Archives of otolaryngology--head & neck surgery
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Arch. Otolaryngol. Head Neck Surg. · Nov 2009
Comparative StudyCentral neck dissection for papillary thyroid cancer.
To examine the role of central neck dissection (CND) in patients with papillary thyroid cancer (PTC). ⋯ After total thyroidectomy and CND, recurrence in the central neck is uncommon, but hypocalcemia is more common, raising questions about the use of routine CND in patients with PTC.
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Arch. Otolaryngol. Head Neck Surg. · Nov 2009
Comparative StudyMinimally invasive parathyroidectomy: use of intraoperative parathyroid hormone assays after 2 preoperative localization studies.
To review minimally invasive parathyroidectomy (MIP) in patients undergoing initial surgical management of primary hyperparathyroidism (HPT) with preoperative, localizing sestamibi scanning (MIBI), and concordant ultrasonography (US) to determine if intraoperative parathyroid hormone (iPTH) is necessary in these cases. Minimally invasive parathyroidectomy has become an acceptable therapeutic option in treating primary HPT. Preoperative MIBI scanning, high-resolution US with color Doppler flow, and iPTH monitoring have refined this technique. ⋯ Our results show that iPTH monitoring may be eliminated in MIP surgery in a carefully selected group of patients who have preoperative, localizing MIBI with concordant US. This potentially allows an increase in operating room efficiency and a decrease in costs while performing MIP.
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Arch. Otolaryngol. Head Neck Surg. · Nov 2009
Comparative StudyFactors that predict postoperative pulmonary complications after supracricoid partial laryngectomy.
To determine the risk factors related to postoperative pulmonary complications in patients who undergo supracricoid partial laryngectomy. ⋯ Patients 60 years or older and patients with cricohyoidopexy are at high risk of having postoperative pulmonary complications after supracricoid partial laryngectomy.
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Arch. Otolaryngol. Head Neck Surg. · Nov 2009
Comparative StudyRelation of final intraoperative parathyroid hormone level and outcome following parathyroidectomy.
To determine if final intraoperative parathyroid hormone (IOPTH) level predicts those at risk for recurrence after parathyroidectomy. Minimally invasive parathyroid exploration guided by preoperative imaging and IOPTH level is an accepted alternative to bilateral exploration for the treatment of primary hyperparathyroidism (HPT). However, additional enlarged, hypercellular parathyroid glands are present in some patients in whom IOPTH levels fall to normal after excision of a single adenoma. At least 15% of patients are normocalcemic with elevated PTH levels (PPTH) after parathyroidectomy. In these patients, a higher risk of recurrent HPT has been found. ⋯ Patients with a final IOPTH level of 40 pg/mL or higher are at higher risk of having persistent HPT and should be followed up closely and indefinitely following parathyroidectomy.