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  1. Article ; Online: Stage, Grade, Resection status, Age, Symptoms (S-GRAS) score in predicting survival after resection of adrenocortical carcinomas.

    Mihai, Radu

    BJS open

    2024  Volume 8, Issue 1

    MeSH term(s) Humans ; Adrenocortical Carcinoma ; Adrenal Cortex Neoplasms
    Language English
    Publishing date 2024-02-07
    Publishing country England
    Document type Journal Article
    ISSN 2474-9842
    ISSN (online) 2474-9842
    DOI 10.1093/bjsopen/zrae001
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  2. Article ; Online: Voice and swallowing symptoms after thyroid surgery assessed using the ThyVoice online platform.

    Mihai, Radu

    European thyroid journal

    2023  Volume 12, Issue 4

    Abstract: Objective: The aim of this multicentre study was to investigate the progression of patient-reported outcomes after thyroid surgery, with emphasis on voice and swallowing difficulties.: Methods: An online platform was used to collect replies to ... ...

    Abstract Objective: The aim of this multicentre study was to investigate the progression of patient-reported outcomes after thyroid surgery, with emphasis on voice and swallowing difficulties.
    Methods: An online platform was used to collect replies to standardised questionnaires (voice handicap index, VHI; voice-related quality of life, VrQoL; EAT-10) preoperatively and at 2-6 weeks and 3-6-12 months after surgery.
    Results: A total of 236 patients were recruited from five centres that contributed with median of 11 cases (range 2-186 cases). Average symptoms scores showed voice changes lasting up to 3 months: VHI increased from 41 ± 15 (preop) to 48 ± 21 (6 weeks) and returned to 41 ± 15 at 6 months. Similarly, VrQoL increased from 12 ± 4 to 15 ± 6 and returned to 12 ± 4 (6 months). Severe voice changes (VHI > 60) were reported in 12% of patients preop, 22% at 2 weeks, 18% at 6 weeks, 13% at 3 months and 7% at 12 months. Only five patients with normal preoperative voice had persistent severe voice changes after 6-12 months. Those with severe voice changes at 2 weeks (median VHI 70.5, IQR 65-81) had significant improvement by 6 months (median VHI 54, IQR 39-65) (P < 0.001). Swallowing assessment showed a median preop score of 0 (IQR 0-3) increasing to a median of 2 (IQR 0-8) at 2 weeks and normal values afterwards.
    Conclusion: The ThyVoice online platform allows the assessment of patient-reported outcome measures in thyroid surgery. Voice morbidity appears to be more frequent than commonly reported, and this risk should the quoted during informed consent. Swallowing difficulties are mild but significant in the first 2 weeks.
    MeSH term(s) Humans ; Thyroid Gland ; Deglutition ; Quality of Life ; Voice ; Voice Disorders/diagnosis ; Deglutition Disorders/diagnosis
    Language English
    Publishing date 2023-06-21
    Publishing country England
    Document type Multicenter Study ; Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 2659767-6
    ISSN 2235-0802 ; 2235-0640
    ISSN (online) 2235-0802
    ISSN 2235-0640
    DOI 10.1530/ETJ-23-0008
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  3. Article ; Online: Surgery for phaeochromocytomas and paragangliomas: Current practice in the United Kingdom.

    Bojoga, A / Balasubramanian, S P / Mihai, R

    Annals of the Royal College of Surgeons of England

    2024  

    Abstract: Introduction: There is wide variability in the perioperative management of phaeochromocytoma and paraganglioma (PPGL) in different centres. This study aimed to summarise the management of PPGLs as reported in the United Kingdom Registry for Endocrine ... ...

