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  1. Article ; Online: Comment on: Double faecal immunochemical testing in patients with symptoms suspicious of colorectal cancer.

    Chong, Yuki / Perin, Giordano / Balasubramanian, Sabapathy P

    The British journal of surgery

    2023  Volume 110, Issue 7, Page(s) 872

    MeSH term(s) Humans ; Sensitivity and Specificity ; Mass Screening ; Colorectal Neoplasms/diagnosis ; Occult Blood ; Early Detection of Cancer ; Feces/chemistry ; Colonoscopy ; Hemoglobins/analysis
    Chemical Substances Hemoglobins
    Language English
    Publishing date 2023-05-08
    Publishing country England
    Document type Letter ; Comment
    ZDB-ID 2985-3
    ISSN 1365-2168 ; 0263-1202 ; 0007-1323 ; 1355-7688
    ISSN (online) 1365-2168
    ISSN 0263-1202 ; 0007-1323 ; 1355-7688
    DOI 10.1093/bjs/znad122
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Impact of adrenal surgeon volume on outcome: analysis of 4464 operations from the United Kingdom Registry of Endocrine and Thyroid Surgery (UKRETS).

    Rajan, Sendhil / Patel, Neil / Stechman, Michael / Balasubramanian, Sabapathy P / Mihai, Radu / Aspinall, Sebastian

    The British journal of surgery

    2024  Volume 111, Issue 2

    Abstract: Background: There is a surgeon volume-outcome effect in adrenal surgery but the threshold for high-volume surgeon remains controversial. This study aimed to determine predictors of high-risk adrenal operations and to explore whether these should be ... ...

    Abstract Background: There is a surgeon volume-outcome effect in adrenal surgery but the threshold for high-volume surgeon remains controversial. This study aimed to determine predictors of high-risk adrenal operations and to explore whether these should be restricted to high-volume surgeons.
    Methods: Patients undergoing adrenal surgery and registered in the United Kingdom Registry of Endocrine and Thyroid Surgery between 2004 and 2021 were analysed. Outcomes included postoperative complications, duration of hospital stay, and mortality. Factors included in multivariable analysis were age, sex, diagnosis, surgical approach, laterality, and surgeon volume. Patients with missing data were excluded.
    Results: A total of 4464 of 6174 patients (72.3%) were analysed. Postoperative complications occurred in 418 patients (9.4%) and 14 (0.3%) died. Median duration of hospital stay was 3 (i.q.r. 2-5) days. Co-variables significantly associated with an increase or decrease in postoperative complications (P < 0.050) were age (OR 1.02, 95% c.i. 1.01 to 1.03), adrenal cancer (OR 1.64, 1.14 to 2.36), minimally invasive approach (OR 0.317, 0.248 to 0.405), bilateral surgery (OR 1.66, 1.03 to 2.69), and surgeon volume (OR 0.98, 0.96 to 0.99). An increase or decrease in mortality was associated with patient age (OR 1.08, 1.03 to 1.13), minimally invasive approach (OR 0.08, 0.02 to 0.27), and bilateral surgery (OR 6.93, 1.40 to 34.34). The incidence of postoperative complications was significantly lower above a threshold of 12 operations per year (P = 0.034) and 20 per year (P < 0.001), but not six per year (P = 0.540). Median duration of hospital stay was 2 days for surgeons doing over 20 operations per year, compared with 3 days for those undertaking fewer than 20, fewer than 12 or fewer than 6 operations per year.
    Conclusion: Increasing surgical volume is associated with shorter hospital stay and fewer complications. This analysis supports the case for centralization of surgery for adrenal cancer and bilateral tumours to higher-volume surgeons performing a minimum of 12 operations per year.
    MeSH term(s) Humans ; Thyroid Gland/surgery ; Adrenal Gland Neoplasms ; Surgeons ; United Kingdom/epidemiology ; Registries ; Postoperative Complications/epidemiology ; Postoperative Complications/etiology
    Language English
    Publishing date 2024-02-02
    Publishing country England
    Document type Journal Article
    ZDB-ID 2985-3
    ISSN 1365-2168 ; 0263-1202 ; 0007-1323 ; 1355-7688
    ISSN (online) 1365-2168
    ISSN 0263-1202 ; 0007-1323 ; 1355-7688
    DOI 10.1093/bjs/znae002
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Comment on: Validation of the Liver Transplant Risk Score in Europe.

