1
|
Bojoga A, Balasubramanian SP, Mihai R. Surgery for phaeochromocytomas and paragangliomas: Current practice in the United Kingdom. Ann R Coll Surg Engl 2024. [PMID: 38362758 DOI: 10.1308/rcsann.2023.0054] [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] [Indexed: 02/17/2024] Open
Abstract
INTRODUCTION There is wide variability in the perioperative management of phaeochromocytoma and paraganglioma (PPGL) in different centres. This study aimed to summarise the management of PPGLs as reported in the United Kingdom Registry for Endocrine and Thyroid Surgery (UKRETS) database and to determine current perioperative management of PPGLs by surveying UK clinicians. METHODS Data recorded on UKRETS from 2005 to 2021 were subjected to descriptive analyses. British Association of Endocrine and Thyroid Surgeons members were invited to participate in an open survey relating to the perioperative management of patients with PPGLs. RESULTS A total of 2,007 operations for PPGL from 49 participating centres were included. The median annual workload in each centre was four cases. Operations were performed predominantly laparoscopically (69%). The median length of stay (4 days) was the same in groups of surgeons stratified by volume. The survey had 29 respondents from 22 centres across the UK, and a formal protocol for perioperative management exists in 48% of the centres. Phenoxybenzamine (72%) was preferred for alpha-blockade. The practice of admitting patients for optimisation from 1 to 7 days before the day of surgery was common (62%). Central venous pressure and blood glucose monitoring were mentioned as routine intraoperative adjuncts by 72% of the responders. CONCLUSIONS There is significant variation in the workload and perioperative management of PPGLs in the UK. This is potentially detrimental to patient outcomes and a consensus document might be beneficial to harmonise practice across the UK.
Collapse
Affiliation(s)
- A Bojoga
- University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
| | - S P Balasubramanian
- Sheffield Teaching Hospitals NHS Foundation Trust, UK
- University of Sheffield, UK
| | - R Mihai
- Oxford University Hospitals NHS Foundation Trust, UK
| |
Collapse
|
2
|
Tokidis E, Marshall D, Balasubramanian SP. Letter to the Editor: Spontaneous Resolution of Uncomplicated Appendicitis may Explain Increase in Proportion of Complicated Appendicitis During Covid-19 Pandemic: A Systematic Review and Meta-Analysis by Andersson et al. World J Surg 2023; 47:3441-3442. [PMID: 37737886 DOI: 10.1007/s00268-023-07182-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2023] [Indexed: 09/23/2023]
Affiliation(s)
- E Tokidis
- Northern General Hospital/Sheffield Teaching Hospitals, Herries Rd, Sheffield, S57AU, UK.
| | - D Marshall
- Northern General Hospital/Sheffield Teaching Hospitals, Herries Rd, Sheffield, S57AU, UK
| | - S P Balasubramanian
- Northern General Hospital/Sheffield Teaching Hospitals, Herries Rd, Sheffield, S57AU, UK
| |
Collapse
|
3
|
Mayer AW, Sharp A, Aziz S, Balasubramanian SP. Distribution of inadvertently excised parathyroid glands during thyroid surgery and the link with post-surgical hypoparathyroidism. J Laryngol Otol 2023; 137:1226-1232. [PMID: 36876328 DOI: 10.1017/s002221512300035x] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
OBJECTIVES To evaluate the incidence of inadvertent parathyroidectomy, identify risk factors, determine the location of inadvertently excised glands, review pathology reporting in inadvertent parathyroidectomy, and explore relationships between inadvertent parathyroidectomy and post-surgical hypoparathyroidism or hypocalcaemia. METHODS A retrospective cohort study of 899 thyroidectomies between 2015 and 2020 was performed. Histopathology slides of patients who had an inadvertent parathyroidectomy and a random sample of patients without a reported inadvertent parathyroidectomy were reviewed. RESULTS Inadvertent parathyroidectomy occurred in 18.5 per cent of thyroidectomy patients. Central neck dissection was an independent risk factor (inadvertent parathyroidectomy = 49.4 per cent with central neck dissection, 12.0 per cent without central neck dissection, p < 0.001). Most excised parathyroid glands were extracapsular (53.3 per cent), followed by subcapsular (29.1 per cent) and intrathyroidal (10.9 per cent). Parathyroid tissue was found in 10.2 per cent of specimens where no inadvertent parathyroidectomy was reported. Inadvertent parathyroidectomy was associated with a higher incidence of six-month post-surgical hypoparathyroidism or hypocalcaemia (19.8 per cent who had an inadvertent parathyroidectomy, 7.7 per cent without inadvertent parathyroidectomy). CONCLUSION Inadvertent parathyroidectomy increases the risk of post-surgical hypoparathyroidism or hypocalcaemia. The proportion of extracapsular glands contributing to inadvertent parathyroidectomy highlights the need for preventative measures.
Collapse
Affiliation(s)
- A W Mayer
- Endocrine Surgery Unit, Directorate of General Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - A Sharp
- Department of Pathology, Directorate of Laboratory Services, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - S Aziz
- Department of Pathology, Directorate of Laboratory Services, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - S P Balasubramanian
- Endocrine Surgery Unit, Directorate of General Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| |
Collapse
|
4
|
Edafe O, Tan ET, Jackson R, Sionis S, Balasubramanian SP, Beasley N. Evaluation of hypoparathyroidism following laryngectomy. Ann R Coll Surg Engl 2023; 105:62-67. [PMID: 35132880 PMCID: PMC9773242 DOI: 10.1308/rcsann.2021.0276] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Hypoparathyroidism is a recognised complication following laryngectomy; it is associated with significant short-and long-term morbidity. This study aimed to further characterise this condition, identify risk factors and describe preventative and management strategies in a large cohort. MATERIALS AND METHODS This was a retrospective study at a tertiary referral centre for head and neck cancers. All consecutive patients who had total laryngectomy over an eight-year period were included. RESULTS A total of 140 patients were included. Rates of transient and long-term hypoparathyroidism were 14.3% and 10.1%, respectively. The following factors were significantly associated with transient post-surgical hypocalcaemia or hypoparathyroidism: total thyroidectomy (relative risk, RR, 4.33; 95% confidence interval, CI, 1.86-10.10), oesophagectomy (RR 6.05; 95% CI 2.92-12.53) and female sex (RR 3.23; 95% CI 1.45-7.19). In addition, total thyroidectomy (RR 5.89; 95% CI 1.94-17.86), central neck dissection (RR 3.97; 95% CI 1.42-11.10), oesophagectomy (RR 9.38; 95% CI 4.13-21.3), pharyngectomy (RR 7.14; 95% CI 2.08-24.39) and female sex (RR 5.52; 95% CI 1.95-15.63) were risk factors for long-term hypoparathyroidism. There was variability in the use of preventative measures, monitoring and management of hypocalcaemia and hypoparathyroidism following total laryngectomy. CONCLUSIONS Transient hypocalcaemia and long-term hypoparathyroidism occur in a significant proportion of patients after laryngectomy. A standard protocol is required to improve care.
Collapse
Affiliation(s)
- O Edafe
- Sheffield Teaching Hospitals NHS Foundation Trust, UK
| | - ET Tan
- Sheffield Teaching Hospitals NHS Foundation Trust, UK
| | - R Jackson
- Sheffield Teaching Hospitals NHS Foundation Trust, UK
| | - S Sionis
- Sheffield Teaching Hospitals NHS Foundation Trust, UK
| | | | - N Beasley
- Sheffield Teaching Hospitals NHS Foundation Trust, UK
| |
Collapse
|
5
|
Gaunt A, Moore AR, Huvenne C, Dhami A, Eades M, Balasubramanian SP. Is conservative management of the indeterminate thyroid nodule [Thy3f or Bethesda category IV] safe? Eur Arch Otorhinolaryngol 2022; 279:5905-5911. [PMID: 35881191 DOI: 10.1007/s00405-022-07541-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 07/04/2022] [Indexed: 01/04/2023]
Abstract
PURPOSE The histological diagnosis after diagnostic thyroidectomy for indeterminate thyroid nodules is often non-malignant and some cancers detected are considered 'indolent'. The safety and effectiveness of conservative management in these patients are unclear. The aim of this study was to determine the safety of conservative management of indeterminate thyroid nodules and to explore association between clinical features and pathology in patients undergoing surgery. METHODS This is a retrospective cohort study of patients presenting to a single centre over a 4-year period (2013-2016) with thyroid nodules that were considered indeterminate (thy3f in the UK RCPath classification) on cytology. Demographic data, ultrasound features, follow-up details (in those undergoing conservative management) and histology details (in those undergoing surgery) were collected. RESULTS Of 164 patients that had Thy3f cytology, 34 were initially managed conservatively; however, 4 of these eventually had surgery (due to patient preference). No patient on conservative management had significant disease progression on ultrasound at a median (interquartile range) of 27 (16-40) months. Of the 134 patients that underwent surgery, 26 had thyroid malignancy. The BTA 'U' classification, gender and age (> 55) were not associated with malignancy in these nodules, but larger nodules (> 40 mm) were more likely to be malignant (p = 0.042). CONCLUSIONS Conservative management of indeterminate (Thy3f or Bethesda stage IV) thyroid nodules is safe in the short term and may be indicated in selected cases after appropriate discussion of risks and benefits of surgery.
