Truncal vs Branch Ligation of Inferior Thyroid Arteries in Total Thyroidectomy: Does It Affect Postoperative Hypoparathyroidism?

2020 ◽  
pp. 019459982095728
Author(s):  
Talat Waseem ◽  
Safia Zahir Ahmed ◽  
Hadia Baig ◽  
Muhammad Hasham Ashraf ◽  
Asad Azim ◽  
...  
Keyword(s):  
Serum Calcium ◽  
Tertiary Care ◽  
Prospective Trial ◽  
High Volume ◽  
Parathyroid Function ◽  
Postoperative Hypoparathyroidism ◽  
Increased Risk ◽  
Significant Difference ◽  
Randomized Prospective Trial ◽  
Thyroid Capsule

Objective Postthyroidectomy hypoparathyroidism remains a significant challenge. Truncal ligation of the inferior thyroid arteries (ITAs) may lead to an increased risk of hypoparathyroidism; however, dissection along the thyroid capsule with branch ligation of the thyroid arteries could be a safer option. This study’s objective was to compare the effect of truncal versus branch ligation of the ITAs on the rate of postoperative hypoparathyroidism. Study Design Randomized prospective trial in line with the CONSORT guidelines. Setting The study was conducted at a high-volume tertiary care setting. Methods We randomized 319 patients into 2 groups: truncal ITA ligation (n = 157) and branch ITA ligation (n = 162). The primary outcomes were serum calcium and parathormone levels on the second postoperative day, followed by the levels on months 1, 3, 6, and 12. The need for exogenous replacements was noted. The secondary outcomes, such as operative time, blood loss, and other complications, were also recorded. Results Our study revealed a significant difference in the incidence of transient hypocalcemia in patients undergoing truncal ITA ligation and branch ITA ligation (22.9% vs 3.1%, P < .05). The results showed that the levels of serum calcium and parathormone dropped on the second postoperative day and that 36 patients from the truncal ITA ligation group required exogenous calcium and vitamin D replacement. In contrast, only 5 patients from the branch ITA ligation group required the same. Conclusions This is the largest randomized trial of patients undergoing thyroidectomy, and it shows that dissection along the thyroid capsule with branch ligation of the ITAs is more likely to preserve parathyroid function as opposed to truncal ligation of ITAs.

Seroprevalence of anti-SARS-CoV-2 IgG antibodies in hospitalized patients at a tertiary referral center in North India (Preprint)

2020 ◽  
Author(s):  
Dr. Animesh Ray ◽  
Dr. Komal Singh ◽  
Souvick Chattopadhyay ◽  
Farha Mehdi ◽  
Dr. Gaurav Batra ◽  
...  
Keyword(s):  
Tertiary Care ◽  
Age Groups ◽  
Hospitalized Patients ◽  
North India ◽  
P Value ◽  
Care Hospital ◽  
Igg Antibodies ◽  
Igg Antibody ◽  
Increased Risk ◽  
Significant Difference

BACKGROUND Seroprevalence of IgG antibodies against SARS-CoV-2 is an important tool to estimate the true extent of infection in a population. However, seroprevalence studies have been scarce in South East Asia including India, which, as of now, carries the third largest burden of confirmed cases in the world. The present study aimed to estimate the seroprevalence of anti-SARS-CoV-2 IgG antibody among hospitalized patients at one of the largest government hospital in India OBJECTIVE The primary objective of this study is to estimate the seroprevalence of SARS-CoV-2 antibody among patients admitted to the Medicine ward and ICU METHODS This cross-sectional study, conducted at a tertiary care hospital in North India, recruited consecutive patients who were negative for SARS-CoV-2 by RT-PCR or CB-NAAT. Anti-SARS-CoV-2 IgG antibody levels targeting recombinant spike receptor-binding domain (RBD) protein of SARS CoV-2 were estimated in serum sample by the ELISA method RESULTS A total of 212 hospitalized patients were recruited in the study with mean age (±SD) of 41.2 (±15.4) years and 55% male population. Positive serology against SARS CoV-2 was detected in 19.8%patients(95% CI 14.7-25.8). Residency in Delhi conferred a higher frequency of seropositivity 26.5% (95% CI 19.3-34.7) as compared to that of other states 8% (95% CI 3.0-16.4) with p-value 0.001. No particular age groups or socio-economic strata showed a higher proportion of seropositivity CONCLUSIONS Around, one-fifth of hospitalized patients, who were not diagnosed with COVID-19 before, demonstrated seropositivity against SARS-CoV-2. While there was no significant difference in the different age groups and socio-economic classes; residence in Delhi was associated with increased risk (relative risk of 3.62, 95% CI 1.59-8.21)

