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Endocrine Surgery
Published in Tjun Tang, Elizabeth O'Riordan, Stewart Walsh, Cracking the Intercollegiate General Surgery FRCS Viva, 2020
This patient's newborn baby has a RET mutation consistent with MEN 2A. Would you offer surgery? If so, when?Current guidelines suggest prophylactic thyroidectomy should be offered.The timing of prophylactic surgery depends on level of risk according to the specific RET mutation.
Genetics and cancer
Published in Mark R Baker, Modernising Cancer Services, 2018
Prophylactic surgery can be offered to try to prevent cancer in these high-risk cases. In many familial cancer syndromes such surgery has been shown to prevent cancer. For example, more than 99% of individuals with gene mutations in the APC gene, which causes FAP, will develop multiple colonic polyps from mid-childhood onwards. Since there are so many polyps, there is inevitable progression to cancer, which on average occurs around the age of 40 years. Total colectomy when polyps appear will prevent the development of colorectal cancer.
Bronchogenic cyst
Published in Alisa McQueen, S. Margaret Paik, Pediatric Emergency Medicine: Illustrated Clinical Cases, 2018
Congenital pulmonary malformation and resection. Congenital pulmonary malformations (CPMs) of the lung are present in 1:11,000 to 1:35,000 live births. In the neonate, they have a wide range of presentations from respiratory failure to a well-appearing infant. In children, they usually present with cough but can also present with dyspnea and fever. Hemoptysis is a rarer presentation. About 13% of children will present with a pneumonia or recurrent respiratory infections and 10% present with a pneumothorax. In children, congenital cystic adenomatoid malformations are the most common type of CPMs to convert into cancer with bronchogenic cysts (pictured earlier) as the second most common. In symptomatic patients, resection through lobectomy (versus segmentectomy or removal of cyst only) is the most common treatment. Controversy exists over the treatment of incidental or asymptomatic CPMs. Some surgeons recommend prophylactic surgery to prevent future infections, enhance compensatory lung growth, and to prevent development of malignancy. Most studies cite the lifetime malignant transformation rate of CPMs to be less than 5%. Pleuropulmonary blastoma is the most common cancer associated with CPMs in children and can develop from a cyst at any time. There is no consensus about surveillance of these cysts for malignancy as chest x-rays are not sensitive enough and repeated CT scans increase the risk for iatrogenic cancer. Other cancers that CPMs can evolve into include rhabdomyosarcoma, adenocarcinoma, squamous cell carcinoma, and mesenchymoma.
Outcome and negative events in thoracic disc herniation surgery: a Danish registry study
Published in British Journal of Neurosurgery, 2021
Thea Overgaard Wichmann, Mindaugas Bazys, Gudrun Gudmundsdottir, Jakob Gram Carlsen, Peter Duel, Kestutis Valancius, Niels Katballe, Mikkel Mylius Rasmussen
The indication for surgery was progressive or intractable radiculopathy, and myelopathy or myelopathic sign of magnetic resonance imaging. One asymptomatic patient underwent prophylactic surgery. Surgical approach and technique depended on herniation characteristics along with surgeon preferences. A neurosurgeon (82%) or an orthopedic surgeon (18%) performed the surgeries. Lateral access was carried out in 22 patients (31%), while posterior access was chosen in the vast majority (69%). The most frequent choice was discectomy without arthrodesis (70%). When using arthrodesis, 18 (86%) patients were fused together with instrumentation. Arthrodesis was most commonly performed at the lower thoracic spine when using a lateral approach (46%) (Table 2).
The safety profile of denosumab in oncology beyond the safety of denosumab as an anti-osteoporotic agent: still more to learn
Published in Expert Opinion on Drug Safety, 2021
Maria V. Deligiorgi, Dimitrios T. Trafalis
The over-suppression of bone remodeling may impede the healing of AFFs, resulting in high rates of failure of conservative treatment [101] rendering the surgery a more reliable option. A systematic review addressing the treatment of AFFs showed that the nonoperative treatment of incomplete fractures often failed; therefore, surgery was eventually needed in nearly half of patients (47%). Moreover, the rate of healing following prophylactic surgery was 97%. This study revealed also the superiority of intramedullary nailing over plate fixation as regards the internal fixation. Revision surgery was required for 31.3% of AFFs treated with plate fixation and for 12.9% of AFFs treated with intramedullary nailing (p < 0.01) [111].
Meckel's diverticulum in the adult: surgical treatment
Published in Acta Chirurgica Belgica, 2019
Ismael Mora-Guzmán, José Luis Muñoz de Nova, Elena Martín-Pérez
During the period examined, major postoperative complications (Clavien-Dindo ≥ III) occurred in 2 patients within symptomatic group (6.6%). No complications occurred in the asymptomatic group (without specific morbidity related to prophylactic surgery). In the symptomatic group, one patient underwent reintervention due to anastomotic leak, and another patient underwent reintervention because of haemorrhage. No mortality was observed within 30 days. Median of postoperative stay was 8 days (range, 6–16) in symptomatic group and 15 days (range, 7–22) in incidental group.