1
|
Sinclair CF, Buczek E, Cottril E, Angelos P, Barczynski M, Ho AS, Makarin V, Musholt T, Scharpf J, Schneider R, Stack BC, Tellez MJ, Tolley N, Woodson G, Wu CW, Randolph G. Clarifying optimal outcome measures in intermittent and continuous laryngeal neuromonitoring. Head Neck 2021; 44:460-471. [PMID: 34850992 DOI: 10.1002/hed.26946] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 11/15/2021] [Accepted: 11/18/2021] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND Intraoperative neuromonitoring (IONM) techniques have evolved over the past decade into intermittent IONM (I-IONM) and continuous IONM (C-IONM) modes of application. Despite many prior publications on both types of IONM, there remains uncertainty about what outcomes should be measured for each form of IONM. The primary objective of this paper is to define categories of benefit for I-IONM/C-IONM and to clarify and standardize their reporting outcomes. METHODS Expert review consensus statement utilizing modified Delphi methodology. RESULTS I-IONM provides diagnosis, classification, and prevention of nerve injury through accurate and early nerve identification. C-IONM provides real-time information on nerve functional integrity and thus may prevent some types of nerve injury but cannot assist in nerve localization. Sudden mechanisms of nerve injury cannot be predicted or prevented by either technique. CONCLUSIONS I-IONM and C-IONM are complementary techniques. Future studies evaluating the utility of IONM should focus on outcomes that are appropriate to the type of IONM being utilized.
Collapse
Affiliation(s)
- Catherine F Sinclair
- Department of Otolaryngology Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Erin Buczek
- Department of Otolaryngology Head and Neck Surgery, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Elizabeth Cottril
- Department of Otolaryngology Head and Neck Surgery, Jefferson University, Philadelphia, Pennsylvania, USA
| | - Peter Angelos
- Department of Surgery, University of Chicago, Chicago, Illinois, USA
| | - Marcin Barczynski
- Department of Endocrine Surgery, Jagiellonian University Medical College, Krakow, Poland
| | - Allen S Ho
- Department of Otolaryngology Head and Neck Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Viktor Makarin
- Saint Petersburg State University Hospital, Saint Petersburg, Russian Federation
| | - Thomas Musholt
- Department of Endocrine Surgery, Gutenberg University Mainz, Mainz, Germany
| | - Joseph Scharpf
- Department of Otolaryngology Head and Neck Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Rick Schneider
- Department of Visceral, Vascular and Endocrine Surgery, Martin Luther University of Halle-Wittenberg, Halle, Germany
| | - Brendan C Stack
- Department of Otolaryngology Head and Neck Surgery, Southern Illinois University School of Medicine, Springfield, Illinois, USA
| | - Maria J Tellez
- Department of Neurosurgery, Mount Sinai Hospital, New York, New York, USA
| | - Neil Tolley
- Department of Otolaryngology Head and Neck Surgery, Imperial College Healthcare NHS Trust, London, UK
| | - Gayle Woodson
- Department of Otolaryngology Head and Neck Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Che Wei Wu
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Greg Randolph
- Department of Otolaryngology Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
2
|
Buzanakov D, Sleptsov I, Semenov A, Chernikov R, Novokshonov K, Karelina J, Makarin V, Uspenskaya A, Chinchuk I, Gorskaya N, Timofeeva N, Malugov Y, Fedorov E, Sablin I, Alekseeva S, Pridvizhkina T, Borisenko T, Dzhumatov T, Gerasimova K, Zolotukho A, Pushkaruk A, Bubnov A. Bilateral Neck Exploration May Not Reduce the Risk of Persistence but Shows a Perspective Advantage. J Endocr Soc 2021. [PMCID: PMC8090039 DOI: 10.1210/jendso/bvab048.520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
There is still no consensus for an optimal surgical treatment of primary hyperpararthyroidism (PHPT). Virtually, most of the patients could be successfully treated with the selective parathyroidectomy (SPTE) based on preoperative visualization. However, this approach still has a “blind area” of undetected multiglandular disease (MGD). Bilateral neck exploration (BNE) may serve as a reasonable alternative but it meets the higher requirements for the surgical technique. A retrospective cohort study was conducted in order to reveal factors associated with the persistence of PHPT. 587 cases of PHPT patients who had received surgical treatment at SPSU Hospital in 2017–2018 were included. All the patients have at least one preoperative visualization study (neck ultrasound performed by a surgeon) before the operation. In 356 cases two studies were performed (additional 4D CT or MIBI scan) and 116 cases had all three. A surgeon was free to choose a type of the operation (selective or explorative) according to their strategic preferences. Bilateral neck exploration was performed in 160 cases. There was no difference in bilateral exploration rate (p = 0.3896) between the groups (with 1, 2 or 3 studies performed) indicating that the additional visualization does not allow to avoid bilateral exploration. MGD rate accounted for 7.4% (40 cases). It is important that any set of preoperative visualization modalities prove the absence of MGD reliably and select patients for SPTE precisely. Negative predictive value for different combinations of concordant studies (US+MIBI, US+CT and US+CT+MIBI) did not differ significantly and was 96.95%, 97.4% and 97.7% respectively. 26 cases of persistent disease were reported with no significant difference between BNE and SPTE groups. (6 vs 20 respectively, p = 0.792). A history of the thyroid or parathyroid operations was found to be the only factor predicting the higher risk of persistence (OR = 7.98; 95% CI [2.62 - 24.27]), while neither the number of parathyroid glands found during the surgery nor the number of preoperative visualization studies showed statistical significance. Only 47,5% cases of BNE was reported to have all four glands visualized. There rate of failure to found each gland was similar. Surprisingly, the superior parathyroid adenomas (P4) were more likely to be removed (chi-squared 10.378, p = 0.0006) but not in the cases with all four glands visualized intraoperatively (chi-squared 1.822, p = 0.0884). The true rate difference due to a hypothetical feature of parathyroid physiology seems to be not very likely. One may rather suggest than it is not an uncommon for a surgeon to identify a P3 gland as a P4 unless all for glands are visualized. This fact shows a perspective advanantage which may prevent some cases of persistence.
