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Allouche E, Lachter G, Aissa MS, Ben Jemaa H, Boudiche F, Ben Ahmed H, Ouechtati W, Bezdah L, Bousnina S, Antit S, Ben Kaab B, Boussabah E, Zakhama L, Brahmi H, Ammar F, Belkhiria H, Dali A, Daassa C, Jamel A, Ben Halima N, Hamdani A, Ajra Z, Bayar MF, Gheni R, Rashikou L, Ben Hmida R, Ounissi T, Ibn Elhadj Z, Chelbi H, Fekih R, Boufares A, Thameur M, Abdelhedi M, Neji S, Boudiche F, Chetoui A, Ouechtati W, Cherif N, Mekki N, Slim M, Ouannes S, Ghardallou H, Neffati E, Kadardar F, Hachani M, Iddir S, Marzouki Y, Dardour S, Mejber W, Ben Slima H, Lassoued T, Chamtouri I, Jomaa W, Ben Hamda K, Maatouk F, Hakim K, Ben Othmen R, Msaad H, Ouarda F, Ben Gandoura A, Ben Halima A, Taktak I, Draoui Y, Yaakoubi W, Tamallah K, Chourabi C, Oussema M, Haggui A, Hajlaoui N, Fehri W, Ben Romdhane R, Tlili R, Azaiez F, Bachraoui K, Drissa M, Ben Youssef A, Fatou AW, Khadra H, Diouf MT, Ba S, Diouf D, Sarr MN, Mingou JS, Sarr SA, Dioum M, Ngaide AA, Beye SM, Manga S, Affangla DA, Diouf Y, Diop KH, Bodian M, Leye MMCB, Ndiaye MB, Mbaye A, Kane AD, Diao M, Kane A, Ben Ghorbel C, Soudani S, Gribaa R, Leye M, Ismael Ibouroi MH, Ba EHM, Affangla DA, Ba DM, Diagne Diallo A, Fall AL, Saidane S, Mzoughi K, Bouzidi H, Khannouch A, Ben Mrad I, Kamoun S, Zairi I, Kraiem S, Guesmi A, Mestiri B. ABSTRACTS CONGRÈS STCCCV 2022. Tunis Med 2022; 100:809-818. [PMID: 37551524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
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Al-Qurayshi Z, Sullivan CB, Khadra H, Shama M, Lee GS, Kandil E. Presentation and outcomes of patients with undifferentiated thyroid carcinoma: a national perspective. Gland Surg 2021; 10:1971-1979. [PMID: 34268081 DOI: 10.21037/gs-20-927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 04/14/2021] [Indexed: 11/06/2022]
Abstract
Background Undifferentiated thyroid cancer (UTC) accounts for only 1-2% of all thyroid cancers. UTC is one of the most aggressive solid tumors with high metastatic rates and mortality. The objectives of this study are to examine the characteristics of patients with UTC and their overall survival. Methods Retrospective analysis utilizing the National Cancer Database, 2004-2014 is performed. The study population included adults (≥18 years) patients with UTC or differentiated thyroid carcinoma (DTC), which served as a reference group. Results A total of 1,870 UTC and 209,707 DTC patients were identified. The median follow-up time of UTC patients was 3.9 months (interquartile range: 1.6-9.0 months). When compared to DTC patients, patients with UTC were more likely to be ≥45-year-old [OR: 48.62, 95% CI: (35.75, 66.14), P<0.001], male [OR: 2.02, 95% CI: (1.84, 2.22), P<0.001], and/or black [OR: 1.27, 95% CI: (1.08, 1.49), P=0.004]. UTC patients were more likely to have Medicaid/Medicare or no insurance and treated in low-volume hospitals (P<0.001). Overall survival in patients with UTC was lower in patients older than 65 years [OR: 1.63, 95% CI: (1.12, 2.38), P=0.011], with multiple comorbidities [OR: 1.65, 95% CI: (1.02, 2.67), P=0.040] and/or presented with metastatic disease [OR: 1.93, 95% CI: (1.71, 2.17), P<0.001]. Compared to thyroidectomy alone, patients without metastasis who received adjuvant radiotherapy and/or chemotherapy had a better overall survival (P<0.001 each). In patients with metastatic disease, any intervention or combination of interventions other than thyroidectomy alone improved survival (P<0.05). Conclusions Older age, male, and/or black are associated with a higher prevalence of UTC compared to DTC. Although overall survival is poor in UTC, utilization of multi-modal treatment may improve survival.
