Twenty-year perspective on blunt traumatic diaphragmatic injury in level 1 trauma centre: Early versus delayed diagnosis injury patterns and outcomes.

Objective: Blunt traumatic diaphragmatic injury (TDI) is typically associated with severe trauma and concomitant injuries. It is a diagnostic challenge in the setting of blunt trauma and can be easily overlooked especially in the acute phase often dominated by concurrent injuries.

Methods: A retrospective review was conducted of patients with blunt-TDI identified from a level 1 trauma registry.

Artificial Intelligence for Pre-operative Diagnosis of Malignant Thyroid Nodules Based on Sonographic Features and Cytology Category.

Background: Current diagnosis and classification of thyroid nodules are susceptible to subjective factors. Despite widespread use of ultrasonography (USG) and fine needle aspiration cytology (FNAC) to assess thyroid nodules, the interpretation of results is nuanced and requires specialist endocrine surgery input. Using readily available pre-operative data, the aims of this study were to develop artificial intelligence (AI) models to classify nodules into likely benign or malignant and to compare the diagnostic performance of the models.

Cancer in thyroglossal duct cysts.

Background: Thyroglossal duct cysts (TDC) account for 7% of midline neck swellings. TDC carcinoma (TDCC) is rare, reported in 1% of all TDCs. We aimed to describe the incidence of TDCC, the accuracy of fine needle aspiration cytology (FNAC), and to identify suspicious, predictive ultrasound (USG) features.

ECMO (extra corporeal membrane oxygenation) in major trauma: A 10 year single centre experience.

Aim To review the indications, complications and outcomes of extracorporeal membrane oxygenation (ECMO) in major trauma patients. Methods Single centre, retrospective, cohort study. Results Over a ten year period, from 13,420 major trauma patients, 11 were identified from our institutional trauma registry as having received ECMO.

Investigation of recurrent laryngeal palsy rates for potential associations during thyroidectomy.

Background: There are many clinical associations and potential mechanisms of injury resulting in recurrent laryngeal nerve palsy (RLNP) after thyroidectomy. One possible cause of RLNP is focal intralaryngeal compression of the recurrent laryngeal nerve (RLN), which may be associated with the tracheal tube (TT). Therefore, we examined current RLNP rates to investigate potential associations, including intralaryngeal, airway, anaesthetic and anthropometric factors.

Emergency department resuscitative thoracotomy at an adult major trauma centre: Outcomes following a training programme with standardised indications.

Objective: The objective of this study was to report the procedural incidence and patient outcomes after the 2009 introduction of an institutional resuscitative thoracotomy (RT) programme. Emergency physicians, general surgeons and emergency nursing trauma team members were trained to perform RT on thoracic trauma patients with an unresponsive systolic blood pressure (SBP) <70 mmHg within 30 min of arrival, prior to cardiothoracic team back-up.

Methods: A retrospective cohort study was conducted on patients who underwent RT from 2009 to 2017.

Survival following traumatic thoracic compartment syndrome managed with VV-ECMO.

Whilst post-traumatic respiratory failure is the most common indication for use of VV-ECMO in trauma patients, its use in traumatic thoracic compartment syndrome is not yet well described. Thoracic compartment syndrome, a rare complication of thoracic trauma, occurs in the setting of chest wall injuries, impaired chest wall compliance, pulmonary contusions and subsequent high ventilatory pressures. This in turn impairs venous return and increases risk of circulatory arrest due to obstructive shock.

Feasibility study for implementation of resuscitative balloon occlusion of the aorta in peri-arrest, exsanguinating trauma at an adult level 1 Australian trauma centre.

Objective: This prospective, observational, interventional study sought to determine if the introduction of resuscitative balloon occlusion of the aorta (REBOA) at an Australian adult major trauma centre would improve survival for major trauma patients.

Methods: Patients aged 18-60 years, transported directly from scene with exsanguinating, sub-diaphragmatic haemorrhage and hypovolaemic shock (systolic BP <70 mmHg or hypovolaemic cardiac arrest) were eligible for recruitment and followed up until hospital discharge (ACTRN12618000550202).

Results: During the 14-month study period (17 January 2015 to 12 March 2016) 3032 patients were admitted direct from scene with an overall mortality of 97 (3.

Parathyroidectomy Without the Utilisation of iPTH: The Gold Standard is Still a Good Operation-How Understanding the Anatomy and a Simple US Can Help.

Parathyroid surgery is frequently performed after at least two preoperative localisation studies, in addition to the use of intraoperative ioPTH. The key to performing a successful parathyroidectomy is reliant on the surgeon having an outstanding knowledge of parathyroid embryology and anatomy. With this, it is possible to undertake surgery with a simple neck ultrasound and without more expensive pre- and intraoperative localisation studies.

Thyroidectomy Then and Now: A 50-Year Australian Perspective.

Background: Since the mid-1800s, thyroidectomy has transformed from a procedure associated with high to near-zero mortality. Nonetheless, surgeons must continue to strive to improve patient care. Using historical records and contemporary data, this study compares the practice and outcomes of thyroid surgery at a tertiary institution during two periods, 50 years apart.

Total thyroidectomy for pressure symptoms in patients with Hashimoto's thyroiditis.

Background: Hashimoto's thyroiditis (HT) is rarely on its own the indication for thyroidectomy. However, surgery in patients with HT will be undertaken when there is malignancy and may be required for pressure symptoms. Therefore, this study aimed to investigate the indications for surgery in HT patients.

Temporal analysis of thyroid cancer management in a Melbourne tertiary centre.

