Comparing SF-6D and EQ-5D utilities across groups differing in health status

Objectives  To compare the EQ-5D and SF-6D within socio-demographic and clinical groups in a representative sample (n = 1,005) of the Greek general population and to examine mean utility differences across groups differing in health in this population and in a highly morbid disease sample (diabetes, n = 215). Methods  Association and level of agreement between instruments were estimated with Pearson’s r and the intraclass correlation coefficient (ICC), respectively. Paired-samples t-test was used to identify significant score differences, which were regarded as minimally important differences (MID) when they exceeded 0.03. The EQ-VAS was used to classify individuals into health status groups, covering the range from very poor to very good health, and the same classification was used in the diabetes sample. Results  EQ-5D and SF-6D were in agreement and strongly correlated over the entire sample (ICC = 0.536, P < 0.001 and r = 0.662, P < 0.001), but correlation varied according to socio-demographic factors and clinical conditions. In healthier responders, EQ-5D scores were significantly higher than SF-6D scores (P < 0.001) and differences constituted MIDs. Contrarily, in individuals with clinical conditions, SF-6D scores were predominantly higher than EQ-5D. The pattern of results was replicated in the disease sample as well. Conclusions  The hypotheses that EQ-5D generates higher scores in healthier populations and the SF-6D in less healthier groups were confirmed. Based on the evidence provided here, EQ-5D and SF-6D measuring discrepancies generate utility differences across VAS-based health groups, which warrant further within-sample investigation.     

Total thyroidectomy for benign disease in the pediatric patient—feasible and safe

Purpose

Total thyroidectomy (TT) is a safe and efficacious treatment of malignant thyroid disease in children. The role of TT in benign thyroid disease is less well-defined. The goal of this study was to compare the safety of TT performed for benign and malignant disease.

Methods

The medical records of 31 patients undergoing TT from January 2000 to June 2007 at a single center were reviewed. The benign cohort totaled 15 patients consisting of 12 with Graves' disease, 2 with hyperthyroidism, and 1 with large and symptomatic multinodular goiter. The malignant cohort totaled 16 patients consisting of 9 with malignant disease, 4 with a nodule and history of cancer or radiation exposure, and 3 with RET proto-oncogene mutations.

Results

The most common complication was transient hypocalcemia observed in 7 (46%) of 15 patients with benign disease and 9 (56%) of 16 patients with malignancy (P = .72). Permanent hypocalcemia, defined as need for calcium supplement 6 months postprocedure, was observed in 1 patient with benign disease (6.67%) and 1 patient with malignancy (6.25%; P = 1.0). A single parathyroid gland was reimplanted in 2 patients with malignancy and 2 patients with benign disease (P = 1.0). One case of keloid scar was noted, and no cases of recurrent laryngeal nerve palsy, nerve paralysis, tracheal injury, tracheostomy, or wound infection were encountered in either cohort. There were no cases of relapse hyperthyroidism in the benign cohort.

Conclusions

Similar rates of postoperative complications can be expected with TT for benign thyroid disease as compared to TT for malignant disease. Total thyroidectomy is a safe treatment option for benign thyroid disease in children.     

