A Clinical Audit of Thyroid Hormonal Replacement After Total Thyroidectomy.

Background Thyroid hormone replacement (THR) in athyreotic patients post-thyroidectomy due to thyroid cancer might seem like a straightforward clinical issue to address. To investigate the impact of THR on enhancing thyroid-stimulating hormone (TSH) levels, we conducted a clinical audit, tailoring the dosage based on patient weight and aligning with the standards outlined by the National Institute for Health and Care Excellence and the American Thyroid Association guidelines. Methodology This retrospective and prospective audit analyzed outpatient clinic records for hormone replacement therapy (HRT) post-total thyroidectomy. Retrospective data from March to May 2022 were collected, followed by prospective data after interventions adjusting HRT based on patient weight to digitize clinic notes. The second phase involved changes for 20 scheduled thyroidectomy patients among the total 37 included in the study. Results The thyroid profiles of both groups in the initial and subsequent cycles, treated with adjusted doses of THR, exhibited normal levels of thyroid hormones and calcium. No substantial differences were observed between the groups. On multivariate logistic regression analysis, we found that older age, male sex, body mass index, and preoperative TSH level were the only significant predictors of the need for hormonal therapy. Conclusions Optimal dose of THR after total thyroidectomy had a positive effect on TSH levels in hypothyroidism patients. Hence, THR should be prescribed according to patient weight based on standards and guidelines.

Bone Scans in Preoperative Investigations of Breast Cancer Cases.

BACKGROUND: Breast cancer constitutes about 28% of all new cancer diagnoses in women, making it the most frequently diagnosed cancer among them. Our objective was to assess the role of bone scans (BS) in preoperative investigations of breast cancer. METHODS: This study involved 105 patients with varying stages of breast cancer, ranging from T1 to T4. We categorized them into three groups: group 1 comprised 40 women with breast cancer who underwent retrospective BS, group 2 included 30 patients with breast cancer who prospectively did not require BS for all cases, and group 3 consisted of 35 women retrospectively diagnosed with breast cancer who did not necessitate BS for all cases. The diagnosis of bone metastasis was confirmed upon obtaining a positive result through bone scintigraphy, subsequently affirmed by another imaging technique such as CT, X-ray, or MRI. RESULTS: The hospital costs were significantly lower in groups 2 and 3 compared to that of group 1, indicating that performing a BS for every case is unnecessary. It was observed that the time taken for surgery was notably shorter in groups 2 and 3 compared to that of group 1. BS in cases classified as M stage were deemed both costly and time-consuming. CONCLUSIONS: Routine BS are not cost-effective and represent an unnecessary investment of time. They should not be deemed mandatory as preoperative investigations in breast cancer cases. Instead, they should be considered in conjunction with MRI, particularly in cases of T4 breast cancer.

Comparison of Two Different Methods to Evaluate Ankle Syndesmosis on Lateral Ankle Radiographs.

Background Ankle sprains and fractures rank among the most commonly occurring musculoskeletal injuries and hold significant relevance in current medical practice. Accurate information regarding these injuries is crucial for their effective treatment. This study aimed to explore the viability of utilizing ankle lateral radiographs to evaluate syndesmosis in both emergency settings and operating theatres. Methods This randomized retrospective clinical study involved the analysis of 150 ankle lateral radiographs (54 males and 96 females) from patients who presented at our emergency department with suspected ankle injuries. Two authors jointly examined these radiographs and reached a consensus. The anterior tibiofibular (ATF) ratio and anterior-posterior tibiofibular (APTF) ratio were computed. Patients requiring syndesmotic fixation were classified as having experienced a genuine syndesmotic injury. Participants were randomly divided into two equal groups: Group I (normal group) without fractures and Group II (abnormal group) with fractures. Comprehensive patient data, including medical history and clinical examinations, were recorded. Results Gender distribution within the studied population consisted of 54.67% males (n=41) and 45.33% females (n=34) in the abnormal group, while the normal group comprised 37.33% males (n=28) and 62.67% females (n=47). Both APTFR and ATFR methods were found to be inconclusive and unreliable for syndesmosis assessment in ankles. The sensitivity of APTFR stood at 21.33%, with a specificity of 86.67%, a positive predictive value (PPV) of 61.5%, and a negative predictive value (NPV) of 52.4%. Meanwhile, the sensitivity of ATFR was 32%, with a specificity of 80%, a PPV of 61.5%, and an NPV of 54.1%. Conclusions Both techniques demonstrated low sensitivity when ankle fractures were present, indicating their unsuitability for routine clinical diagnosis of syndesmotic disruption via lateral ankle radiographs.

A Successful Central Gastrectomy and Gastro-Gastric Anastomosis for a Large Gastric GIST.

PURPOSE: Partial gastrectomy is always the preferred technique for GIST resection. Central gastrectomy is a practical technique that can be employed in many situations during the resection of both subepithelial stromal tumors and gastric tumors. CASE PRESENTATION: A 53-year-old Egyptian female patient with a 15 × 19 cm large fungating gastric GIST managed by central gastrectomy. Central gastrectomy and gastro-gastric anastomosis were performed with negative resection margins, and the patient received post-operative imatinib, achieving disease control throughout an 8-month post-operative follow-up. CONCLUSION: Central gastrectomy is an effective method of partial gastrectomy that can be considered in GIST resection; however, more studies are needed to evaluate the efficiency of central gastrectomy in terms of long-term follow-up and terms of R0 respectability in gastric cancer.

