Possibilities of surgical correction of vocal cord palsy after thyroid gland operations

  Wstęp: Powikłania po zabiegach chirurgicznych gruczołu tarczowego są stale najczęstszą przyczyną obustronnego porażenia fałdów głosowych, a zaburzenia oddychania są głównym problemem w tych sytuacjach. Istnieje wiele procedur operacyjnych poszerzenia szpary głośni w przypadku obustronnego porażenia fałdów głosowych. Celem pracy była prezentacja możliwości poszerzenia szpary głośni, ocena wykonywanych technik operacyjnych oraz wyników leczenia w przypadku porażeń fałdów głosowych po zabiegach operacyjnych tarczycy. Materiał i metody: W badaniu oceniono pięć technik operacyjnych: laserowa tylna chordektomia według Denisa i Kashimy, laserowa obustronna arytenoidektomia przyśrodkowa według Crumlaya, laserowa tylna wentrykulo-chordektomia według Pia, laserowa całkowita arytenoidektomia z chordektomią tylną według Ossoffa oraz laterofiksacja według Lichtenbergera. Subiektywnej oceny poprawy wentylacyjnej dokonywano przy użyciu skali VAS. Wyniki: W latach 1998–2014 autorzy zoperowali 270 pacjentów z obustronnym porażeniem fałdów głosowych, z czego 255 (94,4%) przypadków jatrogennych po operacjach tarczycy, a 15 (7,6%) z innych przyczyn. U znacznej większości pacjentów — 77,6%, zastosowano laserową całkowitą arytenoidektomię z chordektomią tylną, a u 13,7% laterofiksację metodą Lichtenbergera. Zabieg operacyjny według Ossoffa pozwala na osiągnięcie dobrych wyników wentylacyjnych: udana dekaniulacja (62,9% po pierwszym zabiegu, 97,6% jako ostateczny odsetek) oraz znaczna lub istotna stopnia subiektywna poprawa wydolności oddechowej u 96% pacjentów. Wnioski: Arytenoidektomia według Ossoffa jest bezpieczną procedurą dającą zadowalające wyniki wentylacyjne. Pacjenci relacjonują satysfakcjonującą jakość życia oraz możliwość powrotu do życia zawodowego. Zdaniem autorów pracy, laterofiksacja powinna pozostać jako alternatywa dla czasowej tracheotomii raczej niż zabieg zasadniczy. (Endokrynol Pol 2015; 66 (5): 412–416)    Introduction: Surgery of the thyroid gland remains the main cause of bilateral vocal cord palsy (VCP). Ventilation problem is the main problem in such situations. There are a couple of corrective surgical procedures in the case of VCP. The aim of our study was to show the possibility of widening of the glottis, and to evaluate the techniques and effects of surgical treatments due to bilateral VCP resulting from thyroid gland surgery. Material and methods: Five methods of surgical treatment were used: laser-assisted posterior cordectomy, according to Denis and Kashima; laser-assisted bilateral medial arytenoidectomy, as proposed by Crumley; laser-assisted posterior ventriculocordectomy, as described by Pia; laser-assisted total arytenoidectomy with posterior cordectomy, as presented by Ossoff; and laterofixation, according to Lichtenberger. The postoperative patient’s subjective improvement was assessed using visual analogue scale. Results: Between 1998 and 2014 we operated on 270 patients with bilateral VCP. Paresis occurred as the result of the iatrogenic effect of thyroid gland surgery in 255 patients (94.4%) vs. 15 (7.6%) from other causes. The majority of our patients (77.6%) had undergone laser arytenoidectomy with posterior partial cordectomy, and in 13.7% of them Lichtenberger laterofixation had been performed. Ossoff ’s surgery gives good ventilation results: successful decannulation (62.9% after first surgery; 97.6% final rate) and significant subjective ventilation improvement in 96% of patients. Conclusions: Ossoff ’s laser arytenoidectomy with posterior cordectomy is a safe procedure that gives acceptable ventilation improvement. Patients report satisfactory quality of life and the possibility of returning to active professional life. Laterofixation should be considered as an alternative for tracheotomy rather than permanent procedure. (Endokrynol Pol 2015; 66 (5): 412–416)

Electrodeposition of copper and brass coatings with olive-like structure

One method of creating a brass coating is through electrodeposition, which is most often completed in cyanide galvanic baths. Due to their toxicity, many investigations focused on the development of more environmentally friendly alternatives. The purpose of the study was to explore a new generation of non-aqueous cyanide-free baths based on 1-ethyl-3-methylimidazolium acetate ionic liquids. The study involved the formation of copper, zinc, and brass coatings. The influence of the bath composition, cathodic current density, and temperature was determined. The obtained coatings were characterized in terms of their morphology, chemical composition, phase composition, roughness, and corrosion resistance. It was found that the structure of the obtained coatings is strongly dependent on the process parameters. The three main structure types observed were as follows: fine-grained, porous, and olive-like. To the best knowledge of the authors, it is the first time the olive-like structure was observed in the case of an electrodeposited coating. The Cu-Zn coatings consisted of 19–96 at. % copper and exhibited relatively good corrosion resistance. A significant improvement of corrosion properties was found in the case of copper and brass coatings with the olive-like structure

