Introduction. Surgery for thyroid cancer carries a higher risk of morbidity given the region's complicated anatomy, the setting of malignancy and extent of the surgery. Aim. To investigate the rate of complications related to the recurrent nerve and parathyroid glands lesions in patients with thyroid carcinoma that undergo thyroid surgery and lymph node dissection. Patients and Methods. The data of 71 patients who underwent total thyroidectomy and 19 patients who underwent total thyroidectomy and central neck dissection with various associated neck dissection techniques were investigated using appropriate statistical tests. Results. As expected, the rate of recurrent nerve injury observed in the neck dissection group was higher than in the total thyroidectomy group (15.7% vs. 2.8%, p=0.05). As for postoperative hypocalcemia, the rate observed in the neck dissection group, both for postoperative day 1 (p<0.0001) and day 30 (p=.0.0003) was higher than in the total thyroidectomy group (68.4% vs. 19.7% postoperative day 1, 31.5% vs. 4.2% postoperative day 30). Conclusions. The risk of morbidity concerning the recurrent nerve injury and postoperative hypoparathyroidism increases with the extent of surgery. Extensive surgery may achieve proper oncologic outcomes but increases the risk of postoperative morbidity and decreases quality of life. In deciding for extensive surgery, both patient and medical team need to understand these risks.

Introduction. Retrosternal goitre enlargement can cause compression of several mediastinal structures, especially the trachea and the superior vena cava. Retrosternal goitre as a cause of superior vena cava syndrome is a rare occurrence. We report the case of a middle aged man that underwent surgery for retrosternal goitre with compression of both innominate veins presenting as superior vena cava syndrome.Case Presentation. A 50 year old man presented with a 2 year history of cyanosis of the upper limbs, head and neck, marked facial edema, plethora, dyspnea on exertion and choking sensation. Pemberton's sign was present. Computer tomography diagnosed retrosternal goitre at the level of the aortic arch, tracheal compression and important collateral circulation. Endocrine evaluation showed normal thyroid function (fT4 15.8 pmol/L) with low -normal TSH (0.5mU/L), normal calcitonin (<2 pg/mL). The patient underwent successful total thyroidectomy with cervical approach and his symptoms dramatically improved. The facial oedema persisted for the next 3 weeks.Discussion. Less than 3% of superior vena cava syndromes are secondary to a variety of benign causes. Superior vena cava syndrome caused by slow growing retrosternal goitres is very rare and can be asymptomatic for a long period due to venous collateral development.Conclusion. Superior vena cava syndrome secondary to retrosternal goitres, a very rare occurrence, is an indication for total thyroidectomy, with low postoperative morbidity and dramatic resolution of symptoms.

Retroperitoneal spontaneous hematoma is a serious condition, sometimes fatal. It occurs in association with anticoagulant therapy, unrelated to any trauma, surgery, invasive procedures or aortic aneurysm.A 68-year-old male patient is admitted for a non ST elevation myocardial infarction. He has a history of ischemic dilated cardiomyopathy with severe systolic dysfunction and atrial fibrillation. He is started on double antiplatelet therapy, anticoagulation, statin, beta blocker, ACE, and iv diuretic. Eight days later he suffers a syncope and the clinical examination reveals a large tender abdominal mass. The computed tomography examination shows a massive retroperitoneal hematoma. Although the antiplatelet and anticoagulant therapy is discontinued, the volume resuscitation (with crystalloids and packed red blood cells) is initiated and vasoconstrictor drugs are used, his condition continues to deteriorate. He is taken to the operation room for emergency laparotomy and the hematoma is evacuated. Although his clinical status improved and he remained hemodinamically stable, he suffers a cardiac arrest 27 days later and the resuscitation maneuvers are unsuccessful.

Background. The recurrent paralysis is the most important complication after total thyroidectomy. Vocal dysfunction can have multiple causes. Based on strict clinical criteria, the follow-up of patients who underwent a thyroidectomy may lead to wrong conclusions concerning possible recurrent nerve injury.Purpose. The aim of this study was to evaluate recurrential complications after total thyroidectomy by an ENT endoscopic examination.Method. We prospectively analyzed 100 cases of thyroid operations with a total number of 190 recurrent laryngeal nerve with lesional risk. Fourteen patients were operated for malignant disease. The patients were divided into two groups: group A (patients with high risk of recurrential injury) and group B (patients with low risk of recurrential injury). The operations were performed by one surgical team. The surgical interventions were followed in the 2nd postoperative day by an ENT endoscopic examination in order to assess vocal cords mobility. In patients with voice changes, ENT examination was repeated as many times was needed. At the same time a clinical examination of the quality of phonation was carried out.Results. From the total number of 100 patients examined with 190 nerves at risk, there were 7 patients with recurrent temporary paralyses (3.7%). After 6 months postoperative, there was a single patient with recurrent paralysis (0.5%). Regarding permanent recurrent paralysis, there was no patient with paresis after one postoperative year (0%). There was no significant difference regarding the recurrent paralysis between patients with high or low risk of recurrential injury.Conclusions. The damage function of the recurrent nerve is recovered in 30 days in most cases and almost 100% in six months. Belonging to a low or high risk group is not associated with the development of motility disorders. The simple following of the clinical manifestations can lead to erroneous conclusions.