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Affiliation(s)
- Zaid Al-Qurayshi
- Department of Otolaryngology - Head & Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Christopher Blake Sullivan
- Department of Otolaryngology - Head & Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Helmi Khadra
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Mohamed Shama
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Grace S Lee
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Emad Kandil
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
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Kaplan J, Khadra H, Sholl AB, Kandil E. DIAGNOSTIC UTILITY OF HUMAN CHORIONIC GONADOTROPIN WASHOUT IN CERVICAL LYMPH NODE FINE-NEEDLE ASPIRATION FOR METASTATIC TESTICULAR CANCER. AACE Clin Case Rep 2020; 5:e201-e203. [PMID: 31967034 DOI: 10.4158/accr-2018-0445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 12/07/2018] [Indexed: 11/15/2022] Open
Abstract
Objective This case report will describe the first adjunct use of directly measuring the concentration of human chorionic gonadotropin (HCG) in fine-needle aspiration (FNA) washout for diagnosing metastatic non-semi-nomatous germ cell tumor (NSGCT) of the testicle in a patient with cervical lymphadenopathy. Methods We present the clinical, laboratory, imaging, and pathologic findings, along with a review of the literature. Results A 23-year-old, otherwise healthy man who first presented with left testicular discomfort and swelling was diagnosed with NSGCT after undergoing a left orchiectomy. A few years later, the patient presented with a 2-cm left supraclavicular mass. Upon ultrasound of the thyroid and soft tissues of the neck, a 1-cm left thyroid nodule was revealed, as well as a 2.8-cm left supraclavicular lymph node, which was cystic in nature and worrisome for metastatic disease given the patient's history of metastatic NSGCT. The results of the FNA of the left thyroid nodule were benign, however the results from the supraclavicular mass were nondiagnostic. Due to the nondiagnostic FNA results, another aspiration with cytopathology and HCG evaluation washout was performed. The HCG aspirate came back with a value of 162 mIU/mL, despite the patient's negative serum HCG results. Conclusion This case demonstrates a novel way to diagnose metastatic testicular germ cell tumors utilizing FNA-HCG washout. Future prospective trials are needed to further elucidate this important finding.
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Khadra H, Johnson H, Crowther J, McClaren P, Darden M, Parker G, Buell JF. Bile duct injury repairs: Progressive outcomes in a tertiary referral center. Surgery 2019; 166:698-702. [PMID: 31439402 DOI: 10.1016/j.surg.2019.06.032] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 05/26/2019] [Accepted: 06/22/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND Bile duct injury during laparoscopic cholecystectomy persists as a significant problem in general surgery, resulting in complex injuries, arterial damage, and post repair strictures. METHODS We performed a retrospective analysis between 2 eras of bile duct injury repairs: 1987 to 2001 (n = 58) and 2002 to 2016 (n = 52) using logistic regression analyses to assess presentation, repair complexity, and outcomes. RESULTS No differences in demographics, incidence of cholecystitis, conversion, time to presentation, level of injury, or arterial injury were identified. The second era had an increase in patient age, transhepatic catheter use, prior repair, and utilization of complex repairs. This approach resulted in equivalent complications and mortality rates with increased resource utilization but a lesser incidence of post-repair strictures (P = .004). Regression modeling correlated strictures to prior operative repairs (OR 4.25; P = .016) and a protective effect of repairs performed in the second era (OR 0.23; P = .045). CONCLUSION The second era identified a decreasing trend of attempted repairs by referring surgeons but an increase in transhepatic catheters and complex repairs resulting in lesser rates of post-repair stricture. Final regression modeling confirmed increased operative experience decreased post-repair stricture reaffirming the benefits of early identification and referral of bile duct injuries to an experienced hepatobiliary surgeon at a specialty center.
