Preservation of parathyroid glands during thyroid and neck surgery

The parathyroid glands are situated in close proximity to the thyroid gland. They have an important endocrine function maintaining calcium and phosphate homeostasis in the body by the secretion of parathormone (PTH), which is responsible for this function. The parathyroid glands are commonly damaged during thyroid surgeries. This could lead to transient or permanent hypoparathyroidism in 30% of cases. Preservation of the parathyroid glands, is an important and integral part of thyroidectomy and other surgical interventions in the neck. The main principle underlying this is a thorough understanding of parathyroid anatomy in relation to the thyroid gland and other important structures in the area. There can also be significant variation in the anatomical location of the glands. Various techniques and methods have been described for parathyroid preservation. They include intraoperative identification utilizing indocyanine green (ICG) fluorescence, carbon nanoparticles, loupes, and microscopes. The techniques of surgery (meticulous capsular dissection), expertise, central compartment neck dissection, preoperative vitamin D deficiency, extent and type of thyroidectomy are the risk factors associated with damaged thyroids, inadvertent parathyroidectomy and subsequent hypoparathyroidism. Parathyroid Autotransplantation is a treatment option for inadvertent parathyroidectomy. Ultimately, the best way to assure normal parathyroid function is to preserve them in situ intraoperatively undamaged

A Successful Treatment of Encapsulating Peritoneal Sclerosis in an Adolescent Boy on Long-term Peritoneal Dialysis: A Case Report.

Encapsulating peritoneal sclerosis (EPS) is a rare life-threatening complication associated with peritoneal dialysis (PD). EPS is characterized by progressive fibrosis and sclerosis of the peritoneum, with the formation of a membrane and tethering of loops of the small intestine resulting in intestinal obstruction. It is very rare in children. We present a case of a 16-year-old adolescent boy who developed EPS seven years after being placed on continuous ambulatory peritoneal dialysis (CAPD) complicated by several episodes of bacterial peritonitis. The diagnosis was based on clinical, radiological, intraoperative and histopathological findings. The patient was successfully treated with surgical enterolysis. During a 7-year follow-up, there have been no further episodes of small bowel obstruction documented. He still continues to be on regular hemodialysis and is awaiting a deceased donor kidney transplant. EPS is a long-term complication of peritoneal dialysis and is typically seen in adults. Rare cases may be seen in the pediatric population and require an appropriate surgical approach that is effective and lifesaving for these patients

Toxicities, kinetics and degradation pathways investigation of ciprofloxacin degradation using iron-mediated H\u3csub\u3e2\u3c/sub\u3eO\u3csub\u3e2\u3c/sub\u3e based advanced oxidation processes

© 2018 Institution of Chemical Engineers Ciprofloxacin (CIP) is a widespread emerging water pollutant and thus its removal from aquatic environment is vital. The use of Fe3+/H2O2 and Fe2+/H2O2 resulted in 38 and 64% removal of CIP (8.0 ppm), respectively, within 80 min reaction time (pH 5.8, [H2O2]0 = 80 ppm, and [iron]0 = 20 ppm). Low pH, high temperature, high dose of H2O2 and Fe2+, and low CIP concentration facilitated removal of CIP. The radical scavenger studies proved in situ generated [rad]OH to be involved primarily in the removal of CIP. The effect of temperature was used to estimate enthalpy and activation energies of the removal of CIP. At 800 min reaction time, the Fe2+/H2O2 resulted in 54% mineralization of CIP using 16.0 ppm [CIP]0, 320.0 ppm [H2O2]0, and 40.0 ppm [Fe2+]0. The potential degradation pathways of CIP established from the degradation of CIP by [rad]OH and products evolved was found to be initiated at C6 through the loss of fluoride ion. The acute and chronic toxicities of CIP and its degradation products were estimated with the final product found to be non-toxic. The results suggest that Fe2+/H2O2-mediated AOPs have high potential for degradation as well as toxicity elimination of CIP and its degradation products

Surveillance arterioveNous fistulAs using ultRasound (SONAR) trial in haemodialysis patients: a study protocol for a multicentre observational study.

