Single port thoracoscopic diaphragm plication: A novel treatment approach to bilateral phrenic nerve palsy and diaphragm paralysis.

INTRODUCTION AND IMPORTANCE: The diaphragm is the primary muscle of respiration. Bilateral paralysis of the diaphragm due to phrenic nerve palsy causes severe dyspnoea and is life threatening. Diaphragmatic Plication has shown great promise in treating diaphragm paralysis and has evolved as operative treatment from an open thoracotomy to multiport and robotic video assisted thoracoscopic surgery. CASE PRESENTATION: Here we present a case of idiopathic bilateral diaphragm paralysis resulting significant deterioration in lung function tests, supplemental oxygen, and ventilator dependence. The patient was treated with a 2-stage operative plication of each hemidiaphragm through a 2.5 cm single incision thoracoscopic technique, which resulted in normalization of lung function tests, elimination of oxygen dependence and negligible analgesia requirements. CASE DISCUSSION: This is the first case reported in the literature of a single port VATS plication of the diaphragm for the treatment of bilateral phrenic nerve palsy. Surgery, specifically diaphragm plication, is indicated for patients with significant symptoms and persistent paralysis. Video-assisted thoracoscopic surgery (VATS) has evolved from open operations to smaller incisions, offering improved lung function, postoperative pain, hospital stay, morbidity, and mortality. CONCLUSION: Single port diaphragmatic plication is a novel approach to the treatment of bilateral phrenic nerve palsy. We make the case for indication of the technique for treatment of diaphragmatic paralysis.

Thyroidectomy for thyroid cancer in the elderly: A meta-analysis.

Thyroid cancer, the most common endocrine malignancy, has patients who generally have excellent prognosis. It has been shown that elderly patients are more likely to undergo sub-therapeutic management, despite having more aggressive disease, resulting in increased mortality and morbidity. The present study aimed to quantitatively investigate the risks of elderly patients who underwent thyroidectomy for thyroid cancer regarding mortality/survival, recurrence of disease, and complications arising from thyroidectomy. A systematic search and meta-analysis was carried out using the electronic databases PubMed and Medline. We searched for articles containing epidemiological evidence of mortality and recurrence of disease in patients above the age of 60, who are treated for operatively thyroid cancer and data involving complications following total thyroidectomy. The meta-analysis consisted of a total of 16 studies meeting the inclusion and exclusion criteria. The current study confirmed that patients have increased risk of recurrence (HR 4.84; 95% CI = 22.2-10.52; I2 = 0.00; P = 0.98) including increased risk of lymph node recurrence and distant metastases. Additionally these patients had an increased risk of complications (OR 1.82; 95% CI = 0.88-3.77; I2 = 77.01; P = 0.005) following thyroidectomy compared to patients in the younger cohort. The current study also qualitatively compared survival data between the different age cohorts, and identified a reduced overall survival and disease free survival for elderly patients. The current study suggests that elderly patients should be classified as higher risk following total thyroidectomy for thyroid cancer and puts an emphasis is early detection and intervention.

Multifocality as a prognostic factor in thyroid cancer: A meta-analysis.

BACKGROUND: Thyroid cancer is one of the most common endocrine cancers whose incidence has been steadily increasing. Previous studies have suggested that multifocality in thyroid cancer is associated with poor prognosis. The present study aims to quantify the data on multifocality as a factor indicating poor prognosis by meta-analysis. METHODS: A systematic search was carried out using the electronic databases PubMed and Medline. We searched for articles containing keywords of multifocality and thyroid cancer, as well as risk factors and prognostic factors for thyroid cancer (Lymph node metastases, extrathyroidal extension, distant metastases, disease recurrence, Age, tumour size. and gender). Data sets containing hazard ratios and odds ratios were then compared. RESULTS: The meta-analysis was performed using a total of 21 articles, showed that multifocality is associated with an increased risk of development of LNM (12 Studies: OR = 1.87; 95% CI = 1.51-2.32; I2 = 49.11; p-value = .03), Extrathyroidal extension (15 Studies: OR = 3.18; 95% CI = 0.69-14.71; I2 = 95.62; p-value <.001), Tumour Size > 1 cm (3 Studies: OR = 2.75; 95% CI = 1.95-3.89; I2 = 0.00 and p-value = .88) and disease recurrence (5 Studies: HR = 2.81; 95% CI = 1.07-7.36; I2 = 95.85; p-value < .001). Risk factors that did not significantly contribute to a higher incidence of multifocality include Age >45, Male Gender. CONCLUSIONS: Multifocality in thyroid cancer is a significant risk factor for disease progression and increases the risk of disease recurrence. The present study suggests that patients who have multifocal disease should therefore be managed more aggressively from an operative and post-operative perspective.

The association between breast cancer and thyroid cancer: a meta-analysis.

Previous studies have suggested an association between breast cancer and thyroid cancer; however, there has not been a formal meta-analysis which collates the existing evidence supporting the hypothesis that breast cancer or thyroid cancer predisposes an individual to developing the other. A systematic search was carried out using PubMed and Medline. We searched for articles containing epidemiological evidence of breast cancer following thyroid cancer and vice versa. Additionally, we searched for articles that included epidemiological data involving the incidence of all second primary malignancies (SPMs) following both breast cancer and thyroid cancer, and compared the datasets. The meta-analysis performed in a total of 18 studies showed that there is a significantly increased risk of developing thyroid cancer as a second primary malignancy of breast cancer (SIR = 1.59, 95 % confidence interval (CI) 1.28-1.99). Additionally, there was marginally increased risk of developing breast cancer as a second primary malignancy of thyroid cancer (SIR = 1.24, 95 % CI 1.16-1.33), compared to the general risk of developing a second primary malignancy following thyroid cancer. The findings suggest that the risk of developing thyroid cancer as a second primary malignancy of breast cancer and vice versa is increased compared to the background risk of developing other SPMs. The risk of developing thyroid cancer after a primary breast cancer was higher than the risk of developing breast cancer as a second primary malignancy of thyroid cancer. This suggests that the effects of treatment-related factors and specific pathological processes of each cancer may contribute to the increased risk rather than common risk factors including genetic factors. Elucidation of the common mechanisms between breast cancer and thyroid cancer will have important implications in both diagnostic and therapeutic management of these cancers. Benefit of thyroid ultrasound screening after breast cancer surgery needs to be assessed.

On the superhydrophobic properties of nickel nanocarpets.

A surface formed by dense, aligned nickel nanowires (a "nanocarpet") was prepared by electrodeposition through an alumina membrane template, followed by dissolution of the membrane. The nickel nanowires forming the nanocarpet have a very high aspect ratio ( approximately 250), with a diameter of 200 nm and a length of several tens of micrometers. The nickel nanowires are highly rigid, perpendicularly aligned in the nanocarpet with respect to the substrate, and they touch each other at the tips, forming microscale "tepee"-shaped aggregates. By comparison, nanocarpets made of platinum nanowires have a more disordered, wave-like appearance. The nickel nanocarpet, once coated with a hydrophobic surfactant (stearic acid) has superhydrophobic properties (advancing contact angle approximately 158 degrees), and retains its superhydrophobicity after periods of immersion in water, similar to the hydrophobised platinum nanocarpet (advancing contact angle approximately 162 degrees). Interestingly, we observe that simple electrodeposition of platinum also produces pronounced superhydrophobic properties on "flat" copper surfaces. The magnetic properties of nickel might widen the range of applications in which nanocarpets can be gainfully used, such as in surfaces of switchable wettability for microfluidic applications.