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Affiliation(s)
- Helmi Khadra
- Department of Surgery, Tulane University, New Orleans, LA
| | | | - Jason Crowther
- Department of Surgery, Tulane University, New Orleans, LA
| | - Patrick McClaren
- Department of Surgery, Louisiana State University, New Orleans, LA
| | - Michael Darden
- Carey Business School, Johns Hopkins University, Baltimore, MD
| | - Geoffrey Parker
- Thayer School of Engineering, Dartmouth College, Hanover, NH
| | - Joseph F Buell
- Department of Surgery, Tulane University, New Orleans, LA.
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Carsky K, Carr C, Werner C, Khadra H, Hamner JB, Paramesh AS, Dumont AS. De novo malignancy in recipients of solid organ transplant from donors with intracranial cancer. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.e13507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e13507 Background: In 2016, 33,610 organ transplants were performed in the US. Nevertheless, there is a critical deficiency of available organs. Currently, malignant neoplasms in the donor preclude organ donation, with some exceptions, such as certain CNS tumors without metastatic disease. The literature illustrates the risk of CNS tumor transmission with organ transplantation as 0-3% in the absence of additional risk factors, but organs from fewer than 0.5% of the 13,000 patients that die of glioma annually are procured. Given the critical need, we sought to reaffirm the safety of organs from donors with intracranial cancer by examining de novo malignancy outcomes in a large dataset. Methods: We examined the UNOS database to determine whether recipients of solid organ transplant from donors with intracranial cancer were at increased risk of de novo malignancy. Included were 119,430 subjects ages 18 to 65 who underwent heart, heart and lung, intestine, kidney, kidney and pancreas, liver, lung, or pancreas transplant from 1987 to 2012 and for whom there was complete data on donor history of intracranial cancer. 2-by-2 contingency tables were used to calculate odds ratios of exposure to donors with intracranial cancer. Outcomes included five-year survival, composite development of any malignancy, and development of specific malignancies including melanoma, esophageal, stomach, small intestine, pancreas, larynx, mouth, colorectal, primary liver tumor, and metastasis to liver. A p value of ≤ 0.05 was statistically significant. Results: 718 (0.60%) organs came from donors with intracranial cancer. 437 (79.02%) recipients of organs from donors with intracranial cancer survived 5 years, versus 71,055 (77.64%) recipients of organs from donors without intracranial cancer (p = 0.47). 113 (15.74%) recipients of organs from donors with intracranial cancer developed de novo malignancy, versus 17,963 (15.13%) recipients of organs from donors without intracranial cancer (p = 0.60). Of 17 contingency analyses of development of specific malignancies, we detected only 1 statistically significant positive association, de novo colorectal cancer in recipients of solid organ transplant from donors with intracranial cancer (p = 0.048, OR = 2.56). Given the large number of analyses and marginal significance of this in a very large dataset, it is likely type I error. Conclusions: Metastasis of primary CNS tumors beyond the CNS is a rare occurrence without additional risk factors. With the current organ shortage, donors with primary CNS malignancy are ideal candidates for organ donation.
