Follow-up of large thyroid nodules without surgery: Patient selection and long-term outcomes.

BACKGROUND: The management of large thyroid nodules remains controversial. Mandatory resection is recommended by some authors. METHODS: All patients with thyroid nodules ≥3 cm between January 2009 and January 2013 were followed until August 2017. Follow-up data were collected using an integrated hospital-community system. RESULTS: A total of 141 nodules were included. Of these, 37/141 (26%) nodules were initially referred to surgery, resulting in a 32% malignancy rate (12/37). The remaining 104/141 (74%) were referred to follow-up. During the follow-up period, 24 additional operations were done, resulting in a 4% malignancy rate (1/24). An indication of nonbenign cytology was significantly associated with malignancy compared with other indications. Median follow-up was 53.5 months. No patient developed regional or distal diseases. The mean change in nodule size during the follow-up period was a 7% reduction, with no significant trend of change over time. CONCLUSION: Careful patient selection based on clinical, sonographic, and cytologic features can reduce diagnostic surgery allowing for safe follow-up of large thyroid nodules without surgery.

Antepartum Membrane Stripping in GBS Carriers, Is It Safe? (The STRIP-G Study).

OBJECTIVE: Stripping of the membranes is an established and widely utilized obstetric procedure associated with higher spontaneous vaginal delivery rates, reduced need for formal induction of labor and a lower likelihood of post-term pregnancy. Due to the theoretical concern of bacterial seeding during the procedure many practitioners choose not to sweep the membranes in Group B Streptococcus (GBS) colonized patients. We conducted 'the STRIP-G study' in order to determine whether maternal and neonatal outcomes are affected by GBS carrier status in women undergoing membrane stripping. STUDY DESIGN: We conducted a prospective study in a tertiary referral center, comparing maternal and neonatal outcomes following membrane stripping among GBS-positive, GBS-negative, and GBS-unknown patients. We compared the incidence of composite adverse neonatal outcomes (primary outcome) among the three study groups, while secondary outcome measure was composite adverse maternal outcomes. RESULTS: A total of 542 women were included in the study, of which 135 were GBS-positive, 361 GBS-negative, and 46 GBS-unknown status. Demographic, obstetric, and intra-partum characteristics were similar for all groups. Adverse neonatal outcomes were observed in 8 (5.9%), 31 (8.6%), and 2 (4.3%) in the GBS-positive, GBS-negative, and unknown groups, respectively (P = 0.530), (Odds Ratio between GBS-Positive vs. GBS-Negative groups 0.67 (95%, CI = 0.30-1.50)); while composite adverse maternal outcomes occurred in 9 (6.66%), 31 (8.59%), and 5 (10.87%) in the GBS-positive, GBS-negative, and unknown groups, respectively (P = 0.617). CONCLUSIONS: Antepartum membrane stripping in GBS carriers appears to be a safe obstetrical procedure that does not adversely affect maternal or neonatal outcomes.