Volume-Outcome Associations for Parathyroid Surgery in England: Analysis of an Administrative Data Set for the Getting It Right First Time Program.

Importance: Previous studies have suggested an association between surgical volume and patient outcomes for parathyroid surgery. However, most previous studies are relatively small and the literature is dominated by studies form the US, which might not be readily generalizable to other settings.

Objective: To investigate volume-outcome associations for parathyroid surgery in England.

The volume and outcome relationship for thyroidectomy in England.

Purpose: The delivery of surgical care in England has seen a momentum towards centralisation within larger volume hospitals and surgical teams. The aim of this study was to investigate outcomes in England in relationship to hospital and surgeon annual volumes for total thyroidectomy.

Methods: Data were extracted from the Hospital Episodes Statistics (HES) database for England.

Volume-outcome relationship for adrenalectomy: analysis of an administrative dataset for the Getting It Right First Time Programme.

Background: A minimum volume threshold of at least six procedures per annum per surgeon has been set in UK and European guidelines for adrenal surgery. The aim of this study was to investigate outcomes for adrenal surgery in England relative to annual surgeon and hospital trust volume.

Methods: Data were extracted from the Hospital Episodes Statistics database for England.

Retained port connectors after central venous port removal.

We report three cases where the connector/sleeve, which helps fix the flexible catheter section to a port injection chamber, was inadvertently left in scar tissue during port removal. Concerned patients presented months later with a palpable subcutaneous nodule, near the port site. The nodules were variably imaged with plain X-rays, mammography or ultrasound with the diagnosis correctly made by a surgeon familiar with devices.

RETROSTERNAL GOITRES: A PRACTICAL CLASSIFICATION.

Background: There is no standard definition for goitres extending below the thoracic inlet and no clear guidelines for pre-operative planning of surgery. The aim of this study is a practical classification of retrosternal goitres (RSG) based on the anatomical , radiological shape and size of the thyroid.

Methods: Retrospective analysis of all thyroidectomies performed in a referral centre between January 2012 and December 2016.

PRIMARY HYPERPARATHYROIDISM - STRATEGY FOR MULTIGLAND DISEASE IN THE ERA OF SPECT-CT.

Purpose: To re-examine our clinical practice and review strategy for treatment of primary hyperparathyroidism in patients with multigland disease.

Methods: Retrospective analysis of 121 consecutive primary hyperparathyroidism (PHPT) patients who underwent surgery in a tertiary center between January 2010 and December 2014.

Results: Of 121 patients with PHPT 87% had single gland adenoma (SGD) and 13% had multigland disease (MGD).

A COMPARATIVE ANALYSIS OF THE INITIAL EAST EUROPEAN CENTER EXPERIENCE WITH A WESTERN HIGH-VOLUME CENTER FOR OPEN MINIMALLY INVASIVE PARATHYROIDECTOMY (OMIP) AS TREATMENT OF PRIMARY HYPERPARATHYROIDISM.

Objective: To compare results of treatment of primary hyperparathyroidism (PHPT) in two teaching hospitals (eastern and western Europe) and to establish conclusions regarding quality of surgery for PHPT in Romania.

Methods: We reviewed two prospectively collected databases of patients submitted to open minimally invasive parathyroidectomy (OMIP) for symptomatic PHPT in two centers from Romania and the United Kingdom (UK). We included patients with biochemically proven PHPT and positive pre-operative localization studies.

The calpain system is associated with survival of breast cancer patients with large but operable inflammatory and non-inflammatory tumours treated with neoadjuvant chemotherapy.

The calpains are a family of intracellular cysteine proteases that function in a variety of important cellular functions, including cell signalling, motility, apoptosis and survival. In early invasive breast cancer expression of calpain-1, calpain-2 and their inhibitor, calpastatin, have been associated with clinical outcome and clinicopathological factors.The expression of calpain-1, calpain-2 and calpastatin was determined using immunohistochemistry on core biopsy samples, in a cohort of large but operable inflammatory and non-inflammatory primary breast cancer patients treated with neoadjuvant chemotherapy.

