Citations

ABSTRACTIntroductionThe outcomes of completion thyroidectomy are not well‐documented. The study aim is to compare the risks of total thyroidectomy (TT), thyroid lobectomy (TL), and completion thyroidectomy (CT) using a large multi‐institutional database.MethodsAll cases of thyroidectomy without lymphadenectomy were identified using the CESQIP national database (2013–2023). Completion thyroidectomy was defined as contralateral lobectomy following previous lobectomy. Outcomes were examined including hematoma requiring evacuation, vocal cord dysfunction on post‐op laryngoscopy, and clinical concern for hypoparathyroidism.ResultsAmong 33,154 cases, TT, TL, and CT were performed in 19,057 (57%), 13,135 (40%) and 962 (3%), respectively. 30‐day hematoma rates were overall low: 135 (0.8%) in TT, 57 (0.5%) in TL, and < 10 (0.7%) in CT (p < 0.01). 30‐day vocal cord dysfunction was documented in 233 (1.4%), 159 (1.3%), and < 10 (1.0%) for TT, TL, and CT, respectively (p = 0.65). Temporary hypoparathyroidism was more common after TT than CT (989 (6%) versus 20 (2%), p < 0.01). Among 16,311 (49%) patients with reported long‐term outcomes, there were no differences in the rates of vocal cord dysfunction by type of operation (p = 0.34). However, long‐term hypoparathyroidism was more likely after TT than CT (237 (2.5%) versus < 10 (0.7%), p < 0.01).ConclusionIn this multi‐institutional endocrine surgery database, the reported long‐term complication rates after completion thyroidectomy were the same as for first‐time thyroid lobectomy. However, clinical hypoparathyroidism was 2.5‐fold more likely for total thyroidectomy than for completion thyroidectomy at 30‐days and remained 3.7‐fold higher in the long term suggesting that completion thyroidectomy does not pose a higher risk of complications.

Fontan-associated liver disease (FALD) occurs in all patients who have undergone Fontan palliation for functional single ventricle congenital heart defects. While liver fibrosis is universal in patients who have undergone Fontan palliation, FALD may lead to more serious consequences including portal hypertension, cirrhosis, and hepatocellular carcinoma. Scientific studies of the pathophysiology and clinical management of FALD have been limited to date by the heterogeneous nature of the disease, relatively small population of patients with Fontan physiology, and inaccuracy of noninvasive staging tests. As survival after the Fontan procedure improves, the population of adults with Fontan physiology is growing, leading to more severe extracardiac complications related to the Fontan circulation and growing demand for heart and liver transplantation. The accurate evaluation, staging, and management of FALD comprises a clinical challenge which requires expert multidisciplinary input.

Abstract The pulvinar has been proposed as an effective neuromodulation target for patients with posterior quadrant and temporal epilepsies. However, the pulvinar has a large tissue volume, multiple subnuclei, and widespread cortical connections. It remains unknown whether electrical stimulation of distinct pulvinar subregions affects the temporal, occipital, and parietal areas differently. To address this gap, we delivered single-pulse electrical stimulation to the pulvinar and measured the resulting brain stimulation evoked potentials in twelve patients undergoing stereotactic EEG for drug-resistant epilepsy. Brain stimulation evoked potentials were parameterized across the occipital, temporal and parietal cortex. Stimulation of the lateral pulvinar elicited significant brain stimulation evoked potentials in striate and extrastriate areas that diminish as stimulation shifts towards the medial pulvinar. Conversely, stimulation of the ventral aspect of the medial pulvinar produced significant lateral temporal evoked potentials, which diminish with lateral pulvinar stimulation. We also found that stimulation of the dorsomedial pulvinar evoked significant parietal responses with limited striate/extrastriate and lateral temporal responses. These results demonstrate that electrical stimulation of specific pulvinar subregions influences distinct occipital, parietal and lateral temporal areas. Selective targeting of pulvinar subregions to maximize seizure network engagement may be essential for individualized treatment of posterior quadrant and temporal epilepsies.

A 46-year-old man, an immigrant from Central America, presented to the emergency department after a motor vehicle collision. He had developed a progressive headache over the previous 48 hours, which had suddenly worsened while driving, causing him to crash. There was no significant head trauma. Clinical and radiological findings prompted a workup for atypical subarachnoid haemorrhage.

