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[PMID]: 28501106 [Au] Autor: Morris R; Yen TWF; Doffek K; Carr AA; Wilson SD; Evans DB; Wang TS [Ad] Endereço: Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin Milwaukee, WI. [Ti] Título: Concurrent endocrine and other surgical procedures: an institutional experience. [So] Source: J Surg Res;211:107-113, 2017 May 01. [Is] ISSN: 1095-8673 [Cp] País de publicação: United States [La] Idioma: eng [Ab] Resumo: INRODUCTION: The number of endocrine procedures, specifically parathyroidectomy, thyroidectomy, and adrenalectomy, being performed is increasing. There is a paucity of literature on the feasibility of combining these procedures with other surgical procedures. Therefore, the aim of this study was to determine the effect of performing concurrent surgical procedures on postoperative outcomes. METHODS: This is a single institution retrospective review of multiple prospectively maintained databases of patients who underwent elective thyroidectomy, parathyroidectomy, and/or adrenalectomy in combination with another procedure. The other procedures included soft tissue, breast or hernia, abdominal major, abdominal minor, cervical, and "other". Demographics, operative details, length-of-stay, and 30-d outcomes were reviewed. "Endocrine-specific" complications included recurrent laryngeal nerve injury, hypoparathyroidism, cervical wound infection, hematoma, and other. RESULTS: The cohort comprised 104 patients. Overall, 19 (18%) patients had 21 complications, including endocrine-specific complications in eleven (11%) patients. These eleven complications included recurrent laryngeal nerve injury (n = 3; 3%), hematoma (n = 2; 2%), wound infection (n = 1; 1%), transient hypoparathyroidism (n = 2; 2%), and other (n = 3; 3%). The remaining complications included three (3%) general complications, six (6%) patients with complications related to the concurrent procedure, and one patient who underwent an open adrenalectomy and hysterectomy and developed a midline wound dehiscence, which could not be specifically attributed to either procedure. CONCLUSIONS: Less than 5% of patients undergoing a surgical endocrine procedure underwent a concurrent procedure, ranging from soft tissue to major abdominal. Short-term endocrine-specific complications were managed safely, suggesting that concurrent procedures can be considered, with minimal effect on patient outcomes. [Mh] Termos MeSH primário: Procedimentos Cirúrgicos Endócrinos Complicações Pós-Operatórias/etiologia [Mh] Termos MeSH secundário: Adulto Idoso Idoso de 80 Anos ou mais Bases de Dados Factuais Estudos de Viabilidade Feminino Seres Humanos Tempo de Internação/estatística & dados numéricos Masculino Meia-Idade Avaliação de Resultados (Cuidados de Saúde) Readmissão do Paciente/estatística & dados numéricos Complicações Pós-Operatórias/epidemiologia Estudos Retrospectivos Fatores de Risco [Pt] Tipo de publicação: JOURNAL ARTICLE; OBSERVATIONAL STUDY [Em] Mês de entrada: 1709 [Cu] Atualização por classe: 170901 [Lr] Data última revisão: 170901 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 170515 [St] Status: MEDLINE

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[PMID]: 28205245 [Au] Autor: Kahramangil B; Berber E [Ad] Endereço: Department of Endocrine Surgery, Cleveland Clinic, Cleveland, Ohio. [Ti] Título: The use of near-infrared fluorescence imaging in endocrine surgical procedures. [So] Source: J Surg Oncol;115(7):848-855, 2017 Jun. [Is] ISSN: 1096-9098 [Cp] País de publicação: United States [La] Idioma: eng [Ab] Resumo: Near-infrared fluorescence imaging in endocrine surgery is a new, yet highly investigated area. It involves indocyanine green use as well as parathyroid autofluorescence. Several groups have described their technique and reported on the observed utility. However, there is no consensus on technical details. Furthermore, the