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Thyroid surgery has the potential for significant life-changing postoperative complications. Since 1995, the NHS Litigation Authority has handled litigation claims in England. This article reviews all thyroid surgery litigation claims between 1995 and 2012 and looks at potential strategies to minimize future claims.

Geobacillus pallidus RAPc8 (NRRL: B-59396) is a moderately thermophilic gram-positive bacterium, originally isolated from Australian lake sediment. The G. pallidus RAPc8 gene encoding an inducible nitrilase was located and cloned using degenerate primers coding for well-conserved nitrilase sequences, coupled with inverse PCR. The nitrilase open reading frame was cloned into an expression plasmid and the expressed recombinant enzyme purified and characterized. The protein had a monomer molecular weight of 35,790 Da, and the purified functional enzyme had an apparent molecular weight of approximately 600 kDa by size exclusion chromatography. Similar to several plant nitrilases and some bacterial nitrilases, the recombinant G. pallidus RAPc8 enzyme produced both acid and amide products from nitrile substrates. The ratios of acid to amide produced from the substrates we tested are significantly different to those reported for other enzymes, and this has implications for our understanding of the mechanism of the nitrilases which may assist with rational design of these enzymes. Electron microscopy and image classification showed complexes having crescent-like, "c-shaped", circular and "figure-8" shapes. Protein models suggested that the various complexes were composed of 6, 8, 10 and 20 subunits, respectively.

A cDNA clone encoding a presumed full-length glycine-rich ribonucleic acid (RNA) binding protein was isolated from a lambda-ZAP Express cDNA library generated from primarily nondormant Prunus avium (wild cherry) embryonic axes. The cDNA, designated Pa-RRM-GRP1 (Prunus avium RNA recognition motif glycine-rich protein 1), contains a single N-terminal RNA recognition motif (RRM) and single C-terminal glycine-rich domain. The glycine-rich domain is unusually long at 91 amino acids, 58 of which are glycines. The 534-base pair (bp) open reading frame (ORF) of this clone encodes a 178-amino-acid polypeptide with a predicted molecular weight of 17.33 kDa and pI of 7.84. Comparative sequence alignment of Pa-RRM-GRP1 reveals extensive homology to known and presumed glycine-rich RNA binding proteins from angiosperms and gymnosperms. Genomic Southern blot analysis suggests that this gene exists as a single copy in P. avium. Expression of this gene in P. avium embryonic axes during low-temperature dormancy-breaking treatments was studied and found to be induced by cold (3 degrees C) using real-time PCR of total cDNA supported by Northern blot analysis of total RNA. Expression dropped during prolonged storage at 3 degrees C and was reduced to control levels by interruption of cold treatment by warming to 20 degrees C.

Epidermoid cysts are rare lesions accounting for 1% of intracranial tumors with approximately 50% located within the cerebello-pontine angle (CPA). Resection is complicated by their close anatomical relation to critical neurovascular structures and their tendency to be densely adherent making complete removal a significant neurosurgical challenge. We present a 35-year-old woman with left sided tongue numbness and lower lip paresthesias with a CPA epidermoid. An endoscopic assisted retrosigmoid approach was utilized for resection. A 30-degree endoscope was used to assist in removal of unseen tumor in Meckel's cave, medial to the lower cranial nerves, and along the ventral pons.The video can be found here: http://youtu.be/bv0lMPbX7BY.

Rare earth (RE) magnets have become virtually indispensible in a wide variety of industries such as aerospace, automotive, electronics, medical, and military. RE elements are essential ingredients in these high performance magnets based on intermetallic compounds RECo5, RE2TM17 (TM: transition metal), and RE2TM14B. Rare earth magnets are known for their superior magnetic properties—high induction, and coercive force. These properties arise due to the extremely high magnetocrystalline anisotropy made possible by unique 3d-4f interactions between transition metals and rare earths. For more than 40 years, these magnets remain the number one choice in applications that require high magnetic fields in extreme operating conditions—high demagnetization forces and high temperature. EEC produces and specializes in RECo5 and RE2TM17 type sintered magnets. Samarium and gadolinium are key RE ingredients in the powder metallurgical magnet production processes which include melting, crushing, jet milling, pressing, sin...

