Hypocalcemia is a common complication following thyroidectomy. However, the incidence of postoperative hypocalcemia varies widely in the literature, and factors associated with hypocalcemia after thyroid surgery are not well established. We aimed to identify incidence trends and independent risk factors of postoperative hypocalcemia using the nationwide inpatient sample (NIS) database from 1998 to 2008. Overall, 6,605 (5.5%) of 119,567 patients who underwent thyroidectomy developed hypocalcemia. Total thyroidectomy resulted in a significantly higher increased incidence (9.0%) of hypocalcemia when compared with unilateral thyroid lobectomy (1.9%; P < .001). Thyroidectomy with bilateral neck dissection, the strongest independent risk factor of postoperative hypocalcemia (odds ratio, 9.42; P < .001), resulted in an incidence of 23.4%. Patients aged 45 years to 84 years were less likely to have postoperative hypocalcemia compared with their younger and older counterparts (P < .001). Hispanic (P = .003) and Asian (P = .027) patients were more likely, and black patients were less likely (P = .003) than white patients to develop hypocalcemia. Additional factors independently associated with postoperative hypocalcemia included female gender, nonteaching hospitals, and malignant neoplasms of thyroid gland. Hypocalcemia following thyroidectomy resulted in 1.47 days of extended hospital stay (3.33 versus 1.85 days P < .001).
PurposePathologic downstaging following chemotherapy for stage III-N2 NSCLC is a well-known positive prognostic indicator. However, the predictive factors for locoregional recurrence (LRR) in these patients are largely unknown.MethodsBetween 1998 and 2008, 153 patients with clinically or pathologically staged III-N2 NSCLC from two cancer centers in the United States were treated with induction chemotherapy and surgery. All had pathologic N0-1 disease, and none received postoperative radiotherapy. LRR were defined as recurrence at the surgical site, lymph nodes (levels 1–14 including supraclavicular), or both.ResultsMedian follow-up was 39.3 months. Pretreatment N2 status was confirmed pathologically (18.2 %) or by PET/CT (81.8 %). Overall, the 5-year LRR rate was 30.8 % (n = 38), with LRR being the first site of failure in 51 % (22/+99877943). Five-year overall survival for patients with LRR compared with those without was 21 versus 60.1 % (p < 0.001). Using multivariate analysis, significant predictors for LRR were pN1 disease at time of surgery (p < 0.001, HR 3.43, 95 % CI 1.80–6.56) and a trend for squamous histology (p = 0.072, HR 1.93, 95 % CI 0.94–3.98). Five-year LRR rate for pN1 versus pN0 disease was 62 versus 20 %. Neither single versus multistation N2 disease (p = 0.291) nor initial staging technique (p = 0.306) were predictors for LRR. N1 status also was predictive for higher distant recurrence (p = 0.021, HR 1.91, 95 % CI 1.1–3.3) but only trended for poorer survival (p = 0.123, HR 1.48, 95 % CI 0.9–2.44).ConclusionsLRR remains high in resected stage III-N2 NSCLC patients after induction chemotherapy and nodal downstaging, particularly in patients with persistent N1 disease.Electronic supplementary materialThe online version of this article (doi:10.1245/s10434-012-2800-x) contains supplementary material, which is available to authorized users.
F-FDG PET/CT may be helpful with localization of painful abnormalities in the inflamed regions of the joints, which could potentially be used to direct individualized treatment in moderate and severe OA. Furthermore, SUV measurement on F-FDG PET/CT could serve as an inflammation activity index in the knees that may be predictive of outcomes and progression rate of OA.
This series provides an update on the best use of different imaging methods for common or important clinical presentations. The series advisers are Fergus Gleeson, consultant radiologist, Churchill Hospital, Oxford, and Kamini Patel, consultant radiologist, Homerton University Hospital, London. To suggest a topic for this series, please email us at practice@bmj. com.The choice of imaging modality for suspected scaphoid fracture depends on factors such as age, patient activity, cost, and availability of services A 26 year old previously healthy woman presented to the emergency department immediately after being involved in a road traffic incident. After clinical examination, scaphoid injury was suspected. A radiograph of the left wrist was obtained and found to be equivocal (fig 1). What is the next investigation?Scaphoid fractures should be suspected with trauma involving the hand and/or wrist, particularly falls onto an outstretched hand and road traffic incidents. Such fractures most commonly occur among men aged 20-30 years, with about 10% presenting with an associated fracture. 1 Less than 20% of patients with a clinically suspected scaphoid fracture have a true fracture. 2 In most of the patients with true scaphoid fracture, the fracture is diagnosed with wrist radiography, the initial examination recommended by the Royal College of Radiologists 3 and the American College of Radiology's "appropriateness criteria" (tables 1 and 2), which are based on a literature review incorporating robust meta-analyses, prospective studies, and retrospective case series). 4 If initial imaging fails to show a fracture, the hand or wrist is often put in a cast before any further imaging, with the presumption that there is a fracture (presumptive casting). Reflecting a paucity of consensus in the literature, the British and US colleges differ slightly in their recommendations for second line imaging. The British college recommends magnetic resonance imaging (MRI) as the second line approach, with bone scintigraphy and computed tomography as alternatives. 3 The US college favors MRI or presumptive casting with repeat radiography to detect subsequently formed fracture lines; it also suggests computed tomography as a third line option. 4 RadiographyObtain four total views-including posteroanterior, lateral, oblique, and ulnar-deviated posteroanterior with cephalad angulation-to evaluate patients with suspected scaphoid fractures. 4 5 Compared with other carpal bone injuries, scaphoid fractures are particularly difficult to identify on initial radiographs and may not be seen in 15-20% of cases. 6 7 Consider repeating radiographs 10-14 days after initial injury and presumptive casting to allow time for resorption to produce a visible fracture line. 4 Meta-analysis has shown that such repeat radiologic assessments have a relatively low sensitivity (91.1%). 8 The total cost of radiography is estimated at £24 (€28; $36) per patient. 2 Magnetic resonance imaging MRI is an ideal diagnostic modality when initial plain films are negative....
Placental sonolucencies detected on first-trimester screening sonograms in the general obstetric population are not predictive of poor obstetric outcomes.
Sialolithiasis is a common salivary pathology, suggested to affect over 1% of the population by postmortem studies. An uncommon complication of sialadenitis and sialolithiasis is the formation of fistulous tracts to other cervicofacial compartments. Submandibular gland sialocutaneous and sialo-oral fistulae have been sparsely described, but a sialo-pharyngeal fistula manifesting as a tonsillolith has yet to be described. We present an unusual case of a 35-year-old male presenting with recalcitrant neck pain and a presumed tonsillolith in the background of chronic submandibular sialadenitis, subsequently demonstrating a salivary fistula through the parapharyngeal space. We offer a thorough review of the literature to highlight the possibility of migratory sialolithiasis and its complications.
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