correlation between intraoperative findings and postoperative outcomes is unclear. With this study, we aim to review the current literature on fluorescence imaging and share our insights on technical details. [Mh] Termos MeSH primário: Corantes Procedimentos Cirúrgicos Endócrinos Verde de Indocianina Espectroscopia de Luz Próxima ao Infravermelho [Mh] Termos MeSH secundário: Glândulas Suprarrenais/diagnóstico por imagem Glândulas Suprarrenais/cirurgia Seres Humanos Cuidados Intraoperatórios Neoplasias Hepáticas/diagnóstico por imagem Neoplasias Hepáticas/secundário Glândulas Paratireoides/diagnóstico por imagem Glândulas Paratireoides/cirurgia Glândula Tireoide/diagnóstico por imagem Glândula Tireoide/cirurgia [Pt] Tipo de publicação: JOURNAL ARTICLE; REVIEW [Nm] Nome de substância: 0 (Coloring Agents); IX6J1063HV (Indocyanine Green) [Em] Mês de entrada: 1708 [Cu] Atualização por classe: 170823 [Lr] Data última revisão: 170823 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 170217 [St] Status: MEDLINE [do] DOI: 10.1002/jso.24583

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[PMID]: 27896825 [Au] Autor: Kluijfhout WP; Pasternak JD; van der Kaay D; Vriens MR; Propst EJ; Wasserman JD [Ad] Endereço: Division of General Surgery, University Health Network Toronto, Toronto, Ontario, Canada. [Ti] Título: Is it time to reconsider lobectomy in low-risk paediatric thyroid cancer? [So] Source: Clin Endocrinol (Oxf);86(4):591-596, 2017 Apr. [Is] ISSN: 1365-2265 [Cp] País de publicação: England [La] Idioma: eng [Ab] Resumo: OBJECTIVE: Current guidelines recommend total thyroidectomy for nearly all children with well-differentiated thyroid cancer (WDTC). These guidelines, however, derive from older data accrued prior to current high-resolution imaging. We speculate that there is a subpopulation of children who may be adequately treated with lobectomy. DESIGN: Retrospective analysis of prospectively maintained database. PATIENTS: Seventy-three children with WDTC treated between 2004 and 2015. MEASUREMENTS: We applied two different risk-stratification criteria to this population. First, we determined the number of patients meeting American Thyroid Association (ATA) 'low-risk' criteria, defined as disease grossly confined to the thyroid with either N0/Nx or incidental microscopic N1a disease. Second, we defined a set of 'very-low-risk' histopathological criteria, comprising unifocal tumours ≤4 cm without predefined high-risk factors, and determined the proportion of patients that met these criteria. RESULTS: Twenty-seven (37%) males and 46 (63%) females were included in this study, with a mean age of 13·4 years. Ipsilateral- and contralateral multifocality were identified in 27 (37·0%) and 19 (26·0%) of specimens. Thirty-seven (51%) patients had lymph node metastasis (N1a = 18/N1b = 19). Pre-operative ultrasound identified all cases with clinically significant nodal disease. Of the 73 patients, 39 (53·4%) met ATA low-risk criteria and 16 (21·9%) met 'very-low-risk' criteria. All 'very-low-risk' patients demonstrated excellent response to initial therapy without persistence/recurrence after a mean follow-up of 36·4 months. CONCLUSIONS: Ultrasound and histopathology identify a substantial population that may be candidates for lobectomy, avoiding the risks and potential medical and psychosocial morbidity associated with total thyroidectomy. We propose a clinical framework to stimulate discussion of lobectomy as an option for low-risk patients. [Mh] Termos MeSH primário: Neoplasias da Glândula Tireoide/cirurgia Tireoidectomia/métodos [Mh] Termos MeSH secundário: Adolescente Criança Procedimentos Cirúrgicos Endócrinos/métodos Feminino Seres Humanos Metástase Linfática Masculino Recidiva Local de Neoplasia Estudos Retrospectivos Medição de Risco Neoplasias da Glândula Tireoide/patologia [Pt] Tipo de publicação: JOURNAL ARTICLE [Em] Mês de entrada: 1710 [Cu] Atualização por classe: 171010 [Lr] Data última revisão: 171010 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 161130 [St] Status: MEDLINE [do] DOI: 10.1111/cen.13287