Wall thickness is a poorly documented characteristic of cerebral aneurysms which may provide insight into adaptive aneurysmal growth, aneurysm rupture risk and response to endovascular treatment. The distribution of aneurysm wall thickness, as observed by intraoperative video microscopy, is described.54 unruptured saccular cerebral aneurysms were selected based on the availability of intraoperative video obtained from patients undergoing microsurgical clipping. Aneurysms were assessed for the distribution of wall thickness based on color translucence and quantitation of pixel values at superthin translucent, intermediate and thick regions of the dome. The data were analyzed with respect to aneurysm morphology, location and associated demographic factors.The mean proportions of tissue characteristic among all domes analyzed were found to be 27% superthin, 65% intermediate, and 8% thick. Smaller aneurysms having a maximal dimension Dmax7 mm had a higher proportion of superthin tissue (p=0.003) and lower thick tissue (p=0.001) content. Female gender was associated with a significantly higher proportion of superthin tissue at the aneurysm dome (p=0.038), with no statistical dependence seen with patient age, smoking status or anatomical location.The dome of unruptured aneurysms is a highly heterogeneous region with areas of variable thickness that appear to be intimately related to the process of aneurysm development. This inconstant property affects wall tensile stress, may play a role in aneurysm pathogenesis and focal rupture, and should be incorporated into future analyses of aneurysm rupture risk and mechanics.

Background The reported outcome of total elbow replacement is inferior to hip and knee arthroplasty, and there might be an element of institutional bias. Methods We analyzed the outcome of Souter and Coonrad-Morrey total elbow prosthesis in rheumatoid elbow performed by a single surgeon from a center independent from standpoint of being involved in the designing or manufacturing of the implant. Results We had 44 Souter elbows with a mean follow-up of 108 months and 55 Coonrad-Morrey elbows with mean follow-up of 60 months. The Mayo Elbow Performance Score was comparable in both the groups with similar subjective satisfaction. Souter elbow showed a survivorship of 92.9% at 5 years and 76% at 10 years, with aseptic loosening rate of 18% and instability of 9% as main reasons for the failure. The Coonrad-Morrey elbow shows 100% survival at mean follow-up of 5 years in our series. Conclusion We find high rate of instability and loosening of Souter prosthesis with an inferior 5-year survival compared to Coonrad-Morrey prosthesis.

Variation amongst strains of Helicobacter pylori was examined by 35S-methionine-labelled protein SDS-PAGE (Radio-PAGE), immunoblot and DNA fingerprinting techniques. These methods allowed discrimination amongst isolates and showed total correlation. Pig and baboon gastric Helicobacter pylori-like organisms were found to be very similar to Helicobacter pylori by both Radio-PAGE and immunoblotting, whereas a Helicobacter mustelae isolate was markedly different. The HindIII restriction endonuclease digest patterns of Helicobacter pylori DNA illustrated the considerable genomic variation of this organism. The Radio-PAGE and immunoblot typing methods both gave precise identification of Helicobacter pylori strains, but Radio-PAGE was found to give higher resolution and represents a standardised universally applicable fingerprinting method for Helicobacter pylori.

The fungal cyanide hydratases form a functionally specialized subset of the nitrilases which catalyze the hydrolysis of cyanide to formamide with high specificity. These hold great promise for the bioremediation of cyanide wastes. The low resolution (3.0 nm) three-dimensional reconstruction of negatively stained recombinant cyanide hydratase fibers from the saprophytic fungus Neurospora crassa by iterative helical real space reconstruction reveals that enzyme fibers display left-handed D(1) S(5.4) symmetry with a helical rise of 1.36 nm. This arrangement differs from previously characterized microbial nitrilases which demonstrate a structure built along similar principles but with a reduced helical twist. The cyanide hydratase assembly is stabilized by two dyadic interactions between dimers across the one-start helical groove. Docking of a homology-derived atomic model into the experimentally determined negative stain envelope suggests the location of charged residues which may form salt bridges and stabilize the helix.