    Suresan, Srutti / Perin, Giordano / Balasubramanian, Sabapathy P

    The British journal of surgery

    2022  Volume 110, Issue 2, Page(s) 277

    MeSH term(s) Humans ; Liver Transplantation ; Risk Factors ; Europe/epidemiology ; Retrospective Studies
    Language English
    Publishing date 2022-09-07
    Publishing country England
    Document type Letter ; Comment
    ZDB-ID 2985-3
    ISSN 1365-2168 ; 0263-1202 ; 0007-1323 ; 1355-7688
    ISSN (online) 1365-2168
    ISSN 0263-1202 ; 0007-1323 ; 1355-7688
    DOI 10.1093/bjs/znac345
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: Letter to editor: A systematic review of the incidence of thyroid carcinoma in patients undergoing thyroidectomy for thyrotoxicosis.

    Edafe, Ovie / Balasubramanian, Sabapathy P

    Clinical otolaryngology : official journal of ENT-UK ; official journal of Netherlands Society for Oto-Rhino-Laryngology & Cervico-Facial Surgery

    2020  Volume 45, Issue 6, Page(s) 963

    MeSH term(s) Humans ; Incidence ; Thyroid Neoplasms/epidemiology ; Thyroid Neoplasms/surgery ; Thyroidectomy ; Thyrotoxicosis/epidemiology ; Thyrotoxicosis/etiology ; Thyrotoxicosis/surgery
    Language English
    Publishing date 2020-08-09
    Publishing country England
    Document type Letter ; Comment
    ZDB-ID 2205891-6
    ISSN 1749-4486 ; 1749-4478 ; 0307-7772 ; 1365-2273
    ISSN (online) 1749-4486
    ISSN 1749-4478 ; 0307-7772 ; 1365-2273
    DOI 10.1111/coa.13612
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: Development of a large adrenal myelolipoma in the context of long-term elevated ACTH.

    Arshad, Muhammad Fahad / Kaluarachchi, Vidumini T S / Ross, Richard / Balasubramanian, Sabapathy P

    BMJ case reports

    2021  Volume 14, Issue 1

    MeSH term(s) Adrenal Gland Neoplasms/blood ; Adrenal Gland Neoplasms/diagnosis ; Adrenal Gland Neoplasms/etiology ; Adrenocorticotropic Hormone/blood ; Adult ; Humans ; Male ; Myelolipoma/blood ; Myelolipoma/diagnosis ; Myelolipoma/etiology
    Chemical Substances Adrenocorticotropic Hormone (9002-60-2)
    Language English
    Publishing date 2021-01-12
    Publishing country England
    Document type Case Reports ; Journal Article
    ISSN 1757-790X
    ISSN (online) 1757-790X
    DOI 10.1136/bcr-2020-240493
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article ; Online: Consensus statement on the management of incidentally discovered FDG avid thyroid nodules in patients being investigated for other cancers.

    Wadsley, Jonathan / Balasubramanian, Sabapathy P / Madani, Gitta / Munday, Jean / Roques, Tom / Rowe, Christopher W / Touska, Philip / Boelaert, Kristien

    Clinical endocrinology

    2023  

    Abstract: With the widespread use of 18F-fluorodeoxyglucose positron emission tomography (FDG PET/CT) in the investigation and staging of cancers, incidental discovery of FDG-avid thyroid nodules is becoming increasingly common, with a reported incidence in the ... ...

    Abstract With the widespread use of 18F-fluorodeoxyglucose positron emission tomography (FDG PET/CT) in the investigation and staging of cancers, incidental discovery of FDG-avid thyroid nodules is becoming increasingly common, with a reported incidence in the range 1%-4% of FDG PET/CT scans. The risk of malignancy in an incidentally discovered FDG avid thyroid nodule is not clear due to selection bias in reported retrospective series but is likely to be less than 15%. Even in cases where the nodule is found to be malignant, the majority will be differentiated thyroid cancers with an excellent prognosis even without treatment. If, due to index cancer diagnosis, age and co-morbidities, it is unlikely that the patient will survive 5 years, further investigation of an incidental FDG avid thyroid nodule is unlikely to be warranted. We provide a consensus statement on the circumstances in which further investigation of FDG avid thyroid nodules with ultrasound and fine needle aspiration might be appropriate.
    Language English
    Publishing date 2023-03-06
    Publishing country England
    Document type Journal Article
    ZDB-ID 121745-8
    ISSN 1365-2265 ; 0300-0664
    ISSN (online) 1365-2265
    ISSN 0300-0664
    DOI 10.1111/cen.14905
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  7. Article ; Online: Calcium, vitamin D or recombinant parathyroid hormone for managing post-thyroidectomy hypoparathyroidism.