    Abstract Introduction: There is wide variability in the perioperative management of phaeochromocytoma and paraganglioma (PPGL) in different centres. This study aimed to summarise the management of PPGLs as reported in the United Kingdom Registry for Endocrine and Thyroid Surgery (UKRETS) database and to determine current perioperative management of PPGLs by surveying UK clinicians.
    Methods: Data recorded on UKRETS from 2005 to 2021 were subjected to descriptive analyses. British Association of Endocrine and Thyroid Surgeons members were invited to participate in an open survey relating to the perioperative management of patients with PPGLs.
    Results: A total of 2,007 operations for PPGL from 49 participating centres were included. The median annual workload in each centre was four cases. Operations were performed predominantly laparoscopically (69%). The median length of stay (4 days) was the same in groups of surgeons stratified by volume. The survey had 29 respondents from 22 centres across the UK, and a formal protocol for perioperative management exists in 48% of the centres. Phenoxybenzamine (72%) was preferred for alpha-blockade. The practice of admitting patients for optimisation from 1 to 7 days before the day of surgery was common (62%). Central venous pressure and blood glucose monitoring were mentioned as routine intraoperative adjuncts by 72% of the responders.
    Conclusions: There is significant variation in the workload and perioperative management of PPGLs in the UK. This is potentially detrimental to patient outcomes and a consensus document might be beneficial to harmonise practice across the UK.
    Language English
    Publishing date 2024-02-16
    Publishing country England
    Document type Journal Article
    ZDB-ID 80044-2
    ISSN 1478-7083 ; 0035-8843
    ISSN (online) 1478-7083
    ISSN 0035-8843
    DOI 10.1308/rcsann.2023.0054
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  4. Article ; Online: A Two-Dimensional K-Shell X-ray Fluorescence (2D-KXRF) Model for Soft Tissue Attenuation Corrections of Strontium Measurements in a Cortical Lamb Bone Sample

    Mihai R. Gherase

    Metrology, Vol 3, Iss 4, Pp 325-

    2023  Volume 346

    Abstract: Human bones store elements such as calcium, phosphorus, and strontium, and accumulate toxic elements such as lead. In vivo measurements of elemental bone concentration can be done using X-ray fluorescence (XRF) techniques. Monte Carlo (MC) simulations of ...

    Abstract Human bones store elements such as calcium, phosphorus, and strontium, and accumulate toxic elements such as lead. In vivo measurements of elemental bone concentration can be done using X-ray fluorescence (XRF) techniques. Monte Carlo (MC) simulations of X-ray interactions were predominantly employed in this field to develop calibration methods that linked XRF measurements to concentrations. A simple and fast two-dimensional K-shell X-ray fluorescence model was developed to compute the KXRF signal of elements in bone and overlying soft tissue samples. The model is an alternative to MC methods and can guide future bone XRF studies. Contours of bone and soft tissue cross sections were elliptical and only KXRF signals from absorption of primary photons were considered. Predictions of the model were compared to Sr KXRF measurements using the bare lamb bone (LB) and the LB with overlying leather. XRF experiments used a small X-ray beam, silicon X-ray detector, and three positioning stages. Linear attenuation coefficients of the leather and LB were measured and used in the model. Measured and model-derived values of the Sr X-rays leather attenuation and Sr Kβ/Kα ratio agreed, but estimated bone Sr concentrations were likely overestimated. Results, approximations, future work directions, and applications were discussed.
    Keywords X-ray fluorescence ; calibration ; bone ; strontium ; Electronic computers. Computer science ; QA75.5-76.95 ; Applied mathematics. Quantitative methods ; T57-57.97
    Subject code 616
    Language English
    Publishing date 2023-10-01T00:00:00Z
    Publisher MDPI AG
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  5. Article ; Online: Low dose methylene blue in the surgical management of hyperparathyroidism.

    Mihai, R

    Annals of the Royal College of Surgeons of England

    2016  Volume 98, Issue 5, Page(s) 347

    MeSH term(s) Coloring Agents ; Female ; Humans ; Hyperparathyroidism/diagnosis ; Hyperparathyroidism/surgery ; Male ; Methylene Blue ; Parathyroidectomy/methods
    Chemical Substances Coloring Agents ; Methylene Blue (T42P99266K)
    Language English
    Publishing date 2016-05
    Publishing country England
    Document type Comment ; Letter
    ZDB-ID 80044-2
    ISSN 1478-7083 ; 0035-8843
    ISSN (online) 1478-7083
    ISSN 0035-8843
    DOI 10.1308/003588415X14181254789006
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  6. Article ; Online: Parathyroid Cancer: Updates and Postoperative Surveillance Imaging.

