RESUMEN

BACKGROUND: The aim of this study was to determine whether the use of indocyanine green angiography to identify devascularized parathyroids during thyroidectomy for thyroid cancer would decrease the rates of postoperative hypoparathyroidism. METHODS: Retrospective study of patients who had undergone total thyroidectomy for treatment of thyroid cancer between March 2021 and March 2023. The indocyanine group included patients with all four parathyroids identified and evaluated by indocyanine green angiography at the end of the procedure. Those with parathyroid glands classified with no vascularization had the glands autotransplanted. A group without indocyanine angiography was used to compare results. RESULTS: The analysis included 100 patients in each group. Indocyanine angiography identified 14.75% of devascularized parathyroids at surgery. The number of parathyroids with a score of 2 (i.e., good vascularization) was not a safe predictor of normal parathyroid hormone levels after surgery. Indeed, 29.2% of the patients with three parathyroids with a score of 2 developed transient hypoparathyroidism. Permanent hypoparathyroidism occurred in 7% of the patients without indocyanine group and in none of the patients in the indocyanine group (p = 0.014). CONCLUSION: Intraoperative angiography with indocyanine green could contribute to reduce the occurrence of permanent hypoparathyroidism in patients undergoing surgical treatment for thyroid cancer.

Asunto(s)

Insuficiencia Cardíaca/complicaciones , Implantación de Prótesis de Válvulas Cardíacas/efectos adversos , Síndrome de las Piernas Inquietas/etiología , Anciano , Femenino , Insuficiencia Cardíaca/fisiopatología , Insuficiencia Cardíaca/cirugía , Humanos , Válvula Mitral/cirugía , Síndrome de las Piernas Inquietas/fisiopatología

Asunto(s)

Anciano , Femenino , Humanos , Insuficiencia Cardíaca/complicaciones , Implantación de Prótesis de Válvulas Cardíacas/efectos adversos , Síndrome de las Piernas Inquietas/etiología , Insuficiencia Cardíaca/fisiopatología , Insuficiencia Cardíaca/cirugía , Válvula Mitral/cirugía , Síndrome de las Piernas Inquietas/fisiopatología

RESUMEN

A síndrome das pernas inquietas é uma neuropatia causadora de relevante deterioração da qualidade devida nos pacientes acometidos. É conhecida desde a década de 40, mas somente nos últimos anos tem sidoamplamente investigada. Trabalhos recentes têm apontado a importância da história familiar na incidência eno prognóstico da doença, e alguns genes envolvidos já foram identificados. Embora a fisiopatogenia não estejatotalmente elucidada, sabe-se que deficiência de ferro e alterações das vias dopaminérgicas são a basepara o desenvolvimento do quadro. A síndrome das pernas inquietas é caracterizada por sintomas subjetivosde desconforto, principalmente em membros inferiores, acompanhada da urgência em movimentar as regiõesacometidas com relativa atenuação dos sintomas com a movimentação. Por se manifestar predominantementeao fim do dia, nos períodos de repouso e inatividade, o quadro resulta em má qualidade do sono e sonolênciaexcessiva diurna. A gravidade desse quadro é amplamente variável no tempo e no espaço. O diagnóstico éessencialmente clínico. As investigações laboratoriais geralmente são usadas para confirmação da causa. Asopções terapêuticas mostram os agentes dopaminérgicos como a classe mais eficiente de medicamentos, masse podem incluir opiáceos ou benzodiazepínicos em certos casos. Há muitas questões a respeito do mecanismoe do tratamento da síndrome das pernas inquietas, que demandam estudos mais consistentes

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The restless legs syndrome is a neurological disorder responsible for reduced quality of life secondary to sleep deterioration. It has been described in the 40?s, but only recently more extensively investigated. The role playedby familiar history has only recently been identified with the determination of some possibly implicated genes.Although its physiopathology has not yet been completely elucidated, it seems possible that iron metabolism anddopaminergic mechanisms form the physiologic basis for understanding this disorder temporal development. Themain features of restless legs syndrome are urging to move the limbs often associated to subjective discomfortsensations, improved by moving or fidgeting. There is a circadian worsening with the symptoms increasing duringthe day and with inactivity, not uncommonly resulting in a bad sleep?s night and daytime sleepiness. The severityof restless legs syndrome symptoms varies in time and space. The diagnostic is essentially clinical. Laboratorywork up is mostly used for etiological confirmation. Therapeutic options show dopaminergic agents as the mostefficient drug class, but it can also include opiates or benzodiazepines in certain cases. There are many openquestions concerning restless legs syndrome mechanisms and treatment options that need to be addressed byconsistent research trials.