Maria Evasovich

Trends in the incidence and treatment of parathyroid cancer in the United States.

Parathyroid cancer is a rare cause of hyperparathyroidism. The objectives of this study were to determine the patterns of disease, treatment trends, and outcomes among patients with parathyroid cancer by using a population‐based data source.

Does pneumoperitoneum during laparoscopy increase bacterial translocation

AbstractBackground: To evaluate the impact of laparoscopy in the presence of peritonitis, this study was designed to assess bacteremia caused by E. coli–induced peritonitis with a carbon dioxide pneumoperitoneum in a rat model. Methods: Sixty Sprague-Dawley rats were divided into inoculum groups (no E. coli, 106 colony-forming units [CFU] E. coli, and 108 CFU E. coli), followed by induction of a carbon dioxide pneumoperitoneum or no pneumoperitoneum. Fifteen-minute-interval blood cultures were obtained to determine time of bacteremia development. Statistical assessment to determine significant differences among groups was done using ANOVA and t-test analysis. Results: A total of 20 animals with E. coli introduced into the peritoneum and a carbon-dioxide-induced pneumoperitoneum had more frequent positive blood cultures at all time intervals compared to identical inoculum subgroups without a pneumoperitoneum. ANOVA revealed a significant difference in bacteremia within the same concentration inoculum groups in animals receiving a pneumoperitoneum vs none (p < 0.01). Bacteremia increased significantly as inoculum concentrations increased (25% with 106E. coli inoculum vs 80% with 108E. coli), especially among the insufflated subgroups (45% with 106E. coli vs 100% with 108E. coli) over 180 min (p < 0.01). Conclusion: Carbon dioxide pneumoperitoneum increases the incidence of E. coli bacterial translocation from the peritoneum into the bloodstream in this rat model.

The economic effect of child abuse in the burn unit

The financial burden imposed on society by abusing children through burn injury is unknown. This study retrospectively evaluates the economic impact and demographics of such abuse on patients and their families treated at Childrens Hospital Medical Center of Akron (CHMCA) from four counties over a 5 year period. The inclusive group consisted of all children evaluated during the stated period referred to Social Services for possible child abuse. There were 104 children (55 females and 49 males, 46% black and 56% white) with a mean age of 3.76 years. 71% of the patients came from single parent homes (all single mothers). There were a total of 58 admissions with a mean length of stay of 10.53 days. Total cost for all patients was approximately 1.2 million dollars for health care, of which 65% was government funded. In addition to hospital costs, the perpetrators incurred court costs and jail costs, all of which were the financial responsibility of Summit County. Child abuse through burns imposes a potentially preventable financial burden. This study does not take into account the socioeconomic and psychological impact on the abused victims through life, which is incalculable. By increasing awareness about the demographics and financial burden of child abuse, this paper may serve as a focus for further study and prevention of such abuse.

Correlation Between Histological Diagnosis and Mutational Panel Testing of Thyroid Nodules: A Two-Year Institutional Experience

BACKGROUND Indeterminate thyroid fine-needle aspiration (FNA) cytology, including atypia of undetermined significance (AUS/FLUS) and suspicious for follicular neoplasm (SFN), continues to generate uncertainty about the presence of malignancy, resulting in repeated follow-up, repeat FNA, or diagnostic surgery. Mutational panel testing may improve the malignancy risk prediction in indeterminate nodules, but the general application of such testing has not been investigated extensively. METHODS A retrospective review was performed of all patients undergoing thyroidectomy at a tertiary care facility over a two-year period. Mutational panel test results, when present, were analyzed relative to FNA cytologic result and surgical histopathologic diagnosis. Malignancy rates, sensitivity, specificity, positive predictive values (PPV), negative predictive values (NPV) and positive and negative likelihood ratios (LR) were calculated. RESULTS A total of 261 operated thyroid nodules had the following initial FNA cytology results: 2% non-diagnostic, 23% benign, 28% AUS/FLUS, 11% SFN, 9% suspicious for malignancy (SUSP), and 27% malignant. The histopathologic malignancy rate was 48%, subcategorized by cytology into benign 7%, AUS/FLUS 30%, SFN 38%, and SUSP 83%. Mutations were more frequent in indeterminate nodules that were histologically malignant versus benign (p < 0.0001) or versus adenoma (p = 0.001). Mutational analysis in 44 AUS/FLUS nodules resulted in a malignancy detection sensitivity of 85%, a specificity of 65%, a PPV of 50%, a NPV of 91%, and a positive LR of 2.4. In 12 SFN nodules analyzed with ThyroSeq(®) testing, sensitivity was 100%, specificity 57%, PPV 63%, NPV 100%, and LR 2.3. Performance of the seven-gene mutational panel was not significantly different from the ThyroSeq(®) panel in the AUS/FLUS group. The malignancy yield, comparing the mutation positive AUS/FLUS group with the untested AUS/FLUS surgical cohort, did not reach statistical significance (p = 0.17). CONCLUSIONS In a surgical cohort, a similar NPV but a lower PPV was found with the use of mutational panel testing compared to the published literature. Following the identification of a mutation, the prevalence of malignancy in the AUS/FLUS or SFN category was increased by nearly 15% to 45% and 53%, respectively. Further study is needed to confirm these results and to analyze clinical outcome subcategories relative to the utility of mutational testing.