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[PMID]: 27866719 [Au] Autor: Krishnamurthy VD; Gutnick J; Slotcavage R; Jin J; Berber E; Siperstein A; Shin JJ [Ad] Endereço: Department of Endocrine Surgery, The Cleveland Clinic, Cleveland, OH. Electronic address: vikramdk83@gmail.com. [Ti] Título: Endocrine surgery fellowship graduates past, present, and future: 8 years of early job market experiences and what program directors and trainees can expect. [So] Source: Surgery;161(1):289-296, 2017 Jan. [Is] ISSN: 1532-7361 [Cp] País de publicação: United States [La] Idioma: eng [Ab] Resumo: BACKGROUND: Given the increasing number of endocrine surgery fellowship graduates, we investigated if expectations and job opportunities changed over time. METHODS: American Association of Endocrine Surgeons (AAES) fellowship graduates, surgery department chairs, and physician recruiters were surveyed. Univariate analysis was performed with JMP Pro 12 software. RESULTS: We identified 141 graduates from 2008-2015; survey response rate was 72% (n = 101). Compared to earlier graduates, fewer academic opportunities were available for the recent graduates who intended to join them (P = .001). Unlike earlier graduates, recent graduates expected to also perform elective general surgery, which ultimately represented a greater percentage of their practices (both P < .05). Interview offers increased for recent graduates, but job offers decreased. Overall, 84% of graduates matched their intended practice type and 98% reported being satisfied. Reponses from graduates, department chairs, and physician recruiters highlighted opportunities to improve mentor involvement, job search strategies, and online job board utilization. CONCLUSION: The endocrine surgery job market has diversified resulting in more graduates entering nonacademic practices and performing general surgery. This rapid evolution supports future analyses of the job market and opportunities for job creation. Almost every graduate reported job satisfaction, which encourages graduates to consider joining both academic and nonacademic practices equally. [Mh] Termos MeSH primário: Emprego/estatística & dados numéricos Procedimentos Cirúrgicos Endócrinos/educação Bolsas de Estudo/tendências Satisfação no Emprego Avaliação de Programas e Projetos de Saúde [Mh] Termos MeSH secundário: Adulto Escolha da Profissão Educação de Pós-Graduação em Medicina/métodos Bolsas de Estudo/normas Feminino Seres Humanos Masculino Satisfação Pessoal Diretores Médicos Sociedades Médicas Inquéritos e Questionários Fatores de Tempo [Pt] Tipo de publicação: JOURNAL ARTICLE [Em] Mês de entrada: 1707 [Cu] Atualização por classe: 170719 [Lr] Data última revisão: 170719 [Sb] Subgrupo de revista: AIM; IM [Da] Data de entrada para processamento: 161122 [St] Status: MEDLINE

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[PMID]: 27865597 [Au] Autor: Phitayakorn R; Kelz RR; Petrusa E; Sippel RS; Sturgeon C; Patel KN; Perrier ND [Ad] Endereço: Department of Surgery, The Massachusetts General Hospital and Harvard Medical School, Boston, MA. Electronic address: rphitayakorn@mgh.harvard.edu. [Ti] Título: Expert consensus of general surgery residents' proficiency with common endocrine operations. [So] Source: Surgery;161(1):280-288, 2017 Jan. [Is] ISSN: 1532-7361 [Cp] País de publicação: United States [La] Idioma: eng [Ab] Resumo: BACKGROUND: Proficiency with common endocrine operations is expected of graduating, general surgery residents. However, no expert consensus guidelines exist about these expectations. METHODS: Members of the American Association of Endocrine Surgeons were surveyed about their opinions on resident proficiency with common endocrine operations. RESULTS: