RESUMO
INTRODUCTION: The oncological benefit of completion thyroidectomy (CT) following thyroid lobectomy (TL) is presumed to be similar to that of upfront total thyroidectomy(TT), from a patient's perspective the risk and inconvenience of further surgery adds significantly to the impact of the overall treatment. The aim of this study is to assess the impact of CT in terms of the duration of admission and associated complications. METHODS: A study of consecutive patients with DTC identified from prospective MDT records of South-East Scotland from 2009 to 2015. Surgical data was extracted from electronic medical record. RESULTS: Of 361 patients diagnosed with DTC, 161 (45%) had CT. The median postoperative stay was 1 day (range 1-5days). In total 22 patients (14%)suffered complications. Four patients (3%) developed postoperative haematoma. Two (1%) had an identified permanent nerve palsy on the completion side. 13 patients (8%) remained on calcium supplementation for more than 6 months postoperatively and three patients (2%) developed wound complications. CONCLUSIONS: Our study confirms that CT is regularly performed (45%). Recent changes in international guidelines recognize increasing number of patients as eligible for a conservative approach but recommend CT based on whether upfront TT would have been recommended if the TL pathology were known from the outset. Such an approach fails to consider the additional risk and inconvenience of CT on the overall patient experience. Due to a relatively high rate of complications, only those patients who are most likely to benefit from further surgery to facilitate adjuvant radioactive iodine should be offered additional surgery.
Assuntos
Adenocarcinoma Folicular/cirurgia , Tempo de Internação , Complicações Pós-Operatórias/epidemiologia , Câncer Papilífero da Tireoide/cirurgia , Neoplasias da Glândula Tireoide/cirurgia , Tireoidectomia/métodos , Adenocarcinoma Folicular/patologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Cálcio/uso terapêutico , Feminino , Humanos , Hidroxicolecalciferóis/uso terapêutico , Hipocalcemia/tratamento farmacológico , Hipocalcemia/epidemiologia , Radioisótopos do Iodo/uso terapêutico , Queloide/epidemiologia , Masculino , Pessoa de Meia-Idade , Hemorragia Pós-Operatória/epidemiologia , Radioterapia Adjuvante , Escócia/epidemiologia , Câncer Papilífero da Tireoide/patologia , Neoplasias da Glândula Tireoide/patologia , Paralisia das Pregas Vocais/epidemiologia , Infecção dos Ferimentos/epidemiologia , Adulto JovemRESUMO
BACKGROUND: This study reports the clinical outcomes of head and neck adenoid cystic carcinoma treatment over a 20-year period. METHODS: The treatment outcome of 51 head and neck adenoid cystic carcinoma patients treated between 1992 and 2013 were analysed. Patients were stratified into radical treatment and disease control groups. RESULTS: A total of 40 patients underwent surgery and post-operative radiotherapy. The 10-year disease-specific survival rate was 93 per cent. Eleven patients had tumour recurrence: of these, nine were pulmonary metastases. The 11 patients in the disease control group had a median follow up of 21 months (range, 2-172 months); 5 underwent radical radiotherapy with palliative intent. CONCLUSION: There was late tumour recurrence in over 25 per cent of patients. Adenoid cystic carcinoma has a high tendency to relapse even after radical excision and adjuvant therapy. However, definitive radiotherapy should still be considered on an individual basis because it may provide local control and prolong patient survival.
Assuntos
Carcinoma Adenoide Cístico/terapia , Neoplasias de Cabeça e Pescoço/terapia , Recidiva Local de Neoplasia/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma Adenoide Cístico/secundário , Intervalo Livre de Doença , Feminino , Neoplasias de Cabeça e Pescoço/patologia , Humanos , Neoplasias Pulmonares/secundário , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Otorrinolaringológicos , Radioterapia Adjuvante , Taxa de Sobrevida , Adulto JovemAssuntos
Neoplasias de Cabeça e Pescoço/secundário , Doenças Linfáticas/patologia , Neoplasias Primárias Desconhecidas/patologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Estudos de Coortes , Feminino , Humanos , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Encaminhamento e Consulta , Reino Unido , Adulto JovemRESUMO
BACKGROUND: Variation in otolaryngology intervention rates is reported in the Scottish Surgical Profiles Project. Tonsillectomy is one of the selected key indicator procedures. The variation in practice was discussed nationally at the Scottish Otolaryngology Society summer meetings in 2009 and 2010. NHS Grampian had a significantly higher tonsillectomy rate compared with other Scottish NHS boards. AIMS: To determine the accuracy of NHS Grampian data reported by the Information Service Division (ISD) and to record the appropriateness of listing of patients for tonsillectomy with reference to the Scottish Intercollegiate Guidelines Network (SIGN). METHODS: Retrospective review of case notes and surgical records of patients who had undergone tonsillectomy between March 2007 and March 2008 in NHS Grampian. RESULTS: Between March 2007 and March 2008, 509 tonsillectomy cases were performed in NHS Grampian. This corresponded to the data received from ISD. 87% of tonsillectomies performed were compliant with SIGN guidelines. CONCLUSION: The Scottish otolaryngology clinicians have found the reporting of the intervention rates stimulating and challenging. Discussion of the surgical profile project regularly at national specialty meetings resulted in a preliminary detailed targeted audit of those who were persistent outliers for tonsillectomy. This refuted the presumed reasons for this variation, namely inaccurate figures from ISD and inappropriate listings by clinicians.