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Affiliation(s)
- Katie Carsky
- Tulane University School of Medicine, New Orleans, LA
| | | | | | - Helmi Khadra
- Tulane University School of Medicine, New Orleans, LA
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Khadra H, Mohamed H, Al-Qurayshi Z, Sholl A, Killackey M, Kandil E. Superior detection of metastatic cystic lymphadenopathy in patients with papillary thyroid cancer by utilization of thyroglobulin washout. Head Neck 2018; 41:225-229. [PMID: 30536535 DOI: 10.1002/hed.25488] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 03/30/2018] [Accepted: 07/19/2018] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Fine-needle aspiration (FNA) cytology has been the standard of care in the workup of cervical lymph nodes (LNs) in patients with recurrent papillary thyroid cancer (PTC) and suspicious cervical LNs. Recently, FNA thyroglobulin (TG) washout measurement has been proposed as an adjunct in the management of these patients. We hypothesize that using FNA-TG washout for suspicious cervical LNs would increase the accuracy of diagnosing metastatic disease especially in cystic and highly vascular cervical LN in patients with recurrent PTC. METHODS This is a retrospective study of a prospectively collected database for patients with thyroid cancer who underwent preoperative FNA followed by selective neck dissection by one surgeon at an academic institution. FNA-cytology and FNA-TG washout were performed simultaneously. A total of 138 patients were included in our study, of which 92 (66.7%) had undergone surgical intervention. Results of both methods were then correlated with the final surgical pathology. RESULTS FNA-cytology alone showed a sensitivity of 80.0%, specificity of 100.0% with a negative predictive value (NPV) of 60.0%. By contrast, FNA-TG washout had a sensitivity of 95.8%, specificity of 90.5% with a NPV of 86.4%. Combination of the FNA-cytology with FNA-TG washout of cystic/highly vascular LN increased the accuracy of diagnosis with a sensitivity of 98.2%, specificity of 100.00% with a NPV of 95.0%. All 14 malignant cervical LNs with false-negative FNA-cytology showed elevated FNA-TG washout, 10 (71.4%) of which were cystic in nature and 4 were highly vascular on ultrasonography. CONCLUSION FNA-TG washout increases the diagnostic accuracy in detecting metastatic disease in patients with recurrent thyroid cancer. FNA-TG washout may be of special diagnostic importance in cystic or highly vascular LNs, which might have falsely negative cytology. LEVEL OF EVIDENCE 2B.
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Affiliation(s)
- Helmi Khadra
- Division of Endocrine and Oncologic Surgery, Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana
| | - Hossam Mohamed
- Division of Endocrine and Oncologic Surgery, Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana
| | - Zaid Al-Qurayshi
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa College of Medicine, Iowa City, Iowa
| | - Andrew Sholl
- Department of Pathology and Laboratory Medicine, Tulane University School of Medicine, New Orleans, Louisiana
| | - Mary Killackey
- Division of Endocrine and Oncologic Surgery, Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana
| | - Emad Kandil
- Division of Endocrine and Oncologic Surgery, Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana
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Khadra H, Souza SS, Cushing T, Kandil E. Overlapping Endocrine Surgery: Examining Safety and Efficacy Concerns. J Am Coll Surg 2018. [DOI: 10.1016/j.jamcollsurg.2018.08.324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Abstract
Background The use of hemostatic agents in thyroid surgery has been widely reported in the literature. The aim of this study is to assess the safety and efficacy of hemostatic agents in comparison to conventional techniques for hemostasis by meta-analysis of the current literature. Methods Articles were identified from PubMed and EMBASE using the following keyword searches: "hemostatic agent and thyroid surgery" and "hemostatic agent and thyroidectomy". Outcomes included total operative time, estimated blood loss, length of hospital stay, and intraoperative and postoperative complications. Data were extracted following review of appropriate studies by two independent authors and outcome differences were calculated using analysis of variance and the Bonferroni method. Results Thirty-four publications were identified and 10 studies met our inclusion criteria, totaling 941 patients, 519 (55.1%) of which received a hemostatic agent during thyroid surgery. Of these patients who had hemostatic agents, 369 (71%) received a hemostatic gel and 150 (29%) received an oxidized cellulose patch. Outcome measures in each of these groups were compared with the patients receiving only conventional methods of hemostasis. The risk of hematoma formation in the hemostatic gel group was comparable to conventional hemostatic methods (95% CI: 0.33, 2.59). This was also true when comparing conventional hemostasis to the patch (95% CI: 0.64, 15.24). No difference in the risk for seroma formation was found between the conventional and hemostatic gel groups (95% CI: 0.26, 3.95). Drain output was significantly less in the gel group 40.75±35.6 mL compared to 66.26±31.2 mL in the conventional group (95% CI: -23.422, -7.460). Patients who received hemostatic agents had shorter hospital stays when compared to the conventional group (95% CI: -1.057, -0.203). Conclusions Our meta-analysis suggests that the use of a hemostatic agent in thyroid surgery yields minimal advantages for the management of perioperative bleeding risk.