S S85 Comparisons with historical cohorts from this region shows a significant increase in the proportion of DTC (65% in the 1960s, 58% in the 1980s and 87% currently. Conclusion: The incidence of thyroid cancer in South Yorkshire is lower than many other parts of Europe. Age and gender distribution of each type is similar to published series and the causes of increased incidence are explored. http://dx.doi.org/10.1016/j.ejso.2015.08.094 19. Parathyroidectomy in Pregnancy: A single centre 10-year experience Paul C. Dent, Niyati Lobo, Susan Kirby, Neil S. Tolley, F.Fausto Palazzo Hammersmith Hospital, Imperial College Healthcare NHS Trust, UK Introduction: Primary hyperparathyroidism (PHPT) affects approximately up to 0.15% of the population with an almost 3:1 female to male ratio. However the prevalence of PHPT in women under the age of 40 is thought to be less than 4/10,000. It is suggested that PHPT in pregnancy in addition to the standard morbidity is associated with a risk of miscarriage and fetal death but best practice is not evidence based. We present our 10 year experience of parathyroidectomy performed during pregnancy. Methods: We retrospectively reviewed a prospectively maintained audit database of all cases of parathyroidectomy performed between 2005 and 2015 and identified operations performed in pregnant women. Data analysed include patient demographics, clinical features, preand post-operative biochemical studies, radiological and pathological findings, and outcome of pregnancy. Results: 932 parathyroidectomies were performed for PHPT between 2005e2015 and 12 women (aged 34.9 4.1 years) were pregnant at the time of surgery. The mean corrected calcium was 2.96 0.19 mmol/L with a PTH 16.7 10.6 pmol/L. Ultrasound localization was performed in all patients prior to surgery and 4/13 were helpful in localizing the correct parathyroid gland. Parathyroidectomy was performed with an obstetric anaesthetist. 12 patients were in the second trimester and 1 in the early third trimester (19.7 3.6 weeks). Anaesthetic time was 61.3 16.7minutes. Cure was achieved in 11 patients at first surgical intervention with no reported complications at follow up. The one patient with mild persistence/recurrence (normal corrected calcium and PTH level immediately post-operatively with an unaccommodated PTH at 6 months), had undergone a minimally invasive parathyroidectomy under LA. All foetus’ had a normal pre& post operative heart monitor. There were no immediate maternal or foetal complications and all completed their pregnancy. Conclusion: Parathyroidectomy during pregnancy is safe with obstetric anaesthesia. The absence of nuclear imaging makes four gland visualisation the approach most likely to achieve permanent cure. http://dx.doi.org/10.1016/j.ejso.2015.08.095 20.Anatomic study of the external branch of the superior laryngeal nerve. Anatomic findings and its implication in thyroid surgery Xenophon Kochilas, Konstantinos Argiris, Thanos Bibas 1 Brighton and Sussex Universities NHS Trust, UK Hippocration University Hospital Athens Greece, Honorary Reader in Otolaryngology, Ear Instituted UCL, London, UK Introduction: The External Branch of the Superior Laryngeal Nerve (EBSLN) has been described as the “neglected” in thyroid surgery. The purpose of this study was to describe the topography of the EBSL and its relationship to the adjacent anatomical structures. Material and Methods: 21 formalin-embalmed human cadavers of both sexes ranging in age from 52 to 94 (mean, 78 years) were included in this study. A total of 42 superior thyroid poles (SPT) were dissected and the exact course of the EBSLN was identified and its relationship to: i) the superior pole of the thyroid gland (SPTG) ii), the superior thyroid vessels (STV), and iii) the inferior constrictor muscle of pharynx (ICMPH) was noted. Results: The EBSLN was identified in 41 specimens (97.61%). In (19.04%) the EBSLN was crossing the STV > 1 cm above the SPTG In (54.76%) the EBSLN was crossing the STV A at 9q22.23 in a Western European cohort of patients with thyroid cancer compared to controls. Methods: DNAwas extracted from buccal swabs or whole blood of patients with differentiated non-medullary thyroid cancer by ethanol precipitation. Patients were recruited from two tertiary referral centres in Ireland and France. Cancer-free controls were recruited from the community. Genotyping was performed using Taqman-based PCR. Data was analysed using SPSS V22. Results: One hundred and eighty one cases and eighty-three controls were genotyped for the variant. The frequency of the minor allele among cases was 0.46 compared to 0.31 among controls. The genotypic odds ratio for heterozygous carriers was 2.41 (1.36e4.26, p 1⁄4 0.002), increasing to 3.56 (1.48e8.53, p 1⁄4 0.003) for rare homozygotes. Conclusion: The FOXE1 variant was identified in patients with thyroid cancer significantly more frequently than controls in both heterozygous and homozygous forms. An allele dosage effect was observed, with rare homozygous genotype conferring greater risk than heterozygotes. http://dx.doi.org/10.1016/j.ejso.2015.08.097 22. Investigating the role of polymorphism rs2910164 in mir146a in cancer predisposition Terri P. McVeigh, Patrick W. Owens, Robert Mulligan, Nicola Miller, Carole Guerin, Frederic Sebag, Denis Quill, Marcia Bell, Aoife J. Lowery, Joanne B. Weidhaas, Michael J. Kerin 1 Department of Surgery, Galway University Hospital, Galway, Ireland Department of Clinical Genetics, Our Lady’s Children’s Hospital Crumlin, Dublin, Ireland Department of Endocrine Surgery, Hopital de la Timone, Marseilles, France