Velcro Ties in Early Postoperative Pediatric Tracheostomy Care: A Systematic Review and Meta-analysis

2020 ◽  
pp. 019459982096472
Author(s):  
Brent A. Chang ◽  
Joshua Gurberg ◽  
Erin Ware ◽  
Kimberly Luu
Keyword(s):  
Meta Analysis ◽  
Prospective Trial ◽  
Final Analysis ◽  
Cochrane Central Register ◽  
Limited Data ◽  
Cochrane Database ◽  
Central Register ◽  
Significant Difference ◽  
Randomized Prospective Trial ◽  
The Difference

Objective To systematically review the literature to determine the difference in complications between standard twill and Velcro ties following pediatric tracheostomy. Data Sources MEDLINE, Embase, the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, Web of Science, and CINAHL Plus were searched up to August 2020. Review Methods Two authors independently screened articles for eligibility. Retrospective and prospective studies were included as long as there was a direct comparison between twill and Velcro ties. Quantitative and qualitative analysis was performed. The main outcomes were skin-related complications and accidental decannulation. Results Three studies were included in the final analysis: 1 randomized prospective trial and 2 retrospective studies. There were 238 patients total (137 twill, 101 Velcro). Combined analysis showed skin-related complications in 23% of the Velcro group and 44% of the twill group. Meta-analysis for skin-related complications showed no significant difference when comparing Velcro with standard twill ties (risk ratio, 0.53 [95% CI, 0.24-1.17]; P = .12, n = 238 participants from 3 studies, I2 = 66%). Accidental decannulation rates were overall low and comparable between groups (1.0% of twill, 1.4% of Velcro). Conclusion Based on limited data, skin-related complications were not statistically different between Velcro and twill ties. Accidental decannulation is rare with Velcro and standard twill ties, and both are viable options following pediatric tracheostomy.

scholarly journals Pancreaticoduodenectomy: Volume is not Associated with Outcome within an Academic Health Care System

HPB Surgery ◽  
2008 ◽  
Vol 2008 ◽  
pp. 1-6 ◽  
Author(s):  
Micheal T. Schell ◽  
Anthony Barcia ◽  
Austin L. Spitzer ◽  
Hobart W. Harris
Keyword(s):  
Health Care ◽  
San Francisco ◽  
Medical Center ◽  
Care Center ◽  
Tertiary Care ◽  
Survival Rates ◽  
High Volume ◽  
Care Pathways ◽  
Complication Rates ◽  
Significant Difference

Hypothesis. Smaller and lower-volume hospitals can attain surgical outcomes similar to high-volume centers if they incorporate the expertise and health care pathways of high-volume centers. Setting. The academic tertiary care center, Moffit-Long Hospital (ML); the community-based Mount Zion Hospital (ZION); the San Francisco County General Hospital (SFGH); and the Veterans Affairs Medical Center of San Francisco (VAMC). Patients. 369 patients who underwent pancreaticoduodenectomy between October 1989 and June 2003 at the University of California, San Francisco (UCSF) affiliated hospitals. Interventions. Pancreaticoduodenectomy. Design. Retrospective chart review. To correct for the potentially confounding effect of small case volumes and event rates, data for SFGH, VAMC, and ZION was combined (Small Volume Hospital Group; SVHG) and compared against data for ML. Main Outcome Measures. Complication rates; three-year and five-year survival rates. Results. The average patient age and health, as determined by ASA score, were similar between ML and the SVHG. The postoperative complication rate did not differ significantly between ML and the SVGH (58.8% versus 63.1%). Patients that experienced a complication averaged 2.5 complications in both groups. The perioperative mortality rate was 4% for patients undergoing pancreaticoduodenectomy at either ML or the SVGH. Although the 3-year survival rate for patients with adenocarcinoma of the pancreas was nearly twice as high at ML (31.2% versus 18.3% at SVHG), there was no significant difference in the 5-year survival rates (19% at ML versus 18.3% at SVHG). Conclusions. Low-volume hospitals can achieve similar outcomes to high-volume tertiary care centers provided they import the expertise and care pathways necessary for improved results.

