Search

Background: The British Thyroid Association and American Thyroid Association guideline definitions for low-risk differentiated thyroid cancers are susceptible to differing interpretations, resulting in different clinical management in the UK. Objective: To explore the national effect of these guidelines on the management of low-risk differentiated thyroid cancers. Methods: Anonymised questionnaires were sent to multidisciplinary teams performing thyroidectomies in the UK. Risk factors that multidisciplinary teams considered important when managing low-risk differentiated thyroid cancers were established. Results: Most surgeons (71 out of 75; 94.7 per cent) confirmed they were core multidisciplinary team members. More than 80 per cent of respondents performed at least 30 hemi- and/or total thyroidectomies per annum. A majority of multidisciplinary teams (50 out of 75; 66.7 per cent) followed British Thyroid Association guidelines. Risk factors considered important when managing low-risk differentiated thyroid cancers included: type of tumour histology findings (87.8 per cent), tumour size of greater than 4 cm (86.5 per cent), tumour stage T3b (85.1 per cent) and central neck node involvement (85.1 per cent). Extent of thyroid surgery (e.g. hemi- or total thyroidectomy) was highly variable for low-risk differentiated thyroid cancers. Conclusion: Management of low-risk differentiated thyroid cancers is highly variable, leading to a heterogeneous patient experience. [ABSTRACT FROM AUTHOR]

In adult mammalian brain, occurrence of the synthesis of estradiol from endogenous cholesterol has been doubted because of the inability to detect dehydroepiandrosterone synthase, P45017 [alpha]. In adult male rat hippocampal formation, significant localization was demonstrated for both cytochromes P45017 [alpha] and P450 aromatase, in pyramidal neurons in the CA1-CA3 regions, as well as in the granule cells in the dentate gyrus, by means of immunohistochemical staining of slices. Only a weak immunoreaction of these P450s was observed in astrocytes and oligodendrocytes. ImmunoGold electron microscopy revealed that P45017 [alpha] and P450 aromatase were localized in pre- and postsynaptic compartments as well as in the endoplasmic reticulum in principal neurons. The expression of these cytochromes was further verified by using Western blot analysis and RT-PCR. Stimulation of hippocampal neurons with N-methyl-o-aspartate induced a significant net production of estradiol. Analysis of radioactive metabolites demonstrated the conversion from [[sup.3]H]pregnenolone to [[sup.3]H]estradiol through dehydroepiandrosterone and testosterone. This activity was abolished by the application of specific inhibitors of cytochrome P450s. Interestingly, estradiol was not significantly converted to other steroid metabolites. Taken together with our previous finding of a P450scc-containing neuronal system for pregnenolone synthesis, these results imply that 17 [beta]-estradiol is synthesized by P45017 [alpha] and P450 aromatase localized in hippocampal neurons from endogenous cholesterol. This synthesis may be regulated by a glutamate-mediated synaptic communication that evokes [Ca.sup.2]+ signals.

