Vol 11, No 3 (2017)

Clinical practice
Pediatric endocrine surgery development
Dedov I.I., Peterkova V.A., Kuznetsov N.S., Brovin D.N., Danilenko O.S., Anikiev A.V.

Department of pediatric surgery at the Endocrinology Research Centre has been around for nearly two years. During operation, surgical treatment has received more than 500 patients with various endocrine disorders. The article discusses modern diagnostic approaches and surgical options for diseases included in the new direction of pediatric surgery – endocrine surgery in children. There are discussions about options for radical treatment of Graves disease in children, positive and negative aspects of surgical and radioactive iodine treatment. Is own stats of postoperative hyperparathyroidism. Is proposed to optimize the algorithm of actions in identifying thyroid nodules in children. In primary hyperparathyroidism, the emphasis is on the complexity of the postoperative management of patients related to the feature of children’s age in determining the severity of the reactions on the water-electrolyte disorders. Separately reviewed the literature of the adrenal glands diseases in children, demonstrating their own clinical cases which required surgical intervention. The authors describe the possibilities of modern neurosurgical equipment in the Endocrinology Research Centre in operations on the pituitary gland in children. Patients of different age groups performed transnasal transsphenoidal removal of tumors of the chiasm-sellar region using endoscopic assistance. The article also cited research data of pancreas diseases and their surgical treatment. Much attention is paid to the gender section of endocrine surgery in children. Discusses the tactics in disorders of sex development, gonadal tumors in children, diseases of the breast. In conclusion outlines the prospects for the development of endocrine surgery in children.

Endocrine Surgery. 2017;11(3):109-123
Case-control study of the safety of total thyroidectomy for amiodarone-induced thyroiditis
Dickfos M., Franz R.

Aim. Amiodarone, can be a life-saving medication however it can also cause amiodarone-induced thyroiditis (AIT). AIT is a complex and life-threatening side effect which can cause significant cardiac dysfunction and lead to cardiac failure. A small sub-group do not respond to medical therapy and their cardiovascular function continues to deteriorate. This select group is referred for a semi-elective total thyroidectomy. Without surgical removal of their thyroid gland these patients have a 30-50% mortality rate. Though surgery is known to be safer in euthyroid patients, prolongation of medical therapy can lead to worsening of heart function and higher surgical risk. This research aims to evaluate the safety of surgical management of AIT in those who have failed medical treatment.

Method. A comparison was made between a group of surgically-treated AIT patients to a group of patients undergoing total thyroidectomies for alternate reasons. The patient demographics, ASA states, weight of the thyroid gland, surgical complications, anaesthetic complications and incidence of thyrotoxic crisis were assessed.

Results. This research has shown that a total thyroidectomy is a relatively safe procedure to treat AIT that is not responding to medical therapy. Similar complication rates between the two groups were evident.

Coinclusion. Total thyroidectomy is an equivocally safe procedure to perform in patients with AIT.

Clinical Significance. Surgeons can consult their patients with realistic risks for their surgery. treating physicians can feel confident that surgery is a safe option for their patients with amiodarone-induced thyroiditis.

Endocrine Surgery. 2017;11(3):124-135
Clinical, laboratory and instrumental methods of pre-surgical diagnosis of the parathyroid glands cancer
Mokrysheva N.G., Krupinova J.A., Mirnaya S.S.

Backgraund. When defining symptomatic primary hyperparathyroidism (PHPT), differential diagnosis between a benign and malignant neoplasm of parathyroid glands (PG) may be challenging. The diagnosis of carcinoma or a benign tumor determines the extent of the surgical intervention and further observation tactics.

Aims. The purpose of the study is to determine the clinical and laboratory and instrumental predictors of PG cancer.

Materials and methods. A retrospective study included 385 patients with PHPT (273 with adenomas of the PG, 66 with hyperplasia, and 19 patients with cancer of the PG), who had been examined and operated from 2000 to 2014. The primary goal of the study was to define the level of ionized calcium (Ca++), parathyroid hormone (PTH), and the volume of the tumor PG specific for cancer of the PG. The level of parathyroid hormone (PTH) was determined by electrochemoluminescent method on the Roche analyzer Cobas 6000; ionized calcium (Ca++) ion-selective method. The size of the PG was determined by the ellipse formula: V(cm3) = (A × B × C) × 0.49 by ultrasound investigation using the Valuson E8 device from General Electric.

Results. The group of patients with PG carcinoma showed the increased level of Ca++ of more than 1.60 mmol/l (p = 0.004) and increased level of PTH of more than 600 pg/ml (p = 0.03). The size of tumors of more than 6 cm3 is more typical to malignant neoplasm compared to the adenoma of the PG (p = 0.01).

Conclusions. The group of patients with PHPT that are at risk of having PG carcinoma include individuals that have a combination of the following indicators: PTH levels of more than 600 pg/ml, an increase in ionized calcium of more than 1.60 mmol/l, the tumor size of more than 6 cm3.

Endocrine Surgery. 2017;11(3):136-145
Clinical Case
Extralaryngeal variants of the location of the recurrent laryngeal nerve. Clinical observation in thyroid surgery
Malyuga V.Y., Kuprin A.A.

The recurrent laryngeal nerve can have a variety of options in extralaryngeal position, which often changes the technique of surgical intervention in each specific case. Below there are two clinical observations of the non-recurrent laryngeal nerve and additional collateral anastomosingstructures of the recurrent laryngeal nerve. The non-recurrent laryngeal nerve, according to the recent research, is found in the general population somewhat more often (up to 4.8%) than the practicing surgeon may suggest. The identification of a non-recurrent laryngeal nerve before surgery is an important object of research. According to many authors, the cord palsy in the non-recurrent laryngeal nerve increases many times compared with the recurrent laryngeal nerve. The functional and clinical significance of the anastomosing structures of the recurrent laryngeal nerve is still unknown. To visualize them during surgery is a rare phenomenon, which ultimately leads to their damage. Thus, an alternative to the theory of traction damage of the recurrent laryngeal nerve is the damage to its non-standard anatomical variants and anastomosing structures. Taking into account that such an option of extralaryngeal location of the recurrent laryngeal nerve is so rare, we consider it appropriate to share our own experience.

Endocrine Surgery. 2017;11(3):146-156
Letter to the Editor
Toxicity management of angiogenesis inhibitors: resolution of expert panel
Rumiantsev P.O., Volkova M.I., Podvyaznikov S.O., Romanov I.S., Shavarova E.K., Shatokhina E.A.

On 22 June 2017 in St. Petersburg the expert panel was held on the topic “Management of toxicity of angiogenesis inhibitors”, which discussed current issues of systemic therapy of advanced differentiated thyroid cancer resistant to radioactive iodine therapy, advanced kidney cancer and questions of efficacy and safety of new target drugs in the treatment of these diseases. The reports and discussions of experts raised the following questions: 1. Own experience of using lenvatinib in patients with differentiated thyroid cancer refractory to therapy with radioactive iodine and kidney cancer. 2. Profile of efficacy and safety of modern targeted therapy with multikinase inhibitors. 3. Prophylaxis and management of predictable toxicity.

Endocrine Surgery. 2017;11(3):157-163

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