Facial Nerve Outcomes in Middle Cranial Fossa vs Translabyrinthine Approaches

2005 ◽  
Vol 133 (6) ◽  
pp. 906-910 ◽  
Author(s):  
Brandon Isaacson ◽  
Steven A. Telian ◽  
Hussam K. El-Kashlan
Keyword(s):  
Facial Nerve ◽  
Tertiary Care ◽  
Middle Cranial Fossa ◽  
Vestibular Schwannomas ◽  
Care Hospital ◽  
Case Review ◽  
Retrospective Case ◽  
Increased Risk ◽  
Significant Difference ◽  
Cranial Fossa

OBJECTIVE: To compare the final facial nerve outcomes between middle cranial fossa (MCF) vs translabyrinthine (TL) resection of size-matched vestibular schwannomas. STUDY DESIGN AND SETTING: Retrospective case review at a tertiary care hospital. All patients who underwent resection utilizing either MCF or TL approaches with tumors 18 mm or smaller and complete data were included in the analysis. One hundred twenty-four patients were identified meeting the above criteria, with sixty-three in the translabyrinthine group and sixty-one in the middle fossa group. One-week-postoperative and final facial nerve examinations were compared in the two surgical groups. Patients were separately analyzed in subgroups: tumors smaller than 10 mm and those that were between 10 and 18 mm. RESULTS: The tumor size range for the MCF group was 3-18 mm while it was 4-18 mm for the TL group. No statistically significant difference was found in facial nerve outcomes between the two surgical groups, at the first postoperative visit week and at last follow-up. CONCLUSION: Facial nerve outcomes are similar using TL and MCF approaches for resection of vestibular schwannomas up to 18 mm in size. SIGNIFICANCE: Patients undergoing the MCF approach for hearing preservation can be counseled that there is no increased risk of permanent facial nerve weakness, compared to the TL approach. EBM RATING: B-3

scholarly journals Short-term outcome in preterm infants depending on whether they were born from singleton, twin or triplet pregnancy: Data from a tertiary care hospital in Serbia

2020 ◽  
Vol 148 (1-2) ◽  
pp. 58-63
Author(s):  
Gordana Velisavljev-Filipovic ◽  
Aleksandra Matic ◽  
Marina Dragicevic ◽  
Divna Damjanovski
Keyword(s):  
Preterm Infants ◽  
Tertiary Care ◽  
Mode Of Delivery ◽  
Fertility Treatment ◽  
Care Hospital ◽  
Multiple Pregnancies ◽  
Short Term ◽  
Gestation Age ◽  
Increased Risk ◽  
Significant Difference

Introduction/Objective. After the introduction of the national program of fertility treatment, increased frequency of multiple pregnancies was noted. The literature has shown controversies regarding the higher risk of morbidity and mortality of the preterm newborns from multiple pregnancies. Methods. Preterm singletons, twins and triplets born within a two-year study period were included in the analysis. Data about preterm twins were extracted first. For each pair of twins, two singletons of the same gestation age were chosen. The set of the examinees was completed by including the triplets born during the same period. The short-term outcomes were compared between these three groups. Results. A total of 210 preterm infants were included in the study, out of which 84 singletons, 84 twins and 42 triplets. Statistical analysis showed significant difference between the three groups regarding type of conception (p < 0.0001), mode of delivery (p < 0.001) and birth weight (p = 0.005). Short-term mortality and morbidity (neonatal death, the need for intubation at birth, respiratory support, surfactant therapy, and intracranial hemorrhage) were significantly increased in triplets comparing to singletons and twins. Conclusion. Preterm triplets have an increased risk for adverse short-term outcomes comparing to singletons and twins of the similar gestation age in our study sample.

scholarly journals Focused Versus Conventional Radiotherapy in Spinal Oncology: Is There any Difference in Fusion Rates and Pseudoarthrosis?

2021 ◽  
Author(s):  
Oluwaseun Akinduro ◽  
Geatano DeBiase ◽  
Anshit Goyal ◽  
Jenna H Meyer ◽  
Roman O Kowalchuk ◽  
...  
Keyword(s):  
Tertiary Care ◽  
Spinal Tumors ◽  
Wound Complications ◽  
Tumor Type ◽  
Conventional Radiotherapy ◽  
Instrumented Fusion ◽  
Radiation Delivery ◽  
Increased Risk ◽  
Significant Difference ◽  
Secondary Outcomes

