Outpatient hemithyroidectomy.

UNLABELLED: Outpatient surgery consists of performing an elective surgical procedure in the context of a day-only admission. This type of management is the result of sociological changes and allows a reduction of the cost. Hemithyroidectomy is a well-defined surgical procedure with known complications. The authors assessed the feasibility, patient satisfaction and cost of outpatient hemithyroidectomy. MATERIAL AND METHODS: One hundred and forty-six hemithyroidectomies were performed between August 2011 and September 2012. Inclusion criteria for outpatient surgery were surgical, anaesthetic and patient-dependent. Exclusion criteria were related to the bleeding risk, socio-economic conditions and the patient's understanding of the procedure. Preoperative information and the modalities of anaesthesia, surgery, postoperative surveillance and follow-up were standardized. Patient satisfaction was evaluated by questionnaire and cost was evaluated on the basis of medical information department data. RESULTS: Forty patients were eligible and 34 patients agreed to outpatient surgery (M/F sex ratio: 1/4; mean age: 46 ± 6.3 years), but only 32 operations were performed on an outpatient basis. Two conversions to conventional hospitalisation were required, one because of preoperative initiation of platelet anti-aggregants and the other because of nausea. One patient remained in hospital on the day after the operation because of severe asthenia and nausea. CONCLUSION: Patients were satisfied with this type of management and 100% of them reported that they would repeat the experience. The economy for our establishment was €711 per patient. This procedure improves patient comfort without increasing the risks and allows a reduction of management costs.

Assessment of tumor angiogenesis as a prognostic factor of survival in patients with oligodendroglioma.

According to World Health Organization (WHO) and Daumas-Duport grading systems, progression of oligodendrogliomas (ODGs) to a higher grade (WHO grade III, grade B) is associated with increased angiogenesis. Based on multivariate assessment of molecular, pathological, and radiological parameters, we further assessed the influence of tumor angiogenesis on tumor progression and patient survival. Patients with a diagnosis of ODG, consecutively treated in a single institution, were reviewed and reclassified according to WHO and Daumas-Duport grading systems. MRI scans were reviewed to assess contrast enhancement and necrosis. Tissue sections were used for pathology review and to evaluate immunostaining of vascular endothelial growth factor (VEGF), vascular endothelial growth factor receptor (VEGF-R), Ki-67, and CD34. Multivariate analysis was performed to assess the impact of tumor angiogenesis-related pathological and radiological factors on patient survival. One hundred thirty-four patients with pure ODG were included in this study. Multivariate analysis identified four independent poor prognostic factors: necrosis, absence of seizure, increased vascularization, and age >55 years. A subgroup of patients with tumor necrosis, increased vascularization, and absence of seizures had a significantly worse outcome than predicted, with a median overall survival of 14.2 months. VEGF expression was significantly higher in this subgroup and correlated with disease progression regardless of histologic grade. Based on the presence of radiological or pathological necrosis, contrast enhancement or endothelial hyperplasia, and absence of seizures, a high risk group of ODG can be identified with significantly worse overall survival. Also, VEGF over-expression in ODG constitutes an early marker for predicting tumor progression.

Avoiding sexual harassment liability in veterinary practices.

Harassment based on gender violates the rule of workplace equality established by Title VII of the Civil Rights Act and enforced by the EEOC. In 1986, the US Supreme Court, in Meritor Savings Bank v Vinson, established the criteria that must be met for a claim of hostile environment sexual harassment to be considered valid. Plaintiffs must show that they were subjected to conduct based on their gender, that it was unwelcome, and that it was severe and pervasive enough to alter their condition of employment, resulting in an abusive working environment. There have been few sexual harassment cases involving veterinary professionals, and it is our goal to help keep the number of filed actions to a minimum. The most effective way to avoid hostile environment sexual harassment claims is to confront the issue openly and to adopt a sexual harassment policy for the practice. When it comes to sexual harassment, an ounce of prevention is unquestionably worth a pound of cure.