Collapse
Affiliation(s)
- A Gaunt
- Endocrine Surgery Unit, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.
| | - A R Moore
- Sheffield Medical School, University of Sheffield, Sheffield, UK
| | - C Huvenne
- Sheffield Medical School, University of Sheffield, Sheffield, UK
| | - A Dhami
- Department of Diabetes and Endocrinology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - M Eades
- Endocrine Surgery Unit, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - S P Balasubramanian
- Endocrine Surgery Unit, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| |
Collapse
|
6
|
McAllister J, Arshad MF, Rab E, Balasubramanian SP. Excluding familial hypocalciuric hypercalcaemia before surgery for primary hyperparathyroidism - a practical evaluation of urinary calcium using a retrospective cohort design. Ann R Coll Surg Engl 2022; 104:710-716. [PMID: 35446160 PMCID: PMC9685926 DOI: 10.1308/rcsann.2021.0333] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2021] [Indexed: 11/03/2023] Open
Abstract
INTRODUCTION Familial hypocalciuric hypercalcaemia (FHH) and primary hyperparathyroidism (PHPT) are both associated with raised serum calcium and parathyroid hormone (PTH) levels; the former should be excluded in patients undergoing surgery for the latter. Twenty-four-hour urinary calcium collections (24UCA) can be performed to quantify total calcium excreted; however, results of this method do not take into account factors such as kidney function. Current guidelines suggest measuring urine calcium to creatinine clearance ratio (CCCR) as the initial step. The aim of this study was to evaluate the use of CCCR and 24UCA in a cohort design, to reliably exclude FHH patients before surgery for PHPT. METHODS A retrospective cohort study of all patients having urine calcium investigations in a single centre, over a 2-year period was performed. Relevant biochemical data and recorded diagnoses were collected. RESULTS In total, 296 urine calcium measurements were included from 199 patients. Ten (5%) had genetically confirmed or suspected FHH, 171 (85.9%) had surgically proven or suspected PHPT and the remainder had other diagnoses. At a CCCR cut-off of ≤0.020, positive and negative predictive values (PPV and NPV) were 2.33% and 100%, respectively. At a cut-off of ≤0.015, NPV was maintained at 100% and PPV increased to 3.28%. Low 24UCA measurements (<2.5mmol/L/24h) generated a NPV for FHH of 95.2%. CONCLUSION A CCCR measurement below 0.020 should raise the possibility of FHH and genetic screening should be considered. 24UCA had a lower predictive power to exclude FHH (NPV), and measurements should be interpreted in the context of renal function.
Collapse
Affiliation(s)
| | | | - E Rab
- Sheffield Teaching Hospitals, UK
| | | |
Collapse
|
7
|
Kabia A, Perin G, Balasubramanian SP. Mortality Following Appendicectomy in Patients with Liver Cirrhosis: A Systematic Review and Meta-Analysis. World J Surg 2022; 46:2547-2548. [PMID: 35639165 DOI: 10.1007/s00268-022-06605-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Angela Kabia
- General Surgery, Pinderfields General Hospital, Mid Yorkshire Hospitals NHS Trust, Aberford Road, Wakefield, WF1 4DG, UK.
| | - G Perin
- General Surgery, Pinderfields General Hospital, Mid Yorkshire Hospitals NHS Trust, Aberford Road, Wakefield, WF1 4DG, UK
| | - S P Balasubramanian
- General Surgery, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, F25, F Floor, Sheffield, S10 2J, UK
| |
Collapse
|
8
|
Hashem M, Lim CB, Balasubramanian SP. Is perioperative drop in PTH better than postoperative PTH in predicting hypocalcaemia after thyroid surgery? Br J Surg 2022. [DOI: 10.1093/bjs/znac056.004] [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: 11/12/2022]
Abstract
Abstract
Introduction
Postoperative surgical hypoparathyroidism (PoSH) following thyroid surgery is well known complication. Several predictive factors have been identified including perioperative parathyroid hormone (PTH) levels. The aim of the study is to determine how a drop in perioperative parathyroid hormone (PTH) compares to postoperative day one PTH in predicting hypocalcaemia.
Methods
Medical records of consecutive patients who had either total or completion thyroidectomy with or without central neck dissection between January 2016 and December 2018 in a single thyroid surgery unit were accessed to retrieve data on demographics, pathology, surgery, perioperative biochemistry and management.
Results
Of 295 included patients, there were 227 (76.9%) females. Forty-five (15.3%) had completion thyroidectomy, while the rest had total thyroidectomy. Seventy-eight (26.4%) had concomitant central neck dissection.
64 (21.7%) had day 1 hypocalcaemia and this was persistent at six months in 31 patients (10.5%). Both day one PTH and drop in PTH predicted day one hypocalcaemia (P<0.001) and 6-month hypoparathyroidism (p<0.001). The area under ROC curves for day one PTH and drop in PTH for day one hypocalcaemia (0.729 vs 0.726 respectively) and for 6-month hypoparathyroidism (0.964 vs 0.958 respectively) were similar; albeit slightly better for day 1 PTH.
Conclusion
Day 1 PTH is equivalent to (if not better than) drop in PTH in predicting short and long term PoSH. Preoperative PTH measurements are therefore not needed in detection and/or management of PoSH after thyroid surgery.
Collapse
Affiliation(s)
- Mohamed Hashem
- Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - CB Lim
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | | |
Collapse
|
9
|
McCauley G, Perin G, Balasubramanian SP. Comment on: Antibiotics as first-line alternative to appendicectomy in adult appendicitis: 90-day follow-up from a prospective, multicentre cohort study. Br J Surg 2022; 109:e72. [PMID: 35041747 DOI: 10.1093/bjs/znab455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 12/08/2021] [Indexed: 11/14/2022]
Affiliation(s)
- G McCauley
- General Surgery, Calderdale and Huddersfield NHS Foundation Trust, Huddersfield Royal Infirmary, Huddersfield HD3 3EA, UK
| | - G Perin
- General Surgery, Calderdale and Huddersfield NHS Foundation Trust, Huddersfield Royal Infirmary, Huddersfield HD3 3EA, UK
| | - S P Balasubramanian
- Department of Oncology and Metabolism, University of Sheffield, Sheffield S10 2TN, UK
| |
Collapse
|
10
|
McAllister J, Balasubramanian SP. Spontaneous thyroid abscesses without underlying malignancy: a differential diagnosis for recent onset or rapidly growing thyroid masses. Ann R Coll Surg Engl 2021; 104:e25-e27. [PMID: 34448666 DOI: 10.1308/rcsann.2021.0083] [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] [Indexed: 11/22/2022] Open
Abstract
Thyroid abscess is a rare cause of neck swelling in patients. The rich iodine environment, good vasculature and protective capsule make bacterial growth suboptimal. We present two cases of thyroid abscess without underlying thyroid cancer in immunocompromised patients presenting to a thyroid unit. The demographics, clinical details, investigation, management and outcomes of two patients with thyroid abscess were reviewed. Two octogenarian women were referred with neck lumps originating in the thyroid gland. Ultrasound demonstrated fluid collection in the thyroid, aspiration of which demonstrated Escherichia coli. The patients had underlying diabetes mellitus and raised inflammatory markers at presentation. Both were treated with antibiotics and follow-up demonstrated complete resolution of infection with no underlying thyroid neoplasm. Thyroid abscesses are an important differential diagnosis in rapidly growing thyroid masses due to the potential for rapid deterioration, especially in patients with conditions or medications causing immunosuppression. Urgent admission should be considered to facilitate prompt intervention and rapid recovery.
Collapse
Affiliation(s)
| | - S P Balasubramanian
- Sheffield Teaching Hospitals NHS Foundation Trust, UK.,University of Sheffield, UK
| |
Collapse
|
11
|
Goonoo MS, Arshad MF, Tahir F, Balasubramanian SP. Toxic adenoma: to biopsy or not to biopsy? Ann R Coll Surg Engl 2021; 103:e319-e323. [PMID: 34435917 DOI: 10.1308/rcsann.2021.0008] [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] [Indexed: 11/22/2022] Open
Abstract
Toxic adenoma nodules rarely harbour cancer. Fine-needle aspiration (FNA) is often not done because of the rarity of these lesions being cancer, the difficulty in interpreting cytology in hyperthyroid patients and the rare precipitation of thyrotoxicosis. We present two young, Caucasian female patients aged 29 and 13 years who were each diagnosed with a toxic nodule categorised as benign and indeterminate respectively. They underwent hemithyroidectomy after being rendered euthyroid, however their histology unexpectedly revealed differentiated follicular cancer. Despite thyroid cancer being rare in patients with toxic adenomas, it should be considered when planning treatment, especially if there are risk factors for cancer, or suspicious features on ultrasound examination. A review of the literature shows that compared with adenomas in euthyroid patients, patients in this group are generally younger and predominately female. If an FNA is considered, it should be performed after the patient is rendered euthyroid.
