Search

The systolic time intervals (LVET, PEP, and ratio LVET/PEP) were determined in 53 patients presenting with signs or symptoms of thyroid dysfunction. Patients with clinical evidence of congestive heart failure, with arterial hypertension or old myocardial infarction, and patients receiving cardioactive drugs, were excluded from the study. Thyroid function was evaluated by means of T3-RIA, serum thyroxin and TRH stimulation test.

An unusual case of metastasis of neoplasm to a benign neoplasm is reported. The initial malignancy, a small-cell bronchogenic carcinoma, was found to have metastasis to a renal oncocytoma. A review of the literature indicates, according to our knowledge, no similar case.

Serious postoperative complications following thyroid surgery are to be expected in approximately 3% of cases. Intraoperative blood loss, usually in the region of the superior thyroid artery, should be minimised by careful preparation. Damage to recurrent laryngeal nerves is usually indirect due to stretching. Damage to the recurrent laryngeal nerves can be minimised by thoroughly searching for them. Permanent tetany may be avoided by demonstration and sparing of the parathyroid bodies and their blood supply. Postoperative complications of the various forms of breathing disturbance, secondary bleeding, hyperthyroid crises and hypothyroidism will be discussed in detail.

Nicotine (2 X 10(-4) M) or acetylcholine (5.5 X 10(-4) M) in the presence of 3 X 10(-6) M atropine did not increase the rate or amplitude of contraction in isolated atria or ventricular strips of the chicken heart; both drugs also did not cause an output of noradrenaline or adrenaline and did not evoke antidromic discharges in the right sympathetic nerves of isolated perfused chicken hearts. In contrast, "high K+-solutions" evoked an output of noradrenaline and adrenaline and caused a burst of antidromic discharges. Dimethylphenylpiperazine (DMPP; 3.1 X 10(-4) M), by a tyramine-like action, elicited a small output of noradrenaline and increased rate and amplitude of contraction" but did not evoke antidromic discharges. The noradrenaline output caused by DMPP was not reduced by lowering the extracellular Ca2+ concentration from 1;8 to 0.1125 mM.-Acetyl-choline (10(-5) and 10(-4) M)inhibited the noradrenaline and adrenaline outputs evoked by electrical stimulation of the right sympathetic nerves (3 HZ, 1 ms, 30 V); the inhibition was blocked by 3 X 10(-6) M atropine.-It is concluded that the terminal parts of sympathetic nerves of the chicken heart possess muscarinic inhibitory receptors but lack nicotinic excitatory receptors. Thus prejunctional nicotinic receptors are not an integral part of the terminal sympathetic neurone otherwise they would be present at this neurone in all species.

This paper reports on 96 mediastinal tumors situated exclusively or mainly in the anterior mediastinum. Early surgical intervention is always indicated to establish the diagnosis and to ensure as radical a tumor resection as possible. The surgical approach depends on the tumor size and localization and is made either by sternotomy or thoracotomy. The prognosis depends on the histological classification of the tumors: out of 30 patients with lymphomas, 19 survived as compared to 10 out of 21 patients with thymoma and 15 out of 18 patients with mesenchymal tumors. Of 16 patients with endothoracic and retrosternal goiters, none died of a cause connected with the goiter and nine out of 11 patients with mesodermal tumors survived. The indication for surgery should be established extensively, since one third of the tumors is malignant and the surgical lethality (1.8%) is very low.

In preference to the two long-established operative procedures for recurrent goitre - extracapsular and intracapsular resection - we have introduced meticulous preparation between the thin capsule around the recurrent goitre and the more solid external capsule in a procedure which combines the advantages of both older methods and avoids most of their pitfalls. The recurrent laryngeal nerves and the parathyroids are always outside the external capsule. The incidence of injury to these structures is minimised by this procedure. From 1980-1985 we performed 2575 thyroid operations, of which 165 operations were for recurrent goitre (6.4%), bilateral in 89 cases. Two patients died of cardiopulmonary complications (1.2%). Preoperative laryngeal nerve palsy was present in 21 cases, postoperative acquired nerve injuries occurred in 28 patients, all in all 31 nerve paralysis (18.8%), or 12.2% when compared with nerves at risk. Eight patients suffered laryngeal nerve palsy on both sides (five with preoperative nerve palsy on one side). Eleven patients showed normal function of laryngeal nerves on follow-up, whilst permanent nerve palsy was found in seventeen cases (10.3%), or 6.7% when related to nerves at risk. Hypoparathyroidism was found in 7 patients of which 4 cases showed permanent changes (2.4%).

197 myocardial sutureless screw-in electrodes were implanted between the years 1973 and 1978. A subxyphoidal transmediastinal route and general anaesthesia were used. All patients had initially good pacing results. In 93% the electrode was placed into the right, in 7% into the left ventricle. The peroperative mortality rate was 0, peroperative complications were seen in 1%. Of the 19% of the complications which needed some kind of a treatment, 7.6% were confined to the lead and 11.4% were other complications. The lead, placed into the right ventricle, had to be replaced in five patients (2.7%) because of exit block or sensing problems. The postpericardiotomy syndrome was the most frequent complication but it did not impair the function of the pacemaker. 4% of the patients died within 30 days after the implantation. In 46 patients the pacemaker was replaced after a mean time of 32,5 months. The measurement of the threshold rose from a mean of 0.8 mAmp to 3.2 mAmp and the mean resistance was 530 Ohms. In 44 patients the electrode could be reused.

Serious arrhythmias are accepted to be the main cause of sudden death in acute coronary artery disease (CAD). The purpose of this study was to evaluate the frequency and type of cardiac arrhythmias in patients with chronic CAD. 67 patients with suspected chronic CAD, documented by history and/or Ecg-changes, were investigated by means of a dynamic Ecg (Holter Avionics) with an average of 11 hours monitoring. On the basis of concomitant ST-segment depressions the patients were divided into 3 groups (A: greater than 0.1mV; B: 0.05-0.09mV; C: less than 0.05mV). The frequency of serious arrhythmias increased significantly with a greater degree of ST-segment depression. Serious arrhythmias were observed in 54% in group A, in 46% in group B, but only in 24% in group C. The frequency of minor arrhythmias such as occasional (less than 12/min atrial or ventricular premature contractions was essentially the same in all 3 groups. In 12 patients more than one serious arrhythmia were documented. Of the serious arrhythmias observed, 94% were tachycardias and/or secondary to increased myocardial irritability and therefore could respond favourably to beta-blocking agents. We believe that arrhythmias in patients with known chronic CAD should be taken seriously and longterm treatment with beta-blockers considered.

The recurrent laryngeal nerve palsy is the most important complication in thyroid surgery. It seems to be possible to reduce the rate of palsies by consequently identifying the recurrent laryngeal nerve. A comparison of statistics out of the literature with and without identification of the recurrent laryngeal nerve shows this. A follow-up of our patients of the years 1980-1982 (1312 operations) confirms this finding.