To determine whether increasing body mass index (BMI) is associated with more aggressive disease and adverse surgical outcomes in patients with papillary thyroid cancer (PTC). Design: Retrospective review of a prospective database. Setting: Single academic tertiary care center. Patients: A total of 443 patients older than 18 years who underwent total thyroidectomy for PTC from January 1, 2004, through March 31, 2011, were included in the analysis. Patients were organized into 4 BMI (calculated as weight in kilograms divided by height in meters squared) groups: normal (18.5-24.9), overweight (25-29.9), obese (30-39.9), and morbidly obese (Ն40). Main Outcome Measures: Disease stage at presentation, histologic subtype, duration of anesthetic induction and extubation, duration of surgery, surgical complications, length of hospital stay, and American Society of Anesthesiologists (ASA) class. Results: Ages ranged from 18 to 89 years. Greater BMI was associated with more advanced disease stage at presentation (P Ͻ .001) and more aggressive PTC histopathologic subtype (P=.03). Morbidly obese patients presented more frequently with stage III or IV disease (odds ratio, 3.67; PϽ.001). Greater BMI was also associated with longer duration of anesthetic induction (P Ͻ .001), increased length of stay (P Ͻ.001), and higher ASA class (PϽ .001). Duration of surgery was not associated with BMI. There was a trend toward larger tumors with increasing BMI (P=.06). Obese BMI was associated with more preoperative vocal cord paralysis due to local invasion (odds ratio, 9.21; P=.001). Conclusions: Obese patients present with more advanced stage and more aggressive forms of PTC. This finding suggests that obese patients should be screened for thyroid cancer.
Introduction/Background: Artisanal fishermen dive for sustenance. The lifetime prevalence of decompression sickness (DCS) in this population is alarmingly high. We wanted to understand the level of decompression stress fishermen in this region of the Yucatán experience in their daily fishing effort. We used a mathematical model to quantify nitrogen-loading in a nine-tissue compartment model. Materials and methods: Approved by the UCLA IRB 2#13-000532, this study was conducted during fishing seasons 2012 through 2017. Diving fishermen were instructed to attach dive recorders to their waists every fishing day during the study period. Sensus Ultra dive recorders (ReefNet Inc.), with an accuracy of ± 1 foot of ;seawater (fsw), 0.304 meters, and an activation depth of 10 fsw, 3.04 meters, were used to record dive parameters. Sampling interval was set to 10 seconds. A program in RStudio was created to extract the dive profiles of each fishing day and curtail into single-line outputs: pressure, time, date, start of dive and end of dive. An exponential decay formula was used to calculate the nitrogen-loading pressures for nine theoretical tissue compartments. Final nitrogen pressure, controlling compartments, decompression stop and time at stop were calculated. Results: Fishermen completed 4,961 dives over 1,758 diving days during the study period. The 40-minute compartment controlled most of the dives. The 80-minute compartment controlled 5%-20% of dives two through five. Decompression stop times for the last dive ranged from one minute to 190 minutes. Most of the required stop time observed was seen at depths of 1-15 fsw.
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