scholarly journals 439 Managing Parathyroid Carcinoma in the Age of COVID 19

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
K Greene ◽  
P Truran ◽  
R Bliss ◽  
J Ramsingh
Keyword(s):  
Surgical Management ◽  
Parathyroid Carcinoma ◽  
Elective Surgery ◽  
Endocrine Surgery ◽  
Parathyroid Cancer ◽  
Tertiary Referral Centre ◽  
Cross Sectional ◽  
Operative Outcomes ◽  
Rare Malignancy ◽  
Severe Hypercalcaemia

Abstract Aim Parathyroid carcinoma is a rare malignancy accounting for 1% of cases of primary hyperparathyroidism. Pre-operative diagnosis is difficult because in the absence of metastatic disease, the presentation is similar to benign parathyroid disease. In patients with hyperparathyroidism and severe hypercalcaemia or a significantly raised parathyroid hormone (PTH) level clinicians should consider parathyroid carcinoma and expediting surgical management. During the current pandemic, a high index of suspicion should be maintained to ensure that care is not compromised. A review of the management of patients with suspected parathyroid carcinoma during the COVID-19 pandemic is presented. Method In our tertiary referral centre for Endocrine surgery, 4 presentations of parathyroid cancer were reviewed. Their investigations, surgical management and post-operative outcomes are described with a brief literature review of parathyroid cancer. Results Of the four cases of parathyroid carcinoma described, all presented with severe hypercalcaemia and significantly raised PTH levels. Pre-operative mean calcium was 3.36mmol/L and mean PTH was 80pmol/L (52-99.8). Patients were imaged with a combination of cross-sectional imaging and ultrasound. Two patients had evidence of distant disease at presentation. 1 patient was transferred as an inpatient to our centre and the other three patients were seen within 2 weeks of referral; the mean time from referral to surgery was 14days (1-23). Post-operatively, all patients achieved normocalcaemia, with PTH levels normal in all but one. Conclusions Despite limitations on face-to-face clinic consultations and reduced capacity for elective surgery during the COVID-19 pandemic, all patients were investigated and managed promptly to ensure superior outcomes.

scholarly journals Radiological considerations and surgical planning in the treatment of giant parathyroid adenomas

2015 ◽  
Vol 97 (4) ◽  
pp. e64-e66 ◽  
Author(s):  
G Garas ◽  
M Poulasouchidou ◽  
A Dimoulas ◽  
P Hytiroglou ◽  
M Kita ◽  
...  
Keyword(s):  
Parathyroid Carcinoma ◽  
Surgical Planning ◽  
Rare Clinical Entity ◽  
Cross Sectional ◽  
Parathyroid Adenomas ◽  
Cross Sectional Imaging ◽  
Thoracic Approach ◽  
Severe Hypercalcaemia ◽  
Developed World ◽  
Biochemical Features

Giant parathyroid adenomas constitute a rare clinical entity, particularly in the developed world. We report the case of a 53-year-old woman where the initial ultrasonography significantly underestimated the size of the lesion. The subsequent size and weight of the adenoma (7cm diameter, 27g) combined with the severity of the hypercalcaemia raised the suspicion for the presence of a parathyroid carcinoma. This was later disproven by the surgical and histological findings. Giant parathyroid adenomas are encountered infrequently among patients with primary hyperparathyroidism, and appear to have distinct clinical and biochemical features related to specific genomic alterations. Cross-sectional imaging is mandated in the investigation of parathyroid adenomas presenting with severe hypercalcaemia as ultrasonography alone can underestimate their size and extent. This is important since it can impact on preoperative preparation and planning as well as the consent process as a thoracic approach may prove necessary for certain cases.

scholarly journals Determining the perception of a lung cancer screening programme among high-risk patients in a tertiary referral centre, Kuala Lumpur

2019 ◽  
Vol 29 (1) ◽  
pp. 19-24
Author(s):  
Wei Hao Kok ◽  
Andrea Ban Yu-Lin ◽  
Shamsul Azhar Shah ◽  
Faisal Abdul Hamid
Keyword(s):  
Lung Cancer ◽  
Cancer Screening ◽  
High Risk ◽  
Screening Programme ◽  
Lung Cancer Screening ◽  
High Risk Population ◽  
Willingness To Participate ◽  
Tertiary Referral Centre ◽  
Cross Sectional ◽  
Cancer Screening Programme

