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Leong D, Leslie C, Laurie B, Hou L, Keyser J, Yew MK, Ryan S, Nguyen H, Lisewski D. Tumour size predicts risk of recurrence in tall cell subtype papillary thyroid carcinoma. Am J Surg 2024:S0002-9610(24)00184-3. [PMID: 38580566 DOI: 10.1016/j.amjsurg.2024.03.022] [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: 01/26/2024] [Revised: 03/12/2024] [Accepted: 03/22/2024] [Indexed: 04/07/2024]
Abstract
BACKGROUND The tall cell subtype of papillary thyroid cancer (TCPTC) is the most common aggressive subtype and often treated aggressively. This approach may not be necessary in smaller tumours without adverse histological characteristics. METHODS 97 patients with TCPTC defined as a height-to-width ratio of ≥3:1 and at least 30% tall cells were compared against 390 classical papillary thyroid carcinoma (CPTC) based on tumour size with recurrence free survival (RFS) as the primary outcome. RESULTS TCPTC are more likely to present with adverse histological characteristics. In smaller tumours (<2 cm), only central lymph node metastasis (HR7.16 p = 0.03) and multifocality (HR10.11 p = 0.026) increased recurrence risk. In larger tumours, TCPTC histology (HR3.78 p = 0.002), lymphovascular invasion (HR3.02 p = 0.014) and central lymph node metastasis (HR3.24 p < 0.001) significantly increased recurrence risk. CONCLUSION TCPTC tumours <2 cm without central lymph node metastasis and multifocality are similar in risk of recurrence to classical PTC and could be managed with lobectomy.
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Affiliation(s)
- David Leong
- Endocrine Surgical Services Unit, Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands, Australia; School of Surgery, The University of Western Australia, Nedlands, Australia.
| | - Connull Leslie
- PathWest Laboratory Medicine, QEII Medical Centre, Nedlands, Australia
| | - Brodie Laurie
- Endocrine Surgical Services Unit, Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands, Australia
| | - Lachlan Hou
- Endocrine Surgical Services Unit, Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands, Australia
| | - Jo Keyser
- Western Australia Cancer Network, North Metropolitan Health Service, Australia
| | - Ming Khoon Yew
- Department of Endocrine Surgery, Royal Perth Hospital, Perth, Australia; School of Surgery, Curtin University, Bentley, Australia
| | - Simon Ryan
- Endocrine Surgical Services Unit, Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands, Australia
| | - Hieu Nguyen
- Endocrine Surgical Services Unit, Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands, Australia
| | - Dean Lisewski
- Department of Endocrine Surgery, Fiona Stanley Hospital, Murdoch, Australia
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Seow YT, Nyandoro MG, Poh S, Tee YC, Yew MK, Wong SL. The Impact of Obesity on Mortality and Complications in Posterior Retroperitoneoscopic Adrenalectomy. Cureus 2023; 15:e42421. [PMID: 37497309 PMCID: PMC10367120 DOI: 10.7759/cureus.42421] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2023] [Indexed: 07/28/2023] Open
Abstract
Background Obesity is a global epidemic. It influences surgical technique, ergonomics, safety, and outcomes. However, there is a paucity of evidence of obesity-related impact in posterior retroperitoneoscopic adrenalectomy (PRA). This study compared perioperative outcomes of obese and non-obese participants undergoing PRA. Methodology This is a multi-center retrospective cohort study of elective PRA from March 2014 to December 2022. Patient demographics, surgical techniques, clinicopathological parameters, and outcomes, including overall complication rate, were analyzed using SPSS version 27 (IBM Corp., Armonk, NY, USA). Results Seventy-five patients underwent a PRA, of which 97.3% were completed retroperitoneoscopically. The overall complication rate was (9.3%), and on subgroup analysis, the obese cohort had a lower percentage complication profile at 6.5%. Male participants comprised 52%, with a median age of 55 (IQR=19). The median BMI was 29.0 (IQR=8), of which 41% were obese, and 40% were overweight. Univariate analysis showed that being obese was not significantly associated with a higher complication rate (p=0.471). In addition, there was no significant increase in conversion (p=0.508), bleeding/transfusion (p=0.508), surgical site infection (SSI; p=1.000), incisional hernia (p=1.000), ICU or high dependency unit admission (p=0.292) and any-cause mortality (p=1.000). No sentinel deaths directly related to PRA were recorded. Procedure duration was longer in obese (117 mins) vs. non-obese participants (88.9 mins, p=0.022). However, there was no significant difference in the length-of-hospital stay (p=0.592). The cohort conversion rate was (2.7%), and tumor size was associated with a higher conversion rate (35.4 vs. 62.5mm, p=0.040). Conclusion Posterior retroperitoneoscopic adrenalectomy can be a safe procedure in obese populations, and obesity does not increase perioperative morbidity or mortality.