Relationship between stroke severity, extensity of leukoaraiosis, and brain atrophy in patients with ischaemic stroke

Purpose: Leukoaraiosis (LA), according to the latest classification, is white matter hyperintensity - morphological findings of small blood vessel disease of the brain. This radiological detection of small vessels disease is important because there are no technical possibilities to assess small vessels of the brain using computed tomography (CT) or magnetic resonance imaging (MRI) angiography. Our aim was to analysis the relationship between the extension of leukoaraiosis and severity of ischaemic stroke and brain atrophy. Material and methods: We retrospectively analysed 77 head CT scans of patients admitted from the emergency room (ER) to the Radiology Department due to suspected stroke. We assessed the severity of leukoaraiosis using the van Swieten scale and brain atrophy by numerous linear measurements. Results: Statistical analysis failed to demonstrate differences between LA1 and LA2 groups with regard to stroke severity in National Institutes of Health Stroke Scale (NIHSS) (p = 0.2159). There were no differences with regard to clinical severity of stroke between the study groups divided depending on the extent of brain atrophy. There were statistically significant differences with regard to the anterior horn width of the right and left lateral ventricle, posterior horn width of the right and left lateral ventricle, distance between occipital horn of the left lateral ventricle and internal surface of the cranium and third ventricle width depending on the severity of leukoaraiosis. Conclusions: The results of our studies present an association between the degree leukoaraiosis extension and brain atrophy, but no association between central nervous system tissue atrophy of extent of leukoaraiosis and ischaemic stroke severity

Hypoglossal nerve palsy in the course of dissection of the internal carotid arteries – Case reports

Internal carotid artery dissection (ICAD) has become an increasingly recognized cause of cerebrovascular accidents in young and middle-aged patients. We report 2 cases of hypoglossal nerve palsy in the course of dissection of the internal carotid arteries. The first patient was admitted to the Department of Neurology due to swallowing difficulty, speech articulation disorders and numbness of the right half of the tongue for 4 weeks. Extracranial vessel ultrasound (US) and transcranial colour Doppler (TCD) visualized thrombus causing occlusion of the right internal carotid artery (RICA). Angio-CT revealed a compression on right XII nerve and a dissection of the RICA. The second patient was referred to the Department of Neurology due to articulation disorders and swallowing difficulties. On admission, neurological examination revealed tongue deviation towards the right side with evidence of atrophy of the right half of the tongue, deviation of the uvula to the right side, absence of palatal and pharyngeal reflexes, rhinolalia and dysphagia. Vessel imaging was taken using angio-MR showing mural thrombus of the RICA. Conclusion The diagnosis of spontaneous non-traumatic dissection of the carotid arteries is a major challenge for clinicians. ICAD must be considered for young and middle-aged patients when severe headache is preceded by the co-existence of focal neurological symptoms. The probability of ICAD increases in the presence of predisposing diseases. The final diagnosis is based on imaging studies: color duplex ultrasound, CT angiography or MR angiography

Evaluation of the coexistence of cognitive disorders, leukoaraiosis and other risk factors in patients with stroke

Background. Stroke is a common cause of mortality and disability. There are many risk factors for stroke amongwhich leukoaraiosis (LA) is mentioned. Historically, LA was a radiological term, however, today it is classified asCerebral Small Vessel Disease (CSVD) which clinical presentation depends on the affected brain area. Higher prevalenceof LA is found not only in stroke patients, but also in patients with hypertension and other cerebrovascular riskfactors. Therefore, the aim of the study was to evaluate the relationship between the present LA, selected laboratorytests, the carotid ultrasound markers and cognitive tests results in patients with stroke. Material and methods. The study included 102 patients (W: 56, M: 46) at the age of 70.9 ± 11.5 hospitalized dueto stroke in the Stroke Unit of the Department of Neurology. The clinical assessment included NIHSS score, MMSEtesting, laboratory blood tests, carotid duplex USG and CT scan of the brain. Patients were dichotomized based onthe presence of LA in the CT scan. Results. LA was present in 25 (24.5%) patients. It was more frequently found in older patients (> 72 years old;p < 0.001). In the LA group, higher levels of LDL cholesterol (p = 0.002), lower hemoglobin concentration(p = 0.03) and higher platelets count (p = 0.04) were observed. The carotid ultrasound showed higher intimamediacomplexes in the LA group (p = 0.02). The functional test showed lower scores on the clock test in patientswith LA (p = 0.04). The presence of LA was three times less likely to be present in patients administered withbeta1-adrenolytics (p = 0.03). Conclusions. The occurrence of leukoaraiosis in patients with acute stroke is associated with clustering of othervascular risk factors cognitive impairment, and may be related to ongoing cardiovascular therapy

