Introducing day case thyroid lobectomy at a tertiary head and neck centre.

BACKGROUND: Thyroid lobectomy is considered to be a safe day case procedure by the British Association of Day Surgery. However, currently only 5.5% of thyroid surgeries in the UK are undertaken as day cases. We determine if and how thyroid lobectomy with same-day discharge could safely be introduced in our centre. METHODS: We analysed all thyroid lobectomy surgeries performed between April 2015 and May 2019. Exclusion criteria included completion surgery, revision surgery, additional procedures and disseminated disease. Outcomes were benchmarked against surgeon-reported complications from the British Association of Endocrine and Thyroid Surgery's 5th National Audit. Additionally, we reviewed the number of patients who met day case criteria currently in use at our hospital to determine accessibility to the service. RESULTS: In total, 259 thyroid lobectomy surgeries were undertaken and of these 173 met the inclusion criteria. There was no mortality, return to theatre for evacuation of postoperative haematoma or readmission. There was one postoperative haematoma which was drained at the bedside. Some 47 of the 173 (27.2%) patients met day case criteria currently in use at our centre. CONCLUSIONS: Day case surgery provides a cost-effective solution to rising bed pressures and a coherent protocol can optimise patient safety and experience.

Presentation and initial assessment of ENT problems in patients with granulomatosis with polyangiitis (Wegener's).

BACKGROUND: Granulomatosis with polyangiitis (formerly known as Wegener's granulomatosis) is a primary systemic vasculitis that affects medium to small sized vessels throughout the body. It often presents with symptoms and signs involving the ear, nose, and head and neck area. OBJECTIVE: To highlight salient features of ENT-related issues in granulomatosis with polyangiitis, and raise awareness of the condition. METHODS: A case report of a patient with limited disease and an insidious onset is presented, along with a review of the current literature. In addition, basic initial management is described. RESULTS: Eighty-six publications were used to describe salient features of ENT-related issues in granulomatosis with polyangiitis. CONCLUSION: The time to diagnosis has not reduced significantly in the last 10 years in the UK. A high index of suspicion is required for an earlier diagnosis of granulomatosis with polyangiitis.

Out-patient palliative therapy for advanced cancer of the oesophagus.

OBJECTIVE: To establish an economical, safe and effective palliative mode of treatment in cases of advanced cancer of the oesophagus. DESIGN: A retrospective study on patients with carcinoma of the oesophagus treated with endoscopic pulsion intubation. SETTING: Out-patient treatment at the author's surgery at the Hurlingham Medicare Plaza, Nairobi. SUBJECTS: Seventy three patients with a histologically confirmed diagnosis of carcinoma of oesophagus. INTERVENTION: Endoscopic pulsion intubation with endoprosthesis placement to relieve dysphagia. RESULTS: Marked improvement in dysphagia by at least two grades within six hours of intubation. No major complication or procedure associated mortality. CONCLUSION: Endoscopic pulsion intubation is safe, economical and very effective palliative mode of treatment in advanced cases of cancer of the oesophagus.