Total thyroidectomy: Complications and technique

During the 27-year period from 1957 to 1984, four hundred thirty patients underwent total thyroidectomies for malignant or benign disease of the thyroid gland at our institutions. Thyroid cancer was found in 83.4% of cases, and 47.2% of these had concomitant lymph node dissections. Transient recurrent laryngeal nerve injury occurred in 6.2% of the entire series. Permanent unilateral vocal cord paralysis occurred in 2.5% of the patients operated on, although only 1 patient (0.45%) sustained this complication in the past 14 years. No patient had permanent bilateral vocal cord paralysis. Transient hypoparathyroidism was seen in 16.8% of patients with permanent hypoparathyroidism occurring in 4.0%. The incidence of permanent hypoparathyroidism fell to 2.7% during the past 14 years and was directly related to the extent of thyroid cancer found at operation. Postoperative complications decrease with the experience of the surgeon and increase with reoperations and extensive disease. Total thyroidectomy continues to be our treatment of choice for thyroid cancer. Au cours d'une période de 27 ans de 1957 à 1984, quatre cent trente patients ont subi une thyroïdectomie totale dans notre établissement pour des lésions bénignes ou malignes du corps thyroïdien. Dans 83.4% des cas il s'agit d'un carcinome thyroïdien, nécessitant chez 47.2% d'entre eux un curage ganglionnaire associé. On observe une atteinte transitoire du nerf récurrent laryngé dans 6.2% des cas sur la totalité de la série. Une paralysie permanente unilatérale des cordes vocales survient chez 2.5% des patients opérés, alors que durant les 14 dernières années un seul patient présente cette complication. Aucun des cas de paralysie bilatérale permanente des cordes vocales n'est observé. Une hypoparathyroïdie transitoire est constatée chez 16.8% des patients avec hypoparathyroïdie définitive dans 4.0% des cas. L'incidence de l'hypoparathyroïdisme définitif tombe à 2.7% au cours des 14 dernières années et est directement liée à l'extension du cancer thyroïdien constaté lors de l'intervention. Les complications postopératoires diminuent avec l'expérience du chirurgien et augmentent lors des réinterventions et l'extension des lésions. La thyroïdectomie totale demeure pour les auteurs le traitement de choix du cancer thyroïdien. En el lapso de los 27 años entre 1957 y 1984, cuatro cientos treinta pacientes fueron sometidos a tiroidectomía total por enfermedad maligna o benigna de la glándula tiroides en nuestras instituciones. Cáncer tiroideo fue hallado en 83.4% de los casos, y 47.2% de éstos tuvieron disecciones ganglionares concomitantes. Lesión transitoria del nervio recurrente laríngeo ocurrió en el 6.2% de la serie total. Parálisis permanente unilateral de la cuerda vocal ocurrió en 2.5% de los pacientes operados, mientras sólo un paciente (0.45%) presentó esta complicación en los últimos 14 años. Ningún paciente presento parálisis bilateral permanente de las cuerdas vocales. Hipoparatiroidismo transitorio fue observado en 16.8% de los pacientes, y el hipoparatiroidismo permanente ocurrió en el 4.0%. La incidencia de hipoparatiroidismo permanente descendió a 2.7% en los ültimos 14 años y apareció directamente relacionado con la extensión del cancer tiroideo hallada en la operación. Las complicaciones postoperatorias disminuyen en relación a la experiencia del cirujano y se incrementan con las reoperaciones y con la enfermedad muy extensa. La tiroidectomía total continúa siendo nuestra forma preferida de tratamiento para cáncer tiroideo.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/41277/1/268_2005_Article_BF01655238.pd

Aetiology of allergic rhinitis in Hong Kong

ABSTRACTIn a 1993 survey, allergic rhinitis was identified as the most common allergic disease in Hong Kong, affecting 29.1% of schoolchildren. Recently (1995), the International Study of Asthma and Allergies in Childhood (ISAAC) also reported 44.5% current rhinitis among Hong Kong teenagers. Our objective was to study the aetiology of allergic rhinitis in Hong Kong using serological tests of allergen sensitization. In 57 allergic rhinitis patients and in the same number of age- and sex-matched controls the following were measured: serum total IgE, mixed aeroallergen IgE (Phadiatop™) and specific IgE versus house dust mite (HDM), cockroach, cat and dog dander, mould mixture (Penicillium, Cladosporium, Aspergillus and Alternaria species) and four local pollens (Bermuda grass, Timothy, ragweed and mugwort). Compared with controls, allergic rhinitis patients (26 males, 31 females; mean (± SD) age 25 ±11 years) had a significantly elevated serum total IgE concentration (mean ± SEM: 496 ± 88 vs 179 ± 38 kU/L) and an increased proportion of positive Phadiatop (95 vs 33%) and specific IgE tests versus HDM (90 vs 44%) and cockroach (42 vs 9%; Mann-Whitney U-test and χ2 tests all P < 0.005). There was no significant difference in sensitization to other allergens tested. House dust mite and cockroach are ubiquitous in Hong Kong with a warm, humid climate and crowded living conditions. Their identification as aetiological agents of allergic rhinitis should help in the development of environmental strategies for reducing the inhalant allergen load to prevent and control this prevalent and costly health problem in our community

Adrenergic and dopaminergic control of the canine paw microcirculation

Basal isolated canine paw blood flow was equally distributed between arteriovenous anastomosis (AVA) and capillary circulations. Norepinephrine decreased AVA flow by 92% and capillary flow by 41%. Dopamine significantly reduced AVA flow by 94% compared to baseline with a 37% reduction in capillary flow. However, with [alpha]-adrenergic blockade dopamine decreased AVA flow 66% while capillary flow increased 42%. Isoproterenol increased capillary flow almost twofold and appeared to decrease AVA flow, although the latter was statistically insignificant. Differential effects of adrenergic and dopaminergic agonists on canine paw AVA and capillary blood flow suggest the existence of independent regulation of these components of the microcirculation.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/26330/1/0000417.pd

