Randomized clinical trial of platysma muscle suture versus no suture for wound closure after thyroid surgery.

BACKGROUND: Suturing the platysma muscle during wound closure after thyroid surgery is frequently described in the literature. There is no prospective evidence to support its use or benefit. The aim of this study was to evaluate how a platysma muscle suture influences initial postoperative pain following thyroid surgery. METHODS: Patients were assigned randomly to receive a platysma suture or no platysma suture in this prospective, patient-blinded trial. The duration of follow-up was 6 months. The primary endpoint was wound-specific pain 24 h after thyroid resection. Secondary endpoints were intraoperative and perioperative analgesia requirement, postoperative pain and complications until postoperative day 14, and Patient and Observer Scar Assessment Score (POSAS) 6 months after surgery. RESULTS: Forty-one patients were randomized to each group. Visual analogue scale scores for wound-specific pain were lower in patients without a platysma suture 24 h after surgery (mean(s.d.) 3·15(1·46) versus 2·17(1·41) in groups with and without suture respectively; P = 0·002). There were no differences in the perioperative and postoperative need for analgesics, postoperative wound complications or cervical scar cosmesis 6 months after surgery (mean(s.d.) POSAS 23·99(9·53) versus 26·51(8·69); P = 0·148). CONCLUSION: Omitting the platysma muscle suture after thyroid surgery resulted in less wound-specific pain initially, with no difference in postoperative wound complications or cosmetic results. Registration number: NCT02951000 (http://www.clinicaltrials.gov).

Impact of surgical resection extension on outcome for primary well-differentiated thyroid cancer-a retrospective analysis.

BACKGROUND: The surgical resection extension in well-differentiated thyroid cancer is controversially discussed with the possibility of an overtreatment on the one hand against the risk of local disease recurrence. The aim of this study is to evaluate how the surgical resection extension with the adjunction of radioiodine therapy affects postoperative morbidity and the oncologic outcome of patients primarily treated for well-differentiated thyroid cancer. METHODS: All patients undergoing primary surgery for a well-differentiated, non-recurrent thyroid cancer from January 2005 to April 2013 at Tuebingen University Hospital were retrospectively analyzed. RESULTS: Papillary thyroid cancer (PTC) was present in 73 patients (including 27 papillary microcarinoma) and follicular thyroid cancer in 14 patients. Fifty-six of 87 patients (64%) underwent one-stage surgery, of which 26 patients (30%) received simultaneous lymph node dissection (LND). The remaining 31 patients (36%) underwent a two-stage completion surgery (29 patients with LND). Only in three patients a single lymph node metastasis was newly detected during two-stage completion surgery. Patients with LND at either one-stage and two-stage completion surgery had a significant higher rate of transient postoperative hypocalcemia. Postoperative adjuvant radioiodine therapy was performed in 68 of 87 patients (78%). After a median follow-up of 69 months [range 9-104], one local recurrence was documented in a patient suffering from PTC 23 months after surgery. CONCLUSION: No prophylactic two-stage lymphadenectomy should be performed in case of well-differentiated thyroid cancer to avoid unnecessary complication without any proven oncologic benefit.

Development of a resource protection and waste strategy for water use by the agricultural sector.

The South African Department of Water Affairs and Forestry (DWAF) has started developing a strategy to regulate activities and water uses by the agricultural sector that could impact on the water resource quality. The aim would not be to over-regulate the sector, but to protect the water resource where necessary. Most of these activities constitute diffuse sources of potential pollution. The strategic process will start with investigative discussions with major stakeholders and determining the strategic context and current situation. The latter will consist of a detailed literature and stakeholder survey, and an evaluation of existing agricultural activities. The next steps of determining a vision and the setting of strategic objectives will be done with active participation by the major players. An action plan will be developed to achieve the set objectives. Important components of the strategy will be to: classify activities according to their risk to the water resource, taking into account the sensitivity of the water resource; set regulatory measures in accordance with the risk posed by the activity (measures could include the promulgation of regulations, general authorisations and/or issuing of licenses); harmonise and link the process with existing relevant processes and guidelines within DWAF and other government departments; review existing guidelines; sign agreements with relevant government departments and the agricultural sector; and provide training, built capacity and raise awareness during and after the process.

Antagonistic action of cells of Lactobacillus delbrueckii subsp. lactis against pathogenic and spoilage microorganisms in fresh meat systems.

Cells of Lactobacillus delbrueckii subsp. lactis RM2-5 were added to various meat model systems that had been inoculated with Escherichia coli O157:H7 or Salmonella Typhimurium to determine whether these lactobacilli were antagonistic to the pathogens during storage at 5 degrees C. Experiments in which L. delbrueckii subsp. lactis RM2-5 was directly applied to the surfaces of beefsteaks resulted in significant (P < 0.05) reductions in the growth of psychrotrophs and coliforms plus a slight decrease in the numbers of E. coli O157:H7 over time relative to those for control samples to which no lactobacilli had been added. Experiments involving the direct application of L. delbrueckii subsp. lactis RM2-5 to the surfaces of freshly slaughtered beef and pork carcass samples inoculated with either E. coli O157:H7 or Salmonella Typhimurium showed significant (P < 0.05) declines in numbers of the pathogens as well as a reduction in the growth of psychrotrophs during storage at 5 degrees C for 6 days. The results of the experiments suggest that lactobacillus cultures have potential for use in an intervention technology for the control of foodborne pathogens, especially on the surfaces of beef and pork carcasses. The results of this study also suggest that an extension of the shelf life of meat can result from the decreased growth of psychrotrophic spoilage organisms.