Author: Jason Curtis

Recurrent laryngeal nerve function after central neck dissection (2017)

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Type of publication:
Conference abstract

Author(s):
*Fussey J.; *El-Shunnar S.; *Spinou C.; *Hughes R.; *Ahsan F.

Citation:
European Journal of Surgical Oncology; Dec 2017; vol. 43 (no. 12); p. 2388-2389

Abstract:
It is generally accepted that central compartment neck dissection (CCND) improves locoregional recurrence rates in cases of known central compartment lymph node involvement, however the practice of prophylactic CCND is somewhat more controversial. It is often quoted anecdotally that the risk of damage to the recurrent laryngeal nerve is higher during CND than in thyroidectomy only. The aim of this study was to evaluate recurrent laryngeal nerve injury rates following CND in thyroid cancer patients. Prospectively collected data from three head and neck cancer centres was retrospectively analysed to identify patients who underwent CND with or without concurrent thyroid surgery over a three-year period. Fifty-eight patients underwent CND, 35 of which were bilateral. There were therefore 92 recurrent laryngeal nerves at risk. The temporary recurrent laryngeal nerve palsy rate was 2.2%, and the permanent palsy rate was 3.3%. All cases of permanent recurrent laryngeal palsy occurred in patients undergoing CND and total thyroidectomy for pT4 disease. Many factors can affect recurrent laryngeal nerve palsy rate following CND, including surgeon experience, tumour characteristics and extent of dissection. Our experience suggests that the risk to the nerve in CND is no higher than in standard thyroid surgery.

Incidence of recurrent laryngeal nerve palsy and hypocalcaemia following thyroidectomy in a district general hospital setting by a single surgeon (2017)

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Type of publication:
Conference abstract

Author(s):
*McNamara K.; *Albuidair A.; *Ahsan F.

Citation:
European Journal of Surgical Oncology; Dec 2017; vol. 43 (no. 12); p. 2389

Abstract:
Background: The British Association of Endocrine and Thyroid Surgeons' (BAETS) set a standard of permanent recurrent laryngeal nerve (RLN) palsy of 1-2% and risk of permanent hypocalcaemia of 5-10%. Aim: To establish ates of permanent recurrent laryngeal nerve palsy and post-operative hypocalcaemia from thyroidectomy by a single surgeon in a District General Hospital Setting. Methods: Patient demographics, rates of permanent recurrent laryngeal nerve palsy and postoperative hypocalcaemia were obtained from all hemithyroidectomy, completion thyroidectomy and total thyroidectomy procedures performed between June 2012 and January 2017. Data was collected from the online Clinical Portal. All cases of RLN palsy and hypocalcaemia had been documented in patient's clinical letters. Results: 245 thyroidectomy procedures were performed during this time. This included 179 hemithyroidectomy, 41 completion thyroidectomy and 16 total thyroidectomy procedures. 1/245 (0.4%) patient suffered with permanent recurrent laryngeal nerve palsy in this patient group. 1/57 patients (2%) developed postoperative hypocalcaemia following completion or total thyroidectomy. Conclusion: This study reveals a lower incidence of RLN palsy and hypocalcaemia than is set by standards. Careful preoperative evaluation helps in achieving a satisfactory outcome in thyroid surgery. Thyroid surgery is safe to be done in a District General Hospital in the hands of a Head and Neck surgeon with a subspecialist fellowship training in thyroid.

The novel use of dental suction tubing in the decompression of large dental cysts (2017)

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Type of publication:
Conference abstract

Author(s):
*Otukoya R.; *Mihalache G.; *Castling B.

