Evaluating the introduction of intraoperative neuromonitoring of the recurrent laryngeal nerve in thyroid and parathyroid surgery

Introduction: Paresis of the recurrent laryngeal nerve (RLN) is a complication of thyroid surgery. Neuromonitoring as is gaining acceptance among surgeons. The aim of the study was to assess the number of technical problems in the initial phase of intraoperative neuromonitoring (IONM) use and the specificity, sensitivity, positive predictive value and negative predictive value of neuromonitoring. The number of cases of postoperative paresis (transient and permanent) was assessed. Material and methods: The prospective analysis included 101 thyroid operations with IONM (190 RLNs at risk of injury) in the period from January to April, 2012. Demographic data, rate of RLN identification, sensitivity, specificity and predictive value of the method, the duration of the procedurę and the percentage of RLN paresis were considered. Results: The RLN was identified in 92% of the cases. Technical problems were observed in 12.98%, of which 61% were due to incorrect positioning of the endotracheal tube electrodes in relation to the vocal cords. The sensitivity, specificity, negative and positive predictive value and the accuracy of the method were respectively 71%, 98%, 62.5%, 98.9% and 97%. Early nerve injury occurred in 3.7% of the cases; 2.6% were temporary paresis and 1.1% permanent. Conclusions: During the initial stages of implementing IONM we experienced technical problems that required correction in every tenth patient. The positive predictive value was relatively low; nevertheless, good results in terms of the rate of accurate identification of the RLN as well as the low rate of RLN paresis support the use of this method

Expression of cytokeratin-19 (CK19) in the classical subtype of papillary thyroid carcinoma: the experience of one center in the Silesian region

Introduction. Cytokeratin-19 (CK19) is recognized as a reliable tumor marker of papillary thyroid carcinoma (PTC). The general prognosis in the classical subtype of PTC (CSTPTC) remains favorable, but some cases can be very aggressive. The aim of this study was to evaluate the localization and intensity of immunohistochemical CK19 expression in CSTPTC and its associations with the clinical and pathological characteristics of patients with CSTPTC in the Silesian region. Material and methods. All the available clinical and histopathological data for 149 patients with CSTPTC from the Silesian region were retrospectively analyzed. The group consisted of 135 (90.6%) women and 14 (9.4%) men (mean age and SD: 52.3 ± 15.0). All these patients with CSTPTC underwent surgery at the same center between 2008 and 2013; the follow-up period was 24 to 90 months (mean and SD: 47 ± 20). Results. In 142 (95.3%) of the patients with CSTPTC, positive cytoplasmic staining of CK19 was found. A higher expression of CK19 was observed in the group of patients without the recurrence of the disease (p = 0.015). CK19 expression was not associated with age, gender, tumor focality, disease stage, tumor size (pT), lymph node involvement (pN), or distant metastases (pM). Conclusions. Decreased CK19 expression in CSTPTC cases with relapse suggests that it plays a role in the carcinoma progression of CSTPTC. The association between lower CK19 expression and patients’ unfavorable postoperative course could suggest its possible role as a marker of CSTPTC poor prognosis

The strategies to support the COVID-19 vaccination with evidence-based communication and tackling misinformation

COVID-19 vaccinations are about to begin in various countries or are already ongoing. This is an unprecedented operation that is also met with a loud response from anti-vaccine communities—currently using all available channels to manipulate public opinion. At the same time, the strategy to educate on vaccinations, explain their mechanism of action, and build trust in science is subdued in different world parts. Such actions should go much beyond campaigns promoting the COVID-19 vaccines solely on the information provided by the health institutions and national authorities. In this paper, actions provided by independent expert groups needed to counteract the anti-vaccine propaganda and provide scientific-based information to the general public are offered. These actions encompass organizing groups continuously communicating science on COVID-19 vaccines to the general public; tracking and tackling emerging and circulating fake news; and equipping celebrities and politicians with scientific information to ensure the quality of messages they communicate, as well as public letters, and statements of support for vaccination by healthcare workers, recognized scientists, VIPs, and scientific societies; and no tolerance to false and manipulated claims on vaccination spread via traditional and social media as well as by health professionals, scientists, and academics. These activities should be promptly implemented worldwide, regardless of the current status and availability of the COVID-19 vaccine in a particular region. If we are about to control the pandemic for the sake of public benefit, it is high time to collectively speak out as academic and medical societies with support from decision-makers. Otherwise, the battle will be lost to those who stand against scientific evidence while offering no feasible solution to the problem

Acromegaly associated with GIST, non-small cell lung carcinoma, clear cell renal carcinoma, multiple myeloma, medulla oblongata tumour, adrenal adenoma, and follicular thyroid nodules

Acromegaly is associated with increased growth hormone (GH) and insulin-like growth factor-I (IGF-I) secretion which may support tumour development and growth. A 68-year-old woman was diagnosed with acromegaly due to typical clinical and hormonal characteristics. While contrast-enhanced MRI at diagnosis did not reveal a pituitary adenoma, a 5-mm lesion was identified on repeat scanning 13 months later. Abdominal and chest CT showed tumours of the stomach, right adrenal gland, and right lung. The CT also showed a hypodense lesion in the liver and heterogeneous echostructure of the thyroid gland with left lobe solid-cystic tumour. Somatostatin receptor scintigraphy revealed increased tracer accumulation in the right thyroid lobe. No tracer accumulation was noted at the location of the other tumours. The resected stomach, adrenal, chest, and thyroid lesions did not show GH secretion. The patient refused pituitary surgery, and her acromegaly is currently well-controlled with somatostatin analogue therapy. A CT scan 19 months later revealed a contrast-enhancing left kidney tumour that was a G1-grade clear cell carcinoma. Four years after the acromegaly diagnosis multiple myeloma were diagnosed with secondary renal amyloidosis. Genetic screening for a paraganglioma gene panel, AIP, MEN1, and CDKN1B mutations were negative. A next-generation cancer panel containing 94 cancer genes did not identify any possible unifying gene abnormality in her germline DNA. Coexistence of acromegaly and numerous other tumours suggests a common aetiology of these disorders. However, no genetic abnormality could be identified with the tests that have been performed.