Collapse
Affiliation(s)
- M S Goonoo
- Sheffield Teaching Hospitals NHS Foundation Trust, UK
| | - M F Arshad
- Sheffield Teaching Hospitals NHS Foundation Trust, UK
| | - F Tahir
- Sheffield Teaching Hospitals NHS Foundation Trust, UK
| | | |
Collapse
|
12
|
Khan SM, Perin G, Balasubramanian SP. Comment on 'low pressure versus standard pressure laparoscopic colorectal surgery (PAROS trial): a phase III randomized controlled trial'. Br J Surg 2021; 108:e316. [PMID: 34370829 DOI: 10.1093/bjs/znab206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 05/01/2021] [Indexed: 11/14/2022]
Affiliation(s)
- S M Khan
- General Surgery, Calderdale and Huddersfield NHS Foundation Trust, Huddersfield, England
| | - G Perin
- General Surgery, Calderdale and Huddersfield NHS Foundation Trust, Huddersfield, England
| | - S P Balasubramanian
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, England
| |
Collapse
|
13
|
Corkerry J, Perin G, Balasubramanian SP. Comment on: 'prophylactic sublay non-absorbable mesh positioning following midline laparotomy in a clean-contaminated field: randomized clinical trial (PROMETHEUS)'. Br J Surg 2021; 108:e355. [PMID: 34160003 DOI: 10.1093/bjs/znab241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 06/08/2021] [Indexed: 11/15/2022]
Affiliation(s)
- J Corkerry
- General Surgery, Calderdale and Huddersfield NHS Foundation Trust, Huddersfield, England
| | - G Perin
- General Surgery, Calderdale and Huddersfield NHS Foundation Trust, Huddersfield, England
| | - S P Balasubramanian
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, England
| |
Collapse
|
14
|
Fifer H, Lewis A, Perin G, Balasubramanian SP. Letter to the Editor: Outcomes of Laparoscopic Splenectomy for Treatment of Splenomegaly: A Systematic Review and Meta-analysis. World J Surg 2021; 45:2306-2307. [PMID: 33782731 DOI: 10.1007/s00268-021-06090-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2021] [Indexed: 11/29/2022]
Affiliation(s)
- H Fifer
- General surgery, Calderdale and Huddersfield NHS Foundation Trust, Huddersfield, England.
| | - A Lewis
- The University of Sheffield, Sheffield, England
| | - G Perin
- General surgery, Calderdale and Huddersfield NHS Foundation Trust, Huddersfield, England
| | - S P Balasubramanian
- General Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, England
| | | |
Collapse
|
15
|
Dhanasekar K, Visakan V, Tahir F, Balasubramanian SP. Composite phaeochromocytomas-a systematic review of published literature. Langenbecks Arch Surg 2021; 407:517-527. [PMID: 33651160 PMCID: PMC8933353 DOI: 10.1007/s00423-021-02129-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 02/09/2021] [Indexed: 01/09/2023]
Abstract
Introduction Composite phaeochromocytoma is a tumour containing a separate tumour of neuronal origin in addition to a chromaffin cell tumour. This study reports on two cases from a single centre’s records and presents a systematic literature review of composite phaeochromocytomas. Methods In addition to describing 2 case reports, a systematic search of the Medline database from inception up to April 2020 was done for human case reports on composite phaeochromocytomas. Relevant titles and/or abstracts were screened, and full texts were reviewed to identify appropriate studies. Data was extracted and a descriptive analysis of presentation, clinical features, management strategies and outcomes was performed. The quality of included studies was assessed using a critical appraisal checklist. Results There were 62 studies included, with a total of 94 patients. Of 91 patients where data was available, the median (range) age of patients was 48 (4–86) years. Of 90 patients where information was provided, 57% were female. In at least 28% of patients, a genetic cause was identified. Common presenting features include abdominal pain, palpable mass, cardiovascular and gastrointestinal symptoms. The most common tumour component with phaeochromocytoma is ganglioneuroma; other components include ganglioneuroblastoma, neuroblastoma and malignant peripheral nerve sheath tumours. In patients with follow-up data (n=48), 85% of patients were alive and well at a median (range) follow-up time of 18 (0.5–168) months. Conclusion Composite phaeochromocytoma is a rare tumour, with a significant genetic predisposition. This review summarises available epidemiological data, which will be useful for clinicians managing this rare condition.
Collapse
Affiliation(s)
| | - V Visakan
- Newcastle University, Newcastle upon Tyne, UK
| | - F Tahir
- Sheffield Teaching Hospitals NHS Trust UK, Sheffield, UK
| | - S P Balasubramanian
- University of Sheffield, Sheffield, UK.,Sheffield Teaching Hospitals NHS Trust UK, Sheffield, UK
| |
Collapse
|
16
|
Edafe O, Cochrane E, Balasubramanian SP. Reoperation for Bleeding After Thyroid and Parathyroid Surgery: Incidence, Risk Factors, Prevention, and Management. World J Surg 2020; 44:1156-1162. [PMID: 31822944 DOI: 10.1007/s00268-019-05322-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Bleeding after thyroid and/or parathyroid surgery is a life-threatening emergency. The aim of this study was to determine the rates of reoperation following bleeding, identify risk factors, assess management strategies and outcomes, and develop protocols to reduce risk and improve management of bleeding. METHODS A retrospective cohort study of all consecutive patients who underwent thyroid and/or parathyroid surgery over a 7-year period was conducted. A nested case-control design was used to evaluate specific factors and their association with reoperation for bleeding. RESULTS Of 1913 patients, 25 (1.3%) underwent reoperation for bleeding. Of the 25 patients who bled, 6 (24%) required reoperation before leaving theatre; 17 (68%) had bleeding within 6 h, 1 (4%) between 6 and 24 h, and 1 (4%) after 24 h. Reoperation for bleeding was not associated with age, gender, or surgeon. Patients who had total thyroidectomy were more likely to have reoperation for bleeding compared to hemithyroidectomy (p = 0.045) or parathyroidectomy (p = 0.001). The following factors were not associated with bleeding: neck dissection, re-do surgery, drain use, blood-thinning medication or clotting disorders, and BMI. Patients who had reoperation for bleeding had longer hospital stay (p = 0.001), but similar rates of RLN palsy, wound infection, and hypoparathyroidism. CONCLUSION A higher risk profile for significant post-operative bleeding cannot be determined in patients undergoing thyroid surgery. Based on this experience, we developed protocols to reduce the risk of bleeding (the ITSRED Fred protocol) and for the early detection and management of bleed (the SCOOP protocol) following thyroid and/or parathyroid surgery.
Collapse
Affiliation(s)
- O Edafe
- Department of ENT, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.
- Department of Oncology and Metabolism, University of Sheffield, Beech Hill Road, Sheffield, S10 2RX, UK.
| | - E Cochrane
- Endocrine Surgery Unit, Department of General Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - S P Balasubramanian
- Endocrine Surgery Unit, Department of General Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
- Department of Oncology and Metabolism, University of Sheffield, Beech Hill Road, Sheffield, S10 2RX, UK
| |
Collapse
|
17
|
Arambewela MH, Wijesinghe AM, Randhawa K, Bull M, Wadsley J, Balasubramanian SP. A pragmatic assessment of the British Thyroid Association "U classification" of thyroid nodules with a focus on their follow-up. Clin Radiol 2020; 75:466-473. [PMID: 32184000 DOI: 10.1016/j.crad.2020.02.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Accepted: 02/18/2020] [Indexed: 10/24/2022]
Abstract
AIM To assess the predictive value of the U classification and the significance of follow-up ultrasound in those managed conservatively. MATERIALS AND METHODS A retrospective observational study was carried out among 1,465 patients who underwent thyroid ultrasound in 2016 at a teaching hospital in UK. Details regarding U classification of nodules, cytology, histology in patients who underwent surgery, and follow-up ultrasound in those managed conservatively were obtained. RESULTS Thyroid surgery was performed in 129 patients of which malignancy was seen in 35 (27.1%). The proportion of patients with cancer in U1-U5 categories were 0%, 13.6%, 30.4%, 40%, and 100%, respectively (Fisher's exact test p=0.001). There was no significant difference in U stage, cytology, or histology between incidental and symptomatic nodules. Among patients who did not undergo surgery 5% of U1, 14.6% of U2, 75% of U3, and 71.4% of U4 underwent repeat ultrasound. Radiological progression in nodule size was seen in 4.2% of U1, 1.9% of U2, 0% of U3, and 40% of U4 nodules at median duration of 306, 439, 274, and 748 days, respectively. CONCLUSIONS U classification is reliable in risk-stratifying thyroid nodules. Patients with benign nodules without high-risk features do not require follow-up. The interval between scans in patients with indeterminate nodules can be extended to a period of 6-12 months.
Collapse
Affiliation(s)
- M H Arambewela
- Department of Endocrinology, Sheffield Teaching Hospitals, UK; Department of Physiology, Faculty of Medical Sciences, University of Sri Jayewardenenpura, Sri Lanka.
| | - A M Wijesinghe
- Department of Endocrinology, Sheffield Teaching Hospitals, UK
| | - K Randhawa
- Department of Oncology and Metabolism, University of Sheffield, UK
| | - M Bull
- Department of Radiology, Sheffield Teaching Hospitals, UK
| | - J Wadsley
- Department of Oncology and Metabolism, University of Sheffield, UK; Department of Oncology, Sheffield Teaching Hospitals, UK
| | - S P Balasubramanian
- Department of Oncology and Metabolism, University of Sheffield, UK; Endocrine Surgery Unit, Department of General Surgery, Sheffield Teaching Hospitals, UK
| |
Collapse
|
18
|
Edafe O, Cochrane E, Balasubramanian SP. Author's Reply: Reoperation for Bleeding After Thyroid and Parathyroid Surgery: Incidence, Risk Factors, Prevention, and Management. World J Surg 2020; 44:2443-2444. [PMID: 32157400 DOI: 10.1007/s00268-020-05478-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- O Edafe
- Department of ENT, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK. .,Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK.