Serial MRI scans help in assessing early response to neoadjuvant chemotherapy and tailoring breast cancer treatment.

Background: Tailoring neoadjuvant chemotherapy (NAC) during breast cancer treatment is performed to improve overall tumour response, with increasing evidence to support its role. This study evaluates our breast unit's experience in MRI assessment of tumour response as an aid in tailoring NAC.

Materials And Methods: This is a retrospective study of patients treated with NAC for breast cancer between 2005 and 2009 who underwent MRI to assess tumour response.

Effect of neoadjuvant chemotherapy on breast cancer phenotype, ER/PR and HER2 expression - Implications for the practising oncologist.

Purpose: To assess the effect of neoadjuvant chemotherapy (NACT) on breast cancer characteristics, hormone receptors and human epidermal growth factor receptor 2 (HER2) expression and whether testing should be repeated on residual tumours.

Material And Methods: Patients with primary operable breast cancer who received NACT at a single United Kingdom tertiary referral centre were included. Tumour type, grade (including details of mitotic grade, tubule formation and pleomorphism), oestrogen receptor (ER), progesterone receptor (PR) and HER2 status were compared between pre-treatment and post-treatment residual samples using tissue microarrays.

Palpable ductal carcinoma in situ: analysis of radiological and histological features of a large series with 5-year follow-up.

Background: Palpable pure DCIS is a rare entity that presents differently than screen-detected DCIS. The aim of this study was to evaluate the clinical, radiological, and pathological characteristics and management of pDCIS in a retrospective cohort of patients.

Patients And Methods: Patients diagnosed with pDCIS from January 1999 to December 2011 were identified from an electronic patient database and were included in this study.

Atypical Presentation of Riedel's Thyroiditis: Multifocal Nodular Fibrosis and Resolution with Levothyroxine.

Background: Riedel's thyroiditis is characterised by chronic inflammatory invasive fibrosclerosis of the thyroid gland, surrounding structures, and extrathyroidal fibrosis. We present a case of Riedel's thyroiditis associated with nodular fibrosis of the lungs and liver.

Case: A 40-year-old woman presented with a 3-month history of neck swelling, difficulty swallowing and breathlessness on exertion.

Management of palpable but radiologically occult breast abnormalities.

Objective: To examine the utility of palpation-guided fine-needle aspiration cytology (pgFNAC) in the context of clinically palpable but radiologically occult breast abnormalities in this era of digital mammography and high sensitivity ultrasound.

Methods: Women undergoing pgFNAC from January 2005 to December 2007 were identified from the histopathology database and correlated with clinical and radiological findings recorded prospectively in electronic patient records.

Results: 142 cases matching our selection criteria were identified with a mean age of 43 (SD ±13.

Breast conservation surgery: state of the art.

Breast conservation surgery is available to the vast majority of women with breast cancer. The combination of neoadjuvant therapies and oncoplastic surgical techniques allows even large tumours to be managed with a breast-conserving approach. The relationship between breast size and the volume of tissue to be excised determines the need for volume displacement or replacement.

Culture, attitude and knowledge about breast cancer and preventive measures: a qualitative study of South Asian breast cancer patients in the UK.

Background: Little is known about the influence of culture and beliefs about breast cancer, and its implications on preventive health behaviour among South Asian people in the UK.

Methods: Using a qualitative approach, 24 South Asian breast cancer patients and their significant others were interviewed.

Results: Most patients were unfamiliar with the subject of cancer; they expressed lack of knowledge of cancer as a disease and its symptoms.

Small bowel perforation secondary to accidental dental plate ingestion.

The majority of ingested foreign bodies will pass through the gastrointestinal tract without incident, with less than 1% of cases resulting in complications. Herein we present a case of small bowel perforation secondary to the accidental ingestion of a dental plate. A diagnosis of perforation was made by CT imaging, but the exact cause could only be determined after resection of the affected bowel and histo-pathological examination.

