scholarly journals A Novel Test, the Sternomental Distance Ratio, Used as a Predictor of Difficult Laryngoscopy in a Normal Population and in Thyroid Tumor Surgery Patients: A Preliminary Study

2021 ◽  
Vol 49 (3) ◽  
pp. 249
Author(s):  
Evangelia Kopanaki ◽  
Maria Piagkou ◽  
Theano Demesticha ◽  
Emmanouil Anastassiou ◽  
Panagiotis Skandalakis
Keyword(s):  
Elective Surgery ◽  
Normal Population ◽  
Thyroid Tumor ◽  
Difficult Laryngoscopy ◽  
Surgical Patients ◽  
Tumor Surgery ◽  
Thyroid Tumors ◽  
Distance Ratio ◽  
Glottic View ◽  
Preliminary Study

<p class="Default"><strong><span>Objective. </span></strong><span>The aim of the present preliminary study was to assess whether the sternomental distance ratio (SMDR) could be suitable as a predictor of difficult laryngoscopy, in both normal surgical patients and patients scheduled to undergo thyroid tumor surgery. </span></p><p class="Default"><strong><span>Methods. </span></strong><span>Two hundred and twenty-one consecutive adult patients (among them 122 patients with presumed normal airways and 33 patients with thyroid tumors), scheduled to undergo elective surgery under general anesthesia, were included in this study. Physical and airway characteristics, SMDR, difficult laryngoscopy (using Cormack-Lehane scale) and any kind of assisted intubation were assessed. </span></p><p class="Default"><strong><span>Results. </span></strong><span>Decreased SMDR demonstrated a strong correlation with difficult laryn­goscopy in both thyroid tumor (Kendall’s tau-b -0.578 (P=0.004) and normal patients -0.362 (P&lt;0.001). Difficult laryngoscopy was 0 at SMDR&gt;1.9 and 33% at SMDR &lt;1.55 (P&lt;0.001). The higher the SMDR was, the better the glottic view obtained. </span></p><p class="Default"><strong><span>Conclu­sions. </span></strong><span>Α SMDR&gt;1.9 indicates an easy laryngoscopy, whereas SMDR &lt;1.55 indicates a difficult one in both thyroid tumor and normal patients. SMDR is an objective test to assess difficult airway in thyroid surgery.</span></p>

scholarly journals A Comparison of Wilson Risk Sum Score and Combination of Modified Mallampati Classification, Hyomental Distance Ratio, Ratio of Height to Sternomental and Thyromental Distances for Predicting Difficult Laryngoscopy in Indian Population

2020 ◽  
Vol 7 (50) ◽  
pp. 3038-3045
Author(s):  
Deepak Kumar ◽  
Saurabh Bhargava ◽  
Ravindra Singh Sisodiya ◽  
Deepak Tiwari
Keyword(s):  
Indian Population ◽  
Elective Surgery ◽  
Difficult Laryngoscopy ◽  
Receiver Operating Curve ◽  
Chi Square ◽  
Distance Ratio ◽  
Double Blind ◽  
Combination Methods ◽  
Sum Score ◽  
Chi Square Test

BACKGROUND A few patients of apparently normal appearance unexpectedly present with great difficulties during intubation which may lead to potentially serious consequences. Thus, we worked on this area with the aim to determine the ability to predict difficult visualisation of larynx using the following preoperative airway predictors: MMC (Modified Mallampati Classification), RHSMD (Ratio of Height to Sternomental Distance), RHTMD (Ratio of Height to Thyromental) and HMDR (Hyomental Distance Ratio) and comparison of these with WRSS (Wilson Risk Sum Score), in isolation and in combination. METHODS A double-blind, prospective study was carried out on 300, ASA grade I or II patients posted for elective surgery in supine position under general anaesthesia. Different parameters were recorded in pre-op period and Cormack-Lehane grading and difficulty of intubation was recorded at the time of intubation. Chi Square test and receiver operating curve were used to assess the association of all the airway tests and various combinations with CL grading. Cohen’s kappa was calculated to determine the strength of agreement between laryngoscopy grade and various tests in isolation and combinations. RESULTS In our study, highest strength of agreement was found with WRSS of 0.925 (0.873 - 0.976) and only a fair agreement was seen with HMDR (κ = 0.319). RHSMD and combination of RHSMD + MMC showed good strength with kappa of 0.638 and 0.634 respectively. CONCLUSIONS No single test or group of tests was able to predict all cases of difficult laryngoscopy at the preoperative airway assessment. Wilson Risk Sum Score was found to be the best predictor of difficult laryngoscopy when compared to MMC, RHTMD, RHSMD and HMDR in isolation and any possible combination. KEYWORDS Difficult Laryngoscopy, Difficult Intubation, Wilson Risk Sum Score, Airway, RHSMD, RHTMD