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Affiliation(s)
- Helmi Khadra
- Division of Endocrine and Oncologic Surgery, Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Mohamed Bakeer
- Department of Surgery, Louisiana State University School of Medicine, New Orleans, LA, USA
| | - Adam Hauch
- Division of Endocrine and Oncologic Surgery, Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Tian Hu
- Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Emad Kandil
- Division of Endocrine and Oncologic Surgery, Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
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Khadra H, Deniwar A, Mohsin K, Monlezun D, Kandil E. Can Suspicious Ultrasound Features Predict BRAFV600E Status in Papillary Thyroid Cancer? Eur Thyroid J 2018; 7:205-210. [PMID: 30283739 PMCID: PMC6140597 DOI: 10.1159/000489851] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 05/04/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Papillary thyroid carcinoma (PTC) can be predicted from certain suspicious ultrasound (US) features of thyroid nodules. The aim of this study was to examine if these suspicious features can predict the more aggressive PTC associated with B-type Raf kinase (BRAFV600E) mutation. METHODS This was a retrospective review of prospectively collected data on patients with PTC and known BRAFV600E status. All patients underwent preoperative US by the same surgeon who performed all the operations. We divided patients into BRAFV600E positive and negative groups. All ultrasonographic data were collected including nodule size, echogenicity, solid or cystic nature, presence of calcifications, irregular margins, and internal vascularity. RESULTS Of 141 patients with PTC, BRAFV600E mutation was detected in 48 (34.0$) patients. There was no significant difference in nodule size (2.06 cm ± 1.37 vs. 2.15 cm ±1.55, p = 0.75) between BRAFV600E positive and negative groups. BRAFV600E positivity was associated with higher rates of -hypoechogenicity (57.5$ vs. 36.6, p = 0.02), calcifications (48.9 vs. 19.4$, p < 0.01), and irregular margins (21.3 vs. 6.5$, p < 0.01). There was no significant difference in the noncystic nature or internal vascularity between BRAFV600E positive and negative groups. The presence of all suspicious US features is associated with a positive predictive value of 100.0$. In the absence of all suspicious features, the negative predictive value was 84.2$. When suspicious lymph nodes (LNs) detected by preoperative US were compared, there was no significant difference between BRAFV600E positive and negative groups (30.6 vs. 21.7$, p = 0.35). CONCLUSION The presence of multiple suspicious US findings of thyroid nodules can predict the BRAFV600E mutation status of papillary thyroid cancer nodules. The highest accuracy overall (93.2$) was achieved by combining calcification, irregular margins, and hypoechogenicity with extrathyroidal extension and LN metastasis. Future multi-institutional studies are warranted to help surgeons with risk stratification and operative planning for patients with papillary thyroid cancer.
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Affiliation(s)
- Helmi Khadra
- Division of Endocrine and Oncologic Surgery, Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Ahmed Deniwar
- Division of Endocrine and Oncologic Surgery, Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Khuzema Mohsin
- Division of Endocrine and Oncologic Surgery, Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | | | - Emad Kandil
- Division of Endocrine and Oncologic Surgery, Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
- *Emad Kandil, MD, MBA, FACS, FACE, Edward G. Schlieder Chair in Surgical Oncology, Otolaryngology and Medicine, Endocrine Surgery Section, Department of Surgery, Tulane University School of Medicine, 1430 Tulane Ave., New Orleans, LA 70112 (USA), E-Mail
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Khadra H, Kholmatov R, Monlezun D, Kandil E. Do anticoagulation medications increase the risk of haematoma in ultrasound-guided fine needle aspiration of thyroid lesions? Cytopathology 2018; 29:565-568. [PMID: 29969159 DOI: 10.1111/cyt.12608] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Accepted: 06/18/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND A feared complication of thyroid fine needle aspiration (FNA) is bleeding diathesis and haematoma at the biopsy site. Patients are often advised to discontinue antithrombotic/anticoagulant (AT/AC) medications prior to the procedure. The aim of this study was to examine the risk of bleeding in patients on AT/AC medications undergoing cervical ultrasound (US)-guided FNA. METHODS A retrospective chart review of 803 patients who underwent US-guided FNA of thyroid nodules over 8 years by a single endocrine surgeon was undertaken. Clinical variables, patient demographics and use of AT/AC medications were collected and analysed. The principle outcome measures included the incidence of procedure-related haematoma formation. Multivariable logistic regression was used to investigate the possible independent association between post-FNA haematoma and anticoagulation, adjusting for age, African American race, body mass index, vascularity and lesion size. RESULTS A total of 1568 lesions were included in 803 patients. The mean age for the patients on AT/AC was 63.0 ± 10.4 years and those not on AT/AC was 50.1 ± 14.2 years (P < 0.001). Of those, 148 patients had 336 lesions (21%) biopsied while taking one or more daily AT/AC agent (81 patients: aspirin; 11 patients: Plavix; 17 patients: aspirin and warfarin; 30 patients: aspirin and Plavix; seven patients: rivaroxaban and aspirin; and two patients: ticagrelor and aspirin). Three patients (0.89%) in the AT/AC group compared to six patients (0.49%) not receiving AT/AC medications developed a haematoma (P = 0.41). All complications were treated conservatively and none required intervention. CONCLUSIONS US-guided FNA of thyroid lesions can be safely performed on patients taking AT/AC including newer agents, without an increase in adverse outcomes or decreased diagnostic rate. Further larger prospective multi-institutional studies are warranted to further investigate this important finding.
