Coexistence of Histologically Proven Chronic Lymphocytic Thyroiditis with Other Thyroid Disorders: A Retrospective Study

Abstract Background Hashimoto's thyroiditis (HT) is the commonest autoimmune thyroid pathology. It has been reported in increased numbers recently, probably due to the increase in autoimmune diseases across many parts of the world. It is sometimes found associated with other diseases as well as other diseases of the thyroid. There is an unproven association of this condition with thyroid cancer, particularly papillary thyroid carcinoma (PTC). Methods This was a retrospective study performed over a period of 5 years. The objectives of this study were to find out the prevalence of histopathologically proven HT in surgically resected thyroid glands for various indications and its association with other thyroid disorders, especially thyroid malignancies. Total 4,630 patients who underwent thyroidectomy during the study period and met the criteria for inclusion were considered for analysis. Results Histopathologically proven features of HT were present in 1,295 (28%) of the cases. Among these, 445 (34.36%) had only HT while 850 (65.66%) had HT along with other thyroid diseases. The most common disease associated with HT was multinodular goiter (44.2%), followed by PTC (15.2%). Patients with HT exhibited a higher rate of papillary cancer (16.7%) compared with patients without this pathology (13.8%). Statistically significant association between papillary cancer and HT was found among the female patients. Conclusion The prevalence of HT in patients undergoing thyroidectomy is high in the studied population. A statistically significant association exists between papillary thyroid cancer and thyroiditis among female patients. This could form the basis for further research along these lines.</jats:p

Adult Intussusception at a Tertiary Care Center: A Retrospective Study

Background:&nbsp;In adults, the majority of cases of intussusception are due to malignancy.&nbsp;Aims:&nbsp;The aim of the study is to describe the pattern of intussusception in the adult population diagnosed and treated at a tertiary care center. Subjects and Methods: Study Design: This is a retrospective cross-sectional study based on chart review, and data collection was made from the computer database and inpatient case records. Study Setting: Adult intussusception cases diagnosed and treated at a tertiary care referral center in South India. All inpatient case sheets including investigations and histopathology information on the computer database of all patients diagnosed with intussusception in the period of August 2012 to July 2016 were retracted based on a pretested and standardized form. Demographic data and other baseline data were summarized with descriptive statistics. SPSS software was used for data analysis.&nbsp;Results: Of the 77 patients, 47 (61%) were male. The common presentations were abdominal pain (95%), vomiting (64%), and rectal bleeding (29%). Common examination findings were abdominal tenderness (45%), guarding (39%), and abdominal mass (38%). On ultrasonography, fifty (65%) patients had intussusception with ileocolic (25) as the most common type. Computed tomography abdomen was taken for 28 (36%) patients, in which 23 (82%) had intussusception with ileocolic (9) as the most common type. Surgery was done for 53 (69%) patients, and the most common procedure was right hemicolectomy (25) followed by resection and anastomosis of the small bowel (23). Intraoperatively, 42 (79%) patients had intussusception with ileocolic (23) as the most common type. Intraoperatively, 14 (26%) patients had a bowel gangrene. Biopsy-proven cause for intussusception was present in 46 patients, with malignancy (21) as the most common cause. The patients were on regular follow-up. Recurrence of intussusception occurred in six patients of the small bowel intussusception who had polyposis. Conclusions:&nbsp;Adult intussusception is often associated with malignancy. Hence, a formal resection without reduction is needed and surgery should be done following oncological principles

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background: Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods: The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results: A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P < 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion: Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)