scholarly journals The effectiveness of different patient referral systems to shorten waiting times for elective surgeries: systematic review

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Dimuthu Rathnayake ◽  
Mike Clarke
Keyword(s):  
Primary Care ◽  
Health Systems ◽  
Elective Surgery ◽  
Waiting Times ◽  
Surgical Care ◽  
High Income ◽  
Surgical Patients ◽  
Timely Access ◽  
Referral Systems

Abstract Background Long waiting times for elective surgery are common to many publicly funded health systems. Inefficiencies in referral systems in high-income countries are more pronounced than lower and middle-income countries. Primary care practitioners play a major role in determining which patients are referred to surgeon and might represent an opportunity to improve this situation. With conventional methods of referrals, surgery clinics are often overcrowded with non-surgical referrals and surgical patients experience longer waiting times as a consequence. Improving the quality of referral communications should lead to more timely access and better cost-effectiveness for elective surgical care. This review summarises the research evidence for effective interventions within the scope of primary-care referral methods in the surgical care pathway that might shorten waiting time for elective surgeries. Methods We searched PubMed, EMBASE, SCOPUS, Web of Science and Cochrane Library databases in December-2019 to January-2020, for articles published after 2013. Eligibility criteria included major elective surgery lists of adult patients, excluding cancer related surgeries. Both randomised and non-randomised controlled studies were eligible. The quality of evidence was assessed using ROBINS-I, AMSTAR 2 and CASP, as appropriate to the study method used. The review presentation was limited to a narrative synthesis because of heterogeneity. The PROSPERO registration number is CRD42019158455. Results The electronic search yielded 7543 records. Finally, nine articles were considered as eligible after deduplication and full article screening. The eligible research varied widely in design, scope, reported outcomes and overall quality, with one randomised trial, two quasi-experimental studies, two longitudinal follow up studies, three systematic reviews and one observational study. All the six original articles were based on referral methods in high-income countries. The included research showed that patient triage and prioritisation at the referral stage improved timely access and increased the number of consultations of surgical patients in clinics. Conclusions The available studies included a variety of interventions and were of medium to high quality researches. Managing patient referrals with proper triaging and prioritisation using structured referral formats is likely to be effective in health systems to shorten the waiting times for elective surgeries, specifically in high-income countries.

Status and expression of thep16INK4 gene in human thyroid tumors and thyroid-tumor cell lines

1996 ◽  
Vol 67 (1) ◽  
pp. 29-34 ◽  
Author(s):  
Viola Calabr� ◽  
Maria Strazzullo ◽  
Girolama La Mantia ◽  
Monica Fedele ◽  
Christian Paulin ◽  
...  
Keyword(s):  
Tumor Cell ◽  
Cell Lines ◽  
Thyroid Tumor ◽  
Human Thyroid ◽  
Thyroid Tumors ◽  
Tumor Cell Lines

scholarly journals Sternomental distance ratio as a predictor of difficult laryngoscopy: A prospective, double-blind pilot study