Background: Lung cancer is the second most common cause of cancer-related death and the third most common cancer in Malaysia. The rising prevalence of lung cancer suggests the need to consider disease screening for early detection, especially in the high-risk population, as it offers the best chance of cure. Objectives: The study aims to determine the willingness of high-risk respondents to participate in a lung cancer screening programme if made available to them, and to determine their attitude towards lung cancer screening and explore factors that might affect participation in a screening programme. Method: This is a cross-sectional, descriptive study over 6 months conducted in adult patients attending medical clinics in Universiti Kebangsaan Malaysia Medical Centre (UKMMC) using face-to-face administered questionnaires. Results: In total 180 respondents were analysed. There were 177 (98.3%) males. Mean age was 59.8 ± 9.1 years. Of the respondents, 138 (76.7%) had poor knowledge about cancer screening. Former smokers comprised 119 (66.1%) of the participants, and 61 (33.9%) were current smokers. In total, 141 (78.3%) respondents indicated willingness to participate in a lung cancer screening programme. Out of this group, 68 (48.2%) respondents were unwilling to pay for the procedure. Only 18 (12.8%) were unwilling to undergo lung cancer treatment if detected early. Conclusions: Awareness about general cancer screening is low. Our study showed that when informed of their high-risk status, respondents were willing to participate in lung cancer screening. There should be more health programmes to promote and raise awareness about lung cancer.

scholarly journals Preoperative prevalence of deep vein thrombosis in patients scheduled to have surgery for degenerative musculoskeletal disorders

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Keigo Sato ◽  
Hideki Date ◽  
Takehiro Michikawa ◽  
Mitsuhiro Morita ◽  
Kazue Hayakawa ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Musculoskeletal Disorders ◽  
Pulmonary Thromboembolism ◽  
Elective Surgery ◽  
Knee Surgery ◽  
Care Providers ◽  
Cross Sectional ◽  
Cross Sectional Analysis ◽  
Sectional Analysis ◽  
D Dimer

Abstract Background Although the incidence of symptomatic pulmonary thromboembolism after elective surgery for degenerative musculoskeletal disorders is comparatively low, it is extremely detrimental to both patients and health-care providers. Therefore, its prevention is mandatory. We aimed to perform a cross-sectional analysis of deep venous thrombosis (DVT) before elective surgery for degenerative musculoskeletal disorders, including total knee arthroplasty (TKA), total hip arthroplasty (THA), and spinal surgery, and identify the factors associated with the incidence of preoperative DVT. Methods The clinical data of patients aged ≥ 30 years who underwent TKA or THA, and spine surgery for lumbar or cervical degenerative disorders at our institution were retrospectively collected. D-dimer levels were measured preoperatively in all the patients scheduled for surgery. For the patients with D-dimer levels ≥ 1 µg/mL or who were determined by their physicians to be at high risk of DVT, the lower extremity vein was preoperatively examined for DVT on ultrasonography. Results Overall, we retrospectively evaluated 1236 consecutive patients, including 701 men and 535 women. Of the patients, 431 and 805 had D-dimer levels ≥ 1 and < 1 µg/mL, respectively. Of 683 patients who underwent lower extremity ultrasonography, 92 had proximal (n = 7) and distal types (n = 85) of DVT. The preoperative prevalence of DVT was 7.4 %. No patient had the incidence of postoperative symptomatic venous thromboembolism. A multivariate analysis revealed that age ≥ 80 years (odds ratio [OR], 95 % confidence interval [CI]: 2.8, 1.1–7.3), knee surgery (2.1, 1.1–4.0), American Society of Anesthesiologists (ASA) grade 2 (2.8, 1.2–6.8), ASA grades 3 or 4 (3.1, 1.0–9.4), and malignancy (1.9, 1.1–3.2) were significantly associated with DVT incidence. Conclusions This is the first study to conduct a cross-sectional analysis of preoperative DVT data of patients scheduled for elective surgery for degenerative musculoskeletal disorders. Although whether screening for preoperative DVT is needed to prevent postoperative symptomatic pulmonary thromboembolism remains to be clarified, our data suggested that DVT should be noted before surgery in the patients with advanced age, knee surgery, high ASA physical status, and malignancy.

What Is the Impact of Prior Authorization on the Incidence of Pediatric Tonsillectomy?