    Edafe, Ovie / Mech, Claudia E / Balasubramanian, Sabapathy P

    The Cochrane database of systematic reviews

    2019  Volume 5, Page(s) CD012845

    Abstract: Background: Post-surgical hypoparathyroidism is a common complication after thyroid surgery. The incidence is likely to increase given the rising trend in the annual number of thyroid operations being performed. Measures to prevent post-thyroidectomy ... ...

    Abstract Background: Post-surgical hypoparathyroidism is a common complication after thyroid surgery. The incidence is likely to increase given the rising trend in the annual number of thyroid operations being performed. Measures to prevent post-thyroidectomy hypoparathyroidism including different surgical techniques and prophylactic calcium and vitamin D supplements have been extensively studied. The management of post-thyroidectomy hypoparathyroidism however has not been extensively evaluated. Routine use of calcium and vitamin D supplements in the postoperative period may reduce the risk of symptoms, temporary hypocalcaemia and hospital stay. However, this may lead to overtreatment and has no effect on long-term hypoparathyroidism. Current recommendations on the management of post-thyroidectomy hypoparathyroidism is based on low-quality evidence. Existing guidelines do not often distinguish between surgical and non-surgical hypoparathyroidism, and transient and long-term disease.The aim of this systematic review was to summarise evidence on the use of calcium, vitamin D and recombinant parathyroid hormone in the management of post-thyroidectomy hypoparathyroidism. In addition, we aimed to highlight deficiencies in the current literature and stimulate further work in this field.
    Objectives: The objective of this systematic review was to assess the effects of calcium, vitamin D and recombinant parathyroid hormone in managing post-thyroidectomy hypoparathyroidism.
    Search methods: We searched CENTRAL, MEDLINE, PubMed, Embase as well as ICTRP Search Portal and ClinicalTrials.gov. The date of the last search for all databases was 17 December 2018 (except Embase, which was last searched on 21 December 2017). No language restrictions were applied.
    Selection criteria: We planned to include randomised control trials (RCTs) or controlled clinical trials (CCTs) examining the effects of calcium, vitamin D or recombinant parathyroid hormone in people with temporary and long-term post-thyroidectomy hypoparathyroidism.
    Data collection and analysis: Two review authors independently screened titles, abstracts and full texts for relevance.
    Main results: Database searches yielded a total of 1751 records. We retrieved potentially relevant full texts and excluded articles on the following basis: not a RCT or CCT; intervention, comparator or both did not match prespecified criteria; non-surgical causes of hypoparathyroidism, and studies on prevention. None of the articles was eligible for inclusion in the systematic review.
    Authors' conclusions: This systematic review highlights a gap in the current literature and the lack of high-quality evidence in the management of post-thyroidectomy temporary and long-term hypoparathyroidism. Further research focusing on clinically relevant outcomes is needed to examine the effects of current treatments in the management of temporary and long-term post-thyroidectomy hypocalcaemia.
    MeSH term(s) Calcium, Dietary/therapeutic use ; Dietary Supplements ; Humans ; Hypoparathyroidism/prevention & control ; Parathyroid Hormone/therapeutic use ; Thyroidectomy/adverse effects ; Vitamin D/therapeutic use
    Chemical Substances Calcium, Dietary ; Parathyroid Hormone ; Vitamin D (1406-16-2)
    Language English
    Publishing date 2019-05-22
    Publishing country England
    Document type Journal Article ; Systematic Review
    ISSN 1469-493X
    ISSN (online) 1469-493X
    DOI 10.1002/14651858.CD012845.pub2
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  8. Article ; Online: Outcomes After Urgent Thyroidectomy Following Rapid Control of Thyrotoxicosis in Graves' Disease are Similar to Those After Elective Surgery in Well-Controlled Disease.

    Ali, Adibah / Debono, Miguel / Balasubramanian, Sabapathy P

    World journal of surgery

    2019  Volume 43, Issue 12, Page(s) 3051–3058

    Abstract: Background: Surgery for Graves' disease (GD) is usually performed after adequate control with medical treatment. Occasionally, rapid pre-operative optimization is required. The primary objective was to compare the outcomes of patients undergoing ... ...

