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Lame CA, Atila M, Dembele B, Obeng MK. Management of a Long-Standing Huge Goiter During a Humanitarian Mission: A Case Report. Cureus 2023; 15:e39365. [PMID: 37362472 PMCID: PMC10285428 DOI: 10.7759/cureus.39365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2023] [Indexed: 06/28/2023] Open
Abstract
Giant goiters are still encountered in low-income countries where diagnosis and management remain challenging. The authors report a case of an endemic giant goiter, treated during a humanitarian mission. A 50-year-old female with no particular history presented during a humanitarian mission with a giant nontoxic goiter evolving for 30 years. She underwent a total thyroidectomy removing a 3 kg thyroid gland. The postoperative period was uneventful. Giant goiters are not exceptional in goiter-endemic areas. Diagnostic and surgical management do not require particular technology. Surgery remains feasible even in countries with limited resources.
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Affiliation(s)
| | - Mehmet Atila
- Center for Aesthetic Plastic Surgery, Medical Inn, Düsseldorf, DEU
| | - Bertin Dembele
- Plastic Surgery and Oncology Department, Hôpital de Dermatologie de Bamako, Bamako, MLI
| | - Michael K Obeng
- Plastic Surgery Department, University of Pittsburgh School of Medicine, Los Angeles, USA
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2
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Chweya CM, Ryder CY, Fei‐Zhang DJ, Green KJ, Zemene Y, Okerosi S, Wiedermann JP. Bidirectional needs assessment of otolaryngology-head and neck surgery short-term surgical trips to Ethiopia and Kenya. Laryngoscope Investig Otolaryngol 2023; 8:303-312. [PMID: 36846413 PMCID: PMC9948567 DOI: 10.1002/lio2.1014] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 12/27/2022] [Accepted: 01/12/2023] [Indexed: 01/26/2023] Open
Abstract
Objectives To create an otolaryngology-specific needs assessment tool for short-term global surgical trips and to describe our findings from its implementation. Methods Surveys 1 and 2 were developed based on a literature review and disseminated to Low-Middle Income (LMIC) hosting institutions in Kenya and Ethiopia and to High-Income surgical trip participants (HIC), respectively. Respondents were otolaryngologists identified online, through professional organizations, and by word-of-mouth, who had participated in a surgical trip of <4 weeks. Results HIC and LMIC respondents shared similar goals of expanding host surgical skills through education and training while building sustainable partnerships. Discrepancies were identified between LMIC desired surgical skills and supply needs and HIC current practices. Microvascular reconstruction (17.6%), advanced otologic surgery (17.6%), and FESS (14.7%) were most desired skills and high-demand equipment needs were FESS sets (89%), endoscopes (78%), and surgical drills (56%). Frequently taught techniques included advanced otologic surgery (36.6%), congenital anomaly surgery (14.6%), and FESS (14.6%) with the largest gap between LMIC-need and HIC-offerings being in microvascular reconstruction (17.6% vs. 0%). We also highlight the discrepancy in expectations of responsibility for trip logistics, research, and patient follow-up. Conclusion We created and implemented the first otolaryngology-specific needs assessment tool in the literature. With its implementation in Ethiopia and Kenya, we were able to identify unmet needs as well as attitudes and perceptions of LMIC and HIC participants. This tool may be adapted and utilized to assess specific needs, resources, and goals of both host and visiting teams to facilitate successful global partnerships. Level of Evidence Level VI.
