scholarly journals Should Subtotal Thyroidectomy Be Abandoned in Multinodular Goiter Patients From Endemic Regions Requiring Surgery?

2015 ◽  
Vol 100 (1) ◽  
pp. 9-14 ◽  
Author(s):  
Tayfun Yoldas ◽  
Ozer Makay ◽  
Gokhan Icoz ◽  
Timur Kose ◽  
Gulten Gezer ◽  
...  
Keyword(s):  
Risk Factors ◽  
Surgical Procedures ◽  
Thyroid Disease ◽  
Multinodular Goiter ◽  
Subtotal Thyroidectomy ◽  
Factors Affecting ◽  
Risk Factors For Recurrence ◽  
The Difference ◽  
Transient Hypoparathyroidism ◽  
Benign Thyroid

Abstract The most convenient surgical procedure for benign thyroid diseases is still controversial. The aim of this study is to determine the recurrence rate and risk factors for recurrence after different thyroidectomy procedures in multinodular goiter patients. Patients were separated into two groups according to the detection of a recurrent nodule or not after thyroidectomy. Of the 748 patients, 216 (29%) had recurrence, while 532 had no recurrent nodule. The difference between surgical procedures described as subtotal (ST), near total (NT) and total thyroidectomy (TT) was statistically significant. Transient hypoparathyroidism was significantly higher in NT and TT, when compared to ST patients (P < 0.05). Young age, bilateral multinodular goiter and insufficient surgery are risk factors affecting recurrence for benign nodular thyroid disease. Currently, subtotal procedures should be discontinued and total or near total procedures should be preferred. Meanwhile, the probability of a higher risk of hypoparathyroidism should be kept in mind.

Recurrence risk factors in detachable balloon embolization of traumatic direct carotid cavernous fistulas in 188 patients

2017 ◽  
Vol 10 (7) ◽  
pp. 704-707 ◽  
Author(s):  
Bu-Lang Gao ◽  
Zi-Liang Wang ◽  
Tian-Xiao Li ◽  
Bin Xu
Keyword(s):  
Risk Factors ◽  
Recurrence Risk ◽  
Parent Artery ◽  
Nerve Paralysis ◽  
Factors Affecting ◽  
Risk Factors For Recurrence ◽  
Carotid Cavernous Fistulas ◽  
Abducent Nerve ◽  
Balloon Embolization

PurposeTo investigate the effects of detachable balloons in embolizing traumatic carotid cavernous fistulas (TCCFs) and the risk factors for recurrence after balloon embolization.Materials and methods188 patients with TCCFs were enrolled, and clinical, treatment, and follow-up data were analyzed for possible risk factors for recurrence after embolization.ResultsAmong 188 patients, 182 (96.8%) had successful balloon embolization; 6 patients failed. One balloon was used in 94 cases and multiple (two or more) balloons were used in 62 patients. 26 patients had occlusion of the parent artery whereas the remainder had parent artery preservation. Periprocedural complications occurred in 3 patients (1.6%) including cerebral embolism in 1 and abducent nerve paralysis in the other 2. Immediately following embolization, headache appeared in 92 patients and was relieved after 3–5 days with medications. A total of 165 patients (87.8%) had follow-up (6 months to 16 years, mean 5 years). 23 (13.9%) patients with internal carotid artery preservation had recurrence 1–33 days (mean 11 days) after the first embolization and were retreated to complete occlusion. Factors affecting recurrence were multiple balloons and residual fistula (p<0.05). Logistic regression confirmed the independent factors affecting recurrence were multiple balloons (≥2 balloons, OR 7.80, 95% CI 2.28 to 26.73; p=0.001) and residual fistula immediately following embolization (OR 10.46, 95% CI 2.99 to 36.5; p=0.000).ConclusionThe recurrence rate is high in the first month after embolization with detachable balloons, and multiple balloons and residual fistula are two independent factors affecting recurrence following balloon embolization.

scholarly journals Does the approved tariff cover the actual cost of global surgical procedures?