2020 ◽  
Vol 14 (1) ◽  
pp. 49
Author(s):  
Evangelia Kopanaki ◽  
Maria Piagkou ◽  
Theano Demesticha ◽  
Emmanouil Anastassiou ◽  
Panagiotis Skandalakis
Keyword(s):  
Pilot Study ◽  
Difficult Laryngoscopy ◽  
Distance Ratio ◽  
Double Blind

scholarly journals Ptimary thyroid lymphomas and other rare thyroid tumors

2003 ◽  
Vol 50 (3) ◽  
pp. 141-146 ◽  
Author(s):  
Aleksandar Diklic ◽  
Vladan Zivaljevic ◽  
Ivan Paunovic ◽  
Ksenija Krgovic ◽  
Rastko Zivic ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Residual Tumor ◽  
Hashimoto Thyroiditis ◽  
Local Relapse ◽  
Thyroid Tumor ◽  
Recurrent Nerve ◽  
Thyroid Tumors ◽  
Treatment Frequency ◽  
Recurrent Nerve Palsy

Primary thyroid lymphomas are rare. Surgery is seldom indicated. The aim of the study is to find out the main characteristics of primary thyroid lymphomas in our patients, indications for surgery and the possibility of treatment, frequency and characteristics of rare thyroid tumors. Method: retrospective study of 1044 patient operated for malignant thyroid tumor. Results: From 1995 to may 2003, we operated upon 15 patients with primary thyroid lymphomas, 2 men and 13 women mean age of 50.12 years (from 22 to 74 years), also one patient of age 69 with insular thyroid cancer. Reason for surgery was thyroid tumor in all, compressive disturbances in 9, among them 4 with asphyxia. Radical total thyroidectomy was performed in 4 (26.7%), whole in others some residual tumor tissue was could not be removed in spite of thyroidectomy in 3, hemithyroidectomy in 2, tumor debulking in 5 and only open biopsy was performed in one patient. There was no operative mortality, no postoperative hypocalcaemia and no recurrent nerve palsy. Histological type of tumor was Non-Hodgkin lymphoma in 13 patients, Hodgkin disease in 2 female patients of age 22 and 24. Hashimoto thyroiditis was present in 3 patients. After surgery, 13 patients were treated with chemotherapy, one patient died one month after the operation and one patient refused chemotherapy. Follow-up data are available for 9 patients and the mean follow-up period was 20 months (1-48months). Three patients died after a month, 2 and 3 years after surgery. Six patients are without local relapse. In one patient who refused chemotherapy, a year after thyroid surgery, resection of large intestine was performed because of lymphoma of the colon. Conclusion: Malignant thyroid lymphomas are rare. They present with rapidly growing thyroid tumor, compression and asphyxia. Surgery is only temporarily effective and it is necessary to start with chemo-radiotherapy as soon as possible. Rare forms of thyroid cancer have to be histological recognized in order to choose the best way of treatment.

scholarly journals Frequency of various types of neoplasia in a group of acromegalic patients

2013 ◽  
Vol 57 (8) ◽  
pp. 612-616
Author(s):  
Fernanda Bolfi ◽  
Helio Amante Miot ◽  
Mariangela Resende ◽  
Glaucia M. S. F. Mazeto ◽  
Fernando Gomes Romeiro ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Basal Cell Carcinoma ◽  
Primary Hyperparathyroidism ◽  
High Frequency ◽  
Acanthosis Nigricans ◽  
Thyroid Nodules ◽  
Colon Adenocarcinoma ◽  
Thyroid Tumor ◽  
Thyroid Tumors

OBJECTIVE: To determine the frequency of colon cancer, primary hyperparathyroidism, thyroid tumor, and skin cancer in all acromegalic patients in follow-up at the Clinics Hospital - Botucatu Medical School, from 2005 to 2011. SUBJECTS AND METHODS: These patients were evaluated retrospectively for colon cancer, primary hyperparathyroidism, dermatological, and thyroid tumors. RESULTS: Of 29 patients included at the beginning of the study, two were excluded. Among 19 patients submitted to colonoscopy, one presented colon adenocarcinoma (5%). Thyroid nodules were present in 63% of patients, and papilliferous carcinoma was confirmed in two patients (7,7%). Four patients were confirmed as having primary hyperparathyroidism (15%). The most common dermatologic lesions were thickened skin (100%), acrochordons (64%), epidermal cysts (50%), and pseudo-acanthosis nigricans (50%). Only one patient presented basal cell carcinoma. CONCLUSION: Although a small number of acromegalic patients was studied, our findings confirm the high frequency of thyroid neoplasias and primary hyperparathyroidism in this group of patients.

