Modern Surgical Techniques of Thyroidectomy and Advances in the Prevention and Treatment of Perioperative Complications.

Thyroid cancer is the most common cancer of the endocrine system, and, in recent years, there has been a phenomenon of overdiagnosis followed by subsequent overtreatment. This results in an increasing number of thyroidectomy complications being faced in clinical practice. In this paper, we present the current state of knowledge and the latest findings in the fields of modern surgical techniques, thermal ablation, the identification and assessment of parathyroid function, recurrent laryngeal nerve monitoring and treatment and perioperative bleeding. We reviewed 485 papers, from which we selected 125 papers that are the most relevant. The main merit of this article is its comprehensive view of the subject under discussion-both general, concerning the selection of the appropriate method of surgery, and particular, concerning the selection of the appropriate method of prevention or treatment of selected perioperative complications.

The Use of Artificial Intelligence in the Diagnosis and Classification of Thyroid Nodules: An Update.

The incidence of thyroid nodules diagnosed is increasing every year, leading to a greater risk of unnecessary procedures being performed or wrong diagnoses being made. In our paper, we present the latest knowledge on the use of artificial intelligence in diagnosing and classifying thyroid nodules. We particularly focus on the usefulness of artificial intelligence in ultrasonography for the diagnosis and characterization of pathology, as these are the two most developed fields. In our search of the latest innovations, we reviewed only the latest publications of specific types published from 2018 to 2022. We analyzed 930 papers in total, from which we selected 33 that were the most relevant to the topic of our work. In conclusion, there is great scope for the use of artificial intelligence in future thyroid nodule classification and diagnosis. In addition to the most typical uses of artificial intelligence in cancer differentiation, we identified several other novel applications of artificial intelligence during our review.

Assessment of Preoperative TSH Serum Level and Thyroid Cancer Occurrence in Patients with AUS/FLUS Thyroid Nodule Diagnosis.

Thyroid-stimulating hormone (TSH) is a growth factor associated with the initiation and progression of well-differentiated thyroid cancer (WDTC). Atypia of undetermined significance and follicular lesion of undetermined significance (AUS/FLUS) are the most uncertain cytological diagnoses of thyroid nodules. The aim of the study was to determine the association of histopathological diagnosis with preoperative serum TSH levels in patients with AUS/FLUS thyroid nodule diagnosis. Among 5028 individuals with thyroid nodules, 342 (6.8%) with AUS/FLUS diagnoses were analyzed. The frequency of all histopathology diagnoses was assessed for associations with preoperative serum TSH levels. The median TSH concentration was significantly higher in patients with AUS/FLUS diagnosis and histopathology of WDTC than in patients with the same cytology result and histopathology of a benign tumor (p < 0.0001). The diagnostic potential of serum TSH level was determined to evaluate risk of malignancy in patients with thyroid nodules classified into the Bethesda III category. ROC analysis showed the TSH concentration at a cutoff point of 2.5 mIU/L to be an acceptable prognostic factor for WDTC. For this optimal cutoff point, the AUC was 0.877, the sensitivity was 0.830, and the specificity was 0.902. Preoperative serum TSH levels in patients with AUS/FLUS thyroid tumor diagnosis should be taken into consideration in the decision-making process and clinical management.

Update on the Diagnosis and Management of Medullary Thyroid Cancer: What Has Changed in Recent Years?

Medullary thyroid carcinoma (MTC) is a neoplasm originating from parafollicular C cells. MTC is a rare disease, but its prognosis is less favorable than that of well-differentiated thyroid cancers. To improve the prognosis of patients with MTC, early diagnosis and prompt therapeutic management are crucial. In the following paper, recent advances in laboratory and imaging diagnostics and also pharmacological and surgical therapies of MTC are discussed. Currently, a thriving direction of development for laboratory diagnostics is immunohistochemistry. The primary imaging modality in the diagnosis of MTC is the ultrasound, but opportunities for development are seen primarily in nuclear medicine techniques. Surgical management is the primary method of treating MTCs. There are numerous publications concerning the stratification of particular lymph node compartments for removal. With the introduction of more effective methods of intraoperative parathyroid identification, the complication rate of surgical treatment may be reduced. The currently used pharmacotherapy is characterized by high toxicity. Moreover, the main limitation of current pharmacotherapy is the development of drug resistance. Currently, there is ongoing research on the use of tyrosine kinase inhibitors (TKIs), highly specific RET inhibitors, radiotherapy and immunotherapy. These new therapies may improve the prognosis of patients with MTCs.

Advances in the Diagnosis and Therapeutic Management of Gastroenteropancreatic Neuroendocrine Neoplasms (GEP-NENs).

