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Nathalie Chereau, T Greilsamer, Eric Mirallié, S M Sadowski, M Pusztaszeri, Frederic Triponez, G Baud, Francois Pattou, N Christou, M Mathonnet, Laurent Brunaud, N Santucci, Pierre Goudet, C Guérin, Frédéric Sebag, G Donatini, Jean-Louis Kraimps, Frédérique Tissier, Charlotte Lussey, Laurence Leenhardt, Fabrice Menegaux
BACKGROUND: Encapsulated follicular variant of papillary thyroid carcinoma has recently been reclassified as noninvasive follicular thyroid neoplasm with papillary-like nuclear features on the basis of its highly indolent behavior, as proposed by an international group of experienced thyroid pathologists. METHODS: All patients from 9 high-volume endocrine surgery departments who underwent surgery between 2005 and 2015 and whose final surgical pathology revealed noninvasive follicular thyroid neoplasm with papillary-like nuclear features (>10 mm) were included in this study...
November 9, 2018: Surgery
Yasmine Assadipour, Hui Zhou, Eric J Kuo, Philip I Haigh, Annette L Adams, Michael W Yeh
BACKGROUND: Patients with primary hyperparathyroidism are at risk for skeletal and renal end-organ damage. METHODS: We studied patients with biochemically confirmed primary hyperparathyroidism from 1995-2014 and quantified the frequency of osteoporosis, nephrolithiasis, hypercalciuria, and decrease in renal function. RESULTS: The cohort comprised 9,485 patients. In total, 3,303 (35%) had preexisting end-organ effects (osteoporosis, 24%; nephrolithiasis, 10%; hypercalciuria, 5%)...
November 9, 2018: Surgery
Danilea M Carmona Matos, Samuel Jang, Baraa Hijaz, Alex W Chang, Ricardo V Lloyd, Herbert Chen, Renata Jaskula-Sztul
BACKGROUND: Certain human carcinomas have demonstrated a distinct expression of somatostatin receptors. Data on somatostatin receptor expression in follicular thyroid cancer and anaplastic thyroid cancer has been limited and conflicting. This study seeks to characterize somatostatin receptor expression in follicular thyroid cancer and anaplastic thyroid cancer and to assess the effects of somatostatin analogues. METHODS: Anaplastic thyroid cancer (Hth7 and 8505C) and follicular thyroid cancer (FTC-236) (Sigma-Aldrich, St...
November 8, 2018: Surgery
Ashok R Shaha, Jocelyn C Migliacci, Iain J Nixon, Laura Y Wang, Richard J Wong, Luc G T Morris, Snehal G Patel, Jatin P Shah, R Michael Tuttle, Ian Ganly
BACKGROUND: Tumor, node, and metastasis staging in thyroid carcinoma is important for assessing prognosis. However, patients with stage III or IV disease have an overall survival rate of 90%. The change to 55 years of age as the cutoff will create stage migration and many patients will be downstaged. METHODS: We reviewed our database of 3,650 patients to analyze the impact of the new American Joint Committee on Cancer staging system. There were 994 men (27%) and 2,656 women (73%)...
November 8, 2018: Surgery
Brian C Ruhle, Michael G White, Salman Alsafran, Edwin L Kaplan, Peter Angelos, Raymon H Grogan
BACKGROUND: Primary aldosteronism is a common but underdiagnosed cause of hypertension. Patients with this disorder have worse morbidity compared with those with essential hypertension, but with timely diagnosis and appropriate intervention these patients are potentially cured and may have reversal of target organ damage. The goal of this study was to determine if hypertensive patients considered high risk were checked for primary aldosteronism. METHODS: We reviewed electronic health records to identify patients age 18 years or older with coexisting hypertension and hypokalemia or hypertension and sleep apnea, then determined if they had been investigated with measurement of aldosterone or renin...
November 8, 2018: Surgery
Poongkodi Karunakaran, Chandrasekaran Maharajan, Rajasekaran Chockalingam, Premkumar Asokumar, Kamaleswaran Koramadai Karuppusamy, Vijay Sadasivam
BACKGROUND: Although hyperthyroidism is associated with high turnover osteopenia and its recovery after treatment, the extent of recovery with different forms of therapy remains controversial. This prospective study evaluated the bone mineral density in thyrotoxic subjects undergoing total thyroidectomy and 131 I radioactive iodine therapy. METHODS: Newly diagnosed subjects with hyperthyroidism undergoing total thyroidectomy (group 1; n = 127) and 131 I radioactive iodine therapy (group 2; n = 30) were evaluated for bone mineral density by dual energy x-ray absorptiometry at the time of diagnosis (point A), on achieving euthyroidism with antithyroid drugs (point B), and 6 months after definitive treatment (point C)...