Assuntos
Otolaringologia/estatística & dados numéricos , Adolescente , Adulto , Feminino , Humanos , Masculino , Estudos Retrospectivos , Escócia , Tonsilectomia/estatística & dados numéricos , Tonsilite/cirurgiaAssuntos
Neoplasias de Cabeça e Pescoço/diagnóstico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia por Agulha Fina , Criança , Diagnóstico Diferencial , Feminino , Neoplasias de Cabeça e Pescoço/epidemiologia , Neoplasias de Cabeça e Pescoço/patologia , Humanos , Metástase Linfática/patologia , Masculino , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto , Neoplasias das Glândulas Salivares/diagnóstico , Neoplasias das Glândulas Salivares/epidemiologia , Neoplasias das Glândulas Salivares/patologia , Escócia/epidemiologia , Neoplasias da Glândula Tireoide/diagnóstico , Neoplasias da Glândula Tireoide/epidemiologia , Neoplasias da Glândula Tireoide/patologiaRESUMO
AIMS: We aimed to evaluate a practical, computerised database for collection of patient-reported and clinical outcome data, introduced as a means of characterising our patient population and assessing the effect of our interventions. METHODS: A prospectively updated, computerised database was used to detail each patient's coded and structured diagnosis and clinical findings. Response to treatment was recorded using the Sino-Nasal Outcome Test 22 and changes in graded clinical examination findings. RESULTS: Data for 770 patients were prospectively entered into the database. Patients were grouped diagnostically as follows: rhinitis (20.4 per cent), chronic rhinosinusitis (12.2 per cent), chronic rhinosinusitis with polyps (24.7 per cent), anatomical anomaly (22.7 per cent), epistaxis (3.4 per cent) and 'other' (18.4 per cent). Following initial medical intervention, the greatest improvement in the Sino-Nasal Outcome Test 22 score was seen in the chronic rhinosinusitis with polyps group (-11.3), followed by the rhinitis group (-6.1) and the chronic rhinosinusitis group (-5.4). CONCLUSIONS: The tested rhinology database provides a simple, effective and practical tool for integrating the recording of clinical and patient-reported outcome measures during the out-patient visit. It enables characterisation of the patient population, and accurately monitors and records treatment responses.
Assuntos
Bases de Dados como Assunto , Sistemas Computadorizados de Registros Médicos/normas , Otolaringologia , Avaliação de Resultados em Cuidados de Saúde/métodos , Ambulatório Hospitalar/normas , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Asma/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doenças Nasais/epidemiologia , Doenças Nasais/terapia , Ambulatório Hospitalar/organização & administração , Estudos Prospectivos , Sociedades Médicas , Adulto JovemRESUMO
AIM: To evaluate endoscopic pharyngeal pouch surgery practice in north Glasgow by comparing it to National Institute for Health and Clinical Excellence recommendations. METHODS: We reviewed the case notes of patients who had undergone pharyngeal pouch surgery from 1998 to 2008. Data obtained included patient demographics, procedures performed, complications and outcomes. RESULTS: One hundred patient case notes were reviewed. Surgical procedures performed included endoscopic stapling (n = 58), endoscopic laser surgery (26), external excision (one), cricopharyngeal myotomy (two) and pharyngoscopy with dilatation (three). Endoscopic stapling was abandoned in 10 patients (14.7 per cent), three of whom declined further surgery. There was a 2.2 per cent perforation rate for endoscopic procedures. Twenty-one per cent of patients required further surgery. CONCLUSION: Our practice was not in keeping with National Institute for Health and Clinical Excellence recommendations. Our complication rates were similar to other published series, although our rates for abandoned and revision procedures were higher. We suggest that pharyngeal pouch surgical procedures should be undertaken only by otolaryngologists with a primary head and neck interest.
Assuntos
Prática Profissional/normas , Divertículo de Zenker/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Endoscopia/efeitos adversos , Endoscopia/métodos , Endoscopia/normas , Feminino , Humanos , Lasers de Gás/efeitos adversos , Lasers de Gás/uso terapêutico , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Procedimentos Cirúrgicos Minimamente Invasivos/normas , Reoperação/métodos , Estudos Retrospectivos , Escócia , Grampeamento Cirúrgico/efeitos adversos , Grampeamento Cirúrgico/métodos , Resultado do TratamentoRESUMO
Bilateral facial nerve palsy is a rare but recognised manifestation of HIV seroconversion illness. The pathophysiology of this clinical presentation is thought to be associated with the immune response of the dissemination of virus throughout the body. We describe a case of bilateral facial nerve palsy, subsequently diagnosed with HIV. Related medical literature is also reviewed. The case highlights the vigilance required in unusual, atypical signs and symptoms if a diagnosis of HIV infection is not to be missed. Clinicians should be aware of the potential presentation of HIV seroconversion illness to provide opportunity for early diagnosis and intervention.