Neuroendocrine neoplasms (NENs) are an increasingly common cause of neoplastic diseases. One of the largest groups of NENs are neoplasms localized to the gastroenteropancreatic system, which are known as gastroenteropancreatic NENs (GEP-NENs). Because of nonspecific clinical symptoms, GEP-NEN patient diagnosis and, consequently, their treatment, might be difficult and delayed. This situation has forced researchers all over the world to continue progress in the diagnosis and treatment of patients with GEP-NENs. Our review is designed to present the latest reports on the laboratory diagnostic techniques, imaging tests and surgical and nonsurgical treatment strategies used for patients with these rare neoplasms. We paid particular attention to the nuclear approach, the use of which has been applied to GEP-NEN patient diagnosis, and to nonsurgical and radionuclide treatment strategies. Recent publications were reviewed in search of reports on new strategies for effective disease management. Attention was also paid to those studies still in progress, but with successful results. A total of 248 papers were analyzed, from which 141 papers most relevant to the aim of the study were selected. Using these papers, we highlight the progress in the development of diagnostic and treatment strategies for patients with GEP-NENs.

The analysis of the cases of circulatory and respiratory arrest in the work of the Regional Unit of Ambulance Service - Sródmiescie Station.

The major causes of deaths all over the world are circulatory system diseases, neoplasms and injuries. Each man can become a participant of the event which results in life-threatening emergencies and the most immediate possible actions are essential. The period of time for starting efficient life-restoration actions is very short, estimated at 4-5 minutes. Ambulance Service is a medical organization created to apply aid in life-threatening emergencies. The standards of the developed western countries determine the arrival time at 7-10 minutes from the call time. Both first-aid applied by the accident witnesses and efficient actions of ambulance service have significance for effective pre-hospital aid and increasing the chances of survival of people in need. The study analysed emergency records of the ambulance cars of the Regional Unit of Ambulance Service - Sródmiescie Station in Lublin in the year 2000. 3,723 calls were recorded. In 142 cases complete resuscitation actions were carried out due to circulatory and respiratory arrest. The records selected this way went through a detailed analysis. In 3.8% of the interventions of emergency teams the necessity of applying advanced life support was observed. The time of arrival at the scene, transport of the patient to the admission room as well as efficiency of resuscitation comply with the European standards. The efficiency of resuscitation actions estimated at 51.4% depended on the age of the patient, the cause of circulatory and respiratory arrest and ambulance arrival time. Taking up basic life support by witnesses of the event was observed in 2.8% of cases, in 8.5% aid was applied by the medical staff members who happened to be at the scene.

[Attitude of students of high schools in Lublin towards the problem of first aid]. / Postawy mlodziezy Lubelskich szkól srednich wobec problemu udzielania pierwszej pomocy.

Properly administered first aid--restoration of upper respiratory tract patency, pulmonary-circulatory resuscitation, massive internal bleeding arrest, placement of the victim in safe position--may save the lives of many victims of accidents. Everybody should know first aid principles and administer it before paramedics arrive. The aim of the study was to find out the opinion of high school students on first aid in emergency cases, determint to what extent young people are prepared to administer first aid as well as evaluate of actual way of training young people in schools. The survey study included 642 students of 3rd class of randomly chosen high schools in Lublin. Students filled in anonymous questionnaire with single choice answers. 571 respondents (89%) claimed that citizens of Lublin are not prepared to administer first aid in emergency cases. According to them only a small number of witnesses start first aid procedures. Lack of knowledge as well as disbelief in one's skills stop those who would like to help from taking part in rescue procedures. The results of the study show that almost 80% of respondents know how important first aid is. Only 21% undertakes first aid procedures at the scene of an accident. 67% claimed that their skills are insufficient. Unfortunately the level of first aid training is very poor. Student do not learn practical skills. Training should start in primary school and continue in adult life in the place of work. It should be conducted by physicians using the most modern didactic devices.

The behaviours of the inhabitants of the Lublin region in the situations of sudden cardiac arrest as reflected in the opinions of the Ambulance Service doctors.

Diseases of blood circulation system constitute the major cause of sudden cardiac arrest and deaths in Poland. Approximately 70% of all the cases of cardiac arrest occurs outside hospitals, frequently at patient's home. In the case of applying immediate resuscitation by the event witness in the situation of sudden cardiac arrest the percentage of the victims' survival is estimated at approximately 43%. Each delay of the initiation of Basic (BLS) and afterwards Advanced Life Support (ALS) lowers the chance of survival. Thus, it is extremely significant to educate Polish society in the area of basic resuscitative actions, particularly due to the fact that laypeople are usually the first ones at the scene of an accident. The aim of the paper was to determine to what extent the inhabitants of the Lublin region are prepared to rescue victims of sudden accidents by means of cardiopulmonary resuscitation and proper response in the situation of the sudden cardiac arrest. As results from the executed survey the inhabitants of the Lublin region in the situation of sudden cardiac arrest mostly do nothing but call an ambulance. The witnesses of the sudden cardiac arrest more frequently apply only rescue breathing or only indirect heart massage rather than rescue breathing and indirect heart massage simultaneously. The competence for applying CPR among the inhabitants of the Lublin region is poor and the resuscitative actions are much more frequently taken up by men. Premedical aid trainings are considered insufficient to prepare witnesses of sudden cardiac arrest for applying first-aid. They should be conducted by doctors, in properly prepared and equipped training centers. The majority of the Ambulance Service doctors in Lublin indicated the demand for reminder premedical aid trainings.