Long term results of surgical treatment of medullary thyroid cancer

The aim. To investigate the long term results of medullary thyroid cancer (MTC) surgical treatment in The Hospital of Lithuanian University of Health Sciences Kauno klinikos Surgery Department. The objectives. 1. To review the characteristics of the sample patients. 2. To assess the most frequently used diagnostic methods and treatment options. 3. To compare relapse–free and subsequent relapse patients’ groups. 4. To identify MTC patients’ rates of relapse and survivability . Methods. A retrospective analysis of patients’ case histories was performed. The patients were divided into two groups: group I – relapse–free patients and group II – patients who had a subsequent relapse of the disease. Differences between groups were established using Mann–Whitney U test. Study sample. Patients who underwent surgical treatment for MTC during 2001 – 2016 years in The Hospital of Lithuanian University of Health Sciences Surgery Clinic were enrolled into the study. Results. There were 28 (31,8%) males and 60 (68,2%) females among the sample patients. Primary thyroid surgery was performed in 82 (73,9%) cases and 29 (26,1%) times for relapse patients. The mean age of patients was 54 (16-85) years. On average males were younger than females: 48,3 years and 57,9 years accordingly (p<0,001). The most frequent diagnostic methods were ultrasound (US) (97,5%) and fine needle aspiration (FNA) (82,9%) for primary tumour diagnosis and US (92,3%), CT/MRI (46,2%) for the diagnosis of relapse cases. Group II had statistically significantly more men, p<0,001. Most frequently performed operation for primary surgery was thyroidectomy; for relapse cases – lymphonodectomy. Recurrent laryngeal nerve was injured in 8 (9,3%) cases, from which 4 (4,9%) nerves were damaged while performing primary operations and 4 (13,8%) during relapse operations. Relapse probability was measured to be 15,8%. Disease specific survivability – 97,1%. Conclusions. 1. Medullary thyroid cancer was more often diagnosed to females; diagnosis for males was established in younger age. 2. Ultrasound and FNA were most beneficial for primary tumours diagnosis, relapse cases had more diagnostic benefit from US and CT/MRI. Primary cases were most often treated with thyroidectomy, relapses – with lymphonodectomy. 3. Relapse was more frequent among males who were younger. 4. Relapse probability was measured to be 15,8%. Disease specific survival – 97,1%

Discharge protocol in acute pancreatitis: an international survey and cohort analysis.

There are several overlapping clinical practice guidelines in acute pancreatitis (AP), however, none of them contains suggestions on patient discharge. The Hungarian Pancreatic Study Group (HPSG) has recently developed a laboratory data and symptom-based discharge protocol which needs to be validated. (1) A survey was conducted involving all members of the International Association of Pancreatology (IAP) to understand the characteristics of international discharge protocols. (2) We investigated the safety and effectiveness of the HPSG-discharge protocol. According to our international survey, 87.5% (49/56) of the centres had no discharge protocol. Patients discharged based on protocols have a significantly shorter median length of hospitalization (LOH) (7 (5;10) days vs. 8 (5;12) days) p < 0.001), and a lower rate of readmission due to recurrent AP episodes (p = 0.005). There was no difference in median discharge CRP level among the international cohorts (p = 0.586). HPSG-protocol resulted in the shortest LOH (6 (5;9) days) and highest median CRP (35.40 (13.78; 68.40) mg/l). Safety was confirmed by the low rate of readmittance (n = 35; 5%). Discharge protocol is necessary in AP. The discharge protocol used in this study is the first clinically proven protocol. Developing and testifying further protocols are needed to better standardize patients' care