One hundred and fifty isolates of Campylobacter pylori were divided into nine groups by immunoblot fingerprinting. All isolates were typable and reproducibility between immunoblots was good provided both antigen and antibody preparation were standardised. Discrimination was a problem as Groups 1 and 2 accounted for 66% of isolates. Recurrence after bismuth treatment was due to indistinguishable strains in five patients and different strains in three patients.

Contaminating bacteria from the oropharynx and bacteria that colonise the stomachs of patients with a high gastric pH impede the isolation of Campylobacter pylori from gastric biopsy specimens. Commercially available selective supplements are inhibitory to this organism and therefore a specific selective medium is needed for isolation. Potential selective agents were evaluated for their activity against 97 strains of Campylobacter pylori. A modification of Skirrow's medium was developed; cefsulodin (5 mg/l) was substituted for polymyxin, and amphotericin B (5 mg/l) was added to inhibit Candida spp., a common contaminant of the stomach. No strains of Campylobacter pylori were inhibited by the Campylobacter pylori selective medium and it supported the growth of all strains compared with the biopsy urease test and Gram stained smear. Colonies were slightly larger and more easily recognised on the new medium compared with those grown on chocolate blood agar. This medium greatly improves the isolation of Campylobacter pylori and could be used alone, without a non-selective medium.

A new spiral bacterium, distinct from Campylobacter pylori, was found in the gastric mucosa of six patients with gastrointestinal symptoms. All patients had chronic active type B gastritis and four had oesophagitis. Culture and microscopy for C pylori infection was negative. These unculturable spiral organisms were probably an incidental finding in patients presenting for upper gastrointestinal endoscopy, but it is not possible to say from this small series whether these organisms cause chronic active gastritis. The organism is helical, 3.5-7.5 microns long and 0.9 micron in diameter with truncated ends flattened at the tips, and up to 12 sheathed flagella 28 nm in diameter at each pole. It is proposed that this spiral bacterium should be called "Gastrospirillum hominis Gen.nov., Sp.nov."