Surveillance of emerging drugs of abuse in Hong Kong: Validation of an analytical tool

© 2015, Hong Kong Academy of Medicine Press. All rights reserved. Objective: To validate a locally developed chromatography-based method to monitor emerging drugs of abuse whilst performing regular drug testing in abusers. Design: Cross-sectional study. Setting: Eleven regional hospitals, seven social service units, and a tertiary level clinical toxicology laboratory in Hong Kong. Participants: A total of 972 drug abusers and high-risk individuals were recruited from acute, rehabilitation, and high-risk settings between 1 November 2011 and 31 July 2013. A subset of the participants was of South Asian ethnicity. In total, 2000 urine or hair specimens were collected. Main outcome measures: Proof of concept that surveillance of emerging drugs of abuse can be performed whilst conducting routine drug of abuse testing in patients. Results: The method was successfully applied to 2000 samples with three emerging drugs of abuse detected in five samples: PMMA (paramethoxymethamphetamine), TFMPP [1-(3-trifluoromethylphenyl)piperazine], and methcathinone. The method also detected conventional drugs of abuse, with codeine, methadone, heroin, methamphetamine, and ketamine being the most frequently detected drugs. Other findings included the observation that South Asians had significantly higher rates of using opiates such as heroin, methadone, and codeine; and that ketamine and cocaine had significantly higher detection rates in acute subjects compared with the rehabilitation population. Conclusions: This locally developed analytical method is a valid tool for simultaneous surveillance of emerging drugs of abuse and routine drug monitoring of patients at minimal additional cost and effort. Continued, proactive surveillance and early identification of emerging drugs will facilitate prompt clinical, social, and legislative management.Link_to_subscribed_fulltex

Effect of low molecular weight heparin on bone metabolism and hyperlipidemia in patients on maintenance hemodialysis

The effect of low molecular weight heparin (LMWH) on serum lipid profile in hemodialysis remains controversial and its effect on bone metabolism has not been studied. A crossover study was conducted in 40 patients on stable hemodialysis using unfractionated heparin (UFH) for more than 24 months. These patients were then treated with a LMWH (nadroparin-Ca) for 8 months during hemodialysis and subsequently switched back to UFH for 12 months. Serum lipid profile, biochemical markers for bone metabolism, and bone densitometry (BMD) were monitored at four-month intervals while all medications remained unchanged. Cholesterol (TC), triglyceride (TG), low-density lipoprotein-cholesterol (LDL-C), lipoprotein(a) (Lp(a)), apolipoprotein B (Apo B) were raised in 35%, 29%, 12%, 24% and 24% of patients respectively. High-density lipoprotein-cholesterol (HDL-C) and apolipoprotein A1 (Apo A-1) were reduced in 47% and 9% of patients. Bone-specific alkaline phosphatase (BALP) and intact osteocalcin (OSC), both reflecting osteoblastic activity, were raised in 65% and 94% of patients. Tartrate-resistant acid phosphatase (TRACP) reflecting osteoclastic activity and parathyroid hormone (PTH) were elevated in 35% and 88% of patients. Following LMWH treatment, TC, Tg, Lp(a) and Apo B were reduced by 7%, 30%, 21% and 10% respectively (p<0.05 or <0.01) while Apo A-1 were raised by 7% (p<0.01). Simultaneously, TRACP was reduced by 13% (p<0.05). These biochemical changes were detected soon after 4 months of LMWH administration. Although BMD values in our patients were lower than those of age-matched normal subjects, significant changes were not observed with LMWH treatment. After switching back to UFH for hemodialysis, these biochemical indices reverted to previous values during UFH treatment with a significant higher level in TC and Apo B while serum Apo A-1 remained elevated. Our study suggests LMWH may partially alleviate hyperlipidemia and, perhaps, osteoporosis associated with UFH administration in patients on maintenance hemodialysis.link_to_subscribed_fulltex

Global attitudes in the management of acute appendicitis during COVID-19 pandemic: ACIE Appy Study

Background: Surgical strategies are being adapted to face the COVID-19 pandemic. Recommendations on the management of acute appendicitis have been based on expert opinion, but very little evidence is available. This study addressed that dearth with a snapshot of worldwide approaches to appendicitis. Methods: The Association of Italian Surgeons in Europe designed an online survey to assess the current attitude of surgeons globally regarding the management of patients with acute appendicitis during the pandemic. Questions were divided into baseline information, hospital organization and screening, personal protective equipment, management and surgical approach, and patient presentation before versus during the pandemic. Results: Of 744 answers, 709 (from 66 countries) were complete and were included in the analysis. Most hospitals were treating both patients with and those without COVID. There was variation in screening indications and modality used, with chest X-ray plus molecular testing (PCR) being the commonest (19\ub78 per cent). Conservative management of complicated and uncomplicated appendicitis was used by 6\ub76 and 2\ub74 per cent respectively before, but 23\ub77 and 5\ub73 per cent, during the pandemic (both P < 0\ub7001). One-third changed their approach from laparoscopic to open surgery owing to the popular (but evidence-lacking) advice from expert groups during the initial phase of the pandemic. No agreement on how to filter surgical smoke plume during laparoscopy was identified. There was an overall reduction in the number of patients admitted with appendicitis and one-third felt that patients who did present had more severe appendicitis than they usually observe. Conclusion: Conservative management of mild appendicitis has been possible during the pandemic. The fact that some surgeons switched to open appendicectomy may reflect the poor guidelines that emanated in the early phase of SARS-CoV-2