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Affiliation(s)
- Helmi Khadra
- Division of Endocrine and Oncologic Surgery, Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Roostam Kholmatov
- Division of Endocrine and Oncologic Surgery, Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Dominique Monlezun
- Division of Endocrine and Oncologic Surgery, Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Emad Kandil
- Division of Endocrine and Oncologic Surgery, Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
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Khadra H, Al-Qurayshi Z, Kandil E. Risk and Survival of Patients with Medullary Thyroid Cancer: National Perspective. J Am Coll Surg 2017. [DOI: 10.1016/j.jamcollsurg.2017.07.153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Khadra H, Al-Qurayshi Z, Kandil E. Risk and Survival of Patients with Undifferentiated Thyroid Cancer: National Perspective. J Am Coll Surg 2017. [DOI: 10.1016/j.jamcollsurg.2017.07.154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Abstract
BACKGROUND Performance of thyroid surgery as a same day surgery procedure has been a controversial topic. This study aimed to compare the safety and efficacy of outpatient thyroid surgery with inpatient thyroid surgery by meta-analysis of current literature. METHODS Articles were identified from the following keyword searches: outpatient thyroidectomy/thyroid surgery, same day thyroidectomy/thyroid surgery. Outcomes included perioperative complications including recurrent laryngeal nerve (RLN) injury, hypocalcemia, and readmissions. Data were extracted following review of appropriate studies by authors and random effects models were used. RESULTS 34 potentially relevant publications were identified and 14 studies fulfilled the predetermined inclusion criteria, totaling 10,478 patients, 4,565 of whom were discharged the same day following thyroid surgery. There was no difference in malignancy rate between the two groups (95% CI, 0.84-2.31; P=0.196). Inpatient group were 2.23 times (95% CI, 1.36-3.36; P=0.001) more likely to develop transient RLN injury and 2.32 times (95% CI, 1.06-5.06; P=0.034) more likely to have documented transient hypocalcemia compared to outpatients. Inpatient groups were 2.10 times (95% CI, 1.33-3.33; P=0.002) more likely to have documented other complications. The two groups also had similar readmission rates (95% CI, 0.71-1.41; P=1.000). CONCLUSIONS Our meta-analysis suggests that discharging selective patients the same day after a thyroid surgery is as safe, feasible, and efficacious as admitting them for observation. Admitting patients after thyroid surgery is associated with higher reported risk of complications.