| | - E Cochrane
- Endocrine Surgery Unit, Department of General Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - S P Balasubramanian
- Endocrine Surgery Unit, Department of General Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.,Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| |
Collapse
|
19
|
Stedman T, Chew P, Truran P, Lim CB, Balasubramanian SP. Modification, validation and implementation of a protocol for post-thyroidectomy hypocalcaemia. Ann R Coll Surg Engl 2018; 100:135-139. [PMID: 29182003 PMCID: PMC5838696 DOI: 10.1308/rcsann.2017.0194] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2017] [Indexed: 11/22/2022] Open
Abstract
Introduction The management of post-thyroidectomy hypocalcaemia should facilitate early discharge, and reduce risks of hypocalcaemia, readmission and treatment related hypercalcaemia. This paper describes the implementation, evaluation and revision a protocol for the optimal management of this condition. Methods Day 1 parathyroid hormone (PTH) measurements in addition to calcium measurements were commenced following review of the unit's outcomes and literature on post-thyroidectomy hypocalcaemia. Outcomes from a three-year cohort of patients undergoing thyroid surgery helped amend this protocol (revision 1) to reduce biochemical tests, stipulate the need, nature and dose of vitamin D/calcium supplements, and encourage early discharge. This was further validated over seven months to assess compliance, episodes of hyper and/or hypocalcaemia after discharge, readmissions and need for treatment changes. Further revisions were made (revision 2) and implemented. Results The temporary and long-term postoperative hypocalcaemia rates were 29.1% and 3.2% respectively. Repeat calcium measurements on the first day altered management in only 1.4% of cases. The revised protocol was adhered to in 90% of cases. One patient had hypocalcaemia (due to non-compliance) and one had hypercalcaemia. Revision 2 involved reducing the dose of calcium. Conclusions This is a good example of a unit protocol for post-thyroidectomy hypocalcaemia being developed and modified on the basis of the literature and local experience. Day 1 PTH and calcium levels determine the need for treatment and frequency of follow-up visits, facilitate early discharge, reduce risk of over and/or undertreatment, and are good indicators of permanent hypocalcaemia.
Collapse
Affiliation(s)
- T Stedman
- Sheffield Teaching Hospitals NHS Foundation Trust , UK
| | - P Chew
- Sheffield Teaching Hospitals NHS Foundation Trust , UK
| | - P Truran
- Sheffield Teaching Hospitals NHS Foundation Trust , UK
| | - C B Lim
- Sheffield Teaching Hospitals NHS Foundation Trust , UK
| | | |
Collapse
|
20
|
Edafe O, Collins EE, Ubhi CS, Balasubramanian SP. Current predictive models do not accurately differentiate between single and multi gland disease in primary hyperparathyroidism: a retrospective cohort study of two endocrine surgery units. Ann R Coll Surg Engl 2017; 100:140-145. [PMID: 29022783 DOI: 10.1308/rcsann.2017.0112] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Background Minimally invasive parathyroidectomy (MIP) for primary hyperparathyroidism is dependent upon accurate prediction of single-gland disease on the basis of preoperative imaging and biochemistry. The aims of this study were to validate currently available predictive models of single-gland disease in two UK cohorts and to determine if these models can facilitate MIP. Methods This is a retrospectively cohort study of 624 patients who underwent parathyroidectomy for primary hyperparathyroidism in two centres between July 2008 and December 2013. Two recognised models: CaPTHUS (preoperative calcium, parathyroid hormone, ultrasound, sestamibi, concordance imaging) and Wisconsin Index (preoperative calcium, parathyroid hormone) were validated for their ability to predict single-gland disease. Results The rates of single- and multi-gland disease were 491 (79.6%) and 126 (20.2%), respectively. Cure rates in centres 1 and 2 were 93.2% and 93.8%, respectively (P = 0.789). The positive predictive value (PPV) of CaPTHUS score . 3 in predicting single-gland disease was 84.6%, compared with 100% in the original report. CaPTHUS . 4 and 5 had a PPV of 85.1 and 87.1, respectively. There were no differences in Wisconsin Index (WIN) between patients with single- and multi-gland (P = 0.573). A WIN greater than 1600 and weight of excised gland greater than 1 g had a positive predictive value of 86.7% for single-gland disease. Conclusions The use of CaPTHUS and WIN indices without intraoperative adjuncts (such as IOPTH) had the potential to result in failure to cure in up to 15% (CaPTHUS) and 13% (WIN) of patients treated by MIP targeting a single enlarged gland.
Collapse
Affiliation(s)
- O Edafe
- Department of Oncology and Metabolism, University of Sheffield and Sheffield Teaching Hospitals Foundation Trust , Sheffield , UK
| | - E E Collins
- Department of Oncology and Metabolism, University of Sheffield and Sheffield Teaching Hospitals Foundation Trust , Sheffield , UK
| | - C S Ubhi
- Department of Oncology and Metabolism, University of Sheffield and Sheffield Teaching Hospitals Foundation Trust , Sheffield , UK
| | - S P Balasubramanian
- Department of Oncology and Metabolism, University of Sheffield and Sheffield Teaching Hospitals Foundation Trust , Sheffield , UK
| |
Collapse
|
21
|
Abstract
PURPOSE Treatment options in Graves' disease are clearly defined, but management practices and the perceptions of success are varied. The outcomes of treatment in large consecutive cohorts of Graves' disease have not been well characterised. The study describes the epidemiology, management strategies and medium term outcomes following anti-thyroid drug treatment, radio-iodine ablation and surgery in Graves' disease. METHODS All patients (n = 659) who received treatment for a new diagnosis of Graves' disease in secondary care over a 5 year period were included with a median (interquartile range) follow-up of 42.9 (29-57.5) months. RESULTS The age adjusted incidence of adult onset Graves' disease in Sheffield, UK was 24.8 per 100,000 per year. Excluding 35 patients lost to follow-up, 93.1% (n = 581) were controlled on anti-thyroid drug treatment. Of these, 73.6% went into remission following withdrawal of anti-thyroid drugs; 5.2% were still undergoing initial therapy; 13.3% lost control whilst on anti-thyroid drugs; and 7.9% went on to have either surgery or radio-iodine ablation whilst controlled on anti-thyroid drugs. Of the 428 patients who achieved remission, 36.7% relapsed. Of 144 patients who had radio-iodine ablation treatment, 5.6% relapsed and needed further treatment. Of 119 patients having surgery, 5.2% had long-term hypoparathyroidism and none had documented long-term recurrent laryngeal nerve palsy. CONCLUSIONS In the follow-up, 39.9% of patients underwent surgery or radio-iodine ablation with little morbidity. Up to two-thirds of patients who achieved remission did not relapse. Data on effectiveness and risks of treatments for Graves' disease presented in this study will help clinicians and patients in decision making.
Collapse
Affiliation(s)
- Y S Hussain
- Endocrine Surgery Unit, Directorate of General Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - J C Hookham
- Endocrine Surgery Unit, Directorate of General Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - A Allahabadia
- Directorate of Diabetes and Endocrinology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - S P Balasubramanian
- Endocrine Surgery Unit, Directorate of General Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK.
| |
Collapse
|
22
|
Hillary SL, Hemead H, Berthoud M, Balasubramanian SP. A case report on acute severe hyponatraemia following parathyroid surgery for primary hyperparathyroidism-A rare but life threatening complication. Int J Surg Case Rep 2016; 21:136-8. [PMID: 26994458 PMCID: PMC4802297 DOI: 10.1016/j.ijscr.2016.03.001] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 03/02/2016] [Accepted: 03/03/2016] [Indexed: 10/31/2022] Open
Abstract
INTRODUCTION Parathyroidectomy is a common operation, which is well tolerated and associated with low morbidity. Patients are usually discharged within 24hours of surgery. Severe postoperative hyponatraemia is a rare complication which can cause significant morbidity including seizure, coma, respiratory arrest and even death. PRESENTATION OF CASE We present two patients with clinically significant hyponatremia resulting in seizures and collapse within 24hours after parathyroidectomy, an unreported complication following surgery for primary hyperparathyroidism. One patient required support on the High Dependency Unit and both were treated with fluid restriction which resulted in correction of their electrolyte balance. DISCUSSION We believe this was caused by the relative inability to secrete a water load after surgery and non-psychogenic polydipsia. Preoperatively, neither patient was prescribed any routine medications nor did they have any risk factors for hyponatremia. Both had normal preoperative sodium levels. It is usual practice is to advise patients to increase oral water intake when they are hypercalcaemic. The aim of parathyroidectomy is to treat hypercalcaemia by stopping excess PTH secretion from abnormal parathyroid glands. These patients continued to follow this advice after surgery when they were eucalcaemic after their operation and because they were thirsty. The patients drank several litres of water in 12-24hours after surgery. We believe that this may have contributed to this complication. CONCLUSION Healthcare professionals need to be aware of this complication and patients should be advised to restrict intake of free water after surgery.