Abstract IntroductionRadiotherapy is considered standard of care for adjuvant peri-operative treatment of many spinal tumors, including those with instrumented fusion. Unfortunately, radiation treatment has been linked to increased risk of pseudoarthrosis. Newerfocused radiotherapy strategies with enhanced conformalitycould offer improved fusion rates for these patients, but this has not been confirmed.MethodsWe performed a retrospective analysis of patients at three tertiary care academic institutions withprimary and secondary spinal malignancies that underwent resection, instrumented fusion, and peri-operative radiotherapy. Two board certified neuro-radiologists used theLenke fusion score to grade fusion status at6 and 12-months after surgery. Secondary outcomes includedclinical pseudoarthrosis, wound complications, and the effect of radiation timing, radiobiological dose delivered, the use of photons versus protons, tumor type, tumor location,and use of autograft on fusion outcomes.ResultsAfter reviewof 1252 spinal tumor patients, there were 60 patients with at least 6 months follow-up that were included in our analyses. Twenty-five of these patients received focused radiotherapy,20 patients received conventional radiotherapy, and 15 patients were treated with protons. There was no significant difference between the groups for covariates such assmoking status,obesity, diabetes, intraoperative use of autograft, and use of peri-operative chemotherapy. There was a significantly higher rate of fusion for patients treated with focused radiotherapy compared to those treated with conventional radiotherapy at 6-months (64.0% versus 30.0%, Odds ratio: 4.15, p=0.036) and 12-months (80.0% versus 42.1%, OR: 5.50, p=0.022). There was a significantly higher rate of clinical pseudoarthrosis in the conventional radiotherapy cohortcompared to patients in the focused radiotherapy cohort (19.1% versus 0%,p=0.037). There was no difference in fusion outcomes for any of the secondary outcomes except for use of autograft. The use ofintra-operative autograft was associated with an improved fusion at 12-months (66.7% versus 37.5%, OR: 3.33, p=0.043). ConclusionFocused radiotherapy may be associated withan improved rate of fusion and clinical pseudoarthrosis when compared to conventional radiation delivery strategiesin patients with spinal tumors.Use of autograft at the time of surgery may be associated with improved 12-month fusion rates.Further large-scale prospective and randomized controlled studies are needed to better stratify the effects of radiation delivery modality in these patients.

scholarly journals Low doses v conventional doses of corticoids in immune thrombocytopenic purpura (ITP): results of a randomized clinical trial in 160 children, 223 adults

Blood ◽  
1988 ◽  
Vol 71 (4) ◽  
pp. 1165-1169 ◽  
Author(s):  
S Bellucci ◽  
Y Charpak ◽  
C Chastang ◽  
G Tobelem
Keyword(s):  
Clinical Trial ◽  
Randomized Clinical Trial ◽  
Immune Thrombocytopenic Purpura ◽  
Prospective Trial ◽  
Low Doses ◽  
Thrombocytopenic Purpura ◽  
Significant Difference ◽  
Adults And Children ◽  
Randomized Prospective Trial ◽  
Acute Itp

Abstract A randomized clinical trial was performed in 160 children and 223 adults with acute immune thrombocytopenic purpura (ITP). The role of corticoids at this phase of the disease is still controversial. Therefore, patients were randomized to receive either conventional doses (1 mg/kg/day) of corticotherapy or low doses (0.25 mg/kg/day) for 3 weeks. The remission, defined by platelet count superior to 100,000/microliter was studied for adults and children after 6 months and 12 months, respectively. The statistical analysis showed no significant difference between the two corticotherapy regimens neither in children nor in adults. Overall, 74% of children and 41% of adults were in remission. For the first time in acute ITP, a randomized prospective trial showed that both in children and adults low dose corticotherapy (0.25 mg/kg/day) proves to have the same efficacy as conventional doses (1 mg/kg/day).

scholarly journals Low doses v conventional doses of corticoids in immune thrombocytopenic purpura (ITP): results of a randomized clinical trial in 160 children, 223 adults

Blood ◽  
1988 ◽  
Vol 71 (4) ◽  
pp. 1165-1169 ◽  
Author(s):  
S Bellucci ◽  
Y Charpak ◽  
C Chastang ◽  
G Tobelem
Keyword(s):  
Clinical Trial ◽  
Randomized Clinical Trial ◽  
Immune Thrombocytopenic Purpura ◽  
Prospective Trial ◽  
Low Doses ◽  
Thrombocytopenic Purpura ◽  
Significant Difference ◽  
Adults And Children ◽  
Randomized Prospective Trial ◽  
Acute Itp

A randomized clinical trial was performed in 160 children and 223 adults with acute immune thrombocytopenic purpura (ITP). The role of corticoids at this phase of the disease is still controversial. Therefore, patients were randomized to receive either conventional doses (1 mg/kg/day) of corticotherapy or low doses (0.25 mg/kg/day) for 3 weeks. The remission, defined by platelet count superior to 100,000/microliter was studied for adults and children after 6 months and 12 months, respectively. The statistical analysis showed no significant difference between the two corticotherapy regimens neither in children nor in adults. Overall, 74% of children and 41% of adults were in remission. For the first time in acute ITP, a randomized prospective trial showed that both in children and adults low dose corticotherapy (0.25 mg/kg/day) proves to have the same efficacy as conventional doses (1 mg/kg/day).