Enhanced Recovery After Surgery (ERAS) Approach: A Medical Complex Experience.

BACKGROUND: Enhanced recovery after surgery (ERAS) is a multimodal, multidisciplinary approach aimed at reducing organ failure and mitigating stress reactions in surgery patients. This investigation sought to assess available data concerning the benefits of ERAS protocols in improving patient outcomes for individuals undergoing significant colorectal surgery. METHODS: The study involved 65 patients who underwent colectomy and lower anterior resection for rectal cancers. Patients were divided into three groups: Group 1 comprised 22 patients enrolled retrospectively who received the traditional protocol; Group 2 consisted of 20 patients enrolled prospectively who received the ERAS protocol; and Group 3 included 23 patients enrolled retrospectively who received the ERAS protocol. Each patient underwent a comprehensive history, physical examination, laboratory testing, computed tomography, MRI, and chest radiography. RESULTS: Hospital stay durations were significantly shorter in both ERAS groups during the first and second cycles compared to the non-ERAS group (P<0.001, <0.001), with no significant difference between ERAS groups in either cycle. Delayed intestinal motility was significantly more pronounced in the non-ERAS group compared to ERAS groups in both cycles (P=0.005), with only five (22.7%) cases reported in the non-ERAS group. CONCLUSION: ERAS implementation in the perioperative management of colorectal surgery patients is associated with improved outcomes and shorter recovery times. Implementation of ERAS in hospitals is feasible and beneficial.

The potential protective effects of estradiol and 2-methoxyestradiol in ischemia reperfusion-induced kidney injury in ovariectomized female rats.

AIMS: Investigating the impact of 17ß estradiol (E2) and its endogenous non-hormonal metabolite 2-methoxyestradiol (2ME) on renal ischemia-reperfusion (RIR) induced kidney injury in ovariectomized (OVX) rats and the role of catechol-O-methyltransferase (COMT) in their effects. MAIN METHODS: Eighty female rats were allocated into eight groups. Control group, Sham group, OVX group, OVX and RIR group, OVX + RIR + E2 group, OVX + RIR + 2ME group, OVX + RIR + E2 + Entacapone group and OVX + RIR + 2ME + Entacapone group, respectively. Twenty-four hours post RIR, creatinine (Cr) and blood urea nitrogen (BUN) were determined in serum, while malondialdehyde (MDA), superoxide dismutase (SOD), catalase (CAT), Glutathione (GSH), myeloperoxidase (MPO), as well as the expressions of COMT, hypoxia inducible factor-1α (HIF-1α) and tyrosine hydroxylase (TH) were assessed in the kidney tissues. KEY FINDINGS: Serum Cr, BUN, MPO, as well as HIF-1α and TH expressions were significantly higher with concomitant decrease in COMT expression, SOD and CAT activities and GSH content observed in OVX and RIR group compared to sham group. E2 and 2ME treatment significantly ameliorated all parameters measured in OVX and RIR rats. On the other hand, Entacapone significantly decreased the effect of E2, with no effect on 2ME treatment. SIGNIFICANCE: E2 ameliorates RIR-induced kidney injury and this effect is mediated, at least in part, via its COMT-mediated conversion to 2ME. Thus, 2ME by the virtue of its pleiotropic pharmacological effects can be used as a safe and effective treatment of RIR injury.

Corneal biomechanics and intraocular pressure assessment after penetrating keratoplasty for non keratoconic patients, long term results.

BACKGROUND: To evaluate corneal biomechanical properties by the Ocular Response Analyzer (ORA) in non keratoconic patients underwent penetrating keratoplasty (PK). METHODS: Corneal hysteresis (CH), corneal resistance factor (CRF), Goldmann- correlated intraocular pressure (IOPg), cornea-compensated IOP (IOPcc) using the ORA, and central graft thickness (CGT) were measured in 30 eyes at least two years after penetrating keratoplasty for non keratoconic indications. IOP using the Goldmann applanation tonometer (GAT) was also obtained after compensation for graft thickness and astigmatism. RESULTS: The mean age of patients was 33.1 ± 10.13 years; indications for PK were herpetic corneal scar (53.3%), corneal stromal dystrophy (23.3%), traumatic corneal opacity (10%), chemical corneal opacity (6.7%), and Fuchs endothelial dystrophy (6.7%). Mean CH and CRF were 8.52 ± 1.81 mmHg, and 8.56 ± 1.59 mmHg, respectively. Mean CGT was 532.43 ± 30 µm. Mean IOP GAT, IOPg, and IOPcc were 11.88 ± 3.66, 14.64 ± 4.08, and 17.27 ± 4.60 mmHg, respectively (P < 0.001). No significant association was found between CGT and IOP readings obtained using either the ORA or GAT. There were significant negative association between CH with both IOP GAT and IOPcc, while CRF had significant positive association with IOPg. CONCLUSION: After penetrating keratoplasty for non keratoconic patients, graft biomechanics does not return to average values even 2 years after the operation; moreover, intraocular pressure measurement with ORA gives higher values than thickness compensated GAT.