Influence of Experience on Performance of Individual Surgeons in Thyroid Surgery: Prospective Cross Sectional Multicentre Study

Objective: To determine the association between surgeons’ experience and postoperative complications in thyroid surgery. Design: Prospective cross sectional multicentre study. Setting: High volume referral centres in five academic hospitals in France. Participants: All patients who underwent a thyroidectomy undertaken by every surgeon in these hospitals from 1 April 2008 to 31 December 2009. Main outcome measures: Presence of two permanent major complications (recurrent laryngeal nerve palsy or hypoparathyroidism), six months after thyroid surgery. We used mixed effects logistic regression to determine the association between length of experience and postoperative complications. Results: 28 surgeons completed 3574 thyroid procedures during a one year period. Overall rates of recurrent laryngeal nerve palsy and hypoparathyroidism were 2.08% (95% confidence interval 1.53% to 2.67%) and 2.69% (2.10% to 3.31%), respectively. In a multivariate analysis, 20 years or more of practice was associated with increased probability of both recurrent laryngeal nerve palsy (odds ratio 3.06 (1.07 to 8.80), P=0.04) and hypoparathyroidism (7.56 (1.79 to 31.99), P=0.01). Surgeons’ performance had a concave association with their length of experience (P=0.036) and age (P=0.035); surgeons aged 35 to 50 years had better outcomes than their younger and older colleagues. Conclusions: Optimum individual performance in thyroid surgery cannot be passively achieved or maintained by accumulating experience. Factors contributing to poor performance in very experienced surgeons should be explored further

Results of combined treatment of anaplastic thyroid carcinoma (ATC)

<p>Abstract</p> <p>Background</p> <p>Anaplastic thyroid carcinoma (ATC) is among the most aggressive human malignancies. It is associated with a high rate of local recurrence and with poor prognosis.</p> <p>Methods</p> <p>We retrospectively reviewed 44 consecutive patients treated between 1996 and 2010 at Leon Berard Cancer Centre, Lyon, France. The combined treatment strategy derived from the one developed at the Institut Gustave Roussy included total thyroidectomy and cervical lymph-node dissection, when feasible, combined with 2 cycles of doxorubicin (60 mg/m2) and cisplatin (100 mg/m2) Q3W, hyperfractionated (1.2 Gy twice daily) radiation to the neck and upper mediastinum (46-50 Gy), and then four cycles of doxorubicin-cisplatin.</p> <p>Results</p> <p>Thirty-five patients received the three-phase combined treatment. Complete response after treatment was achieved in 14/44 patients (31.8%). Eight patients had a partial response (18.2%). Twenty-two (50%) had progressive disease. All patients with metastases at diagnosis died shortly afterwards. Thirteen patients are still alive. The median survival of the entire population was 8 months.</p> <p>Conclusion</p> <p>Despite the ultimately dismal prognosis of ATC, multimodality treatment significantly improves local control and appears to afford long-term survival in some patients. There is active ongoing research, and results obtained with new targeted systemic treatment appear encouraging.</p

Потребительский экстремизм как правовое явление

Материалы XIII Междунар. науч. конф. студентов, магистрантов, аспирантов и молодых ученых, Гомель, 21–22 мая 2020 г

Le Risque parathyroïdien après thyroïdectomie totale pour maladie de Basedow

LYON1-BU Santé (693882101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Cancers thyroïdiens différenciés de l'adulte (facteurs pronostiques de récidive : à propos d'une série de 208 patients avec un recul minimum de 5 ans)

LYON1-BU Santé (693882101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Insulinomes sporadiques et problèmes spécifiques des hypoglycémies factices

LYON1-BU Santé (693882101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Facteurs de risque et prise en charge des complications des pancréatectomies segmentaires (analyse rétrospective de 73 pancréatectomies consécutives)

LYON1-BU Santé (693882101) / SudocSudocFranceF

Les Nodules thyroïdiens (étiopathogénie, diagnostic, traitement chirurgical)