Background: The American Thyroid Association (ATA) management guidelines for thyroid cancer were revised in 2009. The aim of this study was to determine if management of thyroid cancer in our institution has changed in accordance with the introduction of the revised ATA guidelines (ATA ), and to compare the characteristics and management of thyroid cancer in a Melbourne endocrine surgery unit over a 7-year period.

Methods: All patients treated by the Monash University Endocrine Surgery Unit for thyroid cancer between 2007 and 2013 were divided into two groups - the pre-ATA group (2007-2010) and the post-ATA group (2011-2013).

Quantitative study of voice dysfunction after thyroidectomy.

Background: Up to 80% of patients without a recurrent laryngeal nerve palsy report alteration in their voice after a thyroid procedure. The aims of this study were (1) to quantify voice changes after thyroid operation; (2) to correlate the changes to the extent of operation; and (3) to correlate voice changes to intraoperative recurrent laryngeal nerve swelling.

Methods: Patients undergoing total and hemithyroidectomy were recruited prospectively from the Monash University Endocrine Surgery Unit during a 12-month period.

Surgery for parathyroid microadenomas: patient characteristics, localization success and operative cures.

Background: In recent years, patients with primary hyperparathyroidism (PHPT) are being diagnosed earlier, with milder elevations in parathyroid hormone (PTH) and serum calcium. We aimed to investigate whether adenoma size reflects biochemical severity of presentation and influences localization of pre-operative scans.

Methods: A total of 630 consecutive patients undergoing parathyroidectomy for PHPT were recruited into either the microadenoma (≤200 mg) or macroadenoma (>200 mg) group.

No need to abandon focused parathyroidectomy: a multicenter study of long-term outcome after surgery for primary hyperparathyroidism.

Objective: The aim of this study was to investigate long-term outcomes after focused parathyroidectomy (FPTX) and open 4-gland parathyroid exploration (OPTX) for primary hyperparathyroidism (pHPT).

Background: Concerns about increased long-term recurrence rates after FPTX in conjunction with decreased operative times for OPTX have led some groups to abandon FPTX in favor of routine 4-gland exploration.

Methods: This is a multicenter retrospective cohort study of patients undergoing parathyroidectomy for pHPT from 1990 to 2013.

Differential recurrent laryngeal nerve palsy rates after thyroidectomy.

Introduction: Recurrent laryngeal nerve (RLN) palsy is a devastating complication of thyroidectomy. Although neurapraxia is thought to be the most common cause, the underlying mechanisms are poorly understood. The objectives of this study were to examine the differential palsy rates between the left and right RLNs, and the role of intraoperative nerve swelling as a risk factor of postoperative palsy.

Thyrotoxicosis does not protect against incidental papillary thyroid cancer.

Background: Thyroid cancer is the 10th most commonly diagnosed cancer in Australia, and many studies have linked thyroid-stimulating hormone (TSH) and papillary thyroid cancer (PTC). Low TSH is thought to be protective against thyroid cancer. Our aim was to evaluate the relationship between thyrotoxicosis, in particular Graves' disease, and the incidence of incidental PTC.

Fine-needle aspiration of the thyroid: correlating suspicious cytology results with histological outcomes.

Purpose: Fine-needle aspiration cytology (FNAC) assists the diagnosis of thyroid malignancy. A 'suspicious for malignancy' on FNAC creates a management dilemma. The aims of this study were to investigate the malignancy rate for patients with suspicious cytology, and to describe a management approach for those with a suspicious result.

Anti-thyroid antibodies as a predictor of thyroid cancer.

Background: Recent literature has suggested an association between autoimmune thyroiditis and papillary thyroid cancer. The aims of this study were to evaluate if positive thyroid antibodies are associated with thyroid carcinoma and to examine the role of thyroid antibodies in the management of thyroid nodules.

Methods: This is a database study of all patients undergoing thyroidectomy with recorded preoperative thyroid antibodies (autoantibodies to thyroglobulin and/or thyroid peroxidase) levels from 2010 to 2012.

Recurrent laryngeal nerve injury in thyroid surgery: a review.

Recurrent laryngeal nerve palsy (RLNP) is an important and potentially catastrophic complication of thyroid surgery. Permanent RLNP occurs in 0.3-3% of cases, with transient palsies in 5-8%.

Follicular thyroid cancer: minimally invasive tumours can give rise to metastases.

Background: The histological characteristics of follicular thyroid carcinomas (FTCs) are important predictors of prognosis, and lesions can be classified as either minimally invasive follicular carcinoma (MIFC) or widely invasive follicular carcinoma (WIFC) based on histopathological characteristics. There has been controversy surrounding the histological classification of FTC, which can present challenges to clinicians attempting to deliver accurate prognostic information to their patients. The aim of the present study was to examine cases of metastatic FTC for characteristics that may predict aggressive tumour behaviour.

Diagnostic lobectomy is not routinely required to exclude malignancy in thyroid nodules greater than four centimetres.

Background: Surgical excision has been recommended as a diagnostic test for thyroid nodules ≥ 4 cm, due to the supposedly higher rate of cancer in larger nodules and the higher reported false-negative rates of fine-needle aspiration cytology (FNAC) testing (>10%). The aims of this study are to determine the prevalence of thyroid cancer in nodules ≥ 4 cm, to examine if a relationship between increasing nodule size and malignancy rate was present and to study the accuracy of preoperative FNAC diagnosis.

Methods: Retrospective analysis of data from patients with thyroid nodules ≥ 4 cm undergoing surgical resection between 1994 and 2008.