Collapse
Affiliation(s)
- S L Hillary
- Clinical Research Fellow, Sheffield Teaching Hospitals NHS Foundation Trust c/o F25, Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2JF, UK.
| | - H Hemead
- Medical Student, University of Sheffield, UK.
| | - M Berthoud
- Consultant Anaesthetist, Sheffield Teaching Hospitals NHS Foundation Trust, UK.
| | - S P Balasubramanian
- Consultant Endocrine Surgeon, Sheffield Teaching Hospitals NHS Foundation Trust, EU35, E Floor, Royal Hallamshire Hospital, Beech Hill Road, Sheffield S10 2RX, UK.
| |
Collapse
|
23
|
Prasad P, Clout C, Lorenz E, Harrison BJ, Balasubramanian SP. Incidentalomas during imaging for primary hyperparathyroidism--incidence and clinical outcomes. World J Surg Oncol 2015; 13:272. [PMID: 26376643 PMCID: PMC4573950 DOI: 10.1186/s12957-015-0687-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Accepted: 09/07/2015] [Indexed: 01/28/2023] Open
Abstract
Background Imaging for pre-operative localisation of parathyroid glands in primary hyperparathyroidism is now routine. This has led to the detection of incidental lesions (incidentalomas) in other organs, the nature of which is not well characterised. The aim of this study was to determine the incidence, characteristics and outcomes in patients who had incidental findings on parathyroid imaging. Methods Records of patients who underwent imaging for primary hyperparathyroidism over 2 years were reviewed to identify incidental lesions detected on parathyroid imaging. Patients with persistent or renal hyperparathyroidism were excluded. Details on the management of detected incidentalomas were obtained from patient records. Results Incidentalomas were identified in 17 of 170 patients (10 %) undergoing parathyroid imaging. Incidentalomas included thyroid (n = 11), breast (n = 3), lateral compartment of the neck (n = 1), lung (n = 1) and clavicle (n = 1). However, no disease of clinical significance needing treatment was detected on further investigation. Conclusions Although a significant proportion of patients undergoing parathyroid imaging had incidental lesions detected, these seem to be of little clinical significance. The morbidity and cost of further interventions on these incidentalomas need to be weighed against the benefits of routine imaging in improving outcomes of first-time surgery in patients with primary hyperparathyroidism.
Collapse
Affiliation(s)
- P Prasad
- Endocrine Surgery Unit, Department of General Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK. .,Academic Unit of Surgical Oncology, Department of Oncology, School of Medicine and Biomedical Sciences, The University of Sheffield, Sheffield, S10 2RX, UK.
| | - C Clout
- Department of Radiology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - E Lorenz
- Department of Radiology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - B J Harrison
- Endocrine Surgery Unit, Department of General Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - S P Balasubramanian
- Endocrine Surgery Unit, Department of General Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.,Academic Unit of Surgical Oncology, Department of Oncology, School of Medicine and Biomedical Sciences, The University of Sheffield, Sheffield, S10 2RX, UK
| |
Collapse
|
24
|
Parker VL, Ritchie JE, Drake TM, Hookham J, Balasubramanian SP. A Randomised Assessment of Trainee Doctors’ Understanding and Interpretation of Diagnostic Test Results. World J Surg 2015; 40:21-8. [DOI: 10.1007/s00268-015-3214-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
25
|
Shariff U, Kullar N, Haray PN, Dorudi S, Balasubramanian SP. Multimedia educational tools for cognitive surgical skill acquisition in open and laparoscopic colorectal surgery: a randomized controlled trial. Colorectal Dis 2015; 17:441-50. [PMID: 25495835 DOI: 10.1111/codi.12863] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [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: 07/02/2014] [Accepted: 09/20/2014] [Indexed: 02/08/2023]
Abstract
AIM Conventional teaching in surgical training programmes is constrained by time and cost, and has room for improvement. This study aimed to determine the effectiveness of a multimedia educational tool developed for an index colorectal surgical procedure (anterior resection) in teaching and assessment of cognitive skills and to evaluate its acceptability amongst general surgical trainees. METHOD Multimedia educational tools in open and laparoscopic anterior resection were developed by filming multiple operations which were edited into procedural steps and substeps and then integrated onto interactive navigational platforms using Adobe® Flash® Professional CS5 10.1. A randomized controlled trial was conducted on general surgical trainees to evaluate the effectiveness of online multimedia in comparison with conventional 'study day' teaching for the acquisition of cognitive skills. All trainees were assessed before and after the study period. Trainees in the multimedia group evaluated the tools by completing a survey. RESULTS Fifty-nine trainees were randomized but 27% dropped out, leaving 43 trainees randomized to the multimedia group (n = 25) and study day group (n = 18) who were available for analysis. Posttest scores improved significantly in both groups (P < 0.01). The change in scores (mean ± SD) in the multimedia group was not significantly different from the study day group (6.02 ± 5.12 and 5.31 ± 3.42, respectively; P = 0.61). Twenty-five trainees completed the evaluation survey and experienced an improvement in their decision making (67%) and in factual and anatomical knowledge (88%); 96% agreed that the multimedia tool was a useful additional educational resource. CONCLUSION Multimedia tools are effective for the acquisition of cognitive skills in colorectal surgery and are well accepted as an educational resource.
Collapse
Affiliation(s)
- U Shariff
- Academic Unit of Surgical Oncology, Department of Oncology, University of Sheffield, Sheffield, UK; Department of General Surgery, Princess Grace Hospital, London, UK
| | | | | | | | | |
Collapse
|
26
|
Abstract
BACKGROUND Preoperative imaging in patients undergoing surgery for primary hyperparathyroidism (PHPT) is used primarily to facilitate targeted parathyroidectomy. Failure of preoperative localisation mandates a bilateral exploration. It is thought that the results of imaging may also predict the success of surgery. The aims of this study were to assess whether the findings on preoperative localisation influenced outcomes following parathyroidectomy for PHPT and to explore factors underlying failure to cure at surgery. METHODS We analysed outcomes of all patients who underwent first-time surgery for PHPT in two centres over a 5-year period to determine an association with demographic characteristics and findings on preoperative imaging. Records of patients not cured by initial surgery were reviewed to explore factors underlying failure to cure. RESULTS The failure rate (persistent disease) in the entire cohort was 5 % (25/541) (bilateral neck explorations, 5 %; unilateral exploration, 7 %; targeted approach, 4 %), while two patients developed recurrent disease. In patients who had undergone dual imaging with an ultrasound scan and (99m)Tc-sestamibi scintigraphy, failure rates with "lateralised and concordant" imaging, "nonconcordant" imaging, and "dual-negative" imaging were 2, 9, and 11 %, respectively (p = 0.01). Of the 25 patients with persistent disease, multigland disease (MGD) was present in 52 % (13/25) and ectopic adenoma in 24 % (6/12). CONCLUSIONS Patients with PHPT who do not have lateralised and concordant dual imaging are at higher risk of persistent disease. A significant proportion of failures are due to the inability to recognise the presence and/or extent of MGD.
Collapse
Affiliation(s)
- A Bagul
- Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK,
| | | | | | | | | |
Collapse
|
27
|
Edafe O, Prasad P, Harrison BJ, Balasubramanian SP. Incidence and predictors of post-thyroidectomy hypocalcaemia in a tertiary endocrine surgical unit. Ann R Coll Surg Engl 2014; 96:219-23. [PMID: 24780788 DOI: 10.1308/003588414x13814021679753] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Post-thyroidectomy hypocalcaemia is a common complication with significant short and long term morbidity. The aim of this study was to determine the incidence and predictors of post-thyroidectomy hypocalcaemia (as defined by a corrected calcium <2.1 mmol/l) in a tertiary endocrine surgical unit. METHODS A total of 238 consecutive patients who underwent completion or bilateral thyroid surgery between 2008 and 2011 were included in this retrospective study. Clinical and biochemical data were obtained from electronic and hard copy medical records. RESULTS The incidence of post-thyroidectomy hypocalcaemia on first postoperative day (POD1) was 29.0%. There was variation in the incidence of hypocalcaemia depending on the timing of measurement on the first postoperative day. At six months following surgery, 5.5% of patients were on calcium and/or vitamin D supplementation. Factors associated with post-thyroidectomy hypocalcaemia were lower preoperative corrected calcium (p=0.005) and parathyroid gland (PTG) auto-transplant (p=0.001). Other clinical factors such as central lymph node dissection, inadvertent PTG excision, ethnicity, preoperative diagnosis and Lugol's iodine were not associated with post-thyroidectomy hypocalcaemia. CONCLUSION The incidence of post-thyroidectomy hypocalcaemia was underestimated by 6% when only POD1 measurements were considered. The timing of measurement on POD1 has an impact on the incidence of post-thyroidectomy hypocalcaemia. Auto-transplantation and lower preoperative calcium were associated with post-thyroidectomy hypocalcaemia.
Collapse
Affiliation(s)
- O Edafe
- Department of Oncology, University of Sheffield, Sheffield, United Kingdom.
| | | | | | | |
Collapse
|
28
|
Edafe O, Antakia R, Laskar N, Uttley L, Balasubramanian SP. Authors' reply: Systematic review and meta-analysis of predictors of post-thyroidectomy hypocalcaemia (Br J Surg 2014; 101: 307-320). Br J Surg 2014; 101:883-4. [PMID: 24817655 DOI: 10.1002/bjs.9538] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- O Edafe
- Department of Oncology, University of Sheffield, Beech Hill Road,, Sheffield S10 2RX, UK.