Background: Remote triage for suspected head and neck cancer (HNC) referrals was adopted by many institutions during the initial peak of the coronavirus disease 2019 pandemic. Its safety in this population has not been established.Methods: A 16-week, prospective, multicenter national service evaluation was started on March 23, 2020. Suspected HNC referrals undergoing remote triage in UK secondary care centers were identified and followed up for a minimum of 6 months to record the cancer status. Triage was supported by risk stratification using a validated calculator.Results: Data for 4568 cases were submitted by 41 centers serving a population of approximately 26 million. These represented 14.1% of the predicted maximum referrals for this population outside of pandemic times, and this gave the study a margin of error of 1.34% at 95% confidence. Completed 6-month follow-up data were available for 99.8% with an overall cancer rate of 5.6% (254 of 4557). The rates of triage were as follows: urgent imaging investigation, 25.4% (n = 1156); urgent face-to-face review, 27.8%; (n = 1268); assessment deferral, 30.3% (n = 1382); and discharge, 16.4% (n = 749). The corresponding missed cancers rates were 0.5% (5 of 1048), 0.3% (3 of 1149), 0.9% (12 of 1382), and 0.9% (7 of 747; P = .15). The negative predictive value for a nonurgent triage outcome and no cancer diagnosis was 99.1%. Overall harm was reported in 0.24% (11 of 4557) and was highest for deferred assessments (0.58%; 8 of 1382).Conclusions: Remote triage, incorporating risk stratification, may facilitate targeted investigations for higher risk patients and prevent unnecessary hospital attendance for lower risk patients. The risk of harm is low and may be reduced further with appropriate safety netting of deferred appointments.Lay Summary: This large national study observed the widespread adoption of telephone assessment (supported by a risk calculator) of patients referred to hospital specialists with suspected head and neck cancer during the initial peak of the coronavirus disease 2019 pandemic. The authors identified 4568 patients from 41 UK centers (serving a population of more than 26 million people) who were followed up for a minimum of 6 months. Late cancers were identified, whether reviewed or investigated urgently (0.4%) or nonurgently (0.9%), but the overall rate of harm was low (0.2%), with the highest rate being seen with deferred appointments (0.6%). [ABSTRACT FROM AUTHOR]

Objectives: The roles of Allied Health Care Professionals (AHPs) in Head and Neck Cancer (HNC) are wide ranging but not clearly defined. Inter‐regional variability in practice results from a lack of standardisation in approaches to the Multidisciplinary Team (MDT) make‐up and structure. Traditionally, the follow‐up of HNC patients is clinician led with multiple scheduled follow‐up appointments. The increasing population of HNC patients provides logistical, monetary and efficiency challenges. This systematic review presents the roles of the multiple AHP sub‐groups in HNC with the aim of presenting how their differing skill sets can be integrated to modernise our approach in follow‐up. Design: We searched MEDLINE, Embase, the Cochrane Library, NIHR Dissemination Centre, The Kings Fund Library, Clinical Evidence, National Health Service Evidence and the National Institute of Clinical Excellence to identify multiple subgroups of AHPs (Dentists, Speech and Language Therapists, Dieticians, Physiotherapists, Psychologists, Clinical Nurse Specialists) and evidence of their role in HNC follow‐up. Evidence not directly relating to HNC follow‐up was excluded. Setting and Participants: This Systematic Review was undertaken online by the Integrate (UK ENT Trainee National Collaborative) Head and Neck Subcommittee. Main Outcome Measures : Most evidence was of low‐quality, and the broad nature of the protocol provided a wide variety of study models. Two authors screened the articles for relevance to the topic before final analysis. Results: The main role identified was improvement in Quality of Life and symptom control rather than detecting recurrence. We also demonstrate that it is possible to stratify HNC follow‐up patients using their received treatment modality and Distress Thermometers to identify groups who will require more intensive AHP input. Conclusions: HNC follow‐up covers a broad group of patients with differing needs. As such, a blanket approach to this phase of treatment is likely to be less effective than a patient‐led model where the group of AHPs are employed on a needs basis rather than at set time points. This will likely lead to greater patient satisfaction, earlier detection of recurrence and efficiency savings. [ABSTRACT FROM AUTHOR]