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Affiliation(s)
- Cynthia M. Chweya
- Department of Otolaryngology‐Head and Neck SurgeryUniversity of Kansas Medical CenterKansas CityKansasUSA
| | | | | | - Katerina J. Green
- Department of Plastic and Reconstructive SurgeryUniversity of Pittsburgh School of MedicinePittsburghPennsylvaniaUSA
| | - Yilkal Zemene
- St. Paul's Hospital Millennium Medical CollegeAddis AbabaEthiopia
| | | | - Joshua P. Wiedermann
- Department of Otolaryngology‐Head and Neck SurgeryMayo ClinicRochesterMinnesotaUSA
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Chaves N, Rodriguez MJ, Broekhuis JM, Chen HW, Bain PA, James BC. Quality of Life in Patients with Benign Non-Toxic Goiter After Surgical Intervention: A Systematic Review and Meta-Analysis. World J Surg 2022; 46:1093-1104. [PMID: 35075521 DOI: 10.1007/s00268-022-06452-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/26/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Prior studies evaluating health-related quality of life (HR-QoL) outcomes in patients undergoing surgery for benign non-toxic goiter have used different instruments and time points, leading to conflicting results. We sought to systematically review the differences in HR-QoL among patients with BNTG at baseline and 6 months after surgery, using exclusively the ThyPRO questionnaire. METHODS A systematic search was performed using PubMed, Embase, Web of Science, Cochrane Central, CINAHL, and PsycINFO for papers reporting the assessment of HR-QoL utilizing ThyPRO. Data were meta-analyzed using a random-effects model, and pooled estimates were calculated using weighted mean differences (WMD) between baseline and 6 months after surgery. We assessed the quality and risk of bias of the studies using the Robins-I tool and previously published minimally important change (MIC) values to assess clinical significance. RESULTS Six papers met the predefined inclusion criteria, describing a total of 496 patients. Meta-analysis demonstrated improved QoL in all thirteen domains of ThyPRO six months post-surgical intervention compared to baseline. Specifically, the largest improvement in QoL was seen in the domains of overall QoL, WMD -25.84 (95% CI -29.70, -21.98, p < 0.001, I2 = 23%), goiter symptoms, 23.96 (95% CI -30.29, -17.64, p < 0.001, I2 = 91%), and tiredness, -16.20 (95% CI -19.23, -13.16, p < 0.001, I2 = 3%). The differences in scores 9 of 13 domains were clinically significant based on MIC. CONCLUSIONS Disease-specific HR-QoL improved in all ThyPRO domains after surgery in patients with BNTG. Future studies of QoL in thyroid surgery patients will benefit from a standard questionnaire and improved reporting of covariates including complications to ensure comparability across studies.
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Affiliation(s)
- Natalia Chaves
- Section of Endocrine Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, 185 Pilgrim Road, Palmer 605, Boston, MA, 02215, USA
| | - M Juanita Rodriguez
- Harvard Medical School, Boston, MA, USA.,Section of Endocrine Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, 185 Pilgrim Road, Palmer 605, Boston, MA, 02215, USA
| | - Jordan M Broekhuis
- Harvard Medical School, Boston, MA, USA.,Section of Endocrine Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, 185 Pilgrim Road, Palmer 605, Boston, MA, 02215, USA
| | - Hao Wei Chen
- Section of Endocrine Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, 185 Pilgrim Road, Palmer 605, Boston, MA, 02215, USA
| | - Paul A Bain
- Countway Library, Harvard Medical School, Boston, MA, USA
| | - Benjamin C James
- Harvard Medical School, Boston, MA, USA. .,Section of Endocrine Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, 185 Pilgrim Road, Palmer 605, Boston, MA, 02215, USA.
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4
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Expanding post-operative follow-up in rural Sierra Leone: A community-based protocol. Am J Surg 2021; 221:895-899. [DOI: 10.1016/j.amjsurg.2020.10.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 09/11/2020] [Accepted: 10/08/2020] [Indexed: 11/24/2022]
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Dedhia PH, Stoeckl EM, McDow AD, Saruni S, Schneider DF, Long KL. Preoperative surgeon-performed ultrasound of massive thyroid goiter in rural Kenya. Am J Surg 2021; 221:925-926. [DOI: 10.1016/j.amjsurg.2020.09.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 09/26/2020] [Indexed: 02/03/2023]
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Windon MJ, Faniriko MBA, Bogale M, Acha E, Koch W. Otolaryngology burden of disease and surgical case triage in resource-limited settings: An example from Cameroon. Laryngoscope Investig Otolaryngol 2021; 6:177-182. [PMID: 33869748 PMCID: PMC8035949 DOI: 10.1002/lio2.522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 12/26/2020] [Accepted: 12/29/2020] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES Otolaryngology services worldwide faced an unprecedented demand for case triage during the SARS-CoV-2 pandemic. We propose and apply a novel case-leveling schema in a resource-limited setting. Describing the surgical burden of otolaryngologic disease in this setting may critically inform resource planning to address global surgical disparities. METHODS This is a retrospective study of otolaryngology cases performed over a 28-month period (1/2016-4/2018) at a hospital in rural Cameroon. Case details were collated and categorized as a surrogate measure of otolaryngologic disease in resource-limited settings. A case-levelling schema based on temporal urgency and anticipated impact on health was proposed and applied. RESULTS 1277 cases took place during the study. The largest proportion of cases were head and neck (517, 40%), followed by pediatrics (316, 25%). A four-tiered leveling system was generated: level 1 cases were immediately life-saving; level 2 cases were expected to result in a significant return to functions of daily living, or would prevent future death from cancer; level 3 cases aimed to significantly improve quality of life; level 4 cases were purely elective. Upon application of the schema, most cases were deemed to be level 2 (661, 52%). CONCLUSION We use our experience in a resource-limited setting to generate and apply a novel schema to be used for otolaryngology case triage in services facing unprecedented states of emergency such as the SARS-CoV-2 pandemic. This is the first study describing the surgical otolaryngologic disease burden in a resource-limited setting, data which may be used for future resource allocation. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Melina J. Windon