| | | | | | | | | |
Collapse
|
29
|
Bagul A, Patel HP, Chadwick D, Harrision BJ, Balasubramanian SP. Authors reply to letter to editor: primary hyperparathyroidism: an analysis of failure of parathyroidectomy. World J Surg 2014; 38:2483. [PMID: 24798027 DOI: 10.1007/s00268-014-2603-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- A Bagul
- Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, S10 2RX, UK,
| | | | | | | | | |
Collapse
|
30
|
Balasubramanian SP, Brignall J, Lin HY, Stephenson TJ, Wadsley J, Harrison BJ, Craig WL, Smart L, Krukowski Z. Sentinel node biopsy in papillary thyroid cancer--what is the potential? Langenbecks Arch Surg 2014; 399:245-51. [PMID: 24446015 DOI: 10.1007/s00423-014-1168-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2013] [Accepted: 01/12/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE Sentinel node biopsy (SNB) may identify lymph node metastases in patients with papillary thyroid cancer (PTC), enabling selective application of central node dissection (CND). The aim of this study was to assess the feasibility of implementing SNB in patients undergoing thyroidectomy for a cytologically indeterminate/suspicious/malignant thyroid nodule and to determine the potential improvement in clinical outcomes and the costs associated with the SNB technique. METHODS The treatment strategies and clinical and pathological outcomes of two retrospective cohorts of patients who underwent preoperative thyroid FNA over a 5-year period in two different centres were studied. The potential for implementing the SNB technique and the benefits and costs associated with implementation were estimated. RESULTS In centre 1, in 819 adult patients who had thyroid fine-needle aspiration cytology, the final cytology was indeterminate, suspicious and diagnostic of malignancy in 113, 29 and 28 patients, respectively. One hundred eight patients were 'suitable' for SNB. Twenty-three of these patients had PTC, six of whom underwent CND. Of these six patients, node metastasis was absent in five--the cohort in whom prophylactic CND may have been avoided consequent to a negative 'sentinel node' biopsy. Morbidity attributable to CND may have been avoided in up to four patients over a 5-year period. Costs associated with implementation of SNB outweighed any potential savings. Analysis of 491 patients in centre 2 confirmed that the benefit of SNB in PTC was similarly limited; morbidity attributable to CND may have been avoided in up to seven patients over a 5-year period. CONCLUSIONS Even under ideal conditions (assuming 100 % node identification rate and 0 % false negative rate), the potential short- to medium-term benefit of sentinel node biopsy in patients with thyroid cancer in centres implementing a policy of selective or routine prophylactic CND is low.
Collapse
|
31
|
Edafe O, Antakia R, Laskar N, Uttley L, Balasubramanian SP. Systematic review and meta-analysis of predictors of post-thyroidectomy hypocalcaemia. Br J Surg 2014; 101:307-20. [PMID: 24402815 DOI: 10.1002/bjs.9384] [Citation(s) in RCA: 395] [Impact Index Per Article: 39.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2013] [Indexed: 01/20/2023]
Abstract
BACKGROUND Hypocalcaemia is common after thyroidectomy. Accurate prediction and appropriate management may help reduce morbidity and hospital stay. The aim of this study was to perform a systematic literature review and meta-analysis of predictors of post-thyroidectomy hypocalcaemia. METHODS A systematic search of PubMed, EMBASE and the Cochrane Library databases was undertaken, and the quality of manuscripts assessed using a modified Newcastle-Ottawa Scale. RESULTS Some 115 observational studies were included. The median (i.q.r.) incidence of transient and permanent hypocalcaemia was 27 (19-38) and 1 (0-3) per cent respectively. Independent predictors of transient hypocalcaemia included levels of preoperative calcium, perioperative parathyroid hormone (PTH), preoperative 25-hydroxyvitamin D and postoperative magnesium. Clinical predictors included surgery for recurrent goitre and reoperation for bleeding. A calcium level lower than 1·88 mmol/l at 24 h after surgery, identification of fewer than two parathyroid glands (PTGs) at surgery, reoperation for bleeding, Graves' disease and heavier thyroid specimens were identified as independent predictors of permanent hypocalcaemia in multivariable analysis. Factors associated with transient hypocalcaemia in meta-analyses were inadvertent PTG excision (odds ratio (OR) 1·90, 95 per cent confidence interval 1·31 to 2·74), PTG autotransplantation (OR 2·03, 1·44 to 2·86), Graves' disease (OR 1·75, 1·34 to 2·28) and female sex (OR 2·28, 1·53 to 3·40). CONCLUSION Perioperative PTH, preoperative vitamin D and postoperative changes in calcium are biochemical predictors of post-thyroidectomy hypocalcaemia. Clinical predictors include female sex, Graves' disease, need for parathyroid autotransplantation and inadvertent excision of PTGs.
Collapse
Affiliation(s)
- O Edafe
- Department of Oncology, University of Sheffield, Sheffield, UK
| | | | | | | | | |
Collapse
|
32
|
Abstract
Abstract
Background
Methylene blue is an intraoperative adjunct for localization of enlarged parathyroid glands. The availability of preoperative and other intraoperative localization methods, and the reported adverse effects of methylene blue make its routine use debatable. The aim of this study was to perform a systematic review of the use of methylene blue in parathyroidectomy.
Methods
A systematic review of English-language literature in MEDLINE and Scopus databases on the use of intravenous methylene blue in parathyroid surgery was carried out.
Results
There were no randomized clinical trials. Thirty-nine observational studies were identified, of which 33 did not have a control arm. The overall median staining rate for abnormal parathyroid glands was 100 per cent. The median cure rates in the methylene blue and no-methylene blue arms were 100 and 98 per cent respectively. Neurotoxicity was reported in 25 patients, all of whom were taking serotonergic medication.
Conclusion
Observational evidence suggests that methylene blue is efficacious in identifying enlarged parathyroid glands. Toxicity appears to be mild in the absence of concomitant use of serotonin reuptake inhibitors. The effectiveness of methylene blue in the context of currently used preoperative and intraoperative localization techniques has yet to be shown.
Collapse
Affiliation(s)
- H P Patel
- Department of Oncology, University of Sheffield, Chesterfield Royal Hospital NHS Foundation Trust, Sheffield, UK
| | - D R Chadwick
- Department of General Surgery, Chesterfield Royal Hospital NHS Foundation Trust, Sheffield, UK
| | - B J Harrison
- Endocrine Surgery Unit, Department of General Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - S P Balasubramanian
- Department of Oncology, University of Sheffield, Chesterfield Royal Hospital NHS Foundation Trust, Sheffield, UK
- Endocrine Surgery Unit, Department of General Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| |
Collapse
|
33
|
Whitaker IS, Oboumarzouk O, Rozen WM, Naderi N, Balasubramanian SP, Azzopardi EA, Kon M. The efficacy of medicinal leeches in plastic and reconstructive surgery: a systematic review of 277 reported clinical cases. Microsurgery 2012; 32:240-50. [PMID: 22407551 DOI: 10.1002/micr.20971] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2011] [Accepted: 09/21/2011] [Indexed: 11/11/2022]
Abstract
BACKGROUND Although there are numerous case reports and small case series describing the experiences of leech therapy in various circumstances, there are relatively few large studies evaluating the effectiveness of leeching to relieve venous congestion. The therapeutic value of leeching is illustrated by these reports but the current literature lacks a cohesive summary of previous experiences. METHODS An electronic search of PubMed, the Cochrane library and the Centre for Reviews and Dissemination between 1966 and 2009 was used to retrieve human studies published in the English language evaluating outcomes following leech therapy. The "success" and "failure" of leech therapy were the primary outcome measures and secondary outcomes included complications, number of leeches used, pharmacological adjuncts and blood transfusion requirements. RESULTS In total, out of 461 articles, 394 articles met the exclusion criteria. The 67 included papers reported on 277 cases of leech use with an age range of 2-81 years and a male to female ratio of almost 2:1. The overall reported "success" rate following leech therapy was 77.98% (216/277). In terms of secondary outcome measures, 49.75% of cases (N = 101) required blood transfusions, 79.05% received antibiotics (N = 166) and 54.29% received concomitant anticoagulant therapy. The overall complication rate was 21.8%. CONCLUSION In the absence of robust randomized controlled trials on which the evidence may be based, this synthesis of current best evidence guides clinicians during the process of consenting patients and using leeches in their practice.
Collapse
Affiliation(s)
- Iain S Whitaker
- Department of Burns and Plastic Surgery, Morriston Hospital, Swansea, Wales, UK.
| | | | | | | | | | | | | |
Collapse
|
34
|
Balasubramanian SP, Harrison BJ. Simplified minimally invasive invasive parathyroidectomy. Ann R Coll Surg Engl 2011; 93:563-4. [PMID: 22004654 DOI: 10.1308/147870811x598542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
|
35
|
Balasubramanian SP, Harrison BJ. Systematic review and meta-analysis of sentinel node biopsy in thyroid cancer. Br J Surg 2011; 98:334-44. [DOI: 10.1002/bjs.7425] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2010] [Indexed: 01/11/2023]
Abstract
Abstract
Background
Sentinel node biopsy (SNB) is employed as standard treatment in some solid organ cancers to assess lymph node spread and enable targeted treatment. Several studies have investigated the role of SNB in thyroid cancer. This is a systematic review and meta-analysis of the role of SNB in the management of thyroid cancer.
Methods
A systematic search was performed in the PubMed database to identify all original articles on the role of SNB in thyroid cancer. Data on methodologies used, short-term outcomes and adverse effects were summarized, and used to address relevant clinical questions related to the application of the SNB technique in thyroid cancer.
Results
Twenty-four studies were included. The overall sentinel node (SN) detection rates for the blue dye, radioisotope and combined techniques were 83·7, 98·4 and 96 per cent respectively. A positive SN was seen in 42·9 per cent of patients with papillary thyroid cancer with an identified SN. The overall false-negative rates for the blue dye, radioisotope and combined techniques were 7·7, 16 and 0 per cent respectively. A negative frozen-section examination of the SN was unreliable in 12·0 per cent of patients. Immunohistochemical assessment of the SN showed evidence of nodal metastases in an additional 15 per cent of patients (7 of 47 sentinel nodes).
Conclusion
SNB in thyroid cancer is a promising technique that has the potential to avoid prophylactic lymph node surgery in up to 57 per cent of patients with clinically node-negative thyroid cancer.