Three simple steps during closed laparoscopic entry may minimize major injuries

Objectives  To describe three steps: (1) the initial Veress pressure (VIP-Pressure), (2) transient high-pressure pneumoperitoneum (HIP-Entry) prior to trocar/cannula insertion, and (3) visual entry with a trocarless cannula during closed laparoscopic entry, which may reduce major injuries. Design  Prospective observational cohort study (Canadian Task Force Classification II-2). Setting  University-affiliated teaching hospital. Interventions  VIP-Pressure. During laparoscopic entry, the initial VIP pressure was measured and correlated against the body habitus and parity of 365 consecutive women. HIP-Entry was performed in 2,498 consecutive cases. In 100 women, the CO₂ volume, heart rate, blood pressure, oxygen saturation, and pulmonary compliance were recorded at pressures of 10, 15, 20, 25, and 30 mmHg. Visual entry with a trocarless blunt cannula was performed in 776 women. The cannula, housing a 0° laparoscope, was rotated clockwise applying minimal downward force. Measurements and results  VIP-Pressure. Pneumoperitoneum was established after one, two or three Veress needle attempts at the umbilicus in 82.4%, 10.9%, and 4.0% of women, respectively. In seven (2.2%), pneumoperitoneum was established at the left upper quadrant (LUQ) during the fourth attempt, and in two (0.6%) entry was abandoned. Median initial Veress pressure was 4 mmHg (range 2–10 mmHg). The VIP pressure correlated positively with women’s weight (r = 0.518, p < 0.001) and body mass index (BMI) (r = 0.545, p < 0.001), and negatively with parity (r = −0.179, p < 0.001). HIP-Entry. The abdomen was insufflated to 25−30 mmHg prior to primary trocar/cannula insertion. There were no changes in cardiovascular parameters between 15 and 30 mmHg. A 21% decrease in pulmonary compliance from 15 to 30 mmHg was of no clinical significance. No injury has been experienced with the visual cannula in 776 cases. Conclusions  (1) A VIP-Pressure (<10 mmHg) indicates intraperitoneal placement of the Veress needle. (2) The use of transient HIP-Entry does not adversely affect cardiopulmonary function in healthy women. (3) Visual cannula offers an additional step towards safer entry.     

How does the operative strategy for primary hyperparathyroidism impact the findings and cure rate? A comparison of 800 parathyroidectomies

BACKGROUND: We hypothesized that a higher frequency of multigland disease and higher cure rate would result if routine four-gland exploration (4GL) was used as compared with focused parathyroidectomy (FP) for treatment of primary hyperparathyroidism. STUDY DESIGN: During a 5-year period, data from two academic endocrine surgical practices were retrospectively reviewed for patients having an operation for primary hyperparathyroidism. Three hundred ninety-five consecutive patients underwent 4GL at one institution (A), and 405 consecutive patients underwent FP with selective use of 4GL at the other institution (B). The main outcomes measures were gender, preoperative imaging, surgical findings, gland weight, and operative success. RESULTS: Three hundred ten (78%) patients at institution A were women, and 292 (72%) at institution B were women (p < 0.05). Routine 4GL strategy at institution A yielded a 16.5% frequency of multigland disease; and an FP strategy at institution B yielded 11.1% multigland disease (p = 0.028). At both institutions, single adenomas weighed more than multigland disease. Gland weights were not significantly different between the two institutions. Nine of 395 (2.3%) patients at institution A remained hypercalcemic postoperatively compared with 15 of 405 (3.7%) at B (p = 0.24; not significant). CONCLUSIONS: A greater frequency of multigland disease was found with routine 4GL. There was no statistically significant difference in operative success between the two approaches. Sound surgical technique and intraoperative judgment, including interpretation of intraoperative parathyroid hormone values, will result in a high success rate, regardless of the operative strategy chosen for primary hyperparathyroidism.     

Prosthetic valve endocarditis due to Acinetobacter spp: a rare case and literature review

A rare case of prosthetic valve endocarditis from Acinetobacter spp occurring 9 months postoperatively is described. The patient initially received empirical therapy against pathogens commonly associated with prosthetic valve endocarditis, but his condition did not improve. Identification of bacteremia due to Acinetobacter spp was not attributed to any of the classic nosocomial factors such as presence of a catheter or a recent invasive procedure. The patient did well with an intravenous regimen of meropenem and tobramycin instituted according to susceptibility testing. Physicians should be aware of this rare association of a nosocomial pathogen such as Acinetobacter spp with prosthetic valve endocarditis occurring long after the initial cardiothoracic procedure.     