November 8, 2018: Surgery
Mary E Condron, Nora E Jameson, Kristen E Limbach, Ann E Bingham, Valerie A Sera, Ryan B Anderson, Katie J Schenning, Shaun Yockelson, Izumi Harukuni, Edward A Kahl, Elizabeth Dewey, SuEllen J Pommier, Rodney F Pommier
BACKGROUND: Sudden massive release of serotonin, histamine, kallikrein, and bradykinin is postulated to cause an intraoperative carcinoid crisis. The exact roles of each of these possible agents, however, remain unknown. Optimal treatment will require an improved understanding of the pathophysiology of the carcinoid crisis. METHODS: Carcinoid patients with liver metastases undergoing elective abdominal operations were studied prospectively, using intraoperative, transesophageal echocardiography, pulmonary artery catheterization, and intraoperative blood collection...
November 8, 2018: Surgery
John F Tierney, Cory Kosche, Erik Schadde, Amjad Ali, Sumeet Virmani, Sam G Pappas, Jennifer Poirier, Xavier M Keutgen
BACKGROUND: 68 Gallium-DOTATATE positron emission tomography-computed tomography (PET CT) has shown superior accuracy in detecting grade 1 and 2 neuroendocrine tumors over previous imaging modalities and was recently included in National Comprehensive Cancer Network guidelines. It remains unclear which patients benefit most from this imaging modality. We therefore reviewed our initial experience with 68 Gallium-DOTATATE PET CT to evaluate its usefulness in diagnosing, staging, and surveilling neuroendocrine tumors...
November 8, 2018: Surgery
Beatriz de Rienzo-Madero, John P Sabra, Elise Gand, Gianluca Donatini, Jean-Louis Kraimps
BACKGROUND: Few long-term studies define the appropriate extent of surgery and recurrence rates for unilateral multinodular goiter. We compared the rate and time to reoperation in patients with multinodular goiter who underwent lobectomy to that of patients with benign solitary nodule. METHODS: Retrospective study of a prospective database of all patients who underwent lobectomy for multinodular goiter or solitary nodule from 1991 to 2017. We analyzed reoperation rates and time to reoperation...
November 8, 2018: Surgery
Brendan M Finnerty, Tyler W Chan, Gregory Jones, Tarek Khader, Maureen Moore, Katherine D Gray, Toni Beninato, Anthony C Watkins, Rasa Zarnegar, Thomas J Fahey
BACKGROUND: Renal transplant allograft function in patients with tertiary hyperparathyroidism who are treated with cinacalcet versus parathyroidectomy remains unclear. METHODS: This is a retrospective, single-center review of patients with tertiary hyperparathyroidism between 2000 and 2017. We compared clinical parameters and outcomes, including renal allograft failure in patients who had undergone parathyroidectomy versus treatment with cinacalcet therapy. RESULTS: A total of 133 patients were included (33 who received parathyroidectomy and 100 who received cinacalcet); median renal allograft survival was 5...
November 8, 2018: Surgery
Zeyad T Sahli, Farah Karipineni, Jen-Fan Hang, Joseph K Canner, Aarti Mathur, Jason D Prescott, Sheila Sheth, Syed Z Ali, Martha A Zeiger
BACKGROUND: A high proportion of cytologically indeterminate, Afirma-suspicious thyroid nodules are benign. The Thyroid Imaging Reporting and Data System was proposed by the American College of Radiology in 2015 to determine appropriate management of thyroid nodules in a standardized fashion. Our aim was to determine the diagnostic value of the Thyroid Imaging Reporting and Data System in cytologically indeterminate and Afirma-suspicious nodules. METHODS: We retrospectively queried cytopathology archives for retrospectively for thyroid fine-needle aspiration specimens obtained between February 2012 and September 2016 that were associated with the following: (1) indeterminate diagnosis, (2) ultrasonographic imaging at our institution, (3) an Afirma Gene Expression Classifier-suspicious result, and (4) surgery at our institution...
November 8, 2018: Surgery
Sarah C Oltmann, Fiemu E Nwariaku
No abstract text is available yet for this article.
November 8, 2018: Surgery
Fady Daniel, Hani Tamim, Mohammad Hosni, Feras Ibrahim, Aurelie Mailhac, Faek Jamali
BACKGROUND: The role of postoperative day 1 drain fluid amylase level in predicting clinically relevant postoperative pancreatic fistula is under investigation. In a previous multicenter study conducted on 338 patients undergoing distal pancreatectomy, day 1 drain fluid amylase level has been correlated to the development of a clinically relevant pancreatic fistula and an amylase value of 2,000 U/L was found to be most predictive of the development of clinically relevant postoperative pancreatic fistula...
November 7, 2018: Surgery
Patience Green, Jonathan Zagzag, Dhaval Patel, Lee S Weinstein, William F Simonds, Jenny Blau, Stephen Marx, Electron Kebebew, Nancy Perrier, Naris Nilubol
BACKGROUND: Because chronic kidney disease is an important comorbidity associated with primary hyperparathyroidism, we sought to evaluate the prevalence of chronic kidney disease and effects of parathyroidectomy on kidney function in patients with multiple endocrine neoplasia type 1-associated primary hyperparathyroidism. METHODS: We performed a retrospective analysis of 112 patients with multiple endocrine neoplasia type 1-associated primary hyperparathyroidism who had at least 1 operation for primary hyperparathyroidism at 2 tertiary referral centers...
