10 research outputs found
Parathyroid adenoma associated with thymoma in a female adult with primary hyperparathyroidism
No full textAbstractINTRODUCTIONParathyroid adenoma associated with a thymoma is a rare clinical entity and few cases have been reported in the literature. This association can be explained by the common embryologic origin of the parathyroid glands and the thymus. These patients may present only with clinical signs and symptoms of primary hyperparathyroidism making it difficult to suspect the coexistence of thymoma.PRESENTATION OF CASEA 68-year-old female with medical history of primary hyperparathyroidism underwent surgical excision of a single parathyroid adenoma. Intra-operatively a small mass was detected in the proximity of the parathyroid adenoma and was also removed. Pathologic examination revealed parathyroid adenoma as suspected pre-operatively whereas the small mass excised was identified as a type A thymoma. The postoperative course of the patient was favourable, with normal serum calcium levels and in six months follow-up the patient is symptom-free and with no recurrence.DISCUSSIONObjective of this study is to report the rare case of a female adult with a parathyroid adenoma and a coexisting thymoma in order to underline the importance of these two pathologies and the ideal treatment that should be followed according to the latest records.CONCLUSIONSurgical removal of parathyroid adenoma is the treatment of choice for primary hyperparathyroidism, with complete recovery and no postoperative complications. Thymoma may be associated with primary hyperparathyoridism, with or without clinical signs and symptoms of myasthenia gravis and this is a rare clinical entity as very few cases have been described worldwide. To our knowledge this is the first case reported in Greece
AB020. 84. Close to the bosom: annual mammogram surveillance as a follow up tool for post-op breast cancer patients
No full textSpontaneous Spleen Rupture in a Teenager: An Uncommon Cause of Acute Abdomen
No full textSpontaneous spleen rupture is a rare complication of infectious diseases and it can become a potentially life-threatening condition if not diagnosed in time. A 17-year-old Greek female presented to the ER due to acute abdominal pain, mainly of the left upper quadrant. She had no recent report of trauma. The patient was pale, her blood pressure was 90/70 mmHg, and her pulse was 120 b/min. Clinical examination of the abdomen revealed muscle contraction and resistance. The patient was submitted to an ultrasound of the upper abdomen and to a CT scanning of the abdomen that revealed an extended intraperitoneal hemorrhage due to spleen rupture. Due to the patient’s hemodynamic instability, she was taken to the operation room and splenectomy was performed. Following a series of laboratory examinations, the patient was diagnosed to be positive for current cytomegalovirus infection. The postoperative course was uneventful, and in a two year follow-up the patient is symptom-free. Spontaneous spleen rupture due to Cytomegalovirus infection is a rare clinical entity, described in few case reports in the world literature and should always be taken into consideration in differential diagnosis of acute abdomen, especially in adolescents with no recent report of trauma
A study demonstrating the accuracy of a new triage system for breast cancer referrals during the Covid-19 pandemic in a tertiary hospital.
No full textGlobal patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries The International Surgical Outcomes Study group
No full textFunded by Nestle Health Sciences through an unrestricted research grant, by a
National Institute for Health Research Professorship held by
R.P., and sponsored by Queen Mary University of London
Prospective observational cohort study on grading the severity of postoperative complications in global surgery research
No full textNestle Health Sciences
Breast cancer management pathways during the COVID-19 pandemic: outcomes from the UK ‘Alert Level 4’ phase of the B-MaP-C study
No full textAbstract: Background: The B-MaP-C study aimed to determine alterations to breast cancer (BC) management during the peak transmission period of the UK COVID-19 pandemic and the potential impact of these treatment decisions. Methods: This was a national cohort study of patients with early BC undergoing multidisciplinary team (MDT)-guided treatment recommendations during the pandemic, designated ‘standard’ or ‘COVID-altered’, in the preoperative, operative and post-operative setting. Findings: Of 3776 patients (from 64 UK units) in the study, 2246 (59%) had ‘COVID-altered’ management. ‘Bridging’ endocrine therapy was used (n = 951) where theatre capacity was reduced. There was increasing access to COVID-19 low-risk theatres during the study period (59%). In line with national guidance, immediate breast reconstruction was avoided (n = 299). Where adjuvant chemotherapy was omitted (n = 81), the median benefit was only 3% (IQR 2–9%) using ‘NHS Predict’. There was the rapid adoption of new evidence-based hypofractionated radiotherapy (n = 781, from 46 units). Only 14 patients (1%) tested positive for SARS-CoV-2 during their treatment journey. Conclusions: The majority of ‘COVID-altered’ management decisions were largely in line with pre-COVID evidence-based guidelines, implying that breast cancer survival outcomes are unlikely to be negatively impacted by the pandemic. However, in this study, the potential impact of delays to BC presentation or diagnosis remains unknown
Bridging pre-surgical endocrine therapy for breast cancer during the COVID-19 pandemic: outcomes from the B-MaP-C study
No full textPurpose:
The B-MaP-C study investigated changes to breast cancer care that were necessitated by the COVID-19 pandemic. Here we present a follow-up analysis of those patients commenced on bridging endocrine therapy (BrET), whilst they were awaiting surgery due to reprioritisation of resources.
Methods:
This multicentre, multinational cohort study recruited 6045 patients from the UK, Spain and Portugal during the peak pandemic period (Feb–July 2020). Patients on BrET were followed up to investigate the duration of, and response to, BrET. This included changes in tumour size to reflect downstaging potential, and changes in cellular proliferation (Ki67), as a marker of prognosis.
Results:
1094 patients were prescribed BrET, over a median period of 53 days (IQR 32–81 days). The majority of patients (95.6%) had strong ER expression (Allred score 7–8/8). Very few patients required expedited surgery, due to lack of response (1.2%) or due to lack of tolerance/compliance (0.8%). There were small reductions in median tumour size after 3 months’ treatment duration; median of 4 mm [IQR − 20, 4]. In a small subset of patients ( n = 47), a drop in cellular proliferation (Ki67) occurred in 26 patients (55%), from high (Ki67 ≥ 10%) to low (< 10%), with at least one month’s duration of BrET.
Discussion:
This study describes real-world usage of pre-operative endocrine therapy as necessitated by the pandemic. BrET was found to be tolerable and safe. The data support short-term (≤ 3 months) usage of pre-operative endocrine therapy. Longer-term use should be investigated in future trials