Alcohol hand abuse: a cross-sectional survey of skin complaints and usage patterns at a large UK teaching hospital.

Objectives: To investigate whether the regular use of alcohol hand gel was having a detrimental effect on hands of healthcare professionals and, if so, to what extent. The study also aimed to establish a link between individuals who felt their hands were suffering from persistent exposure to the gel and those who actively avoided using the gel.

Design: A short descriptive questionnaire was distributed to healthcare professionals and those working within clinical areas within one trust (two teaching hospitals).

The ATAC adjuvant breast-cancer trial: six-year results of the endometrial subprotocol.

Postmenopausal women with localised, early breast cancer (n = 285) were enrolled in a prospective subprotocol of the 'arimidex, tamoxifen, alone or in combination' (ATAC) trial to assess gynaecological abnormalities arising during treatment with anastrozole (1 mg/day) or tamoxifen (20 mg/day). After 6 years' follow-up, there appeared to be non-significantly fewer endometrial abnormalities with anastrozole than with tamoxifen (12.4% vs 20.

Clinical utility of ultrasound and 99mTc sestamibi SPECT/CT for preoperative localization of parathyroid adenoma in patients with primary hyperparathyroidism.

Aim: To evaluate the accuracy of ultrasound and parathyroid scintigraphy using single photon-emission computed tomography/computed tomography (SPECT/CT) for the preoperative localization of solitary parathyroid adenomas in patients with primary hyperparathyroidism who would be suitable for minimally invasive parathyroid surgery.

Materials And Methods: Retrospective study of 63 consecutive patients with biochemical evidence of primary hyperparathyroidism referred for preoperative localization of parathyroid adenoma that proceeded to surgery in the same institution. All patients underwent high-resolution ultrasound and Technetium-99m sestamibi scintigraphy with planar and SPECT/CT imaging.

Changes in and predictors of length of stay in hospital after surgery for breast cancer between 1997/98 and 2004/05 in two regions of England: a population-based study.

Background: Decreases in length of stay (LOS) in hospital after breast cancer surgery can be partly attributed to the change to less radical surgery, but many other factors are operating at the patient, surgeon and hospital levels. This study aimed to describe the changes in and predictors of length of stay (LOS) in hospital after surgery for breast cancer between 1997/98 and 2004/05 in two regions of England.

Methods: Cases of female invasive breast cancer diagnosed in two English cancer registry regions were linked to Hospital Episode Statistics data for the period 1st April 1997 to 31st March 2005.

Patient-physician interactions during early breast-cancer treatment: results from an international online survey.

Objective: To examine, via an international survey, the impact of positive and negative interactions on the patient-physician relationship.

Research Design And Methods: This online survey was conducted in five countries (USA, UK, Germany, Italy and France) in two populations: (1) postmenopausal women diagnosed with early breast cancer (EBC) in the past 5 years, who had undergone surgery; (2) breast-cancer physicians. The survey covered several topics: patient-physician interactions, EBC treatment options and sources of information.

Aromatase inhibitor-induced arthralgia: clinical experience and treatment recommendations.

It is well documented that the aromatase inhibitors (AIs) are superior to tamoxifen as adjuvant endocrine therapy in postmenopausal women with hormone receptor-positive breast cancer. However, compared with tamoxifen, an elevated incidence of arthralgia has been observed during AI treatment. Concerns have been raised that AI-induced arthralgia may dissuade patients from completing their full AI treatment course, and may also deter physicians from prescribing an AI if they feel that patients may be at risk of permanent joint damage.

Video-assisted mediastinoscopy (VAM) for surgical resection of ectopic parathyroid adenoma.

Background: Ectopic mediastinal parathyroid adenomas or hyperplasia account for up to 25% of primary hyperparathyroidism (HPT). Two percent of them are not accessible by standard cervical surgical approaches. Surgical resection has traditionally been performed via median sternotomy or thoracotomy and more recently, via video assisted thoracoscopic surgery (VATS).