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1.
Ear Nose Throat J ; 102(7): NP349-NP357, 2023 Jul.
Article in English | MEDLINE | ID: mdl-33915059

ABSTRACT

OBJECTIVE: The presence of clinically detectable papillary thyroid carcinoma (PTC) metastases in the lateral neck is an indication for neck dissection (ND) and thyroidectomy. Although there is a consensus regarding the importance of therapeutic selective ND of involved levels II to IV in patients with clinically evident locoregional metastatic disease, the prognostic benefit of level V prophylactic ND remains debatable. METHODS: All patients who underwent thyroidectomy with ND for metastatic PTC between 2006 and 2019 were included in a single-institution retrospective study. Preoperative characteristics at initial presentation, imaging workup, intraoperative findings, and the final histopathological reports were retrieved from the institutional database. RESULTS: A total of 189 patients with locally advanced PTC were identified, of whom 22 (11.6%) patients underwent therapeutic selective ND at levels II to IV together with level V dissection due to clinical involvement. Comparison of the patients who were operated on level V to those who were not revealed no significant difference. The disease recurrence rate was 20.1% throughout an average follow-up of 5.1±3.1 years. No significant differences in recurrence rate were found between patients who underwent and those who did not undergo level V ND (22.7% vs 19.8%, P = .648). No recurrence at resected level V was detected during follow-up, while recurrence at level V was found in 4 (2.1%) patients who did not undergo level V dissection. Evidence of macroscopic and microscopic extrathyroidal extension was significant predictors of disease recurrence risk. CONCLUSION: There were no significant associations between level V dissection and risk for recurrence. Recurrence at level V was rare (4/189 patients, 2.1%). Our study's findings suggest a low prophylactic benefit of an elective level V ND. Elective level V ND should not be done routinely when lateral ND is indicated but should rather be considered after careful evaluation in high-risk patients.


Subject(s)
Carcinoma, Papillary , Thyroid Neoplasms , Humans , Neck Dissection/methods , Retrospective Studies , Carcinoma, Papillary/pathology , Neoplasm Recurrence, Local/pathology , Thyroid Neoplasms/surgery , Thyroid Neoplasms/pathology , Thyroidectomy/methods , Thyroid Cancer, Papillary/surgery , Lymph Nodes/pathology
2.
Clin Otolaryngol ; 46(6): 1165-1171, 2021 11.
Article in English | MEDLINE | ID: mdl-34329540

ABSTRACT

OBJECTIVES: To investigate the published time to extrusion of tympanostomy tubes inserted in the various quadrants of the tympanic membrane. METHODS: Publications were selected by a search with 'PubMed', 'Embase' and 'Web of Science'. A meta-analysis of time to extrusion as a function of tympanic membrane quadrant intubation was performed. DESIGN, SETTING, PARTICIPANT-NOT RELEVANT MAIN OUTCOME MEASURED: Extrusion rate of tympanostomy tubes inserted in the various quadrants of the tympanic membrane. RESULTS: Eleven studies describing 2232 tympanostomy tubes were enrolled into the quantitative meta-analysis. The extrusion rate was evaluated at 3-month intervals up to 24 months post-intubation, and it did not differ significantly at any of the time points tested for the superior and inferior anterior quadrants. The cumulative extrusion rates were as follows: 11 and 9%, 32 and 23%, 59 and 36%, 80 and 67%, 87 and 70%, 88 and 82%, and 96 and 89% in the superior and anterior quadrants, respectively, at 3, 6, 9, 15, 18, 21 and 24 months post-intubation, respectively. CONCLUSION: Time to extrusion of tympanostomy tubes are similar for all 3 tympanic membrane quadrants. The anterior superior quadrant intubation has no superiority in terms of intubation time.


Subject(s)
Foreign-Body Migration , Middle Ear Ventilation/methods , Otitis Media with Effusion/surgery , Humans , Prostheses and Implants , Time Factors
3.
Isr Med Assoc J ; 22(10): 605-611, 2020 10.
Article in English | MEDLINE | ID: mdl-33070482

ABSTRACT

BACKGROUND: There is limited clinical information on coronavirus disease-19 (COVID-19) patients in Israel. OBJECTIVES: To describe the characteristics, outcomes, and potential associations of hospitalized COVID-19 patients in Israel. METHODS: We conducted a single-center, retrospective study of 58 consecutive laboratory-confirmed COVID-19 patients admitted to Laniado Hospital, Israel, between 14 March 2020 and 14 May 2020. Demographic, clinical, and laboratory data on admission were collected and analyzed, and the association to subsequent respiratory failure was assessed. RESULTS: Mean age of patients was 70.7 ± 16.9 years (53% males, 47% females.); 74% had at least one co-morbidity. Most patients were of Jewish Ashkenazi descent. During hospitalization 15 patients (mean age 78.18 ± 10.35 years); 80% male, 73% Sephardi descent developed respiratory failure rates of 60% occurring on average 10.6 days following intubation. Laboratory tests at admission displayed a significant increase in C-reactive protein (CRP) and creatine kinase (CK) and a decrease in absolute lymphocyte count (ALC) in patients who eventually developed respiratory failure (163.97 mg/L, 340.87 IU/L, 0.886 K/µl vs. 50.01 mg/L and 123.56 IU/L, 1.28 K/µl, respectively). Multivariate logistic analysis revealed an integrated parameter of CRP, CK, and ALC highly correlated with respiratory failure. Receiver operating characteristic curve revealed the area under the curve of CRP, CK, and ALC and the integrated parameter to be 0.910, 0.784, and 0.754, respectively. CRP was the strongest predictor to correlate with respiratory failure. CONCLUSIONS: CRP, CK, and ALC levels on admission could possibly be used to detect high-risk patients prone to develop respiratory failure.


Subject(s)
Coronavirus Infections/epidemiology , Disease Progression , Emergency Service, Hospital/statistics & numerical data , Pneumonia, Viral/epidemiology , Respiratory Insufficiency/mortality , Severe Acute Respiratory Syndrome/diagnosis , Severe Acute Respiratory Syndrome/therapy , Academic Medical Centers , Aged , Aged, 80 and over , C-Reactive Protein/analysis , COVID-19 , Cohort Studies , Coronavirus Infections/prevention & control , Creatine Kinase/analysis , Diagnostic Tests, Routine/methods , Female , Humans , Israel , Laboratories, Hospital/organization & administration , Logistic Models , Lymphocyte Count , Male , Middle Aged , Multivariate Analysis , Outcome Assessment, Health Care , Pandemics/prevention & control , Pandemics/statistics & numerical data , Pneumonia, Viral/prevention & control , ROC Curve , Respiratory Insufficiency/diagnosis , Respiratory Insufficiency/therapy , Retrospective Studies , Survival Rate
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