    Abstract Background: Surgery for Graves' disease (GD) is usually performed after adequate control with medical treatment. Occasionally, rapid pre-operative optimization is required. The primary objective was to compare the outcomes of patients undergoing elective surgery for well-controlled GD with those undergoing rapid pre-operative treatment. We also propose a formal treatment protocol for future use.
    Methods: A retrospective cohort study in a tertiary referral centre included 247 patients with well-controlled GD undergoing elective surgery and 19 patients with poorly controlled disease undergoing surgery after rapid optimization. The latter group did not respond well to thionamides (carbimazole and/or propylthiouracil) or had intolerance or side effects to thionamides and were treated with a range of non-thionamide drugs, including Lugol's iodine, cholestyramine, beta blockers and steroids (with or without thionamides), and closely monitored for 1-2 weeks before surgery. Outcome measures included thyroid storm, hypoparathyroidism and recurrent laryngeal nerve palsy.
    Results: In total, 266 patients with male-to-female ratio of 1:6 and median (interquartile range) age of 39 (31-51) were included. Overall, long-term recurrent laryngeal palsy and hypoparathyroidism occurred in 1 (0.38%) and 13 (4.9%) patients, respectively. No patient had thyroid storm. There was no significant difference in hypoparathyroidism (p = 1), vocal cord palsy (p = 0.803) and post-operative bleeding (p = 0.362), between elective surgery and rapid optimization groups.
    Conclusion: Rapid pre-operative treatment is effective, safe and is associated with similar outcomes compared to usual treatment. A rapid pre-operative optimization protocol is proposed.
    MeSH term(s) Adrenergic beta-Antagonists/therapeutic use ; Adult ; Antithyroid Agents/therapeutic use ; Elective Surgical Procedures ; Emergencies ; Female ; Graves Disease/surgery ; Humans ; Hypoparathyroidism/etiology ; Iodides ; Male ; Middle Aged ; Postoperative Complications ; Retrospective Studies ; Thyroidectomy/adverse effects ; Thyroidectomy/methods ; Thyrotoxicosis/drug therapy ; Treatment Outcome ; Vocal Cord Paralysis/etiology ; Young Adult
    Chemical Substances Adrenergic beta-Antagonists ; Antithyroid Agents ; Iodides ; Lugol's solution (T66M6Y3KSA)
    Language English
    Publishing date 2019-08-05
    Publishing country United States
    Document type Journal Article
    ZDB-ID 224043-9
    ISSN 1432-2323 ; 0364-2313
    ISSN (online) 1432-2323
    ISSN 0364-2313
    DOI 10.1007/s00268-019-05125-5
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  9. Article ; Online: Systematic review of incidence, risk factors, prevention and treatment of post-laryngectomy hypoparathyroidism.

    Edafe, Ovie / Sandler, Luke M / Beasley, Nigel / Balasubramanian, Sabapathy P

    European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery

    2020  Volume 278, Issue 5, Page(s) 1337–1344

    Abstract: Purpose: Post-laryngectomy hypoparathyroidism is associated with significant short- and long-term morbidities. This systematic review aimed to determine incidence, risk factors, prevention and treatment of post-laryngectomy hypoparathyroidism.: ... ...

    Abstract Purpose: Post-laryngectomy hypoparathyroidism is associated with significant short- and long-term morbidities. This systematic review aimed to determine incidence, risk factors, prevention and treatment of post-laryngectomy hypoparathyroidism.
    Methods: Medline, EMBASE and the Cochrane library were searched for relevant articles on hypocalcaemia and/or hypoparathyroidism after laryngectomy or pharyngectomy. Two authors independently screened titles and abstracts from the search. Data from individual studies were collated and presented (without meta-analysis). Quality assessment of included studies was undertaken. The review protocol was registered in the PROSPERO database (CRD42019133879).
    Results: Twenty-three observational studies were included. The rates of transient and long-term hypoparathyroidism following laryngectomy with concomitant hemi- or total thyroidectomy ranged from 5.6 to 57.1% (n = 13 studies) and 0 to 12.8% (n = 5 studies), respectively. Higher transient (62.1-100%) and long-term (12.5-91.6%) rates were reported in patients who had concomitant oesophagectomy and total thyroidectomy (n = 4 studies). Other risk factors included bilateral selective lateral neck dissection, salvage laryngectomy and total pharyngectomy. There is a lack of data on prevention and management.
    Conclusion: Hypoparathyroidism occurs in a significant number of patients after laryngectomy. Patients who underwent laryngectomy with concomitant hemithyroidectomy may still develop hypoparathyroidism. Research on prevention and treatment is lacking and needs to be encouraged.
    MeSH term(s) Humans ; Hypoparathyroidism/epidemiology ; Hypoparathyroidism/etiology ; Hypoparathyroidism/prevention & control ; Incidence ; Laryngectomy ; Pharyngectomy ; Postoperative Complications/epidemiology ; Postoperative Complications/etiology ; Postoperative Complications/prevention & control ; Risk Factors ; Thyroidectomy/adverse effects
    Language English
    Publishing date 2020-07-22
    Publishing country Germany
    Document type Journal Article ; Meta-Analysis ; Review ; Systematic Review
    ZDB-ID 1017359-6
    ISSN 1434-4726 ; 0937-4477
    ISSN (online) 1434-4726
    ISSN 0937-4477
    DOI 10.1007/s00405-020-06213-2
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  10. Article ; Online: Serum Magnesium Measurements After Parathyroidectomy for Primary Hyperparathyroidism: Should It be Routine?