Citation:
British Journal of Oral and Maxillofacial Surgery; Dec 2017; vol. 55 (no. 10)

Abstract:
Introduction: Dental suction tubing is widely available in OMFS Units. It has a metal radiopaque marker and can easily be cut to the desired length with scissors. It is relatively inexpensive and has a reinforced lumen that makes easy access for saline irrigation.We have used this tubing now in 3 large odontogenic cysts of the jaws and present this as an aid to effective and simple cyst decompression. Materials/Methods: Large odontogenic cysts present a surgical challenge in terms of recurrence prevention, protection of the inferior dental nerve and teeth and avoidance of mandibular fracture. We have effectively managed 3 such cases with the insertion of a segment of dental suction tubing as a decompression grommet at the same time as local anaesthetic biopsy of the cyst lining. The tube rigidity maintains patency and it is robust enough to allow easy self-irrigation by the patient. The position of the tubing can be assessed radiographically. Results: We allowed decompression over a 3 to 6 month period prior to formal cyst enucleation. There were no complications or failures of the tube patency. The benefits of decompression were clear as a demonstrable bony infilling and reduction in cyst size. Additionally the cyst lining became markedly thicker and easier to enucleate intact, an advantage in odontogenic kearatocysts. Conclusions:We would like to commend this dental suction tube grommet technique as an effective way to manage large odontogenic cysts of the jaws.

Sex differences in the splenic flexure (2017)

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Type of publication:
Journal article

Author(s):
Brookes A.F.; Macano C.; Meecham L.; *Stone T.; *Cheetham M.

Citation:
Annals of the Royal College of Surgeons of England; Jul 2017; vol. 99 (no. 6); p. 456-458

Abstract:
INTRODUCTION Anecdotally, surgeons claim splenic flexure mobilisation is more difficult in male patients. There have been no scientific studies to confirm or disprove this hypothesis. The implications in colorectal surgery could be profound. The aim of this study was to assess quantitatively whether there is an anatomical difference in the position of the splenic flexure between men and women using computed tomography (CT). METHODS Portal venous phase CT performed for preoperative assessment of colorectal malignancy was analysed using the hospital picture archiving and communication system. The splenic flexure was compared between men and women using two variables: anatomical height corresponding to the adjacent vertebral level (converted to ordinal values between 1 and 17) and distance from the midline. RESULTS In total, 100 CT images were analysed. Sex distribution was even. The mean ages of the male and female patients were 68.1 years and 66.7 years respectively (p=0.630). The mean vertebral level for men was 8.88, equating to the inferior half of the T11 vertebral body (range: 1-17 [superior half of T9 to inferior half of L2]), and 11.36 for women, equating to the inferior half of the T12 vertebral body (range: 4-16 [superior half of T10 to superior half of L2]). This difference was statistically significant (p=0.0001) and is equivalent to one whole vertebra. The mean distance from the midline was 160.8mm (range: 124-203mm) for men and 138.2mm (range: 107-185mm) for women (p<0.0001). CONCLUSIONS The splenic flexure is both higher and further from the midline in men than in women. This provides one theory as to why mobilising the splenic flexure may be more difficult in male patients.

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Managing glycaemic trends in people with diabetes requiring enteral feeding support: The challenges in primary and secondary care (2017)

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Type of publication:
Journal article

Author(s):
*Richardson, Erica A.; Agbasi, Nneka

Citation:
Journal of Diabetes Nursing; Aug 2017; vol. 21 (no. 7); p. 241-246

Abstract:
Matching therapeutic treatments to manage glycaemic excursions in people with diabetes receiving enteral nutrition (e.g. nasogastric, gastrostomy or jejunostomy) can be difficult. There is evidence to suggest that there is an increased risk of complications and mortality, longer lengths of stay in hospital, higher risk of intensive care input and higher demands for transitional or nursing home care post discharge. Other intrinsic factors, such as illness, timing of medications, poly-pharmacy, types of feeding regimen chosen and history of diabetes, all need to be considered when choosing appropriate treatments. This article describes the challenges of supporting people with diabetes requiring enteral feeding and the implications for diabetes nurses.

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Auditing the complications of LLETZ cervical treatment versus cold-coagulation over a one-year period (2017)

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Type of publication:
Conference abstract

Author(s):
*Ali N.; *Kandareachichi P.; *Blackmore J.; *Papoutsis D.; *Panikkar J.