Introduction Methods Results Conclusions The United Kingdom Registry of Endocrine and Thyroid Surgery (UKRETS) holds the largest database of pediatric parathyroidectomy cases globally. There are currently no quoted acceptable cure or complication rates in the literature.This retrospective database analysis evaluates the efficacy and safety of targeted parathyroidectomy (tPTx) and bilateral neck exploration (BNE) in first‐time parathyroidectomy for pediatric primary hyperparathyroidism (PHPT) through analysis of the UKRETS database (1995–2022). Pre‐, intra‐ and postoperative outcomes were assessed and analyzed.168 cases underwent parathyroidectomy; 25 (15%) familial and 143 (85%) sporadic PHPT. 69% were female with a mean age of 10 years (Range 0–17). BNE was the most common operative approach (61%; n = 103/168). The most frequently used imaging modality was US (80%; n = 135/168). Mean number of glands excised in familial cases was three compared to one gland in sporadic cases (p < 0.05). Familial cases had a significantly higher rate of postoperative hypocalcemia (32% vs. 9%, p < 0.05) and all were BNE. Cure rate was 96.9% (n = 127/131), with differences in cure rates that did not reach statistical significance (sporadic 98.2% vs. familial 90.5%, p = 0.06). Preoperative localization (image‐positive or negative) made no difference to cure rates in either familial (90% vs. 91%, p = 0.94) or sporadic (97.5% vs. 100%, p = 0.4) cases.This analysis demonstrates that first‐time pediatric parathyroidectomy for PHPT is safe and effective. Familial cases have a higher rate of postoperative hypocalcemia; therefore, parents should be informed of this when consented. Targeted parathyroidectomy is safe and effective in both sporadic and familial cases, as long as there is positive preoperative imaging. [ABSTRACT FROM AUTHOR]

Introduction: The treatment of bilateral renal and/or ureteric stones can be challenging due to concerns about its safety and efficacy compared to staged ureteroscopy. This review evaluates the current evidence to look at the outcomes of bilateral simultaneous ureteroscopy (BS-URS) for urinary stone disease., Materials and Methods: A systematic review using studies identified by a literature search between January 1990 and August 2013. All English language articles reporting on outcomes of BS-URS for urolithiasis were included. Two reviewers independently extracted the data from each study., Results: A total of seven studies (312 patients) were identified with a mean age of 40 years. Of the reported stone location, two thirds of the stones were in the ureter. With a mean operative time of 58 minutes, stone free status was achieved in 87.1% after the first look and 91.6% after a re-look for pure ureteric stones. Nearly 86% of patients had a postoperative stent inserted with a mean hospital stay of 2 days. In the pure ureteric stone cohort a total of 134 (50.8%) complications were reported. Around three quarters of the complications were Clavien I grading (hematuria, lower urinary symptoms and flank pain) and under a quarter were Clavien III complications., Conclusion: Although BS-URS achieved a high overall stone free rate; the complication rate seemed to be high. The quality of included studies in this review was weak and future research with good methodology is required to evaluate the feasibility and safety of BS-URS procedure.

Introduction and Objectives: The management of urolithiasis in patients with horseshoe kidney (HSK) is difficult. Stone formation occurred in 1:5 patients with HSK due to impaired urinary drainage and infections. Percutaneous nephrolithotomy and shock wave lithotripsy can be technically challenging due to altered anatomy., Materials and Methods: We conducted a systematic review of the literature to look at the role of ureteroscopy for stone management in these patients. We searched MEDLINE, PubMed and the Cochrane Library from January 1990 to April 2013 for results of ureteroscopy and stone treatment in HSK patients. Inclusion criteria were all English language articles reporting on ureteroscopy in patients with HSK. Data were extracted on the outcomes and complications., Results: A total of 3 studies was identified during this period. Forty-one patients with HSK underwent flexible ureteroscopy and stone treatment. The mean age was 42 with a male:female ratio nearly 3:1. The mean stone size was 16 mm (range: 3-35 mm). The mean operating time was 86 min with multiple stones seen in 15 patients. All 41 patients had a ureteral access sheath used and flexible ureteroscopy and holmium laser fragmentation done. Thirty-two (78%) patients were stone-free with a mean hospital stay of 1-day. Minor complications (Clavien I or II) were seen in 13 (32%) of which 6 had stent discomfort, 3 needed intravenous antibiotics for <24 h, 3 had hematuria of which 2 needed blood transfusion and one had pyelonephritis needing re-admission and antibiotics. There were no major complications found in the review., Conclusions: Retrograde stone treatment using ureteroscopy and lasertripsy in HSK patients can be performed with good stone clearance rate, but with a slightly higher complication rate. This procedure should, therefore, be done in high volume stone center with an experienced stone surgeon/team.