Collapse
Affiliation(s)
| | - B J Harrison
- Department of Endocrine Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| |
Collapse
|
36
|
Affiliation(s)
- R G Hardy
- Department of Endocrine Surgery, Royal Victoria Infirmary, Newcastle-upon-Tyne, UK.
| | | | | | | | | |
Collapse
|
37
|
Cross SS, Lippitt J, Mitchell A, Hollingsbury F, Balasubramanian SP, Reed MWR, Eaton C, Catto JW, Hamdy F, Winder SJ. Expression of beta-dystroglycan is reduced or absent in many human carcinomas. Histopathology 2009; 53:561-6. [PMID: 18983465 DOI: 10.1111/j.1365-2559.2008.03157.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIMS Dystroglycan is an important structural and signalling protein that is expressed in most human cells. alpha-Dystroglycan has been investigated and found to be reduced in human cancers, but there is only one published study on the expression of beta-dystroglycan in human cancer and that was only on small numbers of breast and prostatic cancers. The aim was to conduct a comprehensive immunohistochemical survey of the expression of beta-dystroglycan in normal human tissues and common cancers. METHODS AND RESULTS Triplicate tissue microarrays of 681 samples of normal human tissues and common cancers were stained using an antibody directed against the cytoplasmic component of beta-dystroglycan. beta-Dystroglycan was strongly expressed at the intercellular junctions and basement membranes of all normal human epithelia. Expression of beta-dystroglycan was absent or markedly reduced in 100% of oesophageal adenocarcinomas, 97% of colonic cancers, 100% of transitional cell carcinomas of the urothelium and 94% of breast cancers. In the breast cancers, the only tumours that showed any retention of beta-dystroglycan expression were small low-grade oestrogen receptor-positive tumours. The only cancers that showed retention of beta-dystroglycan expression were cutaneous basal cell carcinomas. CONCLUSIONS There is loss or marked reduction of beta-dystroglycan expression (by immunohistochemistry) in the vast majority of human cancers surveyed. Since beta-dystroglycan is postulated to have a tumour suppressor effect, this loss may have important functional significance.
Collapse
Affiliation(s)
- S S Cross
- Academic Unit of Pathology, School of Medicine & Biomedical Sciences, University of Sheffield, Sheffield, UK.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
38
|
Abstract
BACKGROUND Reference errors in biomedicals journals are well documented. Increasing use of electronic databases and bibliographic software may change the nature and frequency of errors. AIM To study the current incidence of reference errors in four major general surgical journals. METHODS Seventy-five references were randomly selected from original articles published in one issue of each of four general surgical journals. For each reference, ease of retrieval on PubMed and the presence of citation errors were noted. Two observers independently reviewed each reference for quotation errors. RESULTS Of the 300 selected references, 261 from indexed English language biomedical journals were analysed. Retrieval from PubMed was impossible or difficult in six instances, giving a major citation error rate of 2.3%. Overall (major and minor) citation error rate was 11.1%. Of the 258 references that could be retrieved, 20 (7.8%) had quotation errors, 80% of which were considered major. The overall citation error rate was significantly different across the four journals. There was moderate correlation between quotation error rate and number of references in each original article. CONCLUSION Errors in references still appear in current surgical literature. Solutions to address this problem have been discussed.
Collapse
Affiliation(s)
- M S Reddy
- General Surgery, Caithness General Hospital, Wick.
| | | | | | | |
Collapse
|
39
|
Balasubramanian SP. Clinical Trials: Ethics and Quality. World J Surg 2008; 32:494-5; author reply 496-7; discussion 498. [DOI: 10.1007/s00268-007-9297-7] [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: 11/29/2022]
|
40
|
Balasubramanian SP, Azmy IAF, Higham SE, Wilson AG, Cross SS, Cox A, Brown NJ, Reed MW. Interleukin gene polymorphisms and breast cancer: a case control study and systematic literature review. BMC Cancer 2006; 6:188. [PMID: 16842617 PMCID: PMC1553474 DOI: 10.1186/1471-2407-6-188] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2006] [Accepted: 07/14/2006] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Interleukins and cytokines play an important role in the pathogenesis of many solid cancers. Several single nucleotide polymorphisms (SNPs) identified in cytokine genes are thought to influence the expression or function of these proteins and many have been evaluated for their role in inflammatory disease and cancer predisposition. The aim of this study was to evaluate any role of specific SNPs in the interleukin genes IL1A, IL1B, IL1RN, IL4R, IL6 and IL10 in predisposition to breast cancer susceptibility and severity. METHODS Candidate single nucleotide polymorphisms (SNPs) in key cytokine genes were genotyped in breast cancer patients and in appropriate healthy volunteers who were similar in age, race and sex. Genotyping was performed using a high throughput allelic discrimination method. Data on clinico-pathological details and survival were collected. A systematic review of Medline English literature was done to retrieve previous studies of these polymorphisms in breast cancer. RESULTS None of the polymorphisms studied showed any overall predisposition to breast cancer susceptibility, severity or to time to death or occurrence of distant metastases. The results of the systematic review are summarised. CONCLUSION Polymorphisms within key interleukin genes (IL1A, IL1B, IL1RN, IL4R, IL6 and IL10 do not appear to play a significant overall role in breast cancer susceptibility or severity.
Collapse
Affiliation(s)
| | - IAF Azmy
- Academic Surgical Oncology Unit, University of Sheffield, Sheffield, UK
| | - SE Higham
- Academic Surgical Oncology Unit, University of Sheffield, Sheffield, UK
| | - AG Wilson
- Academic Rheumatology Unit, University of Sheffield, Sheffield, UK
| | - SS Cross
- Academic Unit of Pathology, University of Sheffield, Sheffield, UK
| | - A Cox
- Institute of Cancer Studies, University of Sheffield, Sheffield, UK
| | - NJ Brown
- Academic Surgical Oncology Unit, University of Sheffield, Sheffield, UK
| | - MW Reed
- Academic Surgical Oncology Unit, University of Sheffield, Sheffield, UK
| |
Collapse
|
41
|
Balasubramanian SP, Reed MW. Ischemic vascular disease and solid cancers: opposing ends of the angiogenic spectrum? Med Hypotheses 2006; 67:1317-9. [PMID: 16828237 DOI: 10.1016/j.mehy.2006.04.066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2006] [Revised: 04/26/2006] [Accepted: 04/27/2006] [Indexed: 11/25/2022]
Abstract
Angiogenesis is a key pathway crucial to the patho-physiology of both vascular disease and solid cancer. In physiological conditions, a fine balance of pro- and anti-angiogenic factors is maintained as part of normal homeostatic mechanisms. It is widely accepted that excess angiogenesis influences the development or progression of tumours whilst insufficient angiogenesis may predispose to ischemic vascular disease. Although there are some factors, which predispose to both cancers and vascular disease, we believe there is a reasonable body of literature that suggests an inverse association between the two. We hypothesise that pro-angiogenic and anti-angiogenic phenotypes exist in the population. This may be due to a combination of underlying genetic variations and/or environmental factors. Pro-angiogenic phenotypes would have increased susceptibility to solid cancers and decreased predisposition to cardiovascular diseases and vice versa with the anti-angiogenic phenotypes. We propose that genetic and environmental factors causing a shift in the balance of angiogenesis will predispose individuals towards one group of pathologies while protecting them from another. Evaluation of this hypothesis will in the first instance involve carefully designed large population based observational studies to determine if an inverse relationship exists between the predisposition to ischemic vascular disease and the predisposition to solid cancer. Further detailed study of the pathways and underlying mechanisms of angiogenesis especially in disease states would facilitate better understanding of its regulation. Evaluation and validation of molecular markers that affect the 'angiogenesis pathway' may be helpful in determining the angiogenic potential of individual subjects. Determining where individuals lie along this spectrum may have a potential role in the prediction and stratification of risk of cancer and vascular disease. Modifying risk for patients at high risk of disease at the two opposing ends of the spectrum may then be possible by either lifestyle or dietary alterations or drugs targeting the angiogenic pathway.
Collapse
Affiliation(s)
- S P Balasubramanian
- Academic Surgical Oncology Unit, University of Sheffield, K Floor, Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2JF, United Kingdom.
| | | |
Collapse
|
42
|
Cross SS, Harrison RF, Balasubramanian SP, Lippitt JM, Evans CA, Reed MWR, Holen I. Expression of receptor activator of nuclear factor kappabeta ligand (RANKL) and tumour necrosis factor related, apoptosis inducing ligand (TRAIL) in breast cancer, and their relations with osteoprotegerin, oestrogen receptor, and clinicopathological variables. J Clin Pathol 2006; 59:716-20. [PMID: 16489180 PMCID: PMC1860414 DOI: 10.1136/jcp.2005.030031] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Receptor activator of nuclear factor kappabeta ligand (RANKL) has an important role in bone remodelling, and tumour necrosis factor related, apoptosis inducing ligand (TRAIL) can induce apoptosis in cancer cells. Their functions are linked by their interactions with osteoprotegerin (OPG). OBJECTIVE To investigate the expression of RANKL and TRAIL in a large series of unselected breast cancers and to analyse the relations between these expressions and the expression of OPG, oestrogen receptor, and clinicopathological variables. METHODS 395 breast cancers were sampled into tissue microarrays and immunohistochemistry undertaken for RANKL and TRAIL. RESULTS There was strong expression of RANKL in 14% of the cancers and strong expression of TRAIL in 30%. Expression of RANKL had a negative association with expression of oestrogen receptor (p = 0.036). Expression of TRAIL had a negative association with the Nottingham Prognostic Index (p = 0.021). There was a significant negative relation between expression of RANKL and TRAIL (p<0.005). Unsupervised cluster analysis produced a dendrogram that showed a clear division into two groups, and the expression of oestrogen receptor was significantly higher in one of those groups (p = 0.012). CONCLUSIONS There is apparent loss of expression of RANKL in 86% of breast cancers; those tumours that retain expression tend to be oestrogen receptor negative and of a high histological grade. There is strong expression of TRAIL in 30% of breast cancers and these tend to be of better prognostic type. These results may be important in the processes of metastasis to bone and the apoptotic cell death pathway in cancer.