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Affiliation(s)
- Yi Th'ng Seow
- General and Endocrine Surgery, Royal Perth Hospital, Perth, AUS
| | - Munyaradzi G Nyandoro
- General Surgery, Fiona Stanley Hospital, Perth, AUS
- General and Endocrine Surgery, Royal Perth Hospital, Perth, AUS
| | - Shearn Poh
- General and Endocrine Surgery, Royal Perth Hospital, Perth, AUS
| | | | - Ming Khoon Yew
- General and Endocrine Surgery, Royal Perth Hospital, Perth, AUS
- General and Endocrine Surgery, St. John of God Murdoch Hospital, Murdoch, AUS
| | - Sze Ling Wong
- General and Endocrine Surgery, Royal Perth Hospital, Perth, AUS
- General and Endocrine Surgery, St. John of God Murdoch Hospital, Murdoch, AUS
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Beswick DM, Kaushik A, Beinart D, McGarry S, Yew MK, Kennedy BF, Maria PLS. Biomedical device innovation methodology: applications in biophotonics. J Biomed Opt 2017; 23:1-7. [PMID: 29243414 DOI: 10.1117/1.jbo.23.2.021102] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 11/15/2017] [Indexed: 05/03/2023]
Abstract
The process of medical device innovation involves an iterative method that focuses on designing innovative, device-oriented solutions that address unmet clinical needs. This process has been applied to the field of biophotonics with many notable successes. Device innovation begins with identifying an unmet clinical need and evaluating this need through a variety of lenses, including currently existing solutions for the need, stakeholders who are interested in the need, and the market that will support an innovative solution. Only once the clinical need is understood in detail can the invention process begin. The ideation phase often involves multiple levels of brainstorming and prototyping with the aim of addressing technical and clinical questions early and in a cost-efficient manner. Once potential solutions are found, they are tested against a number of known translational factors, including intellectual property, regulatory, and reimbursement landscapes. Only when the solution matches the clinical need, the next phase of building a "to market" strategy should begin. Most aspects of the innovation process can be conducted relatively quickly and without significant capital expense. This white paper focuses on key points of the medical device innovation method and how the field of biophotonics has been applied within this framework to generate clinical and commercial success.
