Complications of Neck Drains in Thyroidectomies: A Systematic Review and Meta-Analysis.

OBJECTIVES: Intraoperative placement of neck drains in thyroidectomy patients remains a widespread practice, despite prevailing evidence discouraging this practice. This systematic review and meta-analysis was conducted to update the currently available evidence base. METHODS: Two independent investigators performed a comprehensive literature search to identify randomized control trials that evaluated postoperative complications associated with neck drains. This was conducted using four databases: Medline, Web of Science, EMBASE, and Cochrane. Identified articles were then screened using a strict eligibility criterion. Sixteen studies were included in the final quantitative analysis and assessed for risk of bias. All methods were in accordance with recommendations from the Cochrane Review Group, U.K. National Health Service Centre for Reviews and Dissemination, and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. RESULTS: Our initial search yielded 743 articles. Of those, 16 were included for final quantitative synthesis. The overall analysis demonstrated that postoperative hematomas [pooled odds ratio (OR) = 2.09 (1.04, 4.21); P = .04] and surgical site infections [pooled OR = 3.85 (2.04, 7.28); P < .01] were significantly more likely in the drained group. Furthermore, hospital stays were longer in the drained group [pooled mean difference = 0.88 days (0.56, 1.20); P < .01]. There were no significant differences in fluid volumes within the thyroid bed between study groups [pooled mean difference = -2.30 mL (-4.82, 0.21); P = .07]. CONCLUSION: The drained patient group had overall higher odds of hematomas, surgical site infections, and longer hospital stays. Therefore, we recommend against this practice of neck drain insertions in patients who have undergone thyroidectomies. Laryngoscope, 131:690-700, 2021.

Assessing the safety of autologous stem cell transplant pathway via ambulatory care for patients with multiple myeloma.

High-dose chemotherapy (HDT) with autologous stem cell transplantation (ASCT) is the standard of care for eligible multiple myeloma (MM) patients with improved progression-free and overall survival. We reviewed the ambulatory care unit pathway for MM patients who underwent HDT/ASCT in a tertiary hospital to assess safety efficacy and outcomes. We concluded that the ambulatory care model offered for MM patients undergoing HDT/ASCT is a safe alternative pathway and highlighted further improvements.

Neurosarcoidosis presenting with a partial Claude syndrome.

Neurosarcoidosis when encountered by neurologists most commonly presents as cranial neuropathy, peripheral mononeuropathy,polyneuropathy, myopathy, meningitis or myelopathy. There are limited reports in the current literature on the cases of neurosarcoidosis patients presenting with ischaemic stroke. We discuss a 52-year-old patient with a known previous history of cutaneous sarcoidosis presenting with an acute third nerve palsy, facial weakness and ataxia. His magnetic resonance imaging (MRI) brain demonstrated focal signal changes in the midbrain consistent with an acute ischaemic event in the region of his third nucleus, suggesting a partial Claude syndrome presentation. Cerebrospinal fluid (CSF) examination demonstrated an elevated angiotensin-converting enzyme (ACE) level. We discuss the difficulties associated with confirming a diagnosis for his presentation and consider distinctions in stroke in neurosarcoid and its management in comparison to more common causes.

Retention of perampanel in adults with pharmacoresistant epilepsy at a single tertiary care center.

RATIONALE: Observational data on antiepileptic drugs (AEDs) inform about their use in clinical practice. We describe our clinical experience with perampanel (PER) in a large UK tertiary epilepsy center. METHODS: Adults initiated on PER between October 2012 and March 2015 were followed until they discontinued PER or 10 September 2016. Data on epilepsy syndrome, duration, seizure types, concomitant and previous AED use, PER dosing, efficacy and side effects were recorded. Efficacy was categorized as temporary or ongoing (at last follow-up) seizure freedom, ≥50% seizure reduction, or other benefit (e.g. No convulsions or daytime seizures). These categories were mutually exclusive except for people with temporary seizure freedom. RESULTS: 391 received a PER prescription, five of whom never took it. No follow-up data were available for ten. 83% had focal epilepsy. People were prescribed PER in addition to 1-7 (Interquartile range [IQR] 2, 2, 3) AEDs and had previously used up to 18 (IQR 5, 7, 10) AEDs. Total exposure was 639patient/years. Retention rates were 60.4% at one year, 48.3% at two years, and 42.7% at three years. 19 (5%) people reported seizure free periods lasting at least six months. A ≥50% reduction in seizures lasting at least six months was reported by 76 people (20%), and marked improvement for ≥6months was seen in 52 (14%). Five (1%) were taken off other AEDs and continued on PER monotherapy for 4-27months. Seizures were aggravated in 57 (15%). Somatic side effects were reported by 197 (52%), mostly CNS. Mood changes, irritability or challenging behavior were reported by 137 (36%). PER was discontinued by 211 (56%) due to adverse effects (39%), inefficacy (26%), or both (35%). No idiosyncratic adverse events were seen. CONCLUSION: PER resulted in some benefit in 40% of those exposed. Adverse effects on mental health and on balance were common and should be discussed with people before initiating PER.