2020 ◽  
pp. 019459982096963
Author(s):  
Vanessa F. Torrecillas ◽  
Kaden Neuberger ◽  
Alexander Ramirez ◽  
Paul Krakovitz ◽  
Jeremy D. Meier
Keyword(s):  
Elective Surgery ◽  
Lag Time ◽  
Cross Sectional Study ◽  
Health Claims ◽  
Third Party ◽  
Prior Authorization ◽  
Cross Sectional ◽  
Before And After ◽  
The Mean ◽  
The Impact

Objective Third-party payers advocate for prior authorization (PA) to reduce overutilization of health care resources. The impact of PA in elective surgery is understudied, especially in cases where evidence-based clinical practice guidelines define operative candidacy. The objective of this study is to investigate the impact of PA on the incidence of pediatric tonsillectomy. Study Design Cross-sectional study. Setting Health claims database from a third-party payer. Methods Any pediatric patient who had evaluation for tonsillectomy from 2016 to 2019 was eligible for inclusion. A time series analysis was used to evaluate the change in incidence of tonsillectomy before and after PA. Lag time from consultation to surgery before and after PA was compared with segmented regression. Results A total of 10,047 tonsillectomy claims met inclusion and exclusion criteria. Female patients made up 51% of claims, and the mean age was 7.9 years. Just 1.5% of claims were denied after PA implementation. There was no change in the incidence of tonsillectomy for all plan types ( P = .1). Increased lag time from consultation to surgery was noted immediately after PA implementation by 2.38 days (95% CI, 0.23-4.54; P = .030); otherwise, there was no significant change over time ( P = .98). Conclusion A modest number of tonsillectomy claims were denied approval after implementation of PA. The value of PA for pediatric tonsillectomy is questionable, as it did not result in decreased incidence of tonsillectomy in this cohort.

scholarly journals COVID-19-related absence among surgeons: development of an international surgical workforce prediction model

BJS Open ◽  
2020 ◽  
Vol 5 (2) ◽  
Author(s):  
◽  
Joana F F Simoes ◽  
Elizabeth Li ◽  
James C Glasbey ◽  
Omar M Omar ◽  
...  
Keyword(s):  
Elective Surgery ◽  
Cross Sectional Study ◽  
Service Planning ◽  
Expert Elicitation ◽  
Cross Sectional ◽  
Surgical Services ◽  
Surgical Workforce ◽  
Elicitation Study ◽  
Absence Rate ◽  
Surgical Teams

AbstractBackgroundDuring the initial COVID-19 outbreak up to 28.4 million elective operations were cancelled worldwide, in part owing to concerns that it would be unsustainable to maintain elective surgery capacity because of COVID-19-related surgeon absence. Although many hospitals are now recovering, surgical teams need strategies to prepare for future outbreaks. This study aimed to develop a framework to predict elective surgery capacity during future COVID-19 outbreaks.MethodsAn international cross-sectional study determined real-world COVID-19-related absence rates among surgeons. COVID-19-related absences included sickness, self-isolation, shielding, and caring for family. To estimate elective surgical capacity during future outbreaks, an expert elicitation study was undertaken with senior surgeons to determine the minimum surgical staff required to provide surgical services while maintaining a range of elective surgery volumes (0, 25, 50 or 75 per cent).ResultsBased on data from 364 hospitals across 65 countries, the COVID-19-related absence rate during the initial 6 weeks of the outbreak ranged from 20.5 to 24.7 per cent (mean average fortnightly). In weeks 7–12, this decreased to 9.2–13.8 per cent. At all times during the COVID-19 outbreak there was predicted to be sufficient surgical staff available to maintain at least 75 per cent of regular elective surgical volume. Overall, there was predicted capacity for surgeon redeployment to support the wider hospital response to COVID-19.ConclusionThis framework will inform elective surgical service planning during future COVID-19 outbreaks. In most settings, surgeon absence is unlikely to be the factor limiting elective surgery capacity.

28 Assessment of Pain and Provision of Non-Pharmacologic Analgesia to Children by Prehospital Providers in Southwestern Ontario: A Cross-Sectional Study

2021 ◽  
Vol 26 (Supplement_1) ◽  
pp. e21-e21
Author(s):  
Karina Burke ◽  
Branka Vujcic ◽  
Jonathan Hamilton ◽  
Charlotte Mace ◽  
John Teefy ◽  
...  
Keyword(s):  
Primary Outcome ◽  
Rating Scale ◽  
A Priori ◽  
Numeric Rating Scale ◽  
Cross Sectional Study ◽  
Subject Area ◽  
Stepwise Logistic Regression ◽  
Tertiary Referral Centre ◽  
Cross Sectional ◽  
Pain Scores