    Thwin, May / Mihai, Radu

    Surgical oncology clinics of North America

    2023  Volume 32, Issue 2, Page(s) 271–278

    MeSH term(s) Humans ; Parathyroid Neoplasms/diagnostic imaging ; Parathyroid Neoplasms/surgery ; Diagnostic Imaging/methods ; Parathyroidectomy ; Parathyroid Hormone
    Chemical Substances Parathyroid Hormone
    Language English
    Publishing date 2023-02-25
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 1196919-2
    ISSN 1558-5042 ; 1055-3207
    ISSN (online) 1558-5042
    ISSN 1055-3207
    DOI 10.1016/j.soc.2022.10.004
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  7. Article ; Online: Diagnosis, treatment and outcome of adrenocortical cancer.

    Mihai, R

    The British journal of surgery

    2015  Volume 102, Issue 4, Page(s) 291–306

    Abstract: Background: Adrenocortical cancer (ACC) is a rare disease with a dismal prognosis. The majority of patients are diagnosed with advanced disease and raise difficult management challenges.: Methods: All references identified in PubMed, published ... ...

    Abstract Background: Adrenocortical cancer (ACC) is a rare disease with a dismal prognosis. The majority of patients are diagnosed with advanced disease and raise difficult management challenges.
    Methods: All references identified in PubMed, published between 2004 and 2014, using the keywords 'adrenocortical cancer' or 'adrenal surgery' or both, were uploaded into a database. The database was interrogated using keywords specific for each field studied.
    Results: In all, 2049 publications were identified. There is ongoing debate about the feasibility and oncological outcomes of laparoscopic adrenalectomy for small ACCs, and data derived from institutional case series have failed to provide an evidence level above expert opinion. The use of mitotane (1-(2-chlorophenyl)-1-(4-chlorophenyl)-2,2-dichloroethane) in combination with chemotherapy in the treatment of metastatic disease has been assessed in an international randomized trial (FIRM-ACT trial) involving patients with ACC. Based on this trial, mitotane plus etoposide, doxorubicin and cisplatin is now the established first-line cytotoxic therapy owing to a higher response rate and longer median progression-free survival than achieved with streptozocin-mitotane. For patients with tumours smaller than 5 cm and with no signs of lymph node or distant metastases, survival is favourable with a median exceeding 10 years. However, the overall 5-year survival rate for all patients with ACC is only 30 per cent.
    Conclusion: Open and potentially laparoscopic adrenalectomy for selected patients is the main treatment for non-metastatic ACC, but the overall 5-year survival rate remains low.
    MeSH term(s) Adrenal Cortex Neoplasms/diagnosis ; Adrenal Cortex Neoplasms/mortality ; Adrenal Cortex Neoplasms/therapy ; Adrenalectomy/statistics & numerical data ; Adrenocortical Carcinoma/diagnosis ; Adrenocortical Carcinoma/mortality ; Adrenocortical Carcinoma/therapy ; Adult ; Antineoplastic Agents, Hormonal/therapeutic use ; Biomarkers, Tumor/metabolism ; Chemotherapy, Adjuvant ; Child ; Female ; Humans ; Laparoscopy/statistics & numerical data ; Male ; Metastasectomy/statistics & numerical data ; Mitotane/therapeutic use ; Mutation ; Neoplasm Recurrence, Local/mortality ; Neoplasm Recurrence, Local/therapy ; Neoplasm Staging ; Prognosis ; Survival Rate
    Chemical Substances Antineoplastic Agents, Hormonal ; Biomarkers, Tumor ; Mitotane (78E4J5IB5J)
    Language English
    Publishing date 2015-03
    Publishing country England
    Document type Journal Article ; Review
    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 10.1002/bjs.9743
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  8. Article: Surgical anatomy of the adrenal gland.

    Mihai, Radu

    Gland surgery

    2019  Volume 8, Issue Suppl 1, Page(s) S1–S2

    Language English
    Publishing date 2019-07-26
    Publishing country China (Republic : 1949- )
    Document type Journal Article
    ZDB-ID 3016969-0
    ISSN 2227-8575 ; 2227-684X
    ISSN (online) 2227-8575
    ISSN 2227-684X
    DOI 10.21037/gs.2019.07.03
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  9. Article: Open adrenalectomy.

    Mihai, Radu

    Gland surgery

    2018  Volume 8, Issue Suppl 1, Page(s) S28–S35

    Abstract: In an era when minimally invasive adrenalectomy is the gold standard treatment for majority of patients presenting with adrenal tumours, open adrenalectomy has become an operation that should be centralised in regional referral centers. Its main ... ...