Collapse
Affiliation(s)
- S S Cross
- Academic Unit of Pathology, School of Medicine and Biomedical Sciences, University of Sheffield, UK.
| | | | | | | | | | | | | |
Collapse
|
43
|
Balasubramanian SP, Kumar ID, Wyld L, Reed MW. Publication of surgical abstracts in full text: a retrospective cohort study. Ann R Coll Surg Engl 2006; 88:57-61. [PMID: 16482660 PMCID: PMC1963619 DOI: 10.1308/003588406x82961] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTIONAbstracts presented at national and international scientific meetings are an important educational resource. However, the work is not peer reviewed and little is known about the quality or validity of the presented results and the fate of such abstracts.MATERIALS AND METHODSThis is a retrospective cohort study of abstracts presented to the 1997 annual meeting of the Association of Surgeons of Great Britain and Ireland. We examined the rates of full-text publication, time to publication, factors influencing publication, inconsistencies between presented and subsequently published manuscripts, and reasons for non-publication of abstracts.RESULTSOf the 241 abstracts presented, 136 (56.4%) were published at a median duration of 18 months. Multicentre studies had a greater tendency to subsequent publication and studies involving academic centres predicted publication in a high impact factor journal. Inconsistencies between presented and published abstracts were common and were significantly associated with delayed publication. Oral and poster presentations were equally likely to be published. Reasons for non-submission of presented abstracts included lack of time, low priority to publish, perceived methodological limitations, lack of novelty of findings and co-investigators leaving the organisation.CONCLUSIONSMore than half of the work presented at a national surgical meeting in the UK has been subsequently published. Various factors that influence the process of publication and remediable causes for non-publication have been identified.
Collapse
|
44
|
Balasubramanian SP, Cooper JC. Diagnostic peritoneal lavage — an obituary ( Br J Surg 2005; 92: 517–518). Br J Surg 2005; 92:1177-8. [PMID: 16106475 DOI: 10.1002/bjs.5162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|
45
|
Ragavan N, Philip J, Balasubramanian SP, Desouza J, Marr C, Javle P. A RANDOMIZED, CONTROLLED TRIAL COMPARING LIDOCAINE PERIPROSTATIC NERVE BLOCK, DICLOFENAC SUPPOSITORY AND BOTH FOR TRANSRECTAL ULTRASOUND GUIDED BIOPSY OF PROSTATE. J Urol 2005; 174:510-3; discussion 513. [PMID: 16006882 DOI: 10.1097/01.ju.0000165158.40132.e2] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Lidocaine periprostatic nerve block (PPNB) provides good procedural pain relief for transrectal ultrasound (TRUS) prostatic biopsy. However, post-procedural pain can be significant. The addition of diclofenac suppository (DS) to lidocaine PPNB might provide additional, particularly post-procedural pain relief. We assessed the procedural and post-procedural pain relief for TRUS biopsy provided by DS, and the combination of DS and lidocaine PPNB compared with lidocaine PPNB alone. MATERIALS AND METHODS A total of 165 patients were randomized into 3 groups, namely group 1-lidocaine PPNB, group 2-DS and group 3-a combination of lidocaine PPNB and DS. In all patients 12 core biopsy was performed. Pain/discomfort at various intervals after the procedure was recorded on a visual analogue scale of 0 to 10 cm. RESULTS Biopsy pain was significantly lower in patients who received lidocaine alone or in combination compared with DS alone (median 1.95, IQR 1.08 to 3.12, 3, IQR 1.25 to 5.47 and 1.8, IQR 0.85 to 3.0, respectively, p = 0.018), while evening pain scores were significantly lower in patients who received DS alone or in combination compared with that in patients who received lidocaine alone (median 1.25, IQR 0.38 to 3.0, 0.3, IQR 0.03 to 1.08 and 0.4, IQR 0 to 1.0, respectively, p = 0.001). There were no significant differences in pain/discomfort due to the probe (p = 0.107), that 1 hour after biopsy (p = 0.076) and that on the day after the procedure (p = 0.165). There were no significant differences in hemorrhagic or infective complications among the groups. CONCLUSIONS The combination of lidocaine PPNB with DS provides additional pain relief during and after prostatic TRUS biopsy.
Collapse
Affiliation(s)
- N Ragavan
- Michael Heal Department of Urology, Leighton Hospital, Crewe and University of Sheffield, Sheffield, United Kingdom.
| | | | | | | | | | | |
Collapse
|
46
|
Abstract
Accumulation of information from scientific advances in genetics and biotechnology has accelerated research investigating the inherent individual variation in disease susceptibility and severity. Gene polymorphisms, in particular single nucleotide polymorphisms, are being evaluated for their role in multi-factorial diseases such as cancer and inflammation. Most surgical diseases are multi-factorial and a better understanding and utilization of the information gained from such studies by clinicians/surgeons is likely to favorably influence patient outcome. In this article, we illustrate the types of genetic variation and the complexities involved in their study and discuss their potential in predicting both the occurrence and outcomes of solid cancers.
Collapse
Affiliation(s)
- S P Balasubramanian
- Academic Unit of Surgical Oncology, K Floor, University of Sheffield, Royal Hallamshire Hospital, Sheffield S10 2JF, UK
| | | | | | | |
Collapse
|
47
|
Glencross J, Balasubramanian SP, Bacon J, Robinson MH, Reed MW. An audit of the management of soft tissue sarcoma within a health region in the UK. Eur J Surg Oncol 2003; 29:670-5. [PMID: 14511616 DOI: 10.1016/s0748-7983(03)00134-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
AIMS Soft tissue sarcomas are rare and heterogeneous tumours only occasionally seen by most individual clinicians. Early recognition, appropriate referral and timely investigations markedly improve outcomes. Our aim was to retrospectively assess the referral patterns, investigation, surgery and outcomes of patients with soft tissue sarcoma in the Trent region of the UK. METHODS Two hundred and four patients with soft tissue sarcoma registered with the Trent Cancer Registry in 1995-1997 were first studied. Clinical details, tumour characteristics, presentation, management and follow-up were recorded from the case notes and analysed.A further group of 40 patients referred to a single cancer centre in 1999 were audited to establish whether there had been any improvements/changes over the 2 years, since the completion of the first audit. RESULTS In the first audit, 49.5% were first referred to general surgeons and 16% to orthopaedic surgeons. Only 15% of patients fit for surgery were referred to a surgeon with a specialist sarcoma interest prior to definitive exploration. Of the deep tumours, 64% had a preoperative biopsy and only 68% had a scan before biopsy or definitive surgery. Tumour grade, completeness of excision and site of the sarcoma influenced survival. The second audit performed on patients treated in 1999 showed only a marginal improvement in management when compared to the first audit.
Collapse
Affiliation(s)
- J Glencross
- Public Health Directorate, Lincolnshire South West Teaching PCT, Lincoln, UK
| | | | | | | | | |
Collapse
|
48
|
Balasubramanian SP. Randomized clinical study of Gastrografin administration in patients with adhesive small bowel obstruction (Br J Surg 2003; 90: 542-546). Br J Surg 2003; 90:1022. [PMID: 12905562 DOI: 10.1002/bjs.4360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
|
49
|
Balasubramanian SP, Murrow S, Holt S, Manifold IH, Reed MW. Audit of compliance to adjuvant chemotherapy and radiotherapy guidelines in breast cancer in a cancer network. Breast 2003; 12:136-41. [PMID: 14659343 DOI: 10.1016/s0960-9776(02)00263-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The North Trent Cancer Network Breast Group in the United Kingdom revised its adjuvant treatment guidelines in breast cancer management in 1998. We aimed to check the compliance to the guidelines, 8 months after their introduction. Data were collected, retrospectively, from the medical records of patients with invasive breast cancer who underwent definitive surgery (in a 3-month period) in different cancer units and the cancer centre within the North Trent Cancer Network. The overall compliance to treatment guidelines was 82% (90% and 74% for chemotherapy and radiotherapy, respectively), which was similar across the network. In 5% of cases, compliance could not be determined. On case review, 22% of the non-compliant incidents were justified and 16% seemed to be due to variation in guideline interpretation. We discuss the possible reasons for non-compliance and show a need to periodically monitor compliance to adjuvant treatment guidelines.
Collapse
Affiliation(s)
- S P Balasubramanian
- Surgical Oncology, K Floor, Royal Hallamshire Hospital, University of Sheffield, Sheffield S10 2JF, UK
| | | | | | | | | |
Collapse
|
50
|
Balasubramanian SP, Dalavaye SK. Acute-phase protein response, survival and tumour recurrence in patients with colorectal cancer ( Br J Surg 2001; 88: 255–60). Br J Surg 2002. [DOI: 10.1046/j.1365-2168.2001.01882-3.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
| | - S K Dalavaye
- Rotherham General Hospital, Moorgate Road, Rotherham S60 2UD, UK
| |
Collapse
|