2020 ◽  
Author(s):  
Ehsan Zarei ◽  
Maedehalsadadt Hashemi ◽  
Abbas Daneshkohan ◽  
Edris Kakemam
Keyword(s):  
Surgical Procedures ◽  
Cross Sectional Study ◽  
Study Data ◽  
Full Time ◽  
Actual Cost ◽  
Medical Sciences ◽  
Cross Sectional ◽  
Factors Affecting ◽  
Supreme Council ◽  
The Difference

Abstract Background: Following the implementation of the health transformation plan in Iran and the significant increase in medical tariffs, it seems there is still a considerable gap between the actual cost of the Global Surgical procedures (GSPs) and the approved tariffs. The aim of this study was to compare the actual costs of GSPs with approved tariffs in hospitals affiliated to Qazvin University of Medical Sciences in 2016. Methods: In this cross-sectional study, data of 6,126 GSPs performed in three hospitals were extracted from Hospital Information System and approved tariffs were also obtained from the Supreme Council of Health Insurance. The difference between the average actual costs of a GSP and its tariff was considered as the tariff-actual cost gap. Regression test was used to determine the factors affecting the tariff-actual cost gap using SPSS.21. Results: The average actual cost of GPSs was 503 USD while the average tariff was 361 USD, indicating a significant negative gap between the approved tariffs and the actual cost of GPSs. In fact, for each procedure, the hospital suffered an average of 142 USD losses. In 54 of 63 GSPs, the average actual cost was 0.3% to 307.4% higher than the tariff. The highest negative gap was related to the “femoral fracture fixation" with -307.4%. The gap was higher in older patients, females, and patients with a longer stay, orthopedic specialty, and full-time surgeons (p<0.05). Conclusions: The findings of this study showed that tariffs covered only 71.8% of actual costs. It is suggested that in the tariff setting of GSPs, factors such as inflation rate, patient's age, comorbidity, disease severity, and hospital function (teaching or referral center) be considered. In addition, hospital management can also reduce the gap by modifying processes and managing resource consumption, especially medicines and consumables items.

scholarly journals Is it Time to Shift to Total Thyroidectomy for Benign Thyroid Disease: An Analysis of 77 Redo Thyroidectomies

2015 ◽  
Vol 5 (1) ◽  
pp. 4-6
Author(s):  
G Raghavendra Prasad
Keyword(s):  
Total Thyroidectomy ◽  
Thyroid Disease ◽  
Recurrent Laryngeal Nerve Palsy ◽  
Benign Disease ◽  
Subtotal Thyroidectomy ◽  
High Rate ◽  
Follicular Neoplasm ◽  
Complication Rates ◽  
Benign Thyroid Disease ◽  
Benign Thyroid

ABSTRACT Aims and objectives To analyze redo thyroidectomies so as to get a possible answer to the controversy surrounding thyroidectomy for benign disease. Materials and methods This is a retrospective observational cohort. From 1996 to 2010, a total 77 cases of redo thyroidectomies were performed. The data of all patients in the department were maintained on a self developed MS access-based software. The data of redo thyroidectomies were reviewed. These patients were from five districts of Andhra Pradesh, 42 were women and 35 men, 51 underwent subtotal thyroidectomy, 21 had hemithyroidectomy and 5 patients had excision procedure; all were benign. The condition varied from multinodular goiter (MNG) and solitary nodule to follicular neoplasm. There were 44 right-sided, and 43 left-sided surgeries. Recurrence occurred in seven in less than 1 year, in 49 in less than 5 years, in 11 of them in less than 10 years and 10 had recurrence after 10 years. A total thyroidectomy was performed in all. Seventy-five had benign disease. Two had suspected neoplasm; one papillary and one Hurthle cell. One patient had transient recurrent laryngeal nerve palsy. Results Seventy-seven redo surgeries for benign thyroid disease were performed. The high rate of referrals for recurrence probably suggests inadequacy of subtotal and hemithyroidectomies for benign thyroid diseases. Conclusion The present series of 77 redo thyroidectomies clearly suggests inadequacy of initial subtotal thyroidectomy. Evidence-based analysis of complication rates and surgical feasibility supports total thyroidectomy as the complete safe, scientifically acceptable choice of primary surgical treatment for benign thyroid disease. How to cite this article Prasad RG. Is it Time to Shift to Total Thyroidectomy for Benign Thyroid Disease: An Analysis of 77 Redo Thyroidectomies. Int J Phonosurg Laryngol 2015;5(1):4-6.