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Affiliation(s)
- Daniel M Beswick
- Stanford University, Department of Otolaryngology, Head and Neck Surgery, Stanford, California, United States
- Oregon Health and Science University, Department of Otolaryngology, Head and Neck Surgery, Portland,, United States
| | - Arjun Kaushik
- SPARK Co-Lab, Perth, Western Australia, Australia
- Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Dylan Beinart
- SPARK Co-Lab, Perth, Western Australia, Australia
- Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Sarah McGarry
- SPARK Co-Lab, Perth, Western Australia, Australia
- Curtin University, School of Occupational Therapy and Social Work, Faculty of Health Sciences, Bentl, Australia
| | - Ming Khoon Yew
- SPARK Co-Lab, Perth, Western Australia, Australia
- Royal Perth Hospital, Department of General Surgery, Perth, Western Australia, Australia
| | - Brendan F Kennedy
- QEII Medical Centre, Harry Perkins Institute of Medical Research, BRITElab, Nedlands, Western Austra, Australia
- University of Western Australia, Centre for Medical Research, Perth, Western Australia, Australia
- University of Western Australia, School of Electrical, Electronic and Computer Engineering, Perth, W, Australia
| | - Peter Luke Santa Maria
- Stanford University, Department of Otolaryngology, Head and Neck Surgery, Stanford, California, United States
- SPARK Co-Lab, Perth, Western Australia, Australia
- University of Western Australia, Department of Ear Sciences, Perth, Western Australia, Australia
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Abstract
BACKGROUND Open mesh repair of inguinal hernia has been shown to be an effective and safe method of hernia repair. In search of the 'ideal' method of open mesh hernia repair, many different methods of mesh placement have been developed. Laparoscopic hernia repair is reported to be superior to open repair in terms of postoperative pain and rehabilitation. These improved functional outcomes could be the result of placement of mesh in the preperitoneal space (underlay), rather than the laparoscopic method per se. A bilayer polypropylene mesh implant has been developed that provides onlay and underlay (preperitoneal) mesh layers. The present study reports the singular experience of a general surgeon with this bilayer polypropylene mesh implant. METHODS A retrospective audit of the first 169 consecutive inguinal hernia repairs was conducted by mailed questionnaire and telephone interview. Data was collected on patient demographics, postoperative pain scores and complications. Patients with potential recurrences at the time of follow up were invited for clinical review. RESULTS One hundred and three patients (71%) participated in the audit. Thirteen per cent of cases were for recurrent hernia. Median age was 60 years (range 21-99). Median length of follow up was 19 months (range 8-27). No recurrences were detected in the patients who underwent primary repair of inguinal hernia. CONCLUSION Inguinal hernia repair with bilayer polypropylene mesh is safe and has low complication and recurrence rates.
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Affiliation(s)
- Ming Khoon Yew
- St. John of God Healthcare, Subiaco and Bentley Regional Hospital, Western Australia, Australia.
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Abstract
Cardiac angiosarcoma is a rare tumour. Current imaging techniques (magnetic resonance imaging, MRI; computed axial tomography, CAT; 2-D echocardiography), although useful in delineating the extent of tumour involvement, do not correlate well with intraoperative findings of resectability. We report a case were palliative surgical resection was technically possible, contrary to expectations from CAT and MRI findings. However, the patient was clinically in extremis, with advanced ventricular dysfunction, and died. Despite the short-term risk involved in surgery, if palliative resection is possible, a multidisciplinary approach with adjuvant chemotherapy and radiation can result in mid-term survival.
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Affiliation(s)
- J M Alvarez
- Sir Charles Gairdner Hospital, Nedlands, Perth, Western Australia, Australia.
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Aronson JK, Chappell MJ, Godfrey KR, Yew MK. Modelling circadian variation in the pharmacokinetics of non-steroidal anti-inflammatory drugs. Eur J Clin Pharmacol 1993; 45:357-61. [PMID: 8299670 DOI: 10.1007/bf00265955] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
A one-compartment model with first-order absorption has provided good fits to five sets of indomethacin data and four sets of ketoprofen data taken at different times of day. There was substantial variation in the model parameters with time of administration and most of the features of this variation applied equally to both drugs. From the data examined, the source of variation appears to be mainly in the absorption phase and this was confirmed using a chronokinetic analysis, in which simultaneous fits were obtained with time-variant rate parameters. However, there may also be circadian variation in protein binding. The danger of quoting parameter values for either of these two drugs based on administration at a single time of day has been illustrated, and this may well be true for other drugs.
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Affiliation(s)
- J K Aronson
- University Department of Clinical Pharmacology, Radcliffe Infirmary, Oxford, UK
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