Short Thyromental Distance: A Predictor of Difficult Intubation or an Indicator for Small Blade Selection?

2006 ◽  
Vol 104 (6) ◽  
pp. 1131-1136 ◽  
Author(s):  
Mukesh Tripathi ◽  
Mamta Pandey
Keyword(s):  
Clinical Study ◽  
Difficult Laryngoscopy ◽  
Adult Patients ◽  
Prospective Clinical Study ◽  
Lateral Neck ◽  
Failed Intubation ◽  
Glottic View ◽  
Curved Blade ◽  
Blade Tip ◽  
American Society

Background Short thyromental distance (TMD; &lt; 5 cm) has been correlated with difficult direct laryngoscopic intubation in adult patients. The authors hypothesized that a smaller Macintosh curved blade (No. 2 MCB) would improve the predicted difficult laryngoscopy in short-TMD patients over that with a standard Macintosh curved blade (No. 3 MCB). Methods In a preliminary study of 11 consenting adults (7 females and 4 males), American Society of Anesthesiologists physical status I and TMD &lt; or = 5 cm, lateral neck radiographs were recorded during laryngoscopy with a No. 2 and No. 3 MCB in sequential fashion. In a prospective clinical study, laryngoscopy and tracheal intubation were evaluated in 83 adult patients with TMD &lt; or = 5 cm by randomly assigning them to two groups for the blade used at first intubation. Those who failed intubation with the first blade were switched to the alternate blade. In total 100 laryngoscopies and intubations were performed: the No. 2 MCB (n = 50) and the No. 3 MCB (n = 50). Results Lateral neck radiographs recorded at the best laryngeal view revealed that the tip of the No. 2 MCB was proximal to the hyoid body with the No. 2 MCB and distal to it with the No. 3 MCB. The intubation distance (C5 to blade tip) on neck radiographs with the No. 2 MCB was significantly greater than it was with the No. 3 MCB for similar anterior jaw displacement. In the clinical study, the laryngoscopic grade with the No. 2 blade was considered easy (median, 2B), better than the grade with the No. 3 MCB (median, 3). When the No. 2 MCB was used, external laryngeal pressure improved the laryngoscopic grade (1, full glottic view) in 46% of patients. In contrast, when the No. 3 MCB was used, pressure improved the grade in only 10% of the patients. Intubation time with the No. 2 MCB was significantly (P &lt; 0.05) less than it was in patients with No. 3 MCB. Overall, 14 patients who failed intubation with the No. 3 MCB were switched to the No. 2 MCB, and intubation was successful with an easy laryngoscopic grade. Three patients who failed intubation with the No. 2 MCB were switched to the No. 3 MCB. Conclusions The predicted difficult laryngoscopy and intubation with the use of the adult No. 3 MCB in standard adult patients with a TMD &lt; or = 5 cm is significantly easier with use of the smaller No. 2 MCB.