Abstract Primary Subject area Emergency Medicine - Paediatric Background There is abundant evidence that provision of pharmacologic analgesia by prehospital providers to children is suboptimal. Most paediatric calls are performed by primary care paramedics (PCPs) who are unable to administer pharmacologic analgesia to children but can administer non-pharmacologic therapies. Objectives Our objective was to describe the provision of non-pharmacologic analgesia to children by prehospital providers. Design/Methods We reviewed all ambulance call reports (ACRs) of children 0-17 years with acutely painful conditions (headache, abdominal pain, injury, head/ears/eyes/nose/throat pain, and back pain) who were transported to a paediatric tertiary referral centre serving a catchment of &gt; 1 million from 2017-2019. Data collection was recorded by two blinded assessors using a study-specific Excel™ sheet. The primary outcome was the proportion of children offered non-pharmacologic analgesia. We performed a stepwise logistic regression on the primary outcome using covariates defined a priori: age, sex, visible deformity, type of crew, complaint, pain score, call time, and prior analgesia. Results All 11,084 ACRs from January 1, 2017 to December 31, 2019 were reviewed. The sample included 5887/11084 (53.1%) males, ranging from 1 month to 17 years, with a mean (SD) age of 10.5 (5.6) years. Calls involved mainly PCPs [8576/11084 (77.4%)]. Non-trauma-related musculoskeletal injuries were most common, comprising 2743/11,084 (24.7%) of calls. Pain scores were documented in 6947/11084 (62.7%) of calls. The verbal numeric rating scale (0-10) was used in 5022/6947 (72.3%) of calls, with a mean (SD) score of 5.2 (3.2). Non-pharmacologic analgesia was provided in 2926/11084 (26.4%) of calls, most commonly splint (1115/2926, 38.1%) and ice (931/2926, 31.8%). Pharmacologic analgesia was provided in 458/11084 (4.1%) of calls. In the multivariate model, mild (OR: 3.2; 95% CI 2.3-4.4; p &lt; 0 .001) and moderate pain (OR: 1.7; 95% CI 1.3-2.2) (versus no pain) were significant predictors of non-pharmacologic analgesia, whereas visible deformity (OR: 0.5; 95% CI 0.3-0.6; p &lt; 0 .001) was a significant negative predictor. Conclusion The provision of non-pharmacologic analgesia to children in Southwestern Ontario by prehospital providers is suboptimal, despite moderate to severe pain. There is a clear need for education surrounding approaches to non-pharmacologic analgesia in children among prehospital providers.

Psychiatric and Social Outcome of Liver Transplantation

1995 ◽  
Vol 166 (4) ◽  
pp. 521-524 ◽  
Author(s):  
Ian Collis ◽  
Andrew Burroughs ◽  
Keith Rolles ◽  
Geoffrey Lloyd
Keyword(s):  
Quality Of Life ◽  
Liver Transplantation ◽  
Nottingham Health Profile ◽  
General Health Questionnaire ◽  
Psychiatric Morbidity ◽  
Medical Patients ◽  
Post Transplantation ◽  
Tertiary Referral Centre ◽  
Cross Sectional

BackgroundThis study measures psychiatric morbidity, quality of life, and cognitive function after liver transplantation.MethodWe undertook a cross-sectional study, with a longitudinal subgroup. The setting was a tertiary referral centre for liver transplantation. The subjects were 30 post-liver-transplantation patients, including 11 also interviewed before the operation. The main outcome measures were the Clinical Interview Schedule (CIS), the General Health Questionnaire (GHQ), the Nottingham Health Profile (NHP), and the Mini-Mental State Examination (MMSE).ResultsOf the patients, 8/30 were CIS cases, and 7/30 were GHQ cases. NHP scores were higher than a previous postal study indicated, with less impairment after than before transplant. MMSE scores were 24–30. Median GHQ was 7.0 before operation and 1.0 after operation (P = 0.03), with no significant change in CIS score.ConclusionLiver transplantation improves quality of life, but not to the level of the general population; post-transplantation patients have a prevalence of psychiatric morbidity comparable with that of general medical patients.

scholarly journals Clinical suspicion and parathyroid carcinoma management

2006 ◽  
Vol 124 (1) ◽  
pp. 42-44 ◽  
Author(s):  
Fabio Luiz de Menezes Montenegro ◽  
Marcos Roberto Tavares ◽  
Marcelo Doria Durazzo ◽  
Claudio Roberto Cernea ◽  
Anói Castro Cordeiro ◽  
...  
Keyword(s):  
Primary Hyperparathyroidism ◽  
Secondary Hyperparathyroidism ◽  
Parathyroid Carcinoma ◽  
Clinical Signs ◽  
Neck Surgery ◽  
Cross Sectional Study ◽  
Clinical Suspicion ◽  
En Bloc ◽  
Cross Sectional ◽  
Adjacent Structures

