medico legal issues of intraoperative neuromonitoring in thyroid surgery

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Body Mass Index Is Associated with Hypercholesterolemia following Thyroid Hormone Withdrawal in Thyroidectomized Patients

Thyroid hormone withdrawal (THW) for postoperative radioiodine adjuvant therapy or diagnostic radioiodine whole body scan in patients with differentiated thyroid cancers results in acute thyroid hormone deficiency and abnormal lipid profiles. To better clarify the clinical pattern of dyslipidemia occurring after THW, we retrospectively analyzed the association between serum total cholesterol level after THW and various clinical factors in a total of 61 patients who underwent total thyroidectomy due to papillary thyroid cancers from January 2010 to March 2012, in Severance Hospital, Seoul, Korea. Preoperative baseline total cholesterol was significantly correlated with post-THW total cholesterol level; however, age, gender, or elevated TSH level after THW itself was not correlated with post-THW total cholesterol level. A significant correlation between preoperative measured BMI and post-THW total cholesterol level was found ( = 0.263, = 0.041). In multiple logistic analysis, BMI was an independent determining factor of post-THW total cholesterol level ( = 0.012)

Robot-assisted posterior retroperitoneoscopic adrenalectomy: single port access

Laparoscopic adrenalectomy has become a gold standard in adrenal gland surgery. More recently, some minimally invasive trials have been conducted on single access surgery on the adrenal gland. In this study, we introduce our first experiences of robot-assisted posterior retroperitoneoscopic adrenalectomy using single-port access and the da Vinci system

Relationship between recurrence and age in the diffuse sclerosing variant of papillary thyroid carcinoma: clinical significance in pediatric patients

BackgroundThe diffuse sclerosing variant (DSV) is among the aggressive variants of papillary thyroid carcinoma (PTC) and is more prevalent in pediatric patients than in adult patients. Few studies have assessed its characteristics owing to its low incidence. We aimed to evaluate the relationship between recurrence and age in the DSV of PTC.MethodsWe retrospectively reviewed patients diagnosed with the DSV or conventional PTC (cPTC) after surgery at a medical center between May 1988 and January 2019. We compared the clinico-pathological characteristics and surgical outcomes of the DSV and cPTC groups and between adult and pediatric patients with DSV.ResultsAmong the 24,626 patients, 202 had the DSV, and 24,424 were diagnosed with cPTC. The recurrence rate was significantly higher in the DSV group than in the cPTC group. In the DSV group, the recurrence rate was significantly higher in the pediatric patient group than in the adult patient group. Moreover, the association between recurrence and age group showed different patterns between the DSV and cPTC groups with restricted cubic splines (RCS). While both RCS curves showed a U-shaped distribution, the RCS curve tended to be located within the younger age group.ConclusionsThis study demonstrated that pediatric patients with DSV are at a greater risk for recurrence compared with adult patients; moreover, the pattern of recurrence risk according to age is different from that of cPTC

OGLE-2016-BLG-1227L: A Wide-separation Planet from a Very Short-timescale Microlensing Event

We present the analysis of the microlensing event OGLE-2016-BLG-1227. The light curve of this short-duration event appears to be a single-lens event affected by severe finite-source effects. Analysis of the light curve based on single-lens single-source (1L1S) modeling yields very small values of the event timescale, t_E ∼ 3.5 days, and the angular Einstein radius, θ_E ∼ 0.009 mas, making the lens a candidate of a free-floating planet. Close inspection reveals that the 1L1S solution leaves small residuals with amplitude ΔI ≲ 0.03 mag. We find that the residuals are explained by the existence of an additional widely-separated heavier lens component, indicating that the lens is a wide-separation planetary system rather than a free-floating planet. From Bayesian analysis, it is estimated that the planet has a mass of _p = 0.79^(+1.30)_(−0.39) M_J and it is orbiting a low-mass host star with a mass of M_(host) = 0.10+0.17−0.05 M_⊙ located with a projected separation of a_ = 3.4^(+2.1)_(−1.0) au. The planetary system is located in the Galactic bulge with a line-of-sight separation from the source star of D_(LS) = 1.21^(+0.96)_(−0.63) kpc. The event shows that there are a range of deviations in the signatures of host stars for apparently isolated planetary lensing events and that it is possible to identify a host even when a deviation is subtle

Do large thyroid nodules (≥4 cm) without suspicious cytology need surgery?

BackgroundFine-needle aspiration biopsy (FNAB) is a good diagnostic tool for thyroid nodules; however, its high false-negative rate for giant nodules remains controversial. Many clinicians recommend surgical resection for nodules >4 cm owing to an increased risk of malignancy and an increased false-negative rate. This study aimed to examine the feasibility of this approach and investigate the incidence of malignancy in thyroid nodules >4 cm without suspicious cytology based on medical records in our center.MethodsThis was a retrospective analysis of 453 patients that underwent preoperative FNAB for nodules measuring >4 cm between January 2017 and August 2022 at Severance Hospital, Seoul.ResultsAmong the 453 patients, 140 nodules were benign and 119 were indeterminate. Among 259 patients, the final pathology results were divided into benign (149) and cancerous (110) groups, and the prevalence of malignancy was 38.9% in the benign group and 55.5% in the indeterminate group. Among the malignancies, follicular carcinoma and follicular variants of papillary carcinoma were observed in 83% of the cytologically benign group and 62.8% of the indeterminate group.ConclusionPreoperative FNAB had high false-negative rates and low diagnostic accuracy in patients with thyroid nodules >4 cm without suspicious cytologic features; therefore, diagnostic surgery may be considered a treatment option