    Novodvorsky, Peter / Lowry, Andrew F / Lim, C Beverly B / Balasubramanian, Sabapathy P

    World journal of surgery

    2020  Volume 44, Issue 6, Page(s) 1898–1904

    Abstract: Background: Parathyroidectomy is the treatment of choice in primary hyperparathyroidism (PHPT). Following surgery, significant changes in bone and mineral metabolism may follow, but routine magnesium monitoring is not standard practice. The occurrence ... ...

    Abstract Background: Parathyroidectomy is the treatment of choice in primary hyperparathyroidism (PHPT). Following surgery, significant changes in bone and mineral metabolism may follow, but routine magnesium monitoring is not standard practice. The occurrence of significant clinical events linked to hypomagnesaemia in 3 patients after parathyroidectomy led to our evaluation of magnesium levels after surgery for PHPT.
    Methods: Serum magnesium levels before and after parathyroidectomy for PHPT were prospectively evaluated in a single centre over a year. The incidence and severity of hypomagnesaemia and its correlation with other biochemical variables were assessed.
    Results: A total of 138 patients underwent parathyroidectomy for PHPT. Pre-operative and day 1 post-operative serum magnesium levels were available in 57/138 (41.3%) and 99/138 (71.7%) patients, respectively. Serum magnesium decreased significantly after surgery (mean ± SD of 0.85 ± 0.08 and 0.75 ± 0.11 mmol/L, respectively, p < 0.001). On the day after parathyroidectomy, 31/99 (31.3%) patients had hypomagnesaemia (<0.70 mmol/L); in 3 of whom it was severe (<0.50 mmol/L). Patients with hypomagnesaemia had lower pre-operative magnesium (mean ± SD of 0.78 ± 0.06 and 0.87 ± 0.07 mmol/L, p < 0.001), higher pre-operative calcium [median (IQR) of 2.83 (2.71-2.99) and 2.71 (2.63-2.80) mmol/L, p = 0.001] and higher post-operative calcium [median (IQR) of 2.41 (2.30-2.51) and 2.35 (2.28-2.43) mmol/L, p = 0.046] compared to those with normomagnesaemia. In addition, these patients demonstrated higher drop in calcium levels after surgery (0.44 ± 0.20 and 0.35 ± 0.18 mmol/L, p = 0.033). Magnesium levels after surgery correlated positively with pre-operative magnesium (r = 0.561, p < 0.001) and post-operative PTH (r = 0.210, p = 0.037) and negatively with pre-operative adjusted calcium (r = - 0.389, p < 0.001).
    Conclusions: Serum magnesium decreased significantly following parathyroidectomy for PHPT and nearly a third of patients developed post-operative, mostly mild hypomagnesaemia. Whilst routine serum magnesium measurements could facilitate prompt recognition and treatment of this electrolyte disturbance, further research needs to establish the clinical importance of mild hypomagnesaemia in these clinical settings and, if indicated, to devise optimal treatment strategies.
    MeSH term(s) Adult ; Aged ; Aged, 80 and over ; Calcium/blood ; Female ; Humans ; Hyperparathyroidism, Primary/blood ; Hyperparathyroidism, Primary/surgery ; Magnesium/blood ; Male ; Middle Aged ; Parathyroidectomy
    Chemical Substances Magnesium (I38ZP9992A) ; Calcium (SY7Q814VUP)
    Language English
    Publishing date 2020-02-13
    Publishing country United States
    Document type Journal Article
    ZDB-ID 224043-9
    ISSN 1432-2323 ; 0364-2313
    ISSN (online) 1432-2323
    ISSN 0364-2313
    DOI 10.1007/s00268-020-05425-1
    Database MEDical Literature Analysis and Retrieval System OnLINE

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