resurfacing, in order to investigate diving-related RPT and inner ear alterations. Physical examination after resurfacing revealed: fungal external otitis, otoscopic findings consistent with middle ear barotraumas and rhinosinusitis. Rhino-manometry showed a remarkable increase in inspiratory nasal flow and a substantial decrease in nasal resistance. No epithelial cell disruption was retrieved comparing pre and post resurfacing samples. Post-diving tubaric dysfunction was found. Pure tone audiometry revealed a bilateral 40 dB HL hearing loss at 4 kHz in 1 diver. Relevant PTA functions did not seem to be affected by the experiment, no remarkable changes were found at the Sensory Organisation Test and at the Motor Control Test. The 14-day underwater period had a positive effect on nasal flows and resistances
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
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