Citation:
BJOG: An International Journal of Obstetrics and Gynaecology; Nov 2017; vol. 124 ; p. 33

Abstract:
Introduction We aim to audit the complication rates of women treated with either LLETZ cervical treatment or cold-coagulation in our colposcopy unit against the standards set out by the NHSCSP guidelines. It is reported that the proportion of treatment associated with primary haemorrhage that requires a haemostatic technique must be less than 5%, and the proportion of cases admitted as inpatients because of treatment complications must be less than 2%. Methods We retrospectively collected data from our electronic colposcopy database for women treated over the time period of August 2015 – July 2016. Hospital notes were retrieved for those who were identified with complications for further data collection. Results We identified 494 patients with LLETZ and 24 patients with cold-coagulation treatment. There were no complications noted after cold-coagulation. There were 12/494 (2.4%) patients who had post-LLETZ bleeding with one patient being admitted as an inpatient for further management (1/518 or 0.2). The bleeding occurred between 2-28 days after treatment, with 42% of women having had treatment under a general anaesthetic mainly due to a large lesion size. The mean age of women with bleeding was 39 years (range: 27-59) with a mean BMI of 26 kg/m2 (range: 17-34). Only one in three women with bleeding required oral antibiotics, and less than 8% of women had a temporary vaginal pack. All women with bleeding were self-referred directly to the colposcopy service without prior GP consultation/examination. Conclusion We are compliant with the NHS-CSP auditable standards with regards to post-treatment complications and inpatient admissions. As very few women actually necessitated further management this puts into question the appropriateness of the initial referral of these women. Areas for improvement therefore involve educating both staff and patients about the possibility of bleeding after excisional treatment and the role of the GP in reviewing these women before onward referral to the colposcopy service.

Does gestational weight gain of more than 12 kg in women increase the risk of a cesarean section delivery, gestational diabetes and pregnancy induced hypertension? A retrospective case series (2017)

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Type of publication:
Journal article

Author(s):
Antonakou A.; *Papoutsis D.; Kechagia A.

Citation:
Clinical and Experimental Obstetrics and Gynecology; 2017; vol. 44 (no. 4); p. 540-544

Abstract:
Purpose: The purpose of this study was to investigate whether the gestational weight gain of more than 12 kg represented a risk factor for an increased rate of cesarean section (CS) delivery, gestational diabetes, and pregnancy-induced hypertension (PIH). Materials and Methods: This was a retrospective case series study performed in a Greek National Health Service hospital and included women having given birth to singleton pregnancies between 2004-2009. Cases with multiple pregnancies, stillbirths, and congenital fetal abnormalities were excluded. Results: 600 eligible women were included in the study. Gestational weight increase correlated positively and was higher in women with a CS delivery, gestational diabetes, and PIH. The prepregnancy body mass index was identified as a predictor of gestational diabetes. The weight gain of less than 12 kg during pregnancy provided a protective effect against CS delivery by reducing the likelihood of this by 85%. Conclusion: The present authors have shown that the increased body weight gain during pregnancy of more than 12 kg is associated with increased rates of CS delivery, gestational diabetes, and hypertensive disorders in pregnancy.

Motor neuron disease in otolaryngology - A review (2017)

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Type of publication:
Journal article

Author(s):
*Fussey J.M.; *Skinner D.W.

Citation:
Otorhinolaryngologist; 2017; vol. 10 (no. 2); p. 79-81

Abstract:
Motor neuron disease is an incurable neurodegenerative disorder affecting both upper and lower motor neurons, resulting in progressive weakness and inevitable death due to respiratory failure. Up to 30% of patients present with bulbar symptoms and therefore may be seen first by an otolaryngologist. Furthermore, almost all patients experience bulbar symptoms in the late stages of the disease and may require the input of an otolaryngologist as part of their multidisciplinary management.