Overall response rate was 38%. A total of 92% of the respondents operate with residents. On average, they believed that the steps of a total thyroidectomy for benign disease and a well-localized parathyroidectomy could be performed by a postgraduate year 4 surgery resident. Specific steps that they thought might require more training included decisions to divide the strap muscles or leaving a drain. Approximately 66% of respondents thought that a postgraduate year 5 surgery resident could independently perform a total thyroidectomy for benign disease, but only 45% felt similarly for malignant thyroid disease; 79% thought that a postgraduate year 5 surgery resident could independently perform a parathyroidectomy. Respondents' years of experience correlated with their opinions about resident autonomy for total thyroidectomy (benign r = 0.38, P < .001; malignant r = 0.29, P = .001) but not parathyroidectomy. On multivariate analysis, sex and years of experience of the respondents were independently associated with opinions on autonomy but only for total thyroidectomy for benign disease (P = .001). Annual endocrine volume of the respondents did not correlate with beliefs in autonomy. CONCLUSION: There was general agreement among responding members of the AAES about resident proficiency and autonomy with common endocrine operations. As postgraduate year 5 residents may not be proficient in advanced endocrine operations, opportunities exist to improve training prior to the transition to independent practice for graduates that anticipate performing endocrine operations routinely. [Mh] Termos MeSH primário: Competência Clínica Educação de Pós-Graduação em Medicina/normas Procedimentos Cirúrgicos Endócrinos/normas Cirurgia Geral/educação Internato e Residência/normas Inquéritos e Questionários [Mh] Termos MeSH secundário: Consenso Estudos Transversais Educação de Pós-Graduação em Medicina/métodos Procedimentos Cirúrgicos Endócrinos/métodos Feminino Seres Humanos Internato e Residência/métodos Masculino Estados Unidos [Pt] Tipo de publicação: JOURNAL ARTICLE [Em] Mês de entrada: 1707 [Cu] Atualização por classe: 170719 [Lr] Data última revisão: 170719 [Sb] Subgrupo de revista: AIM; IM [Da] Data de entrada para processamento: 161121 [St] Status: MEDLINE

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[PMID]: 27755164 [Au] Autor: Lin HS; Terris DJ [Ad] Endereço: aDepartment of Otolaryngology-Head and Neck Surgery, Wayne State University and Karmanos Cancer Institute bDepartment of Surgery, John D. Dingell VA Medical Center, Detroit, Michigan cDepartment of Otolaryngology-Head and Neck Surgery, Augusta University, Augusta, Georgia, USA. [Ti] Título: An update on the status of nerve monitoring for thyroid/parathyroid surgery. [So] Source: Curr Opin Oncol;29(1):14-19, 2017 Jan. [Is] ISSN: 1531-703X [Cp] País de publicação: United States [La] Idioma: eng [Ab] Resumo: PURPOSE OF REVIEW: Recurrent laryngeal nerve (RLN) injury is one of the most common and serious complications associated with thyroid and parathyroid surgery. Although routine visual identification of the RLN is considered the current standard of care, the role of intraoperative neuromonitoring (IONM) of the RLN is more controversial. RECENT FINDINGS: Despite initial enthusiasm that IONM might substantially reduce the rate of RLN injury, most studies failed to show a significant difference in the rate of RLN injury when the use of IONM was compared with visualization of the RLN alone. However, a small number of investigators have reported statistically significant differences in the rates of nerve injury when IONM is used to augment visualization alone, particularly in certain high-risk situations. Despite a lack of conclusive data showing benefit, the use of IONM as an adjunct to visual identification of the RLN has gained increasing acceptance among surgeons. IONM remains an excellent