A Comparison of Whipple Outcomes Between a Safety-Net Hospital and American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) in African Americans.

Purpose The aim of this study was to compare 30-day adverse events following pancreaticoduodenectomy between our safety-net hospital and the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) in a matched cohort of Black/African American (AA) patients. Methods We retrospectively reviewed consecutive Black/AA patients undergoing pancreaticoduodenectomies from 2015 to 2020 at our safety-net institution. The corresponding patients from the ACS-NSQIP (2015-2019) were queried. Propensity-score matching was performed between safety-net and ACS-NSQIP Black/AA cohorts to equate baseline characteristics, and 30-day outcomes were compared between propensity-matched cohorts. Results Thirty-two Black/AAs (16 females; 62.1±10.7 years) were identified from 128 patients undergoing pancreaticoduodenectomies at our safety-net institution and were propensity-score matched to 32 ACS-NSQIP patients. After matching, baseline characteristics did not significantly differ between cohorts. Postoperatively, surgical site infections, wound disruptions, respiratory events, cardiovascular events, urinary tract infections, acute renal failure, sepsis, delayed gastric emptying, and pancreatic fistulas were not significantly different between our safety-net and ACS-NSQIP cohorts. Our length of stay (LOS) was longer (17.0(12.3-27.0) versus 10.0(7.0-16.0) days); however, patients with a LOS>30 days were comparable. Furthermore, 30-day readmissions were similar, and 30-day reoperations were lower (p=0.03) at our safety-net institution. Conclusions Black/AA patients who underwent pancreatectomies at a safety-net hospital had similar outcomes and fewer reoperations compared to a corresponding national cohort. Although we illustrate comparable outcomes, clinical pathways to mitigate and alleviate health disparities in marginalized populations at a safety-net hospital should be emphasized to continue improving outcomes.

Appendix diverticulosis in a patient diagnosed on pathology after laparoscopic appendectomy for appendicular mucinous mass-case report and literature review.

Diverticulum of the appendix is uncommon cause of right iliac fossa pain and inflammation with delayed diagnosis and high risk of complications, as it mimics acute appendicitis. Here we present a case of an elderly male patient who had lung cancer post-treatment. During the follow-up, appendicle lesion was discovered and suspected to be mucinous appendix. The pathology reported after appendectomy as appendicular diverticulosis without evidence of malignancy. As appendicular diverticulum is best confirmed by pathology, still its clinical presentation is difficult to be distinguished from other appendicular diseases. It is frequently linked to increased risk of cancer, particularly carcinoid tumors and mucinous adenomas.

Survival implications of cervical lymphadenectomy in patients with medullary thyroid cancer.

BACKGROUND: The relationship between extent of cervical lymphadenectomy along with the number of involved lymph nodes (LNs) removed and overall survival has not been well documented in patients with medullary thyroid carcinoma (MTC). This study investigates whether the overall number of LNs removed and the number of metastatic LNs are independent prognostic factors for overall survival. METHODS: Data from patients with MTC in the Surveillance, Epidemiology, and End Results (SEER) registry database were examined. After categorizing the study population based on the number of overall LNs examined and the number of metastatic LNs, survival estimates were compared. The total number of examined LNs and their histopathological status were analyzed for their prognostic value in estimating overall survival. RESULTS: 593 patients were included in this study. Those with all negative LNs had the best overall survival; those with LNs examined and at least one positive LN had worst overall survival (p < 0.0001). The total number of examined LNs for both groups with negative and positive LNs was not associated with improved survival outcome (p = 0.41). In node-positive patients, each additional positive LN was significantly associated with an increase in overall mortality [hazard ratio (HR) = 1.05, 95% confidence interval (CI) = 1.02-1.08]. CONCLUSIONS: Cervical LN metastases conferred an independent risk for worse survival rate in MTC. Cervical lymphadenectomy is important for staging and regional disease control, however the extent of lymph node dissection, the overall number of lymph nodes removed along with removal of an increased number of involved lymph nodes do not confer a survival advantage. Future prospective studies are needed.

Familial isolated primary hyperparathyroidism with double adenoma.

Familial hyperparathyroidism includes the diagnoses of multiple endocrine neoplasia type 1, type 2A, and familial isolated primary hyperparathyroidism. Familial isolated primary hyperparathyroidism is a rare, distinct form of familial primary hyperparathyroidism, mainly due to four-gland hyperplasia or single-gland adenoma. We describe our success in treating a 24-year-old woman with familial isolated primary hyperparathyroidism with resection of double adenoma, using the guide of intraoperative parathyroid hormone (PTH) monitoring. Familial isolated primary hyperparathyroidism usually presents with four-gland hyperplasia or single-gland adenoma. However, double adenoma should be considered in the differential diagnosis. Using intraoperative parathyroid hormone levels and minimal-access surgery in familial isolated primary hyperparathyroidism may be promising.

Plasmacytoma in the thyroid.

OBJECTIVE: The paper presents a case of plasmacytoma unexpectedly found in a goiter. PATIENT MATERIAL AND METHODS: The patient presented with compressive symptoms, including dyspnea and dysphagia and had no documented prior history of multiple myeloma. Physical examination revealed thyromegaly with no specific nodule. Computerized tomographic (CT) scan of the neck and chest showed diffuse homogenous enlargement of both the thyroid lobes extending into the mediastinum. Total thyroidectomy was done because of the compressive symptoms. RESULTS: Pathology revealed evidence of fibrosis surrounding small nodules of residual follicles with massive infiltration by plasma cells. The pathologic diagnosis was plasmacytoma. CONCLUSION: Plasmacytoma should be added to the list of causes of diffuse thyromegaly.

Intraoperative parathyroid hormone assay in patients with primary hyperparathyroidism and double adenoma.

OBJECTIVE: To determine the utility of parathyroid hormone (PTH) monitoring for double adenomas (DAs). DESIGN: Retrospective chart review. SETTING: Tertiary referral center. PATIENTS: The study included 47 patients with primary hyperparathyroidism who had DAs identified during first-time parathyroid exploration. MAIN OUTCOME MEASURES: Intraoperative PTH levels were measured in every case, and the intraoperative PTH assay and its influence on surgical outcome were examined. RESULTS: A total of 47 of 552 consecutive patients (8.5%) with primary hyperparathyroidism were found to have DAs; 457 patients (82.7%) had single adenomas; and 48 patients (8.6%) had disease in more than 2 glands. The mean (SD) age of the patients with DAs was 58 (14) years, and 26 patients (55%) were female. The mean (SD) preoperative intact PTH level was 129 (57) pg/mL (to convert to nanograms per liter, multiply by 1), and the preoperative serum calcium level was 11.0 (0.6) mg/dL (to convert to millimoles per liter, multiply by 0.25). In all patients, the intraoperative PTH levels decreased by 79.7% (11.4%) from baseline after removal of both abnormal parathyroid glands. When the location could be confirmed, the second adenoma was ipsilateral in 17 patients (36%) and contralateral in 27 patients (64%). The mean (SD) postoperative intact PTH level was 46 (26) pg/mL at 6 months, and the cure rate was 98%. CONCLUSIONS: Intraoperative PTH monitoring and maintenance of normocalcemia after surgery confirm previous reports that DAs do exist and are not simply missed cases of 4-gland hyperplasia. Intraoperative PTH monitoring accurately predicted the success of parathyroidectomy in 98% of patients with DAs.