Usually, insulinomas are small sized, insulin secreting, benign tumors of the pancreas, and require surgical treatment. We report the case of a female patient, of 61 years old, with pancreatic insulinoma localized in the junction between the head and the istm of the pancreas, of 1,4 cm in size, which induced hypoglycemia due to endogenous insulin hypersecretion. The tumor was removed by laparoscopic enucleation in March 2009. In the postoperative period, the blood glucose level came back to normal.

Hypocalcemia is a common clinical occurrence and has many potential causes, one of which can be congenital or acquired hypoparathyroidism. Acquired hypoparathyroidism is most commonly the result of damage to the glands, usually to their blood supply, during thyroidectomy, parathyroidectomy, or radical neck dissection. We present the case of a 40-year-old female known with Waldenström macroglobulinemia, cronic hepatitis C, who has been diagnosed with Graves disease and associated ophtalmopathy in 2004 and treated with antithyroid drugs for 1.5 years; a decision of total thyroidectomy was made considering the complexity of comorbidities and the fact that the patient already had a relapse under methymazol treatment. The postsurgical evolution was impeared by a sever hypocalcemia, necessitating repeted parenteral calcium administration associated with p.o. calcium and vitamin D, with rapid recovery, seric calcium beeing kept in normal limits and without symptoms.

Mechanical bowel preparation (MBP) is commonly used for preparing patients before elective colorectal surgery. MBP has long been considered indispensable for the prevention of complications, especially of the infectious ones. There is little scientific evidence demonstrating the efficiency of this practice in reducing the rate of infectious complications. The purpose of this study was to evaluate the usefulness of MBP in colorectal surgery. A prospective non randomized study analyzed 99 patients divided into two groups (60 with and 39 without MBP) which underwent colonic surgery finished with anastomosis. Anastomotic fistulas rate was 5% in the group with MBP and 2.5% in the one without MBP, parietal suppuration appeared in 15% of the patients with MBP and in 15% of those without MBP. There was a single intraperitoneal abscess in the group with MBP. Recent randomised clinical studies evaluating MBP in elective colorectal surgery were unable to show its benefits or real effects when compared with the operations without preparation. Colorectal surgery without MBP can be safely performed having the same or even better results than the one with MBP.

Diverticulosis is a common condition and affects one third of patients older than age 45. The treatment of the diverticular disease and of its complications, especially the acute inflammatory ones, is both medical and surgical. It is essential to correlate the two therapeutic means and to set an adequate time for the operation. The present study evaluates in a retrospective manner a number of 231 cases, 49% of which represent complicated forms. Fifty-eight patients underwent a surgical operation, 25 of which needed an emergency intervention. The results of the study show the increase of 1-stage procedures for the complicated forms and recommend laparoscopy as an alternative to open surgery. Recent studies have challenged the prophylactic nature of surgical operations after diverticulitis indicating a need for further evaluation.

Pancreatoduodenectomy has been for a long time a procedure with high postoperative morbidity and mortality. Several complications after pancreatic resections are known, but one of the most severe is the fistula of the pancreatic anastomosis. Avoiding the pancreatic fistula caused many surgical innovations regarding the procedure of reestablishing the continuity after pancreatoduodenectomy. The aim of this retrospective study was to compare pancreatico-jejunostomy vs pancreatico-gastrostomy with regard to safety of pancreatic anastomosis after pancreatoduodenectomy. No technique was proved to be superior so far, the benefits of these 2 types of pancreatic anastomosis being the subject for intense debates. From 2000 to 2004, 17 patients underwent pancreatoduodenectomy, for pancreas, ampulla, distal bile duct or duodenum cancers. Pancreatic anastomosis was accomplished by pancreatico-gastrostomy in 11 cases and by pancreatico-jejunostomy in 6 cases. There was no significant difference between the two groups (age, gender and primary disease). Comparison between the two groups was made mainly analysing postoperative mortality and morbidity. Postoperative morbidity was 9,1% after pancreatico-gastrostomy and 33,3% after pancreatico-jejunostomy. Postoperative mortality was none after pancreatico-gastrostomy and 16,7% after pancreatico-jejunostomy. This study seems to demonstrate the superiority of the pancreatico-gastric anastomosis, but in most cases the surgeon will choose based on his experience. These results have to be confirmed or invalidated by a prospective multicentric randomised study.