- Department of Otolaryngology‐Head and Neck SurgeryJohns Hopkins UniversityBaltimoreMarylandUSA
| | | | - Mesele Bogale
- Department of SurgeryAdama Hospital Medical CollegeAdamaEthiopia
| | - Everistus Acha
- Department of Ear, Nose, and Throat SurgeryMbingo Baptist HospitalMbingoCameroon
| | - Wayne Koch
- Department of Otolaryngology‐Head and Neck SurgeryJohns Hopkins UniversityBaltimoreMarylandUSA
- Department of Ear, Nose, and Throat SurgeryMbingo Baptist HospitalMbingoCameroon
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Shires CB, Beckmann N, Klug T, Boughter JD. Quality of life in obese patients after thyroidectomy for goiter. Gland Surg 2021; 10:1339-1346. [PMID: 33968685 DOI: 10.21037/gs-20-441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Compressive symptoms are common in thyroid disease. Many studies have focused on the size of the gland and its effects on patients. However, few have taken into account the body mass of the patient. The aim of our study was to examine whether or not a patient's body mass index (BMI) influences symptomatic outcomes following thyroid surgery for benign disease. Methods We conducted a prospective analysis evaluating 60 patients that underwent thyroidectomy for benign goiter (single or multinodular) disease. Patients were classified as obese, overweight, or normal based on BMI. Pre- and post-operative surveys were administered including the MRC breathlessness scale, M.D. Anderson Dysphagia Inventory (MDADI), and the ThyPRO quality of life questionnaire to evaluate dysphagia, dyspnea, and quality of life respectively. Results Patients classified as obese (n=37) scored significantly worse pre-operatively on MRC, MDADI, and ThyPRO surveys when compared to overweight (n=13) or normal weight (n=10) counterparts. Subjects in the obese group, but not the other groups, showed post-surgical improvement on both the MRC and MDADI surveys (P<0.0001). Similarly, obese subjects showed significant improvement on all 11 domains of the ThyPRO survey following surgery (P<0.0001), and overall degree of improvement was highly correlated with BMI among all subjects (r=0.60; P=0.0005). Conclusions Obesity, as determined by BMI, is a critical factor to consider in the alleviation of compressive symptoms before and after thyroidectomy for goiter. Our analysis of survey data indicates obese subjects have increased benefit of surgery compared to their lighter counterparts.
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Affiliation(s)
| | - Nic Beckmann
- Colorado ENT & Allergy, Colorado Springs, CO, USA
| | | | - John D Boughter
- Department of Anatomy and Neurobiology, University of Tennessee Health Science Center, Memphis, TN, USA
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Panuganti BA, Jafari A, Shen S, Qualliotine JR, Schueth EA, Campbell B, Ngoitsi H, Cordes S. Predictors of Quality-of-Life Improvements Following Global Head and Neck Surgery Trips to Underserved Regions. Laryngoscope 2021; 131:2006-2010. [PMID: 33734447 DOI: 10.1002/lary.29522] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 02/23/2021] [Accepted: 03/05/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVES/HYPOTHESIS To conduct longitudinal postoperative follow-up and discern health-related quality-of-life (HR-QoL) changes using a validated questionnaire among patients undergoing head and neck surgeries during a short-term, global surgical trip in a resource-limited setting. To identify clinicodemographic predictors of post-operative HR-QoL improvements in this setting. STUDY DESIGN Retrospective observational study with prospective follow-up. METHODS Patients undergoing surgery at Moi Teaching and Referral Hospital in Eldoret, Kenya through the authors' short-term surgical trip (STST) between 2016 and 2019 were asked to complete preoperative Short Form-36 (SF-36) HR-QoL questionnaires, and postoperative SF-36 questionnaires during subsequent follow-up. Preoperative and postoperative SF-36 domain scores, and two composite scores (mental component summary [MCS] and physical component summary [PCS]) were compared. Linear regression models were fit to identify clinicodemographic factors predictors of general health (GH), MCS, and PCS scores. RESULTS Among the 26 participating patients, significant improvements were seen in post-operative GH (mean change = 19.8) and MCS (mean change = 11.2) scores. Lower pre-operative GH, MCS, and PCS scores were predictive of greater improvement in the corresponding post-operative scores. Longer time to follow-up was associated with greater improvement in GH score. Mean follow-up interval was 23.1 months (SD = 1.8 months). CONCLUSIONS Utilizing the SF-36 questionnaire, we found that patients' perception of their general and psychosocial health improved after undergoing head and neck surgeries through a global STST. This study provides important, preliminary evidence that that elective surgeries performed in low-resource settings convey substantial benefit to patient QoL. LEVEL OF EVIDENCE 4 Laryngoscope, 131:2006-2010, 2021.