A randomized prospective trial to compare four different ear packs following permeatal middle ear surgery

1998 ◽  
Vol 112 (2) ◽  
pp. 140-144 ◽  
Author(s):  
H. Zeitoun ◽  
G. S. Sandhu ◽  
M. Kuo ◽  
M. Macnamara
Keyword(s):  
Prospective Study ◽  
Middle Ear ◽  
Prospective Trial ◽  
Middle Ear Surgery ◽  
Ear Surgery ◽  
Post Operative Pain ◽  
Significant Difference ◽  
Different Types ◽  
Randomized Prospective Trial ◽  
Previous Training

AbstractSurgeons choice of an ear pack is dictated by availability, previous training and personal preference. There has been no recent prospective study evaluating the use of different types of ear packs. This randomized prospective study compares the use of BIPP impregnated ribbon gauze (Aurum), Pope wicks (Xomed-Teace), silastic sheeting (Dow Corning) and tri-adcortyl ointment (Squibb) as an ear dressing following ‘clear’ middle ear procedures via a permeatal approach. The results showed that there was no statistically significant difference in post-operative pain and discomfort experienced, neither was there any significant difference regarding the otolaryngologist's assessment of the degree of canal granulation, stenosis or discharge with the above named packs. This study concludes that non-traditional dressings such as tri-adcortyl ointment or simply a thin silastic sheet placed on the drum are no worse than time honoured BIPP. They have, as well, the advantage of being well-tolerated by the patients.

Cricoid Palpability as a Selection Criterion for Bedside Tracheostomy

2005 ◽  
Vol 133 (6) ◽  
pp. 839-844 ◽  
Author(s):  
Omar F. Husein ◽  
Douglas D. Massick
Keyword(s):  
Operating Room ◽  
Perioperative Complications ◽  
Cricoid Cartilage ◽  
Tertiary Care ◽  
Prospective Trial ◽  
Selection Criterion ◽  
University Hospital ◽  
Surgical Tracheostomy ◽  
Significant Difference ◽  
Open Surgical Tracheostomy

OBJECTIVE: To prospectively evaluate the significance of cricoid cartilage palpability as a selection criterion for bedside tracheostomy and to prospectively compare a cohort of patients undergoing bedside tracheostomy with another cohort receiving operating room tracheostomy. STUDY DESIGN/SETTING: Prospective trial comparing 2 cohorts of patients receiving tracheostomies at a tertiary care center (university hospital). In all, 220 consecutive intubated patients selected for elective tracheostomy were enrolled. Of them, 134 patients had palpable cricoid cartilage and underwent open surgical tracheostomy at the bedside. The remaining 68 patients received open surgical tracheostomies in the operating room. Demographic data, patient anatomic features, and perioperative complications were prospectively recorded. There were no statistically significant differences in age, gender, reason for admission, indication for tracheostomy, Acute Physiology and Chronic Health Evaluation II score, number of days intubated, or time required to perform the procedure for those patients whose tracheostomies were performed in the operating room versus the intensive care unit. RESULTS: Patients with a palpable cricoid cartilage had a significantly reduced perioperative complication rate compared with those without a palpable cricoid cartilage (2% vs 22%, P < 0.001). Comparison of cervical girth, mental-to-sternum distance, and thyroid-notch-to-sternum distance showed no significant difference between the 2 groups and did not further define selection criteria. CONCLUSION: This investigation prospectively confirms the safety of bedside tracheostomy placement in properly selected patients. Complication incidences are defined for open surgical tracheostomy at the bedside and in the operating room. Palpability of the cricoid cartilage has significant value as a selection criterion for bedside tracheostomy. SIGNIFICANCE: These findings will aid in the development of protocols and pathways for surgical airway management in critically ill patients to maximize cost-effective, high-quality care. EBM RATING: B-2

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