Fabrication and characterization of new functional graded material based on Ti, Ta, and Zr by powder metallurgy method

In view of the aging population and various diseases worldwide, the demand for implants has been rapidly increasing. Despite the efforts of doctors, engineers, and medical companies, the fabrication of and procedures associated with implants have not yet been perfected. Therefore, a high percentage of premature implantations has been observed. The main problem with metal implants is the mechanical mismatch between human bone and the implant material. Zirconium/titanium-based materials with graded porosity and composition were prepared by powder metallurgy. The whole samples are comprised of three zones, with a radial gradient in the phase composition, microstructure, and pore structure. The samples were prepared by a three-step powder metallurgy method. The microstructure and properties were observed to change gradually with the distance from the center of the sample. The x-ray diffraction analysis and microstructure observation confirmed the formation of diffusive connections between the particular areas. Additionally, the mechanical properties of the obtained materials were checked, with respect to the distance from the center of the sample. An analysis of the corrosion properties of the obtained materials was also carried out

Biokinetics of ^{131}I after endogenous and exogenous stimulation of TSH in patients with DTC

BACKGROUND: The effective radioiodine treatment of patients with DTC is possible only after raising the TSH value over 30 μUI/ml. This effect might be obtained by either endogenous or exogenous stimulation. The aim of this study was to evaluate differences in 131I biokinetics of selected regions of interest (ROIs) in cases of endogenous and exogenous stimulation. MATERIAL AND METHODS: Two groups of 50 patients were enrolled in the study. All patients were treated with 3.7 GBq of 131I; the first group after thyroid hormone withdrawal (THW), the second group after rhTSH administration (rhTSH). On the basis of post-treatment images, the uptake ratios over selected ROIs (thyroid remnants, mediastinum, liver, stomach, abdomen, and whole-body) were compared between groups. RESULTS: In the case of uptake over the whole-body and the liver, statistically significant higher values were received for the THW group. For the remaining regions, the differences between groups were statistically insignificant, but uptake ratios in the rhTSH group were generally numerically lower compared to the THW group. CONCLUSIONS: The revealed difference in radioiodine biokinetics after thyroid hormone withdrawal or administration of recombinant human TSH may influence many important aspects of patients with DTC treatment, such as the choice of proper therapeutic scheme, the cost of therapy, and the dose assessment

Biokinetics of 131I after endogenous and exogenous stimulation of TSH in patients with DTC

BACKGROUND: The effective radioiodine treatment of patients with DTC is possible only after raising the TSH value over 30 μUI/ml. This effect might be obtained by either endogenous or exogenous stimulation. The aim of this study was to evaluate differences in 131I biokinetics of selected regions of interest (ROIs) in cases of endogenous and exogenous stimulation. MATERIAL AND METHODS: Two groups of 50 patients were enrolled in the study. All patients were treated with 3.7 GBq of 131I; the first group after thyroid hormone withdrawal (THW), the second group after rhTSH administration (rhTSH). On the basis of post-treatment images, the uptake ratios over selected ROIs (thyroid remnants, mediastinum, liver, stomach, abdomen, and whole-body) were compared between groups. RESULTS: In the case of uptake over the whole-body and the liver, statistically significant higher values were received for the THW group. For the remaining regions, the differences between groups were statistically insignificant, but uptake ratios in the rhTSH group were generally numerically lower compared to the THW group. CONCLUSIONS: The revealed difference in radioiodine biokinetics after thyroid hormone withdrawal or administration of recombinant human TSH may influence many important aspects of patients with DTC treatment, such as the choice of proper therapeutic scheme, the cost of therapy, and the dose assessment. Nuclear Med Rev 2010; 13, 2: 55–5

Morphological, anatomical, and phytochemical studies of Carlina acaulis L. cypsela

Carlina acaulis L. has a long tradition of use in folk medicine. The chemical composition of the roots and green parts of the plant is quite well known. There is the lowest amount of data on the cypsela (fruit) of this plant. In this study, the microscopic structures and the chemical composition of the cypsela were investigated. Preliminary cytochemical studies of the structure of the Carlina acaulis L. cypsela showed the presence of substantial amounts of protein and lipophilic substances. The chemical composition of the cypsela was investigated using spectrophotometry, gas chromatography with mass spectrometry, and high-performance liquid chromatography with spectrophotometric and fluorescence detection. The cypsela has been shown to be a rich source of macro- and microelements, vegetable oil (25%), α-tocopherol (approx. 2 g/kg of oil), protein (approx. 36% seed weight), and chlorogenic acids (approx. 22 g/kg seed weight). It also contains a complex set of volatile compounds. The C. acaulis cypsela is, therefore, a valuable source of nutrients and bioactive substances