Cardiac arrest and cardiopulmonary resuscitation in “hostile” environments: Using automated compression devices to minimize the rescuers’ danger

Mechanical automated compression devices are being used in cardiopulmonary resuscitation instead of manual, “hands-on”, rescuer-delivered chest compressions. The -theoretical- advantages include high-quality non-stop compressions, thus freeing the rescuer performing the compressions and additionally the ability of the rescuer to stand reasonably away from a potentially “hazardous” victim, or from hazardous and/or difficult resuscitation conditions. Such circumstances involve cardiopulmonary resuscitation (CPR) in the Cardiac Catheterization Laboratory, especially directly under the fluoroscopy panel, where radiation is well known to cause detrimental effects to the rescuer, and CPR during/after land or air transportation of cardiac arrest victims. Lastly, CPR in a coronavirus disease 2019 patient/ward, where the danger of contamination and further serious illness of the health provider is very existent. The scope of this review is to review and present literature and current guidelines regarding the use of mechanical compressions in these “hostile” and dangerous settings, while comparing them to manual compressions.     

Treatment of hydatid liver disease

BACKGROUND: Echinococcal disease is still a serious problem in certain parts of the world. The liver is the organ affected most frequently. Over recent decades, various reports have been published comparing standard surgical and more conservative modalities for the treatment of the disease. Proper selection among the strategies reported so far could be the most appropriate part of successful patient management. METHODS: A thorough review of the most recent reports on the treatment of liver Echinococcus infection, including percutaneous drainage, medical management, and laparoscopic, endoscopic and open surgical approaches has been conducted, focusing on patient outcomes. RESULTS: The standard surgical approach, namely partial capsectomy, drainage, and epiploplasty, remains the most frequent operative method. Previous problems such as disease recurrence and a residual cavity seem to be managed optimally with more radical operations such as total pericystectomy. Laparoscopic and endoscopic approaches (endoscopic retrograde cholangiopancreatography and sphincterotomy) appear to have a crucial role, especially when the location of the cyst or the patient's status does not permit more radical approaches. Percutaneous computed tomography- or ultrasound-guided drainage appears to be of great value in certain cases. Chemotherapeutic agents remain useful as an adjuvant treatment. CONCLUSIONS: Appropriate patient selection and proper use of the various available treatments are of great importance. A tailor-made approach should be employed for each patient. The surgeon's experience constitutes a principal criterion. To achieve the best possible results, an interdisciplinary approach should be used in the majority of patients.     

Pancreatic injury after thoracoabdominal aortic occlusion in a porcine model

BACKGROUND: The aim of this study was to investigate pancreatic injury after 45 min of thoracoabdominal aortic occlusion in a porcine model. METHODS: Twenty-four pigs were used. Six pigs underwent sham operation and 18 intravascular balloon thoracoabdominal aortic occlusions for 45 min. The animals were randomly killed at 12, 48 and 120 h after reperfusion. After killing, all pancreata were examined macroscopically for any signs of acute pancreatitis, whereas gland specimens were harvested for histological study to evaluate pancreatic injury (haematoxylin and eosin staining) and acinar cell apoptosis (Terminal deoxynucleotidyl transferase mediated dUTP Nick-End Labelling staining). RESULTS: Pancreatic injury severity score was mildly increased in terms of oedematous features at 12 h after reperfusion, but normalized to sham levels by the second day and thereafter. Necrotic injury was not statistically significant at any time point. Acinar cell apoptotic index was mildly increased at 12 and 48 h, but showed a tendency to decrease towards sham levels by the fifth day. One animal developed acute pancreatitis. CONCLUSION: Acute pancreatitis is unlikely to occur after 45 min of thoracoabdominal aortic occlusion. However, an early, mild oedematous and apoptotic injury that occurs subclinically seems to be a constant event. This injury might have clinical significance when combined with pre-existent pancreatic pathologies.     

Nonsteroidal anti-inflammatory drugs and coma: a case report of fenoprofen overdose

We present the case of a 17-year-old girl who ingested 24 to 36 g fenoprofen as a suicidal gesture. She presented with coma, hypotension, metabolic acidosis, and respiratory depression within four hours of ingestion. The most common adverse effects of the nonsteroidal anti-inflammatory drugs occur in both therapeutic and toxic doses and include gastrointestinal upset, blood dyscrasias, and analgesic nephropathy. The propionic acid derivatives of nonsteroidal anti-inflammatory drugs, including fenoprofen and ibuprofen, are rarely associated with severe toxic effects. This is the first report of pure fenoprofen overdose presenting as coma and metabolic acidosis.