Recurrent laryngeal nerve paralysis is one of the most frequent complications after thyroid surgery due to goiter and cancers. A higher probability of this complication occurs after secondary procedure of the thyroid and in malignant cases. The symptoms may differ and depend on many factors. Generally, patients need careful ENT and surgical care including diagnosis and treatment. Four hundred and sixty-six patients who underwent thyroid operation due to cancer were analyzed. The group was composed of 227 papillary carcinoma, 87 follicular carcinoma, 51 medullary carcinoma, and 101 anaplastic carcinoma. Two hundred and fifty-three total thyroidectomies, 82 lobectomies and subtotal second lobe operations, 91 subtotal thyroidectomies, and 40 biopsies (wedge resections) were performed. In all 426 total and subtotal thyroidectomies an attempt to identify the recurrent laryngeal nerves was carried out. For 360 patients (77%) the surgical procedure was primary and for 106 patients (23%) the operation was secondary. Preoperative and postoperative laryngoscopic examinations were performed in all patients. Every patient with palsy underwent special laryngological procedures if needed (tracheotomy, phoniatric rehabilitation, conservative treatment and surgery in lack of improvement). The rate of postoperative vocal cord paralysis was 4.7%. The permanent palsy rate was 3.5%. In 1.2% recovery was observed. Of the 4.7% palsy rate, 3.2% concerned unilateral palsy and 1.5% bilateral pathology. Using the chi2 test, no significant differences between the rate of unilateral and bilateral paralysis and between temporary and permanent paralysis were found. On the basis of our material and results, identification the recurrent laryngeal nerves should be mandatory at surgery, thereby avoiding paralysis. Special laryngological procedures and surgical care from the beginning of paralysis are necessary for patients with vocal cord palsy. It allows to diagnose and treat patients with quite good results.
1. Patients with primary thyroid lymphomas should be approached individually using all available methods of treatment, including surgery and radiotherapy and/or chemotherapy. 2. Diagnosis of cold nodules in patients with oncological history should always arouse suspicion of metastases to the thyroid gland. 3. Diagnosis of non-thyroid cancer prior to surgery is difficult to obtain. 4. The need for surgery is usually based on local compression.
The Zn concentration in thyroid tissue and whole blood of patients with Graves' disease, thyroid cancer, and nodular goiter disease was determined using the total-reflection X-ray fluorescence method. The dependence of obtained concentrations on the clinical stage of the examined disease, histopathological grading, and kind of analyzed material (thyroid tissue and blood) was studied. The determined concentration of Zn was the lowest in the thyroid tissue of patients with thyroid cancer (23.1 microg/g) and it was the highest in the case of Graves' disease (41.7 microg/g), whereas in the blood samples, the reverse results were found (7.1 microg/g and 4.8 microg/g, respectively). The physical basis of the method used, the experimental setup, and the procedure of sample preparation are described.
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2Kierownik: dr hab. J. GawrychowskiThe aim of the study was to analyze the gene expression of JUn and ccnd1 in a group of parathyroid tissues obtained from patients with primary hyperparathyroidism in comparison to hyperplastic parathyroid and normal/atrophic parathyroid tissues by real-time quantitative PCR. Our goal was to validate the conclusion of Forsberg et al (2005) who reported overexpression of JUn in parathyroid adenomas by a joint microarray and QPCR study. material and methods. The analysis of JUn, ccnd1 was carried out by QPCR in 14 parathyroid adenomas, 8 hyperplasia cases and 50 normal/atrophic parathyroid samples taken intraoperatively. Expression of the examined genes was normalized to the reference index (geometric mean of reference genes expression: eiF3s10, UBe2d2, atP6V1e). Results. We observed a decrease of JUn expression in parathyroid adenomas in comparison to both normal/atrophic and hyperplastic parathyroids. The fold change value was 0.71 in comparison of adenomas to normal/atrophic samples (p = 0.044) and 0.75 to hyperplastic glands (p = 0.003). For ccnd1 we observed one case of parathyroid adenoma with a very clearly increased expression, while 3 adenomas (21.4% of all adenomas) exhibited the increase over the highest value seen in normal parathyroids (fold change = 3.52). conclusions. In parathyroid adenomas we were not able to confirm any overexpression of JUn gene, as suggested by the previous study. On the contrary, we observed a distinct inhibition of JUn RNA expression in comparison to non-neoplastic parathyroids. For ccnd1 gene overexpression in parathyroid adenomas, we report the frequency of 21.4%.
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