CONTEXT AND OBJECTIVE: Adequate management of parathyroid carcinoma apparently relates to the surgeon’s ability to identify it at the first operation. The objective of this paper was to evaluate the role of clinical suspicion in the management of parathyroid carcinoma. DESIGN AND SETTING: Retrospective analysis of parathyroid carcinoma patients treated in Department of Head and Neck Surgery, Faculdade de Medicina da Universidade de São Paulo. METHODS: Cross-sectional study of 143 patients who underwent surgery from 1995 to 2000, due to hyperparathyroidism. These cases were reviewed to ascertain whether preoperative and intraoperative suspicion of parathyroid carcinoma were helpful during the operation, and which factors demonstrated the suspicion of cancer best. RESULTS: Among 66 patients with primary hyperparathyroidism there were four cases of parathyroid carcinoma (6.1%), and one case was found in secondary hyperparathyroidism (1.3%). Palpable nodules were found in five patients with primary hyperparathyroidism, four of them with parathyroid carcinoma. Preoperative levels of calcium in primary hyperparathyroidism with cancer patients varied from 12.0 mg/dl to 18.2 mg/dl. Two patients had gross macroscopic spread of the tumor to adjacent structures. Except for one patient, with extensive disease, tumors were resected en bloc. In secondary hyperparathyroidism, parathyroid carcinoma was found in a fifth mediastinal gland. One atypical adenoma was observed. CONCLUSIONS: High levels of calcium, palpable tumors and adherence to close structures are more common in parathyroid carcinoma. These clinical signs may be helpful for decision-making during parathyroid surgery.

scholarly journals Outcomes of gastrointestinal fistulas: Results from a multi-continent, multi-national, multi-center cohort

2021 ◽  
Author(s):  
Humberto Arenas Márquez ◽  
María Isabel Turcios Correia ◽  
Juan Francisco García ◽  
Roberto Anaya Prado ◽  
Arturo Vergara ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Elective Surgery ◽  
Spontaneous Closure ◽  
The Other ◽  
Calf Circumference ◽  
Cross Sectional ◽  
Nutritional Characteristics ◽  
Prospective Longitudinal ◽  
Type Of Surgery ◽  
Prospective Longitudinal Cohort

SUMMARYRationaleGastrointestinal fistulas (GIF) represent a severe and potentially lethal complication of the hospital surgical activity. However, evidences are lacking about prognosis and outcomes of GIF in Latin America (LATAM) hospitals.ObjectiveTo describe the prognosis and outcomes GIF in LATAM hospitals.Study designProspective, longitudinal, cohort-type study. The cohort fostered three cross-sectional examinations: First examination: On admission of the patient in the study; Second examination: Thirty days later; and Third (and last) examination: Sixty days after patient’s admission.Study serieOne hundred seventy-seven patients (Males: 58.2 %; Average age: 51.0 ± 16.7 years; Ages ≥ 60 years: 36.2 %) diagnosed with, and assisted for, GIF (ECF: Enterocutaneous: 64.9 % vs. EAF: Enteroathmospheric: 35.1 %) in 76 LATAM hospitals (13 countries) and Europe (4).MethodsCondition (Alive vs. Deceased) and hospital status (Hospitalized vs. Discharged) of the patient, and the GFI patency (Closed vs. Non closed) were recorded in each of the cohort’s examination. Indicators of GFI prognosis thus constructed were correlated demographical, sanitary, surgical and nutritional characteristics of the patientsResultsOn conclusion of the study indicators of GIF prognosis behaved as follows: Mortality:14.7 %; Prolonged hospitalization: 47.4 %; Spontaneous closure of GIF: 36.2 %. Type of GIF influenced upon patient’s survival: ECF: 87.0 % vs. EAF: 82.3 % (Δ = +4.7 %; χ2 = 6.787; p < 0.05). In each examination of the cohort, the number of surviving subjects was always greater among those with ECF: After 30 days: ECF: 92.1 % vs. EAF: 83.9 % (Δ = +8.2 %); After 60 days: ECF: 98.1 % vs. EAF: 90.4 % (Δ = +7.7 %; χ2 = 13.764; p < 0.05). On the other hand, hospital stay was prolonged in the subjects of elective surgery (Elective surgery: 61.4 % vs. Emergency surgery: 38.3 % (Δ = +23.1 %; χ2 = 9.064; p < 0.05) and those with a reduced calf circumference (χ2 = 12.655; p < 0.05). Location of the fistula also influenced upon prolongation of hospital stay (χ2 = 7.817; p < 0.05).ConclusionsType of GIF influences upon survival of the patient. On the hand, hospital stay was dependent upon type of surgery previously performed, location of the fistula, and calf circumference value on admission in the study serie.

Sign in / Sign up

Export Citation Format

Share Document