INTRODUCTION: Arteriovenous fistulas (AVFs) are considered the best and safest modality for providing haemodialysis in patients with end-stage renal disease. Only 20% of UK centres achieve the recommended 80% target for achieving dialysis of the prevalent dialysis population via permanent access (as opposed to a central venous catheter). This is partly due to the relatively poor maturation rate of newly created fistulas, with as many as 50% of fistulas failing to mature.The Surveillance Of arterioveNous fistulAe using ultRasound study will examine whether a protocolised programme of Doppler ultrasound (US) surveillance can identify, early after creation, potentially correctable problems in those AVFs that subsequently fail to mature. METHODS AND ANALYSIS: This is a multicentre observational study that will assess newly created AVFs by Doppler US performed at 2, 4, 6 and 10 weeks after creation. The primary outcome measure will be primary fistula patency at week 10. Secondary outcome measures include: successful use of the fistula; clinical suitability for dialysis; creation of new fistula or radiological salvage; fistula thrombosis; secondary fistula patency rate and patient acceptability. ETHICS AND DISSEMINATION: The study has been approved by the Cambridgeshire and Hertfordshire Research Ethics Committee and by the Health Research Authority (REC 18/EE/0234). The results generated from this work will be published as open access, within 3 years of trial commencement. We will also present our findings at key national/international renal meetings, as well as support volunteers at renal patient groups to disseminate the trial outcome. TRIAL REGISTRATION NUMBER: ISRCTN36033877

Early ultrasound surveillance of newly-created haemodialysis arteriovenous fistula

IntroductionWe assess if ultrasound surveillance of newly-created arteriovenous fistulas (AVFs) can predict nonmaturation sufficiently reliably to justify randomized controlled trial (RCT) evaluation of ultrasound-directed salvage intervention.MethodsConsenting adults underwent blinded fortnightly ultrasound scanning of their AVF after creation, with scan characteristics that predicted AVF nonmaturation identified by logistic regression modeling.ResultsOf 333 AVFs created, 65.8% matured by 10 weeks. Serial scanning revealed that maturation occurred rapidly, whereas consistently lower fistula flow rates and venous diameters were observed in those that did not mature. Wrist and elbow AVF nonmaturation could be optimally modeled from week 4 ultrasound parameters alone, but with only moderate positive predictive values (PPVs) (wrist, 60.6% [95% confidence interval, CI: 43.9–77.3]; elbow, 66.7% [48.9–84.4]). Moreover, 40 (70.2%) of the 57 AVFs that thrombosed by week 10 had already failed by the week 4 scan, thus limiting the potential of salvage procedures initiated by that scan’s findings to alter overall maturation rates. Modeling of the early ultrasound characteristics could also predict primary patency failure at 6 months; however, that model performed poorly at predicting assisted primary failure (those AVFs that failed despite a salvage attempt), partly because patency of at-risk AVFs was maintained by successful salvage performed without recourse to the early scan data.ConclusionEarly ultrasound surveillance may predict fistula maturation, but is likely, at best, to result in only very modest improvements in fistula patency. Power calculations suggest that an impractically large number of participants (>1700) would be required for formal RCT evaluation

Laparoscopic approaches to adrenalectomy for large adrenal tumours:a systematic review

Background: Laparoscopic adrenalectomy (LA) is considered the gold standard for benign, smaller secretory and non-secretory adrenal tumours. There is controversy however about its role for large tumors. In this review, we present the latest evidence on the feasibility of LA for large tumors and analyze the perioperative outcomes. Methods: Using PubMed database, we searched for relevant articles on LA for large tumors published between January 2010 and December 2021. These were scrutinized by two reviewers. Newcastle-Ottawa scale was used to assess the quality of the studies. Studies comparing robotic adrenalectomy with LA, duplicate data in multiple publications, case reports and articles focused on surgical technique or predictive factors were excluded. The outcomes analyzed included operative time, blood loss, surgical complications, average length of hospital stay, conversion to open surgery &amp; tumor recurrence. A database was created on Microsoft ExcelTM. This is an unregistered systematic review. Results: A total of 15 suitable studies were identified. Retroperitoneal laparscopic adrenalectomy (RPLA) or transperitoneal laparoscopic adrenalectomy (TPLA) was found to be safe and effective for large tumours (≥5 cm) when compared to open adrenalectomy (OA). RPLA had shorter operative time, quicker return of bowel function and shorter length of hospital stay when compared to TPLA and OA. Hand assisted LA (HALA) discussed in one study concluded that complication rates were higher than TPLA but lower than OA. However, open conversion in HALA was lower compared to other TPLA studies. Conclusions: LA can be considered for large (≥5 cm) and potentially malignant tumors if the operators have the required technical skills and strict oncological principles are followed. The procedure should ideally be converted to open surgery if local invasion is suspected intraoperatively with potentially compromised resection margins. HALA is an excellent compromise in large tumours with anatomical and technical challenges. Limitations of this study include small sample size and limited number of well constructed prospective studies.</p