November 7, 2018: Surgery
Salman Alsafran, Scott K Sherman, Fadi S Dahdaleh, Brian Ruhle, Frederic Mercier, Edwin L Kaplan, Peter Angelos, Raymon H Grogan
BACKGROUND: Patients undergoing subtotal parathyroidectomy for renal-origin hyperparathyroidism often develop postoperative hypocalcemia, requiring calcitriol and intravenous calcium (Postop-IVCa). We hypothesized that in subtotal parathyroidectomy for renal-origin hyperparathyroidism, preoperative calcitriol treatment reduces the use of postoperative administration of intravenous calcium. METHODS: A retrospective chart review compared subtotal parathyroidectomy for renal-origin hyperparathyroidism patients who received preoperative calcitriol treatment with those patietns who did not receive preoperative calcitriol treatment at one institution...
November 6, 2018: Surgery
Nick A Zaborek, Andy Cheng, Joseph R Imbus, Kristin L Long, Susan C Pitt, Rebecca S Sippel, David F Schneider
BACKGROUND: Patients often struggle to attain euthyroidism after thyroidectomy, and multiple dosing schemes have been proposed to supplant the standard weight-based approach for initial levothyroxine dosing after thyroidectomy. The objectives of this study were to review the literature for existing levothyroxine dosing schemes and compare estimation accuracies with novel schemes developed with machine learning. METHODS: This study retrospectively analyzed 598 patients who attained euthyroidism after total or completion thyroidectomy for benign disease...
November 6, 2018: Surgery
Willemijn Y van der Plas, Anton F Engelsman, Marille Umakanthan, Amanda Mather, Stan B Sidhu, Leigh W Delbridge, Carol Pollock, David Waugh, Mark S Sywak, Schelto Kruijff
BACKGROUND: Since 2004, end-stage renal disease related hyperparathyroidism patients are treated mainly with cinacalcet, which ceased to be subsidized through the Australian Pharmaceutical Benefits Scheme in 2015. We aimed to investigate the impact of these changes on the treatment strategy in the Australian end-stage renal disease population. METHODS: The following groups were formed according to the date of parathyroidectomy: A, before calcimimetics; B, during the era of calcimimetics; and C, after cinacalcet removal by the Australian Pharmaceutical Benefits Scheme...
November 6, 2018: Surgery
Akira Miyauchi, Takumi Kudo, Yasuhiro Ito, Hitomi Oda, Masatoshi Yamamoto, Hisanori Sasai, Takuya Higashiyama, Hiroo Masuoka, Mitsuhiro Fukushima, Minoru Kihara, Akihiro Miya
BACKGROUND: We report on the growth of papillary microcarcinoma during active surveillance and before clinical presentation. METHODS: We conducted a retrospective study of 169 patients with papillary microcarcinoma who were enrolled in active surveillance at our hospital between 2000 and 2004. Patients were followed for a median of 10.1 years using serial ultrasonography (median, 12 examinations), used to calculate the tumor doubling time. To contextualize tumor growth rates during active surveillance, we calculated the hypothetical tumor doubling time before clinical presentation...
November 6, 2018: Surgery
John F Tierney, Alyx Vogle, Jennifer Poirier, Irene M Min, Brendan Finnerty, Rasa Zarnegar, Sam G Pappas, Theresa Scognamiglio, Ritu Ghai, Paolo Gattuso, Thomas J Fahey, Xavier M Keutgen
BACKGROUND: Inhibition of the interaction of programmed death 1 with programmed death ligand 1 and 2 has been used successfully for treatment of multiple advanced cancers, but expression has not been studied in adrenocortical carcinoma. In this study, we investigated programmed death ligand 1 and 2 expression in adrenocortical carcinoma to determine the potential usefulness of checkpoint inhibitors in these malignant neoplasms. METHODS: A total of 56 tissue samples from patients with adrenocortical carcinoma (34) and benign adrenal tissues (22) were identified...
November 6, 2018: Surgery
Stephanie D Talutis, F Thurston Drake, Teviah Sachs, Sowmya R Rao, David McAneny
BACKGROUND: A feared complication after thyroid and parathyroid operations is postoperative hematoma that threatens the airway. The aim of this study was to identify factors associated with postoperative hematoma. METHODS: Patients undergoing thyroidectomy or parathyroidectomy were evaluated for postoperative hematoma requiring operative intervention using the database of the Collaborative Endocrine Surgery Quality Improvement Program. Associations between perioperative factors and postoperative hematoma were evaluated with bivariate methodologies and multivariable logistic regression...
November 6, 2018: Surgery
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