Cold steel versus impedance-dependent tissue sealer tonsillectomy - a study protocol for a randomised controlled trial.

INTRODUCTION: Approximately 7,000 tonsillectomies are performed annually in Denmark on a benign basis. The cold steel surgical technique is the gold standard. The risk of post tonsillectomy bleeding (PTH) in a centre in Jutland is 7.9%. A new impedance-dependent tissue sealer (IDTS) device has been developed, with preliminary results showing a reduction in operation time, perioperative bleeding and post-operative risk of bleeding of 4.5%. METHODS: A randomised, controlled, double-blinded multicentre trial of cold steel tonsillectomy versus IDTS will be performed on 1,250 patients. The main endpoint is PTH, perioperative bleeding, operation time and post-operative pain. The secondary outcomes are days until return to work, food intake, activity and quality of life. Included in the study are patients with indication for surgery weighing ≥ 16 kg, and excluded are patients with malignancy, bleeding disorders and unwillingness to participate in the study. CONCLUSIONS: To our knowledge, the present study is the largest randomised controlled trial in ENT surgery in the Nordic countries. The study will potentially provide evidence on PTH regarding two tonsillectomy methods. FUNDING: The authors have no potential conflicts of interest to declare. The study is supplied with instruments from Medtronic needed for the surgical procedures. Furthermore, a minor part of the funding of the entire project is provided by the aforementioned company. The funding providers have no role in design or conduct of the study. CLINICALTRIALS: gov with the identification number NCT05270109.

[Neuroendocrine paranasal tumour with symptoms from tooth in upper jaw].

In Denmark, the annual incidence of paranasal malignancies is approximately 60, often presenting with symptoms from growth into neighbouring structures. This case report is of a primary neuroendocrine paranasal tumour with distant metastases in an 81-year-old woman. Following a tooth extraction, the patient developed left side proptosis. A CT-scan showed a tumour of left ethmoidal sinus with local spreading to orbita, skull base, and contralateral ethmoid, and following scans visualised lymph node infiltration and multiple metastases. Paranasal malignancies can present with symptoms from teeth in upper jaw.

Outpatient hemithyroidectomy for benign thyroid disease.

INTRODUCTION: Hemithyroidectomy for benign thyroid disease has traditionally been considered an inpatient procedure due to concerns about post-operative complications, in particular the risk of post-thyroidectomy bleeding (PTB). Hemithyroidectomy in an outpatient setting has not yet been evaluated in a Danish context. This study aimed to evaluate outpatient compared to inpatient hemithyroidectomy in selected patients (no suspicion of malignancy, lesser-than 100 ml lobe, American Society of Anesthesiologists class I or II and no anticoagulation therapy) to investigate the safety of the procedure. METHODS: This cohort study was conducted between June 2014 and June 2019 in a Danish regional hospital and included all hemithyroidectomy patients. Data were obtained retrospectively from medical records. The primary outcome was PTB, and secondary outcomes included nerve injury, infection, perioperative drain placement, reintervention and unplanned hospital contacts. RESULTS: Hemithyroidectomy was performed in 229 patients. For 137 patients, the procedure was planned in an outpatient setting; and among these, 124 patients (91%) were completed as planned. None of the patients in either the outpatient or inpatient setting experienced PTB. In the outpatient group, 1.5% had permanent nerve injury of the recurrent nerve and 0.7% had a superficial wound infection which was treated with oral antibiotics. CONCLUSIONS: Hemithyroidectomy for benign thyroid disease is safe to perform in an outpatient setting for a selected patient group. FUNDING: none. TRIAL REGISTRATION: not relevant.

Thyroid fine-needle aspiration and The Bethesda Classification System.

INTRODUCTION: Fine-needle aspiration (FNA) is a cornerstone in diagnosing thyroid nodules. For decades, Danish FNA has been categorised into the groups: "FNA not performed", "Inadequate", "Cystic", "Inconclusive", "Benign", "Suspicious", "Malignant" and "Information missing". Internationally, The Bethesda Classification System (TBCS) is increasingly accepted, especially owing to a detailed specification of FNA suspicious for malignancy. The Danish "Suspicious" group is very broad and includes atypia, follicular neoplasia and FNA suspicious of other malignancies. The purpose of this study was to apply TBCS to the Danish "Suspicious" FNA group and to estimate the frequency of malignancy in the individual Bethesda groups (BG). METHODS: This descriptive study is based on a prospective cohort from the THYKIR database. It includes 479 patients with a "Suspicious" FNA and surgical treatment in The Region of Southern Denmark from 2001 to 2013. Based on pathology records, FNA was classified according to the TBCS. Malignancy was determined by the histological diagnosis from the THYKIR database. RESULTS: The Danish "Suspicious" group was allocated to the BG I, II, III, IV, V and VI with a malignancy risk of 36.4%, 13.3%, 17.2%, 16.1%, 55.3% and 88.2%, respectively. CONCLUSIONS: The Danish "Suspicious" group contains a broad spectrum of BG with varying malignancy risk. The results indicate a need for standardisation of the Danish FNA classification. A national introduction of the TBCS might secure an international and comparable standard. FUNDING: none. TRIAL REGISTRATION: not relevant.

Risk of malignancy in fine-needle aspiration biopsy in patients with thyroid nodules.

INTRODUCTION: Fine-needle aspiration biopsy (FNAB) is the cornerstone of thyroid nodule evaluation. In most cases, FNAB can discriminate between benign and malignant disease. In other cases, it is only indicative of malignancy and the results are considered "suspicious". In Denmark, thyroid FNAB results are categorised into six groups: "inadequate", "cystic", "inconclusive", "benign", "suspicious" and "malignant". The risk of malignancy in the Danish "suspicious" group is of interest for patients as well as doctors participating in the diagnosis and treatment. The Danish Thyroid Surgery Database (THYKIR) registers preoperative thyroid FNAB and final histology. The aim of this study was to assess the malignancy risk among patients with a suspicious thyroid FNAB according to the Danish criteria and to identify possible predictors of malignant histology. METHODS: A prospective cohort counting 483 patients with a "suspicious" thyroid FNAB who had been treated surgically in The Region of Southern Denmark in the 2001-2013 period was retrieved from the THYKIR database. RESULTS: The risk of malignancy in the Danish thyroid FNAB "suspicious" group is 22%. Serum thyroid-stimulating hormone outside the normal range and vocal cord palsy may be patient-related predictors of malignancy. CONCLUSION: Awaiting the introduction of reliable tools for preoperative evaluation, the current practice with histo-logical clarification of the "suspicious" thyroid FNAB seems justified. FUNDING: none. TRIAL REGISTRATION: not relevant.

[Intranasal non-Hodgkin lymphoma diagnosed as subsidiary finding by epistaxis]. / Intranasalt non-Hodgkin-lymfom diagnosticeret som bifund ved næseblødning.

A 84 year-old woman was transferred to the ENT ward for treatment of epistaxis. An anterior rhinoscopy revealed a posterior bleeding source which was cauterised. A submucosal bulge was found in the cavity floor and biopsied. Histologic examination showed diffuse large B-cell lymphoma. Oncologic examination disclosed Ann Arbor stage 1A. The patient was treated with chemotherapy followed by involved field radiation therapy. She responded well to the therapy. Intranasal lymphoma is rare in Denmark with an incidence rate of 0,1-0,2 per 100,000 per year.