Ultrasound for Localization in Primary Hyperparathyroidism

Objective To evaluate the capability of ultrasound for preoperative localization in primary hyperparathyroidism. Study Design Prospective study. Setting Multi-institutional Midwest Head and Neck Cancer Consortium. Subjects and Methods Two hundred twenty patients who underwent preoperative localization and had parathyroid surgery were evaluated. The findings of preoperative localization studies were correlated with surgical findings. Results Preoperative ultrasonography, sestamibi scintigraphy, or both were obtained in 77%, 93%, and 69% of the patients, respectively. Preoperative ultrasonography and sestamibi scintigraphy localized an abnormality in 71% and 79% of patients, respectively. At the time of surgery, the localization by ultrasound was accurate in 82%. The accuracy of localization was similar for sestamibi scintigraphy (85%). In patients with inaccurate ultrasound localization, the sestamibi scintigraphy correctly identified the site of disease in only 45%. In patients with a nonlocalizing ultrasound, sestamibi scintigraphy was able to localize disease in only 47%, with 2 being in the mediastinum. Conclusions Ultrasonography is an acceptable initial localization study for patients with primary hyperparathyroidism. In patients with nonlocalizing ultrasound, sestamibi scintigraphy should be obtained, but can be expected to detect an abnormality in less than 50% of patients.

Indications and extent of central neck dissection for papillary thyroid cancer: An American Head and Neck Society Consensus Statement

The primary purposes of this interdisciplinary consensus statement were to review the relevant indications for central neck dissection (CND) in patients with papillary thyroid cancer (PTC) and to outline the appropriate extent and relevant techniques required to accomplish a safe and effective CND.

Laparoscopic transdiaphragmatic thymectomy without chest incisions.

Mediastinal parathyroid adenomas are rare. Surgical resection is recommended. Traditionally median sternotomy has been the preferred approach; newer less invasive techniques have been described. The aim is to describe an innovative technique for thymectomy via a laparoscopic transdiaphragmatic approach avoiding any thoracic incisions and potentially chronic postoperative intercostal pain in a patient with a well localized mediastinal parathyroid adenoma. No intraoperative complications, parathyroid hormone essay normalized and the patient was discharged home on the second day. Laparoscopic transdiaphragmatic thymectomy seems feasible and safe. Further studies are needed.

An occult ectopic parathyroid adenoma in a pediatric patient: a case report and management algorithm.

Abstract Background: Hyperparathyroidism (HPT) is a rare disease in the pediatric population, and optimal management may be unclear if it is due to an occult parathyroid adenoma. We present a case report of a pediatric patient with an occult, ectopic, supernumerary, parathyroid adenoma. Case presentation: A 13-year-old female who initially presented with anxiety was diagnosed with HPT. Preoperative imaging and bilateral neck exploration with four-gland biopsy were negative for any parathyroid adenoma. Postoperative MRI identified a thymic mass. She subsequently underwent video-assisted thoracoscopic thymectomy with resection of an intrathymic parathyroid adenoma. Conclusions: The diagnosis of pediatric HPT is increasing. Supernumerary or occult parathyroid adenomas are rare and add complexity to presurgical planning and management. Our case represents the rare occurrence of a pediatric ectopic supernumerary occult parathyroid adenoma treated with a two-stage approach utilizing multiple imaging studies. We provide a review of the pathology and propose an algorithmic approach to manage these complex patients.