scholarly journals FACTORS AFFECTING CREDIT SPREAD IN INDIAN DEBT MARKET

2021 ◽  
Vol 9 (2) ◽  
pp. 333-337
Author(s):  
Praveen Gupta, Et. al.
Keyword(s):  
Risk Factors ◽  
Null Hypothesis ◽  
Credit Spread ◽  
Government Bonds ◽  
Factors Affecting ◽  
Linear Dependency ◽  
Debt Market ◽  
Repo Rate ◽  
The Difference ◽  
The Relationship

This paper shows that how Macro risk factors affect the credit spread in the Indian debt market. Credit spread is the difference between government bonds and corporate bonds of the same maturity. Various factors impact the spread directly and indirectly. The main focus of this paper to determine the relationship between these factors and find out which factors are explaining credit spread. This paper determines the significance linear dependency of credit spread on various factors through regression analysis. These factors are the market risk factors such as Inflation, GDP growth, and liquidity factors like the Repo rate. This paper will show that whether we are accepting the null hypothesis which states that these factors affect the credit spread or reject the hypothesis of no impact of variables on credit spread

scholarly journals ASSESSMENT OF RISK FACTORS AND COMPLICATIONS OF LAPAROSCOPIC CHOLECYSTECTOMY

2021 ◽  
Vol 1 (1) ◽  
pp. 08-10
Author(s):  
Maram A. Fagiri ◽  
Turgut İmir Başak ◽  
Serap Nergiz
Keyword(s):  
Risk Factors ◽  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Surgical Procedures ◽  
Bile Leakage ◽  
Developed Countries ◽  
Intraoperative Bleeding ◽  
Complications Of Laparoscopic Cholecystectomy ◽  
Common Etiology ◽  
The Difference

Cholecystectomy is one of the most common abdominal surgical procedures in developed countries. 74 patients of cholecystectomy of both genders were enrolled. was recorded. A thorough clinical examination was done. Lipid profile, Etiology and complications were recorded. Common etiology found to be cholestasis in 38, hyperlipidemia in 24, hereditary spherocystosis and idiopathic cases. The difference was significant (P< 0.05). Complications were intraoperative bleeding, biliary peritonitis, intra-abdominal collections bile duct injury, ligation of CBD, bile leakage, SSI, and retained CBD stones cases. The difference was significant (P< 0.05). Authors found that common etiology found to be cholestasis, hyperlipidemia, hereditary spherocystosis and idiopathic.

Airway Management and Risk Factors for Prolonged Intubation in Patients with Severe Croup

2021 ◽  
Author(s):  
Tadashi Oi ◽  
Norihiko Tsuboi ◽  
Kaoru Tsuboi ◽  
Satoshi Nakagawa
Keyword(s):  
Risk Factors ◽  
Airway Management ◽  
Upper Airway ◽  
Respiratory Illness ◽  
Internal Diameter ◽  
Factors Affecting ◽  
Prolonged Intubation ◽  
Age Appropriate ◽  
The Difference ◽  
Pediatric Icu

AbstractCroup is a common respiratory illness in children with a substantial variation in the severity of symptoms. Most of the patients present with mild symptoms, but patients with severe croup require intensive care unit (ICU) management. The aim of this study was to investigate the airway management of patients with severe croup who required intubation and determine the risk factors for prolonged intubation. We performed an 18-year retrospective observational cohort study at the pediatric ICU of a tertiary children's hospital in Japan. A total of 16 patients with croup who were intubated for upper airway obstruction were included in the study. Most patients (13of 16, 81%) were intubated with an endotracheal tube (ETT) smaller than their age-appropriate size. The median difference in the internal diameter (ID) between the selected ETT and the age-appropriate size was 1.0 mm (interquartile range: 0.5–1.0). Multivariate analysis performed on factors affecting the cumulative incidence of extubation revealed that the difference in ID between the selected ETT and age-appropriate size (mm) significantly reduced the duration of intubation (hazard ratio: 0.092, p = 0.03). A downsized ETT without a cuff may be recommended for intubation of patients with croup.

Reoperative Thyroidectomy for Benign Thyroid Disease: The Diminishing Role of Subtotal Thyroidectomy

2009 ◽  
Vol 119 (S1) ◽  
pp. S89-S89
Author(s):  
David J. Terris ◽  
Sunny A. Khichi ◽  
Susan K. Anderson ◽  
Mayssoun A. El-Choufi ◽  
Melanie W. Seybt
Keyword(s):  
Thyroid Disease ◽  
Subtotal Thyroidectomy ◽  
Benign Thyroid Disease ◽  
Benign Thyroid
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