1. In five subjects, ten consecutive forced expiratory spirograms were recorded on each of 6 different days and the total forced expiratory time (FET) on each spirogram was measured. The mean overall coefficient of variation of the FET was 11·3% and of the ratio forced vital capacity (FVC)/FET was 8%. 2. Twenty-two subjects with probable small (80% predicted) were studied before and after bronchodilatation. There was no significant correlation between change in FET and change in MMEF (r = 0·36, P > 0·01), but between change in MMEF (ΔMMEF) and change in FVC/FET (ΔFVC/FET) there was a positive correlation (r = 0·78, P < 0·001). 3. In six of these twenty-two subjects, the ΔFVC/FET and ΔMMEF on bronchodilatation correlated well with the change in residual volume (ΔRV), but neither measurement correlated well with the change in the ‘closing volume' measurement expressed as the ratio of phase 4/VC(%). The ΔFET did not correlate well with either ΔRV or Δ[phase 4/VC(%)]. 4. In eighty-one selected normal subjects (FVC, FEV, and MMEF all >80% predicted) there was better correlation of age with the FVC/FET (r = −0·676) than with the FET (r = +0·43); both correlations were significant (P < 0·001). 5. These results do not support the use of the FET as a suitable test of small airway function; however, the mean flow rate expressed as FVC/FET may, in the presence of a normal FEV1/FVC ratio, be an adequate test of small airway function.

1. Mean arterial pressure was determined continuously over a 24-h period by computerized data collection in eight control and nine sinoaortic-denervated rats housed in standard-sized metabolic cages. In addition, direct and indirect pressure measurements were made while the rats were resting in a Lucite restrainer. 2. Pressure measurements made during restraint indicated that the baroreceptor-denervated rats were hypertensive: mean aortic pressure averaged 145 ± 3.4 mmHg (mean ± sem) in denervated rats vs 119 ± 2.8 mmHg in control rats (P 3. In contrast, continuous pressure monitoring showed the sinoaortic-denervated rats were normotensive (mean arterial pressure averaged 119 ± 4.7 mmHg vs 119 ± 3.1 mmHg in control rats). 4. Apparently arterial pressure is elevated during restraint in sinoaortic-denervated rats and pressure measurements made under these conditions give a false indication of hypertension.

The MICs of 21 antimicrobial agents were determined for 97 clinical isolates of Campylobacter pylori. The beta-lactams (penicillin, ampicillin, cefoxitin and cephalexin), macrolides (erythromycin and azithromycin), quinolones (ciprofloxacin and ofloxacin), nitrofurans, gentamicin and tetracycline all had MIC90 values of less than or equal to 0.5 mg/l. Aztreonam, flucloxacillin, amifloxacin and rifampicin had moderate activity. All isolates were resistant to vancomycin, cefsulodin and amphotericin B. Five percent of the strains were inhibited by 8 mg/l of polymyxin. Of the oral agents tested, the nitrofurans and ampicillin are probably the most appropriate antimicrobial agents. Azithromycin and the oral form of cefuroxime are promising alternatives. Cefsulodin, vancomycin and amphotericin B would be suitable constituents of selective media for isolation of Campylobacter pylori.

The accuracy of partial weightbearing was assessed in six healthy volunteers and 23 patients who had sustained either a fracture of a lower limb or surgery. They were trained to weightbear partially using the conventional bathroom scale method and were assessed in a gait laboratory using force platforms. The amount of weight exerted on the involved limb during three-point crutch walking was determined. Four of six volunteers exerted a mean of 27% of body weight more than required. The remaining two volunteers exerted a mean of 8.5% of body weight less than required. Of the 23 patients, 21 exerted a mean of 35.3% of body weight more than that prescribed and two patients exerted a mean of 11.97% of body weight less than that prescribed. In both groups there was little relationship between the weightbearing prescribed and actual weightbearing. None of the patients or volunteers was able to reproduce the extent of partial weightbearing for which they were trained using the bathroom scale method, confirming that this technique of instructing patients in partial weightbearing is inaccurate.