Hyperfunctioning Parathyroid Giant Adenoma

Purpose: The objective of this paper is to report the management and treatment of a 47-year-old patient admitted with multiple problems including asthenia, nausea and bradycardia, and was diagnosed with a giant parathyroid adenoma. Case report: A 47-year-old man was admitted to the Department of General Surgery for acute and worsening asthenia, nausea and bradycardia. Blood tests showed hypercalcemia, hypophosporemia, very high serum parathormone level, so that he was diagnosed with primary hyperparathyroidism. Cervical ultrasonography and scintigraphy with technetium 99 mTc Methoxyisobutylisonitrile (99 mTc-MIBI) showed the presence of positive nodule at the isthmus of the thyroid gland. The patient underwent neck exploration. Intra-operative iPTH essay was measured. A giant parathyroid adenoma was identified and excised, with no macroscopic signs of malignancy. Discussion and conclusion: Hyper functioning parathyroid giant adenoma can present with typical symptoms of hypercalcemic crisis: ECG alterations, kidney failure, emotional lability, confusion, delirium, psychosis, asthenia, epilepsy. Elective treatment is the excission. The surgical technique contemplates neck exploration and to ensure the finding of the adenoma, previously identified with imaging tests. It is necessary to measure intra-operative iPTH assay

Post-thyroidectomy respiratory failure in patients with bilateral paralysis of the laringeal nerve after the use of an oxidised regenerated cellulose: Two case reports

Recurrent laryngeal nerve palsy represents the most serious complication in thyroid surgery. This complication is generally unilateral and transient, but occasionally it can be bilateral and permanent and it may be either deliberate or accidental. Bilateral recurrent laryngeal nerve injury is much more serious, because both vocal cords may assume a median or paramedian position and cause airway obstruction and tracheotomy may be required. We report two subjects underwent total suturless thyroidectomy by the same surgeon, presenting with postoperative bilateral transitory recurrent laryngeal nerve palsy. Case1: a 60-year-old caucasian woman with diagnosis of follicular tumor. Case 2: a 49 year-old Caucasian woman with diagnosis of hurtle tumor. We used in both patient the oxidised regenerated cellulose for haemostasis during thyroidectomy, especially in the region of the cricothryoid joint/recurrent laryngeal nerve. In a 60-year-old woman was required a temporary tracheotomy. Damage to the recurrent laryngeal nerve remains the most feared complication with very serious functional sequelae for the patient. Most of the underlying lesions are iatrogenic, however, a variety of different reasons can lead to such a condition. We have examined that the use of the hemostatic agent (oxidised regenareted cellulose) could be a cause of postoperative paralysis for the compression on the laryngeal nerve or for chemical damage. Surgical medicaments are often placed in close proximity to peripheral nerves and may be responsible for some postoperative disturbances