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Affiliation(s)
- Helmi Khadra
- Division of Endocrine and Oncologic Surgery, Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Salah Mohamed
- Division of Endocrine and Oncologic Surgery, Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Adam Hauch
- Division of Endocrine and Oncologic Surgery, Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - John Carter
- Department of Otolaryngology, Head and Neck Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Tian Hu
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Emad Kandil
- Division of Endocrine and Oncologic Surgery, Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
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Andrews JA, Harrison RF, Brown LJE, MacLean LM, Hwang F, Smith T, Williams EA, Timon C, Adlam T, Khadra H, Astell AJ. Using the NANA toolkit at home to predict older adults' future depression. J Affect Disord 2017; 213:187-190. [PMID: 28259086 DOI: 10.1016/j.jad.2017.02.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 12/21/2016] [Accepted: 02/13/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND Depression is currently underdiagnosed among older adults. As part of the Novel Assessment of Nutrition and Aging (NANA) validation study, 40 older adults self-reported their mood using a touchscreen computer over three, one-week periods. Here, we demonstrate the potential of these data to predict future depression status. METHODS We analysed data from the NANA validation study using a machine learning approach. We applied the least absolute shrinkage and selection operator with a logistic model to averages of six measures of mood, with depression status according to the Geriatric Depression Scale 10 weeks later as the outcome variable. We tested multiple values of the selection parameter in order to produce a model with low deviance. We used a cross-validation framework to avoid overspecialisation, and receiver operating characteristic (ROC) curve analysis to determine the quality of the fitted model. RESULTS The model we report contained coefficients for two variables: sadness and tiredness, as well as a constant. The cross-validated area under the ROC curve for this model was 0.88 (CI: 0.69-0.97). LIMITATIONS While results are based on a small sample, the methodology for the selection of variables appears suitable for the problem at hand, suggesting promise for a wider study and ultimate deployment with older adults at increased risk of depression. CONCLUSIONS We have identified self-reported scales of sadness and tiredness as sensitive measures which have the potential to predict future depression status in older adults, partially addressing the problem of underdiagnosis.
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Affiliation(s)
| | | | | | | | | | - T Smith
- Generic Robotics Ltd, Reading, UK
| | | | - C Timon
- University College Dublin, Ireland
| | | | | | - A J Astell
- University of Sheffield, UK; Ontario Shores Centre for Mental Health Sciences, Canada
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Abstract
BACKGROUND Several reports have proposed that increased vascular flow on color Doppler sonography may be associated with malignancy in thyroid nodules. Others have described no correlation between the presence of flow and risk of malignancy. The purpose of this study was to determine whether the vascularity of a thyroid nodule can aid in the prediction of malignancy by performing a meta-analysis of the current literature. METHODS Independent reviewers conducted a systematic review of publications from PubMed, EMBASE, and the Cochrane Database of Systematic Review using the following keyword searches: "vascular thyroid nodule", and "vascular malignant thyroid nodule". Outcomes included vascular flow pattern, nodule size, calcifications, echogenicity, margins, and shape. Data were extracted following review of appropriate studies, and outcome differences were calculated using analysis of variance and the Bonferroni method. RESULTS Eighty-nine publications were identified and 14 prospective studies met inclusion criteria totaling 4,154 thyroid nodules, 1,419 (34%) of which were malignant. Thirty-three percent of malignant thyroid nodules had no vascular flow, while 17% had peripheral and 50% had internal vascular flow. There was no significant difference in vascular flow (95% CI: -14.329, 4.257), or peripheral vascular flow rate between malignant and benign thyroid nodules (95% CI: -29.254, 4.313). Also, there was no significant difference in internal vascularity between malignant and benign thyroid nodules (95% CI: -72.067, 2.824). CONCLUSIONS It appears that utilization of vascular flow on color Doppler sonography may not accurately predict malignancy in thyroid nodules. Further studies are warranted to investigate the predictive role of increased vascularity in diagnosing suspicious thyroid nodules.
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Affiliation(s)
- Helmi Khadra
- Division of Endocrine and Oncologic Surgery, Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Mohamed Bakeer
- Department of Surgery, Louisiana State University School of Medicine, New Orleans, LA, USA
| | - Adam Hauch
- Division of Endocrine and Oncologic Surgery, Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Tian Hu
- Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Emad Kandil
- Division of Endocrine and Oncologic Surgery, Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
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Astell AJ, Hwang F, Brown LJE, Timon C, Maclean LM, Smith T, Adlam T, Khadra H, Williams EA. Validation of the NANA (Novel Assessment of Nutrition and Ageing) touch screen system for use at home by older adults. Exp Gerontol 2014; 60:100-7. [PMID: 25456843 DOI: 10.1016/j.exger.2014.10.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Revised: 10/04/2014] [Accepted: 10/07/2014] [Indexed: 01/04/2023]
Abstract
Prospective measurement of nutrition, cognition, and physical activity in later life would facilitate early detection of detrimental change and early intervention but is hard to achieve in community settings. Technology can simplify the task and facilitate daily data collection. The Novel Assessment of Nutrition and Ageing (NANA) toolkit was developed to provide a holistic picture of an individual's function including diet, cognition and activity levels. This study aimed to validate the NANA toolkit for data collection in the community. Forty participants aged 65 years and over trialled the NANA toolkit in their homes for three 7-day periods at four-week intervals. Data collected using the NANA toolkit were compared with standard measures of diet (four-day food diary), cognitive ability (processing speed) and physical activity (self-report). Bland-Altman analysis of dietary intake (energy, carbohydrates, protein fat) found a good relationship with the food diary and cognitive processing speed and physical activity (hours) were significantly correlated with their standard counterparts. The NANA toolkit enables daily reporting of data that would otherwise be collected sporadically while reducing demands on participants; older adults can complete the daily reporting at home without a researcher being present; and it enables prospective investigation of several domains at once.
