Thyroid surgery: what has changed from (1970 to 2004): a Turkish perspective

Background

Turkey is an endemic region for goiter. The aim of this study was to evaluate the changing factors concerning thyroid disease and thyroid surgery in a referral center in Turkey.

Methods

This study was a retrospective evaluation of reports of patients who underwent surgery for thyroid disease at Hacettepe University Medical School between the years 1970 and 1974, 1980 and 1984, 1990 and 1994, and 2000 and 2004.

Results

A total of 1,270 patients were included in the study. There were 140, 141, 402, and 587 patients in the 1970-1974, 1980-1984, 1990-1994, and 2000-2004 groups, respectively. In the past decade, the use of ultrasonography has increased significantly; more thyroid cancer cases have been diagnosed and more extensive surgical procedures have been applied.

Conclusions

During the past 40 years, significant changes have occurred in the treatment of thyroid disease, particularly diagnostic tools, pathologies, and surgical procedures.     

Noninvasive auto-titrating ventilation (AVAPS-AE) versus average volume-assured pressure support (AVAPS) ventilation in hypercapnic respiratory failure patients

Auto-titrating noninvasive ventilation (NIV) has been developed as a new mode applying variable expiratory-positive airway pressure (EPAP) in addition to variable inspiratory pressures (IPAP), both to deliver targeted tidal volume (VT) and to eliminate upper airway resistance. The purpose of this study is to evaluate whether NIV with auto-titrating mode will decrease more PaCO₂ within a shorter time compared to volume-assured mode in hypercapnic intensive care unit (ICU) patients. The hypercapnic respiratory failure patients treated with average volume assured pressure support- automated EPAP mode (group1) were compared with those treated with average volume-assured pressure support mode (group2). Two groups were matched with each other according to baseline diagnoses, demographic characteristics, arterial blood gas values, target VT settings and daily NIV usage times. Built-in software was used to gather the ventilatory parameters. Twenty-eight patients were included in group 1, and 22 in group 2. The decrease in PaCO₂ had been achieved within a shorter time period in group 1 (p?<?0.05). This response was more pronounced within the first 6 h (mean reduction in PaCO₂ was 7?±?7 mmHg in group 1 and 2?±?5 mmHg in group 2, p?=?0.025), and significantly greater reductions in PaCO₂ (18?±?11 mmHg in group 1 and 9?±?8 mmHg in group 2, p?=?0.008) and plasma HCO₃ levels (from 32 to 30 mEq and from 35 to 35 mEq, p?=?0.007) took place within first 4 days. While mean IPAP was similar in both groups, maximum EPAP, mean VT and leak were significantly higher in group 1 than in group 2 (p?<?0.05). Results of this preliminary study suggest that, this new auto-titrating NIV mode may provide additional benefit on volume-assured mode in decreasing PaCO₂ more efficiently and rapidly in hypercapnic ICU patients.