Collapse
Affiliation(s)
- Dmitrii Buzanakov
- Saint Petersburg State University Hospital, Saint Petersburg, Russian Federation
| | - Ilya Sleptsov
- Saint Petersburg State University Hospital, Saint Petersburg, Russian Federation
| | - Arseny Semenov
- Saint Petersburg State University Hospital, Saint Petersburg, Russian Federation
| | - Roman Chernikov
- Saint Petersburg State University Hospital, Saint Petersburg, Russian Federation
| | | | - Julia Karelina
- Saint Petersburg State University Hospital, Saint Petersburg, Russian Federation
| | - Viktor Makarin
- Saint Petersburg State University Hospital, Saint Petersburg, Russian Federation
| | - Anna Uspenskaya
- Saint Petersburg State University Hospital, Saint Petersburg, Russian Federation
| | - Igor Chinchuk
- Saint Petersburg State University Hospital, Saint Petersburg, Russian Federation
| | - Natalya Gorskaya
- Saint Petersburg State University Hospital, Saint Petersburg, Russian Federation
| | - Natalya Timofeeva
- Saint Petersburg State University Hospital, Saint Petersburg, Russian Federation
| | - Yuri Malugov
- Saint Petersburg State University Hospital, Saint Petersburg, Russian Federation
| | - Elisey Fedorov
- Saint Petersburg State University Hospital, Saint Petersburg, Russian Federation
| | - Ilya Sablin
- Saint Petersburg State University Hospital, Saint Petersburg, Russian Federation
| | - Svetlana Alekseeva
- Saint Petersburg State University Hospital, Saint Petersburg, Russian Federation
| | - Tatyana Pridvizhkina
- Saint Petersburg State University Hospital, Saint Petersburg, Russian Federation
| | - Tatyana Borisenko
- Saint Petersburg State University Hospital, Saint Petersburg, Russian Federation
| | - Timur Dzhumatov
- Saint Petersburg State University Hospital, Saint Petersburg, Russian Federation
| | - Ksenya Gerasimova
- Saint Petersburg State University Hospital, Saint Petersburg, Russian Federation
| | - Anna Zolotukho
- Saint Petersburg State University Hospital, Saint Petersburg, Russian Federation
| | - Alexander Pushkaruk
- Saint Petersburg State University Hospital, Saint Petersburg, Russian Federation
| | - Alexander Bubnov
- Saint Petersburg State University Hospital, Saint Petersburg, Russian Federation
| |
Collapse
|
3
|
Kluger Y, Makarin V, Ravid A, Chen Y, Grenstein A. [Absorbable mesh wrapping of injured kidney: a renal salvage technique]. Harefuah 1999; 136:647-9, 658. [PMID: 10955079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/15/2023]
Abstract
Blunt trauma to the kidney is a rare cause of hospitalization, found in only 3% of patients hospitalized for trauma. Surgery is seldom required, but if necessary there are a variety of surgical techniques to preserve renal function. Organ-wrapping with absorbable mesh is a procedure previously described, but renal-wrapping has not gained the same acceptance as splenic or hepatic wrapping. We describe a 30-year-old man with grade III blunt renal trauma, in whom this technique was applied. He was discharged after 10 days without complications.
Collapse
Affiliation(s)
- Y Kluger
- Dept. of Surgery B, Rabin Trauma Center, Tel Aviv
| | | | | | | | | |
Collapse
|
4
|
Ravid A, Lev D, Makarin V, Klausner Y, Umansky M, Kluger Y. [The "wandering spleen" syndrome]. Harefuah 1999; 136:366-8, 418. [PMID: 10914241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
We describe a 26-year-old woman with thrombocytopenia discovered during gestation. On admission for evaluation of abdominal pain, torsion of an ectopic spleen was found. The spleen was removed and the thrombocytopenia resolved.
Collapse
Affiliation(s)
- A Ravid
- Surgery B Dept., Sourasky Medical Center
| | | | | | | | | | | |
Collapse
|