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Affiliation(s)
- A J Astell
- Ontario Shores Centre for Mental Health Sciences, Canada; University of Sheffield, UK.
| | | | | | - C Timon
- University College Dublin, Ireland
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18
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Ahmad H, Khadra H, Hu T, Kandil E. The use of intraoperative PTH-measurement in the prediction of post-operative hypocalcemia for thyroid surgery: a meta-analysis. J Am Coll Surg 2014. [DOI: 10.1016/j.jamcollsurg.2014.07.607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Ahmad H, Mohamed SE, Deniwar A, Khadra H, Alsaleh N, Kandil E. Anticoagulation and bleeding risk in US-guided fine needle aspiration for thyroid lesions. J Am Coll Surg 2014. [DOI: 10.1016/j.jamcollsurg.2014.07.721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Mohamed SE, Li X, Khadra H, Saeed A, Mohamed H, Kandil E. Different surgical approaches in parathyroid adenoma resections. Gland Surg 2014; 2:227-9. [PMID: 25083487 DOI: 10.3978/j.issn.2227-684x.2013.10.03] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Accepted: 10/14/2013] [Indexed: 11/14/2022]
Abstract
Three patients were referred to our clinic for the management of a persistent symptomatic primary hyperparathyroidism. Pre-operative imageological localization revealed evidence of an adenoma. Here we are presenting three videos demonstrating the different surgical approaches of parathyroid adenoma resection, with the use of an intraoperative gamma probe and nerve monitoring.
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Affiliation(s)
- Salah Eldin Mohamed
- Division of Endocrine and Oncologic Surgery, Department of Surgery, Tulane University School of Medicine, New Orleans, LA 70112, USA
| | - Xinying Li
- Department of Surgery, Xiangya Hospital, Central South University, Changsha 410008, P.R. China
| | - Helmi Khadra
- Division of Endocrine and Oncologic Surgery, Department of Surgery, Tulane University School of Medicine, New Orleans, LA 70112, USA
| | - Ahmed Saeed
- Division of Endocrine and Oncologic Surgery, Department of Surgery, Tulane University School of Medicine, New Orleans, LA 70112, USA
| | - Hossam Mohamed
- Division of Endocrine and Oncologic Surgery, Department of Surgery, Tulane University School of Medicine, New Orleans, LA 70112, USA
| | - Emad Kandil
- Division of Endocrine and Oncologic Surgery, Department of Surgery, Tulane University School of Medicine, New Orleans, LA 70112, USA
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Khadra H, Jackson N, Hu T, Slakey D, Kandil E. Safety and Feasibility of Adrenalectomy Approaches: A Meta-Analysis. J Surg Res 2014. [DOI: 10.1016/j.jss.2013.11.791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Khadra H, Mohamed S, Hu T, Kandil E. Safety of Same-Day Thyroidectomy: Meta-analysis and Systematic Review. J Surg Res 2014. [DOI: 10.1016/j.jss.2013.11.802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Astell A, Adlam T, Hwang F, Khadra H, MacLean L, Smith T, Timon C, Williams E. Validating NANA: Novel assessment of nutrition and ageing. ACTA ACUST UNITED AC 2012. [DOI: 10.4017/gt.2012.11.02.424.00] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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