tool to help verify the identity of the RLN, confirm its functional integrity, and pinpoint the site of nerve injury in the event of dysfunction. SUMMARY: The utility of IONM in reducing the rate of RLN injury is largely unproven and remains controversial. However, the use of IONM may be helpful in certain high-risk cases. Promising new technology, such as vagal nerve monitoring, may allow more real-time monitoring of the functional integrity of the RLN and allow the surgeon to react in a timely manner to evolving dysfunction in order to abort maneuvers that may risk definitive injury. [Mh] Termos MeSH primário: Monitorização Neurofisiológica Intraoperatória/métodos Traumatismos do Nervo Laríngeo/diagnóstico por imagem Traumatismos do Nervo Laríngeo/prevenção & controle Nervos Laríngeos/diagnóstico por imagem Glândulas Paratireoides/cirurgia Glândula Tireoide/cirurgia [Mh] Termos MeSH secundário: Procedimentos Cirúrgicos Endócrinos/efeitos adversos Procedimentos Cirúrgicos Endócrinos/métodos Seres Humanos Traumatismos do Nervo Laríngeo/etiologia [Pt] Tipo de publicação: JOURNAL ARTICLE; REVIEW [Em] Mês de entrada: 1707 [Cu] Atualização por classe: 170726 [Lr] Data última revisão: 170726 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 161019 [St] Status: MEDLINE

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[PMID]: 27664872 [Au] Autor: Clark A; Dackiw AP; White WD; Nwariaku FE; Holt SA; Rabaglia JL; Oltmann SC [Ad] Endereço: Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas. [Ti] Título: Early endocrine attending surgeon presence increases operating room efficiency. [So] Source: J Surg Res;205(2):272-278, 2016 Oct. [Is] ISSN: 1095-8673 [Cp] País de publicação: United States [La] Idioma: eng [Ab] Resumo: BACKGROUND: Preincision operating room (OR) preparation varies greatly. Cases requiring exacting preoperative setup may be more sensitive to inconsistent team members and trainees. Leadership and oversight by the surgeon may facilitate a timely start. The study hypothesized that early attending presence in the OR expedites surgery start time, improving efficiency, and decreasing cost. METHODS: Prospective data collection of endocrine surgery cases at an urban teaching hospital was performed. Time points recorded in minutes. Cost/min of OR time was $54. Patients classified as in the OR ≤10 min before attending arrival or >10 min before attending arrival. RESULTS: A total of 227 cases (166 thyroid, 54 parathyroid, 10 adrenal) were performed over 14 mo. Of the patients, 128 were in the OR ≤10 min before attending arrival, and 99 patients were >10 min (3 ± 3 min versus 35 ± 14 min, P < 0.01). The ≤10 min procedures started sooner after patient arrival in OR (40 ± 11 versus 63 ± 19, P < 0.01) which equated to $1202 of savings before incision. Although attending time in the OR before incision was equivalent between groups for adrenal and parathyroid, time to incision was shorter in the ≤10 min groups, saving $2416 ± 477 and $1458 ± 244, respectively (P < 0.01). Attending time in OR before thyroidectomy was 13 min longer in ≤10 min than >10 min (P < 0.01), but incisions were made 20 min sooner (P < 0.01) equating to $1076 ± 120 in savings. CONCLUSIONS: Early attending presence in the OR shortens time to incision. For parathyroid and adrenal cases, this does not require additional surgeon time. In ORs without consistent teams, early attending presence in the OR improves efficiency and yields significant cost savings. [Mh] Termos MeSH primário: Eficiência Organizacional Procedimentos Cirúrgicos Endócrinos Custos Hospitalares/estatística & dados numéricos Salas Cirúrgicas/organização & administração Duração da Cirurgia Cirurgiões/organização & administração [Mh] Termos MeSH secundário: Adulto Idoso Feminino Hospitais de Ensino/organização & administração Seres Humanos Liderança Masculino Meia-Idade Estudos Retrospectivos Texas [Pt] Tipo de publicação: JOURNAL ARTICLE [Em] Mês de entrada: 1706 [Cu] Atualização por classe: 170806 [Lr] Data última revisão: 170806 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 160925 [St] Status: MEDLINE

