Oncocytic Papillary Carcinoma in an Autonomous Thyroid Nodule.

BACKGROUND Thyroid nodules are a common cause of neck swelling in clinical practice, even in iodine-sufficient communities. Most nodules are benign, but malignancy cannot be excluded. The majority of thyroid cancers occur in nonfunctioning nodules, but in rare cases they can present as an autonomous nodule. Papillary carcinoma, the most common type of thyroid malignancy, typically spreads quickly to local lymph nodes; however, current guidelines do not recommend biopsy of autonomous thyroid nodules. Early detection and surgical intervention can be curative in many of these cases. CASE REPORT This present case involved a woman in her early 30s who presented with an enlarging neck mass. Ultrasound demonstrated a unilateral right thyroid mass, and blood work showed triiodothyronine thyrotoxicosis. Thyroid scintigraphy was performed and showed unilateral increased uptake on the right side. The patient was treated initially with a thyroid lobectomy. Intraoperative frozen sectioning of the removed specimen showed papillary thyroid carcinoma, and a total thyroidectomy was performed. Radioactive iodine ablation therapy was not done, but given the patient's history and risk factors, recurrence of her disease is unlikely. CONCLUSIONS The vast majority of autonomous thyroid nodules are noncancerous. However, patients should be informed of the possibility of malignancy, and cancer should be ruled out clinically. Papillary thyroid carcinoma accounts for the majority of tumors in both hot and cold nodules. However, the oncocytic subtype seen in the patient in this report is less common, presents a higher risk of recurrence, and typically occurs in older patients. Thyroidectomy is usually curative for patients with papillary thyroid carcinoma.

Clinical Outcomes of Cervical Facet Fractures Treated Nonoperatively With Hard Collar or Halo Immobilization.

STUDY DESIGN: Retrospective review. OBJECTIVES: To evaluate the rate of nonoperative treatment failure for cervical facet fractures while secondarily validating computed tomography-based criteria proposed by Spector et al for identifying risk of failure of nonoperative management. METHODS: Single-level or multilevel unilateral cervical facet fractures from 2007 to 2014 were included. Exclusion criteria included spondylolisthesis, dislocated or perched facets, bilateral facet fractures at the same level, floating lateral mass, thoracic or lumbar spine injuries, or spinal cord injury. Patients were placed into 3 groups for evaluation: immediate operative management, successful nonoperative management, and failed nonoperative treatment requiring surgical intervention. RESULTS: Eighty-eight patients (106 facets) were included. Twenty-one patients underwent operative treatment with anterior cervical discectomy and fusion or posterior spinal instrumentation and fusion without any failures. Sixty-seven of these patients were treated nonoperatively with either a hard collar (n = 62) or halo vest (n = 5). Eleven patients failed nonoperative treatment (16.4%), all with an absolute fracture height of at least 1 cm and 40% involvement of the absolute height of the lateral mass. Of the 56 patients successfully treated through nonoperative measures, 8 (14.3%) had fracture measurements exceeding both operative parameters. CONCLUSION: We conclude that it is safe and appropriate for patients with unilateral cervical facet fractures to receive a trial period of nonoperative management. However, patients who weigh over 100 kg, have comminuted fractures, or have radiographic measurements outside of the proposed computed tomography criteria for nonoperative treatment should be educated on the risks of treatment failure.

Inventory of chytrid diversity in two temporary forest ponds using a multiphasic approach.

Food webs in temporary forest ponds are driven by decomposition of terrestrial inputs. Chytrid fungi are important components of the fungal community, degrading leaf litter in streams reliant on terrestrial inputs and in lake ecosystems where they may stabilize the food web. However, little is known about chytrid fungi in temporary forest ponds. We inventoried the chytrid diversity present in two temporary forest ponds via light microscopy of baited samples and ion semiconductor (Ion Torrent) sequencing of environmental DNA. We quantified trends of chytrid alpha and beta diversity as a function of spatial and temporal factors. A total of 59 chytrid taxa were detected throughout the study. Beta diversity exhibited variation across the sampled months for both the entire fungal community as well as for chytrids alone. Shifts in community composition were also apparent, although diversity metrics and composition patterns did not meet adjusted P values. The results of this study highlight the diversity of chytrid fungi in temporary forest ponds and the need for further studies on the spatial and temporal dynamics of chytrid species.

Factors impacting Press Ganey patient satisfaction scores in orthopedic surgery spine clinic.

BACKGROUND CONTEXT: Patient satisfaction is and will continue to become an important metric in the American health care system. To our knowledge, there is no current literature exploring the factors that impact patient satisfaction in outpatient orthopedic spine surgery clinic. PURPOSE: The purpose of this study was to determine which factors impact patient satisfaction in an outpatient orthopedic spine clinic. STUDY DESIGN: This is a case series, level of evidence IV. PATIENT SAMPLE: We reviewed the Press Ganey Associates database to identify patients seen in an orthopedic spine surgery clinic from 2013 to 2015. OUTCOME MEASURES: Outcome measures were self-reported, which included visual analog pain scores and Press Ganey satisfaction scores. METHODS: Retrospective computerized Press Ganey survey review was performed to identify patient demographics and patient visit characteristics. Bivariate analysis was used by splitting the patient response into the following: 0-3 (not satisfied), 4-7 (somewhat satisfied), and 8-11 (satisfied). Kruskal-Wallis test and Fisher exact test were used to evaluate the significance of patient and visit characteristics. Any variable that had a p-value less than .20 was subjected to the Poisson regression model. RESULTS: Overall, 353 patients were seen in an orthopedic spine surgery clinic and completed the Press Ganey survey. Three hundred and thirty-two patients were satisfied with their visit. Patients who were satisfied had a mean pain score of 4.02; patients who were somewhat satisfied or not satisfied had a pain score of 7 and 6, respectively (p=.009). Of 21 patients who felt the provider did not spend enough time with him or her, five (24%) patients were not satisfied with their visit. Poisson regression model confirmed significance of pain score and "provider time spent with you." Most impactful was "provider spent enough time with you" where a "yes, definitely" answer predicted a nearly 60% increase in Press Ganey overall satisfaction score. CONCLUSIONS: Two patient variables that have a statistical significance on Press Ganey patient satisfaction scores were pain score and "provider spent enough time with you."