Prospective Audit and Review of Parathyroid Surgery in Rural Setting.

Primary hyperparathyroidism (PHPT) is a common condition associated with significant morbidity and mortality. Recently Endocrine multidisciplinary team (MDT) has greatly influenced the care of such patient and has helped in improving the outcome and reducing the complications related with surgery. We conducted a review of prospectively collected data of all consecutive parathyroidectomies carried out in our district general hospital between October 2016 and Jan 2020 by a single surgeon. The collected data include patient's characteristics, laboratory results, radiological findings and operative outcomes. There were 53 parathyroidectomies performed during this period for PHPT. Mean age of patients was 75 years. Our results demonstrated a reduction in post-operative PTH in 46 patients (92%). We have identified no cases of vocal cord palsy, significant neck haemorrhage or mortality. 6 patients had temporary hypocalcaemia and 2 patients had hungry bone syndrome. Patient selection and evaluation for parathyroidectomies under endocrine MDT has greatly influenced the outcome for our patients. We had low complication rate and surgery was done at a more convenient location for selected patients. We benefit from dedicated monthly parathyroid clinic and weekly endocrine multidisciplinary team meetings to assist with patient selection and optimisation. A team effort helps in reducing complications and improving outcomes. We feel that surgery can be provided safely and successfully in a district general hospital in rural settings.

Pemphigus Vulgaris and Bullous Pemphigoid of the Upper Aerodigestive Tract: A Review Article and Novel Approaches to Management.

BACKGROUND: Autoimmune bullous diseases are rare conditions characterized by blistering of the skin and mucous membranes. The 2 commonest forms are pemphigus vulgaris and bullous pemphigoid. The oral cavity or oropharynx may be the initial site of presentation or often the only site involved. SUMMARY: These conditions are often misdiagnosed or overlooked leading to poorer patient outcomes. Due to the chronic nature of these conditions and the systemic effects of treatment, there is a significant associated morbidity and mortality. As such, an understanding of the fundamentals of autoimmune bullous diseases is vital to those working in otolaryngology. The mainstay of management in both conditions is topical and systemic corticosteroids. There is also a role for immunomodulating and non-steroidal anti-inflammatory drugs as adjunct or alternative therapies. Surgical intervention may be required to protect the airway. Often multimodality treatment is required involving multidisciplinary input from otolaryngologists, oral surgeons, dermatologists, and rheumatologists. This review article will highlight the aetiology, pathology, clinical features, investigations, and management of both pemphigus vulgaris and bullous pemphigoid including recent advances in management.

Systematic review and meta-analysis of the use of tranexamic acid in tonsillectomy.

Post-tonsillectomy haemorrhage is a serious complication that can lead to death despite the fact that tonsillectomy is one of the commonest procedures performed in otolaryngology. Post-operative haemorrhage can be reduced by a potent antifibrinolytic agent such as tranexamic acid (TXA). This systematic review aims to evaluate the role of TXA in tonsillectomy. Searches were performed on MEDLINE, EMBASE, Web of Science and the Cochrane Library. Study selection, data extraction and quality assessment were conducted independently by two reviewers. Mean difference (MD) in volume of blood loss was calculated with 95 % confidence interval (CI). Risk ratios (RR) with 95 % CI were computed using random effects for the risk of post-tonsillectomy haemorrhage. This review identified and included a total of seven studies. Two studies (n = 180) compared the effects of TXA on volume of blood loss. Meta-analysis of these studies showed a significant decrease in the mean blood loss of 32.72 ml (95 % CI -42.66 to -22.78, p < 0.00001). Five studies (n = 1,670) compared the number of patients with post-tonsillectomy haemorrhage between TXA and control groups. TXA does not reduce the number of patients with post-tonsillectomy haemorrhage significantly (RR = 0.51, 95 % CI 0.25 to 1.07, p = 0.08). TXA led to a significant reduction of tonsillectomy blood loss volume but had no impact on the rate of patients with post-tonsillectomy haemorrhage. This systematic review demonstrated that most studies were conducted before 1980; therefore, a new, large and well-designed randomised controlled trial is needed to investigate the risks and benefits of TXA.

Application of microfluidic systems in management of head and neck squamous cell carcinoma.

Microfluidics is an emerging multidisciplinary field that has the potential to provide solutions to many of the current challenges in managing head and neck squamous cell carcinoma (HNSCC). Treatment strategies for this disease are often complex and associated with significant morbidity and mortality; furthermore, prediction of response to treatment remains inaccurate. Microfluidic technology allows a small sample of tumor to be maintained alive ex vivo within a microenvironment that mimics the in vivo milieu; the response of this tumor biopsy to treatment regimens can subsequently be investigated. Microfluidics is the science and technology of systems that process or manipulate microliter to nanoliter volumes of fluids in purpose-built devices fabricated from glass or other biocompatible polymers. The technology also involves miniaturization and integration of various laboratory procedures into novel analysis devices. The purpose of this review is to provide an overview of microfluidic devices and discuss potential applications in HNSCC management.

The role of sequential chemoradiation for local advanced oropharyngeal carcinoma.

BACKGROUND: This study aims to assess survival, prognostic indicators, and pattern of failure for advanced oropharyngeal cancer treated by induction chemotherapy followed by concomitant chemoradiation (sequential CRT). METHODS: A retrospective review of 80 consecutive patients who underwent chemoradiation [doublet cisplatin and 5-fluorouracil (PF)] for local advanced oropharyngeal carcinoma at a tertiary center from March 2003 to July 2008 is reported. Seven studies utilizing a similar protocol were reviewed, and all outcomes are collated. RESULT: At a median follow-up of 32 months, the 3-year overall survival was 75%. Tumor size (p < 0.001), age at presentation (p < 0.002), and failure to complete the full course of induction chemotherapy (p < 0.01) were all found to be significant factors affecting survival. CONCLUSION: Induction chemotherapy followed by concomitant chemoradiation utilizing doublet PF is an effective treatment for local advanced oropharyngeal carcinoma. At present, the addition of a taxane to the PF regimen cannot be assumed to provide benefit until further evidence emerges from a representative controlled trial.

Extensive endoscopic sinus surgery: does this reduce the revision rate for nasal polyposis?

Nasal polyps treated either medically or surgically have a high recurrence rate. It is hypothesised that the performance of an extensive endoscopic sinus surgery (EESS), involving complete removal of nasal polyps along with full ethmoid clearance, will decrease the recurrence rate and therefore be an advantage to the patient. This study is a retrospective review of 149 patients who underwent EESS in a district general hospital. Surgical revision rates and perioperative complication data were recorded. A comparison was made with patients enlisted with the UK National Comparative Audit who underwent polyp disease removal limited to the anterior ethmoid cavity. A further measure regarding quality of life was derived from sinonasal outcome test 22 (SNOT-22). At 36 months after surgery, five patients from the extensive surgery group had undergone a revision procedure, which was significantly less than the National Audit figure (4.0 vs. 12.3% P = <0.006). The perioperative adverse complication rate was similar (7.4 vs. 6.6% P = <0.774). There is a large improvement in SNOT-22 scores from the pre-operative period (mean 39) to the post-operative period (mean 8). This study provides some evidence that extensive sinus surgery performed by an experienced rhinologist can lead to a lower revision rate without compromising patient safety. If a further prospective study confirms this hypothesis then this may provide a basis for change.