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[PMID]: 27465021 [Au] Autor: Decarolis B; Simon T; Krug B; Leuschner I; Vokuhl C; Kaatsch P; von Schweinitz D; Klingebiel T; Mueller I; Schweigerer L; Berthold F; Hero B [Ad] Endereço: Department of Pediatric Hematology and Oncology, Children's Hospital, University of Cologne, Cologne, Germany. [Ti] Título: Treatment and outcome of Ganglioneuroma and Ganglioneuroblastoma intermixed. [So] Source: BMC Cancer;16:542, 2016 07 27. [Is] ISSN: 1471-2407 [Cp] País de publicação: England [La] Idioma: eng [Ab] Resumo: BACKGROUND: Ganglioneuroma (GN) and ganglioneuroblastoma intermixed (GNBI) are mature variants of neuroblastic tumors (NT). It is still discussed whether incomplete resection of GN/GNBI impairs the outcome of patients. METHODS: Clinical characteristics and outcome of localized GN/GNBI were retrospectively compared to localized neuroblastoma (NB) and ganglioneuroblastoma-nodular (GNBN) registered in the German neuroblastoma trials between 2000 and 2010. RESULTS: Of 808 consecutive localized NT, 162 (20 %) were classified as GN and 55 (7 %) as GNBI. GN/GNBI patients presented more often with stage 1 disease (68 % vs. 37 %, p < 0.001), less frequently with adrenal tumors (31 % vs. 43 %, p = 0.001) and positive mIBG-uptake (34 % vs. 90 %, p < 0.001), and had less often elevated urine catecholamine metabolites (homovanillic acid 39 % vs. 62 %, p < 0.001, vanillylmandelic acid 27 % vs. 64 %, p < 0.001). Median age at diagnosis increased with grade of differentiation (NB/GNBN: 9; GNBI: 61; GN-maturing: 71; GN-mature: 125 months, p < 0.001). Complete tumor resection was achieved at diagnosis in 70 % of 162 GN and 67 % of 55 GNBI, and after 4 to 32 months of observation in 4 GN (2 %) and 5 GNBI (9 %). Eleven patients received chemotherapy without substantial effect. Fifty-five residual tumors (42 GN, 13 GNBI) are currently under observation (median: 44 months). Five patients (3 GN, 2 GNBI) showed local progression; all had tumor residuals > 2 cm. No progression occurred after subtotal resection. Two patients died of treatment, none of tumor progression. CONCLUSIONS: GN/GNBI account for one quarter of localized NT and differ from immature tumors in their clinical features. Chemotherapy is not effective. Subtotal resection appears to be a sufficient treatment. TRIAL REGISTRATION: ClinicalTrials.gov identifiers - NB97 (NCT00017225; registered June 6, 2001); NB2004 (NCT00410631; registered December 11, 2006). [Mh] Termos MeSH primário: Tratamento Farmacológico/métodos Procedimentos Cirúrgicos Endócrinos/métodos Ganglioneuroblastoma/terapia Ganglioneuroma/terapia [Mh] Termos MeSH secundário: Adolescente Idade de Início Criança Pré-Escolar Progressão da Doença Feminino Seres Humanos Lactente Recém-Nascido Masculino Estadiamento de Neoplasias Estudos Retrospectivos Tempo para o Tratamento Resultado do Tratamento [Pt] Tipo de publicação: JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T [Em] Mês de entrada: 1710 [Cu] Atualização por classe: 171120 [Lr] Data última revisão: 171120 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 160729 [Cl] Clinical Trial: ClinicalTrial [St] Status: MEDLINE [do] DOI: 10.1186/s12885-016-2513-9