BODY MASS INDEX OF ORTHOPAEDIC SURGICAL PATIENTS IN JEJU — DOES IT REFLECT THE KOREANS’ NUTRITIONAL STATUS

2020 ◽  
pp. 2050022
Author(s):  
Myung-Sang Moon ◽  
Bum Soo Kim ◽  
Seong-Tae Kim ◽  
Won Rak Choi ◽  
Hyeon Gyu Lim
Keyword(s):  
Body Mass Index ◽  
General Population ◽  
Body Mass ◽  
Elective Surgery ◽  
Normal Weight ◽  
Surgical Patients ◽  
Living Standard ◽  
Orthopaedic Patients ◽  
Obesity Status ◽  
Nutritional Studies

Purpose: To assess the preoperative body mass indices of various orthopaedic conditions, there are a few previous nutritional studies in surgical patients, and none did solely the BMI study in general population in Korea. The current authors planned indirectly to evaluate the Koreans’ obesity. Methods: BMI was used to assess the obesity status of the 2063 orthopaedic patients who were subjected to surgeries; 1272 fractures, 490 various elective surgeries, 232 arthroplasties, 59 musculoskeletal infections, and 10 uninfected diabetics, in Jeju island. Results: Among total 2063 patients, 101 patients (4.8%) had underweight, normal weight in 1220 patients (59.1%), overweight in 630 (30.5%), and the so-called “obese” in 124 cases (6.0%). The obesity in detail of each group is listed in Table 2–6. Among 1272 fracture cases, underweight in 79 (6.2%), normal weight in 752 (61.5%), overweight in 345 (27.1%), and overall class I–III obese in 66 (5.1%). 490 elective surgery patients had overweight in 34.5% and obese in 7.1%. The incidences of obesity in each condition are nearly similar, ranging from 5.2% to 7.3% except for the diabetic one. Conclusions: This study on BMI of the orthopaedic patients disclosed that the incidence of obesity is not high yet in Jeju islanders, in spite of the highly improved living standard.

scholarly journals Lack of Mutations in the Thyroid Hormone Receptor (TR) α and β Genes but Frequent Hypermethylation of the TRβ Gene in Differentiated Thyroid Tumors

2007 ◽  
Vol 92 (12) ◽  
pp. 4766-4770 ◽  
Author(s):  
Biju Joseph ◽  
Meiju Ji ◽  
Dingxie Liu ◽  
Peng Hou ◽  
Mingzhao Xing
Keyword(s):  
Thyroid Cancer ◽  
Thyroid Hormone ◽  
Tumor Cell ◽  
Gene Mutation ◽  
Hormone Receptor ◽  
Thyroid Hormone Receptor ◽  
Thyroid Tumor ◽  
Thyroid Tumors ◽  
Tumor Cell Lines ◽  
Thyroid Adenomas

Abstract Context: It remains inconclusive whether mutations in thyroid hormone receptor (TR) genes naturally occur in thyroid cancer and whether these genes could be suppressors of this cancer. Objectives: Our objectives were to examine further mutations of TRα and TRβ genes in thyroid cancer and also to examine their methylation as an epigenetic silencing mechanism in thyroid cancer. Experimental Design: Instead of using a cDNA sequencing approach used in previous studies, we used genomic DNA to sequence directly the coding regions of the TRα and TRβ genes to search mutations in various differentiated thyroid tumors and used methylation-specific PCR to analyze promoter methylation of these genes. Allelic zygosity status at TRβ was also analyzed. Results: We found no TRα gene mutation in 17 papillary thyroid cancers (PTCs) and 11 follicular thyroid cancers (FTCs), and no TRβ gene mutation in 16 PTCs and 12 FTCs. We also found no methylation of the TRα gene in 33 PTCs, 31 FTCs, 20 follicular thyroid adenomas (FTAs), and 10 thyroid tumor cell lines. In contrast, we found hypermethylation of the TRβ gene in 10 of 29 (34%) PTCs, 22 of 27 (81%) FTCs, five of 20 (25%) follicular thyroid adenomas, and three of 10 (30%) thyroid tumor cell lines, with the highest prevalence in FTC. We additionally examined loss of heterozygosity at TRβ and found it in three of nine (33%) PTCs and three of nine (33%) FTCs. Conclusions: Mutation is not common in TR genes, whereas hypermethylation of the TRβ gene as an alternative gene silencing mechanism is highly prevalent in thyroid cancer, particularly FTC, consistent with a possible tumor suppressor role of this gene for FTC.

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