Recent studies suggest improved outcomes for children undergoing thyroidectomy at high-volume pediatric surgery centers. We present outcomes after thyroid surgery at a single center and advocate for ...referral to high-volume centers for multidisciplinary management of these children.
Medical records were reviewed for all pediatric patients undergoing thyroid surgery at a single institution from 2009 through 2017. Routine recurrent laryngeal nerve and parathyroid hormone monitoring was used. Lymph node dissections were performed in appropriately selected cancer patients. Data collection focused on pathologic diagnosis, surgical technique, and surgical complications, including postoperative hematoma, neurapraxia, permanent nerve damage, hypocalcemia, and transient and permanent hypoparathyroidism.
From 2009 through 2017, 464 patients underwent thyroid surgery. Median age of the cohort was 15 years (range 2–24). Thirty-three percent were diagnosed with benign nodules (n=151), 36% with papillary or follicular thyroid cancer (n=168), 27% with Graves’ disease (n=124), 3% with medullary thyroid cancer (n=14), and 1.5% underwent prophylactic thyroidectomy for MEN2a (n=7). Six patients required return to the OR for hematoma evacuation including 5 patients after surgery for Graves’ disease (RR 8.7, 95% CI 1.06–71.85). In sixteen cases, concern about neurapraxia resulted in laryngoscopy, revealing eleven patients with vocal cord paresis. Two of these patients demonstrated a persistent deficit at 6 months postoperatively (0.4%). Thirty-seven percent of patients had transient hypoparathyroidism (n=137), and two patients had persistent hypoparathyroidism 6 months after total thyroidectomy (0.6%). There was no significant difference in either hypocalcemia or hypoparathyroidism after total thyroidectomy based on age or diagnosis.
Characterizing outcomes for pediatric patients based on diagnosis will assist in preoperative counseling for patients and their families. This high-volume center reports low complication rates after pediatric thyroid surgery, highlighting that referral to high-volume centers should be considered for children and adolescents with thyroid disease requiring surgery.
Level IV
Synthesis of outcrop and subsurface sedimentological and geomorphological datasets across North Africa allows a tentative palaeo-glaciological model of the flow dynamics and recessional character of ...a 440 Ma old (Hirnantian) ice sheet to be proposed. A system of eight cross-shelf trough depocentres is identified from the Late Ordovician of the Sahara region. These are interpreted to have been carved and occupied by ice streams, providing evidence for widespread heterogeneous flow within the ice sheet. During retreat, two key geological features were produced: (1) laterally extensive, sinuous to linear piles of sediment dumped parallel to the ice margin; (2) large meltwater channels (tunnel valleys) cut near the grounding line.
Highlights • CRT and definitive TORS offer similar oncologic outcomes in early stage OPSCC. • TORS resulted in improved short and long-term saliva-related QOL compared to CRT. • Use of adjuvant ...therapy after TORS lead to worse saliva and taste-related QOL. • Use of TORS and N classification were significant predictors of saliva-related QOL.
The New Zealand Active Faults Database Langridge, RM; Ries, WF; Litchfield, NJ ...
New Zealand journal of geology and geophysics,
01/2016, Letnik:
59, Številka:
1
Journal Article
Recenzirano
The New Zealand Active Faults Database (NZAFD) is a national geospatial database of active faults - including their locations, names and degrees of activity - that have deformed the ground surface of ...New Zealand within the last 125,000 years. The NZAFD is used for geological research, hazard modelling and infrastructure planning and is an underlying dataset for other nationally significant hazard applications such as the National Seismic Hazard Model. Recent refinements to the data structure have improved the accuracy of active fault locations and characteristics. A subset of active fault information from the NZAFD, generalised for portrayal and use at a scale of 1:250,000 (and referred to as NZAFD250), is freely available online and can be downloaded in several different formats to suit the needs of a range of users including scientists, governmental authorities and the general public. To achieve a uniform spatial scale of 1:250,000 a simplification of detailed fault locational data was required in some areas, while in other areas new mapping was necessary to provide a consistent level of coverage. Future improvements to the NZAFD will include the incorporation of data on active folds and offshore active faults.
Although whole‐exome sequencing (WES) is the gold standard for the diagnosis of neurodevelopmental disorders (NDDs), it remains expensive for some genetic centers. Commercialized panels comprising ...all OMIM‐referenced genes called “medical exome” (ME) constitute an alternative strategy to WES, but its efficiency is poorly known. In this study, we report the experience of 2 clinical genetic centers using ME for diagnosis of NDDs. We recruited 216 consecutive index patients with NDDs in 2 French genetic centers, corresponded to the daily practice of the units and included non‐syndromic intellectual disability (NSID, n = 33), syndromic ID (NSID = 122), pediatric neurodegenerative disorders (n = 7) and autism spectrum disorder (ASD, n = 54). We sequenced samples from probands and their parents (when available) with the Illumina TruSight One sequencing kit. We found pathogenic or likely pathogenic variants in 56 index patients, for a global diagnostic yield of 25.9%. The diagnosis yield was higher in patients with ID as the main diagnosis (32%) than in patients with ASD (3.7%). Our results suggest that the use of ME is a valuable strategy for patients with ID when WES cannot be used as a routine diagnosis tool.
TruSight One global diagnostic yield in 216 consecutive patients with neurodevelopmental disorder, negative for X fragile and chromosomal microarray from 2 French clinical genetic centers (25.9%).
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