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[PMID]: 27131159 [Au] Autor: Di Girolamo N; Selleri P [Ad] Endereço: Clinica per Animali Esotici, Centro Veterinario Specialistico, Via Sandro Giovannini 53, Roma 00137, Italy. Electronic address: nicoladiggi@gmail.com. [Ti] Título: Medical and Surgical Emergencies in Ferrets. [So] Source: Vet Clin North Am Exot Anim Pract;19(2):431-64, 2016 May. [Is] ISSN: 1558-4232 [Cp] País de publicação: United States [La] Idioma: eng [Ab] Resumo: In the last few years, significant improvement in diagnosis and treatment of ferret emergencies has occurred. Scientific advances demonstrated the need of specific practices when dealing with emergencies in ferrets. The risk of overdiagnosis of hypoglycemia with human portable blood glucose meters is a clear example. The purpose of this article is to describe the current approach to common medical and surgical emergencies in ferrets. [Mh] Termos MeSH primário: Emergências/veterinária Furões [Mh] Termos MeSH secundário: Animais Procedimentos Cirúrgicos Dermatológicos/veterinária Procedimentos Cirúrgicos Endócrinos/veterinária Cuidados Pós-Operatórios/veterinária Medicina Veterinária [Pt] Tipo de publicação: JOURNAL ARTICLE; REVIEW [Em] Mês de entrada: 1612 [Cu] Atualização por classe: 161230 [Lr] Data última revisão: 161230 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 160501 [St] Status: MEDLINE

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[PMID]: 27063343 [Au] Autor: Christakis IA; Potylchansky E; Silva AM; Nates JP; Prieto PA; Graham PH; Grubbs EG; Lee JE; Perrier ND [Ad] Endereço: Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX. [Ti] Título: Cervical hematoma following an endocrine surgical procedure: The MD Anderson experience. [So] Source: Surgery;160(2):377-83, 2016 Aug. [Is] ISSN: 1532-7361 [Cp] País de publicação: United States [La] Idioma: eng [Ab] Resumo: BACKGROUND: Airway compromise from postoperative neck hematoma remains the most feared complication after cervical endocrine operative procedures. Events are rare and potentially lethal, and clear multidisciplinary guidelines for management of these patients are lacking. The aim of our study was to review the experience of a tertiary cancer center in this scenario. METHODS: Data prospectively collected over a 10-year period, between 2005 and 2014, were retrospectively analyzed. We included all adult patients who had had a neck operation and needed reoperation for postoperative neck hematoma after an endocrine procedure. We excluded pediatric patients and cases with incomplete records. RESULTS: The inclusion criteria were met for 21 patients (21/2,930; 0.7%). The median age at operation was 56.2 years (SD: 16.7). The M:F ratio was 1:2. All 21 patients presented with a neck swelling at the time of reoperation. Eight of 21 patients (38%) underwent emergency bedside clot evacuation. Presentation was within 6 hours for two thirds (14/21) of the patients; the remaining one third of the patients had the hematoma develop during the evening/night (from 1700-0500). The mean estimated hematoma size was 98 cc (SD: 58). A source of bleeding was identified in 12 of 21 cases (57%). A total of 15.8% of patients had an airway classified as difficult/awkward under the American Society of Anesthesiologists classification for their wound re-exploration. CONCLUSION: Postoperation, increased vigilance is needed for the first 6 hours to detect patients with neck swelling. Emergency drainage by the bedside was performed in 38% of patients. A difficult airway was uncommon in our series. [Mh] Termos MeSH primário: Procedimentos Cirúrgicos Endócrinos/efeitos adversos Hematoma/etiologia Pescoço/irrigação sanguínea Pescoço/cirurgia Complicações Pós-Operatórias/etiologia [Mh] Termos MeSH secundário: Adulto Idoso Feminino Hematoma/diagnóstico Hematoma/cirurgia Seres Humanos Tempo de Internação Masculino Meia-Idade Duração da Cirurgia Complicações Pós-Operatórias/diagnóstico Complicações Pós-Operatórias/cirurgia Reoperação Estudos Retrospectivos Centros de Atenção Terciária Fatores de Tempo [Pt] Tipo de publicação: JOURNAL ARTICLE [Em] Mês de entrada: 1706 [Cu] Atualização por classe: 170623 [Lr] Data última revisão: 170623 [Sb] Subgrupo de revista: AIM; IM [Da] Data de entrada para processamento: 160412 [St] Status: MEDLINE

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