Introduction: The Undiagnosed Mass Clinic (UMC) at our institution is a clinical and research program created to address gaps in the early diagnostic phase of the cancer care continuum for patients with potential malignant neoplasms. All patients referred to the UMC are invited to participate in the UMC registry, which tracks operational and clinical metrics while maintaining a repository of blood and tissue specimens for future research. Methods: We conducted a retrospective cohort study of the first 100 patients enrolled in the UMC registry. We analyzed patient demographics, final diagnoses, and the time from initial consultation to final diagnosis. Results: Most participants were White (86%), non-Hispanic (93%), and married (72%). The mean (SD) age was 64 (13.9) years. The final diagnoses of the masses were categorized as malignant/neoplastic with malignant potential (n = 53), benign (n = 36), or requiring diagnostic surveillance (n = 10). The mean (SD) time from initial consultation to final diagnosis of malignant/neoplastic with malignant potential masses significantly improved from 37.4 (36.6) days for the first 50 participants to 17.3 (19.7) days for the next 50 participants ( P = .006). Conclusions: These initial insights from the UMC registry will help direct future efforts to improve the care of patients with potential malignant neoplasms.

ABSTRACTBackgroundMyeloproliferative neoplasms (MPN) are associated with an increased cardiovascular risk including acute coronary syndrome. However, there is a lack of comprehensive data regarding the rate of percutaneous coronary intervention (PCI), as well as the in‐hospital characteristics and outcomes for MPN patients.AimsWe aimed to evaluate the temporal trends and outcomes of PCI among patients with MPN.Methods and ResultsThe National Inpatient Sample database from 2016 to 2020 was queried to identify all PCI hospitalizations. Temporal trends and outcomes of patients with and without MPN following PCI were analyzed. Propensity score matching (PSM) was implemented to compare outcomes between MPN and non‐MPN groups. 2,237,210 PCI hospitalizations with 7560 (0.27%) patients with MPN were included in this study. Throughout the study period, the prevalence of MPN among PCI admissions remained stable (p‐value for trend = 0.12). Within the MPN subgroup, essential thrombocythemia (ET) was the predominant condition (53.2). Patients with MPN had higher prevalence of cardiovascular comorbidities than non‐MPN patients. Following PSM, MPNs were significantly associated with a higher risk of blood transfusions (OR: 1.66, 95% CI: 1.22−2.24, p = 0.001) and AKI (OR: 1.39, 95% CI: 1.17−1.65, p < 0.001). In contrast, the risk of in‐hospital mortality (OR: 1.18, 95% CI: 0.83−1.69, p = 0.354 and bleeding (OR: 1.43, 95% CI: 0.90−2.27, p = 0.127) did not significantly differ between the two groups.ConclusionsOur study demonstrated that while the prevalence of MPN among patients undergoing PCI remained stable, those with MPN faced higher risks of bleeding, blood transfusion and acute kidney injury. Further research is warranted to explore the underlying reasons for these increased risks and to improve outcomes in this high‐risk group.

Portal vein thrombosis in non-cirrhotic individuals, although uncommon, is an increasingly explored condition that affects mainly young people, consequently representing a significant disease burden. Reports primarily including western European populations have recently shed light regarding the pathophysiology, risk factors, natural history, treatment, and prognosis of this entity. Underlying predisposing conditions are documented in ~70% of cases, encompassing local risk factors, inherited and acquired thrombophilia, cancer, and systemic inflammatory conditions. Non-cirrhotic portal vein thrombosis can cause significant portal hypertension in the acute setting, but, more frequently, significant portal hypertension-related complications arise when the condition becomes chronic and portosystemic collaterals develop, increasing the risk for variceal bleeding and ascites. The diagnostic approach to screen for underlying thrombophilia remains a challenge, and recommendations in this regard, although scarce and backed by scarce evidence, have changed notably in the last years, leaning toward a universal screen in patients who develop this condition without a clear provoking factor. Recently, studies have shown that long-term anticoagulation may be appropriate even in the absence of clear provoking factors or underlying thrombophilia. Future studies should address which patients may benefit from this approach, which patients may not need it, and what the most appropriate strategies are to approach patients who do not recover portal vein patency with anticoagulation to further prevent portal hypertension-related complications.