Surgery
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Muscle weakness and wasting are known manifestations of hypercortisolism (HC). Central sarcopenia is a marker of frailty and predicts mortality. The hypothesis of this study is that central sarcopenia can be used as a marker of disease severity and frailty in patients with HC. ⋯ PMD and intra-abdominal fat are significantly related to 24HUC levels. Morphometric measures of the overall burden of HC may allow more precise assessment of disease severity.
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Anaplastic thyroid carcinoma (ATC) is fatal with resistance to radiotherapy because of the loss of intrinsic human sodium iodine symporter (hNIS). We determined whether vaccinia virus carrying hNIS kills and induces hNIS reexpression in ATC cells, facilitating deep-tissue imaging. ⋯ GLV-1h153 is an effective oncolytic agent against ATC. The results show hNIS-specific radiouptake in infected ATC cells, facilitating deep-tissue imaging. GLV-1h153 is a promising candidate for treatment and imaging, and potentially enhancing susceptibility to radioiodine therapy by converting non-hNIS-expressing cells into hNIS-expressing ATC cells.
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The optimal initial operative management of medullary thyroid cancer (MTC) and the use of biomarkers to guide the extent of operation remain controversial. We hypothesized that preoperative serum levels of calcitonin and carcinoembryonic antigen (CEA) correlate with extent of disease and postoperative levels reflect the extent of operation performed. ⋯ Preoperative serum calcitonin and TMN stage, but not extent of operation, were independent predictors of postoperative normalization of serum calcitonin levels. Future studies should evaluate preoperative serum calcitonin levels as a determinate of the extent of initial operation.
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Dialysis patients requiring valve surgery have high morbidity and mortality rates. Although elevated serum parathyroid hormone (PTH) levels are associated with increased mortality in dialysis patients, this correlation has not been investigated in patients undergoing cardiac valve operations. This study assesses the impact of PTH levels on mortality in dialysis patients undergoing valve operations. ⋯ Preoperative PTH level ≥ 200 pg/mL is predictive of increased mortality after valve surgery among dialysis patients. Hyperparathyroidism should be investigated further as a possible modifiable risk factor for postoperative mortality in this high-risk patient cohort.
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Evaluating surgical outcomes is an important tool to compare providers and institutions and to drive process improvements. Differing methodologies, however, may provide conflicting measurements of similar clinical outcomes making comparisons difficult. ACS-NSQIP is a validated, risk-adjusted, clinically derived data methodology to compare observed to expected outcomes after a wide variety of operations. The AHRQ-PSI are a set of computer algorithms to identify potential adverse in-patient events using secondary ICD-9-CM diagnosis and procedure codes from hospital discharge abstracts. ⋯ AHRQ-PSI algorithms identified less than a third of the ACS-NSQIP clinically important adverse events. Furthermore, the AHRQ-PSI identified a large number of events with no corresponding clinically important adverse outcomes. The sensitivity of the AHRQ-PSI for detecting clinically relevant adverse events identified by the ACS-NSQIP varied widely. The AHRQ-PSI as applied to postoperative patients is a poor measure of quality performance.