La thèse est structurée en deux parties : partie générale et partie spéciale. La partie générale est un rappel bibliographique sur la croissance et différenciation des thyréocytes, ainsi que sur l'étiopathogénie, la clinique, les investigations préopératoires et la prise en charge thérapeutique des nodules thyroïdiens. La partie spéciale présente les recherches effectuées sur les cultures cellulaires des thyréocytes et la prise en charge clinique des nodules thyroïdiens. Une lignée cellulaire à partir d'un cancer thyroïdien différencié a été établie suite à la mise en culture de 33 tumeurs thyroïdiennes. L'étude de 373 patients opérés pour lésions nodulaires thyroïdiennes a montré qu'il n'existe pas une relation entre les paramètres cliniques et la malignité des nodules et que tous les nodules de plus de 1 centimètre de diamètre doivent bénéficier de ponction-biopsie, s'ils ne sont pas opérés d'emblée pour complications. Une étude sur 369 patients opérés pour nodules thyroïdiens a permis de constater que la scintigraphie thyroïdienne n'a aucun intérêt dans le bilan initial des nodules thyroïdiens, elle reste réservée en cas de TSH basse, goitre plongeant et goitre ectopique. Les résultats post-cure chirurgicale des nodules thyroïdiens ont fait l'objet d'une étude comparative entre une série de 117 patients avec thyroïdectomie partielle et 164 patients avec une thyroïdectomie totale. Cette étude a montré que les taux d'hypocalcémie et de lésions du nerf récurrent est pratiquement similaire dans les deux types de résectionLYON1-BU Santé (693882101) / SudocPARIS-BIUP (751062107) / SudocSudocFranceF

Thyroid cancer: is the incidence rise abating?

OBJECTIVE: The aim of the present study was to determine recent trends in thyroid cancer incidence rates and to analyze histopathological characteristics and geographical distribution. METHODS: Histologically proven 5367 cases were collected over the period 1998-2006 in France from the Rhône-Alpes thyroid cancer registry. Geographical variations of incidence were analyzed using a mixed Poisson model. RESULTS: The average incidence rates, age standardized to the world population, were 3.9/100,000 in men and 12.3/100,000 in women, higher than those previously reported in France. After an initial increase during the first 3 years, a steady level of incidence was observed for the period 2001-2006. The annual incidence rate of microcarcinomas was correlated with that of all cancers in men and women (r=0.78 and 0.89; P<0.01) respectively. Papillary microcarcinomas represented 38% of tumors and two-thirds of them measured less than 5 mm in diameter. They were fortuitously discovered after thyroidectomy for benign diseases in 64% of cases. Histological marks of aggressiveness differed according to the size of the tumor. Despite recent advances in diagnosis, 13% of tumors were diagnosed at advanced stage especially in men. Geographical distribution of incidence based on subregional administrative entities showed lower incidence rates in rural than in urban zones in men (relative rate: 0.72; 95% CI: 0.62-0.84) and women (relative rate: 0.85; 95% CI: 0.73-0.93). CONCLUSION: The present study suggests that the rise in thyroid cancer incidence is now abating. It could reflect standardization in diagnostic procedures. Further studies, performed on a more prolonged period, are necessary to confirm these data

Medios de comunicación y gobernanza turística en Mar del Plata

Se propone el desarrollo de un proyecto de investigación a través del cual observar el vínculo medios de comunicación local - turismo local, a partir de la indagación del contenido de la información relacionada con el turismo presente en medios de prensa gráfica local, a fin de determinar el papel específico que los mismos juegan en los procesos de gobernanza turística local, como así también, realizar una evaluación integral de la gobernanza turística en Mar del Plata.Fil: Cacciutto, Mariangel. Universidad Nacional de Mar del Plata. Facultad de Ciencias Económicas y Sociales; Argentina.Fil: Roldán, Nadia G. Universidad Nacional de Mar del Plata. Facultad de Ciencias Económicas y Sociales; Argentina.Fil: Castellucci, Daniela I. Universidad Nacional de Mar del Plata. Facultad de Ciencias Económicas y Sociales; Argentina.Fil: Corbo, Yanina A. Universidad Nacional de Mar del Plata. Facultad de Ciencias Económicas y Sociales; Argentina.Fil: Cruz, Gonzalo. Universidad Nacional de Mar del Plata. Facultad de Ciencias Económicas y Sociales; Argentina.Fil: Barbini, Bernarda. Universidad Nacional de Mar del Plata. Facultad de Ciencias Económicas y Sociales; Argentina.Fil: Navarro, Viviana Mariel. Universidad Nacional de la Patagonia Austral; Argentina.Fil: Ferrari, Silvia Noemí. Universidad Nacional de la Patagonia Austral; Argentina