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Affiliation(s)
- Bharat A Panuganti
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of California-San Diego, San Diego, California, U.S.A
| | - Aria Jafari
- Division of Rhinology and Endoscopic Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, U.S.A
| | - Sarek Shen
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland, U.S.A
| | - Jesse R Qualliotine
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of California-San Diego, San Diego, California, U.S.A
| | - Elizabeth A Schueth
- Department of Otolaryngology, Indiana University School of Medicine, Indianapolis, Indiana, U.S.A
| | - Bruce Campbell
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, U.S.A
| | - Henry Ngoitsi
- Moi Teaching and Referral Hospital, Moi University School of Medicine, Eldoret, Kenya
| | - Susan Cordes
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland, U.S.A
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Mom T, Gardini B, Rial-Sebbag E, Fraysse B. The humanitarian and outreach ethics charter in ENT. Ethics at the heart of missions. Eur Ann Otorhinolaryngol Head Neck Dis 2020; 138:41-44. [PMID: 32811794 DOI: 10.1016/j.anorl.2020.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Humanitarian action, in the broad sense, including global outreach missions by ENT physicians, has been effective for many years. These volunteer missions have not had any specific regulatory framework, be it medical, social or above all ethical. The testimony of ENT physicians in certain "recipient" countries, in particular during the 2017 Paris Congress of the International Federation of Otorhinolaryngological Societies (IFOS), revealed the importance of adequate coordination between "provider" and "recipient" teams. Several ethical reports have been made, but few specifically focused on ENT outreach. The present review is based on feedback from several missions given to the French Society of OtoRhinoLaryngology and Head and Neck Surgery (SFORL) and IFOS, and on a review of the literature. A specific charter of global outreach and humanitarian missions in ENT has been drawn up. This review is essential for optimizing the sharing of knowledge and training in otorhinolaryngology across the world while respecting mandatory sociocultural and ethical rules.
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Affiliation(s)
- T Mom
- Service ORL et Chirurgie de la Face et du Cou, CHU Hôpital Gabriel Montpied, Université Clermont Auvergne (UCA), Clermont-Ferrand, France.
| | - B Gardini
- Clinique Rive Gauche, Service ORL, Toulouse, France
| | - E Rial-Sebbag
- Laboratoire d'Épidémiologie et de Santé Publique, UMR 1027 INSERM, Université Paul-Sabatier, Toulouse, France
| | - B Fraysse
- Clinique Rive Gauche, Service ORL, Toulouse, France; Innovpole Santé, CHU de Toulouse, Toulouse, France
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Development and Validation of the Data Instrument for Surgical Global Outreach. Plast Reconstr Surg 2020; 145:855e-864e. [DOI: 10.1097/prs.0000000000006700] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Long-Term Follow-Up of Humanitarian Surgeries: Outcomes and Patient Satisfaction in Rural Ghana. J Surg Res 2020; 246:106-112. [DOI: 10.1016/j.jss.2019.08.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 06/28/2019] [Accepted: 08/29/2019] [Indexed: 02/06/2023]
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Banach BS, Netterville JL, Mueller J. Utility of Cytopathology in Complimenting Surgical Medical Mission Trips. Am Surg 2018. [DOI: 10.1177/000313481808401115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - James L. Netterville
- Department of Otolaryngology Vanderbilt University Medical Center Nashville, Tennessee
| | - Jeffrey Mueller
- Department of Pathology University of Chicago Chicago, Illinois
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Krouse JH. Highlights from the Current Issue. Otolaryngol Head Neck Surg 2018; 156:393-394. [PMID: 28248599 DOI: 10.1177/0194599816688662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- John H Krouse
- 1 Department of Otolaryngology/Head and Neck Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
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Abstract
Thyroid disease is one of the most common pathologies in the world, with two of the most clinically important subgroups being iodine deficiency and thyroid goiter, and thyroid cancer. This review looks at the current state of thyroid disease in the world and evaluates the future direction in terms of thyroid disease treatment and prevention. Several of the most impactful epidemiologic studies are presented and analyzed, as well as a brief overview of the current socioeconomic burden of disease.
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Affiliation(s)
- Anastasios Maniakas
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Université de Montréal, 5775 boul. Léger, Montréal, Québec, Canada H1G 1K7
| | - Louise Davies
- Department of Surgery-Otolaryngology, Geisel School of Medicine at Dartmouth, 1 Rope Ferry Road, Hanover, NH 03755, USA
| | - Mark E Zafereo
- Department of Head and Neck Surgery, Division of Surgery, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1445, Houston, TX 77030, USA.
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