    Abstract In an era when minimally invasive adrenalectomy is the gold standard treatment for majority of patients presenting with adrenal tumours, open adrenalectomy has become an operation that should be centralised in regional referral centers. Its main indication is represented by patients with large (>8 cm) phaeochromocytomas and patients with cortical adrenal tumours suspected of malignancy either because of their size (>4-6 cm) or because of radiological appearance of local invasion. Based on local expertise some of these patients might benefit from multidisciplinary input from liver or transplant surgeons. This chapter will discuss the anatomical landmarks and will comment on different steps in the procedure for right- or left-sided procedure. It is outside the scope of this chapter to settle the ongoing debate about patient selection for laparoscopic or open adrenalectomy when the diagnosis of adrenocortical cancer is suspected preoperatively.
    Language English
    Publishing date 2018-11-16
    Publishing country China (Republic : 1949- )
    Document type Journal Article ; Review
    ZDB-ID 3016969-0
    ISSN 2227-8575 ; 2227-684X
    ISSN (online) 2227-8575
    ISSN 2227-684X
    DOI 10.21037/gs.2019.05.10
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  10. Article ; Online: Long-term Cure of Primary Hyperparathyroidism After Scan-Directed Parathyroidectomy: Outcomes From A UK Endocrine Surgery Unit.

    Patel, Neil / Mihai, Radu

    World journal of surgery

    2022  Volume 46, Issue 9, Page(s) 2189–2194

    Abstract: Background: Two-decades ago, the advent of sestamibi scintigraphy led to an enthusiastic acceptance of minimally invasive parathyroidectomy (MIP) in most surgical centres. More recently, concerns have been raised about the efficacy of limited neck ... ...

    Abstract Background: Two-decades ago, the advent of sestamibi scintigraphy led to an enthusiastic acceptance of minimally invasive parathyroidectomy (MIP) in most surgical centres. More recently, concerns have been raised about the efficacy of limited neck exploration and some surgeons proposed bilateral neck exploration to be (once again) the gold standard operation for primary hyperparathyroidism in 2020s.
    Methods: A departmental database was used to identify patients who had MIP after concordant dual localisation with sestamibi scintigraphy and ultrasound scans. Long-term follow-up data were obtained from electronic patient records to ascertain any further treatment for recurrent disease and confirm most recent biochemical status. Patients with negative localisation scans and those with familial disease were excluded from analysis.
    Results: Between June 2001 and August 2014 a total of 404 patients (108 M:296F, median age 63 years, range 17-90 years) underwent MIP and had normalisation of calcium in first 6 weeks after the operation. Information on electronic patient records were missing in 14 patients; therefore, data on 390 patients were analysed. During median follow-up of 78 months (IQR: 21.25-111.75 months), 375 patients had normocalcaemia (2.36 mmol/L, IQR: 2.29-2.44 mmol/L) at a median 75 months, (IQR: 20-118 months) after their operation. Overall, 15 (3.85%) patients had biochemical evidence of recurrent disease (2.70 mmol/L IQR: 2.63-2.75 mmol/L) at 92 months (Range: 6-196) after initial operation. Of these, 5 (1.28%) patients underwent a second parathyroid procedure.
    Conclusion: Recurrence after scan-directed unilateral neck exploration occurred in 4% of patients after a long disease-free interval. Only one patient had recurrent disease within 1-year of primary surgery. The data suggest that bilateral neck exploration at the time of initial operation, in this selected cohort, is unlikely to have uncovered multi-gland disease and prevent disease recurrence. Focused parathyroidectomy in patients with convincing localisation studies should continue.
    MeSH term(s) Child, Preschool ; Humans ; Hyperparathyroidism, Primary/diagnostic imaging ; Hyperparathyroidism, Primary/surgery ; Infant ; Minimally Invasive Surgical Procedures/methods ; Parathyroidectomy/methods ; Radionuclide Imaging ; Radiopharmaceuticals ; Treatment Outcome ; United Kingdom
    Chemical Substances Radiopharmaceuticals
    Language English
    Publishing date 2022-04-12
    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/s00268-022-06556-3
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