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Shawky MS, Sakr MF, Nabawi AS, Abdel-Aziz TE, De Jong MC, García VR, Lam F, Soromani C, Smart J, Honour JW, Kurzawinski TR. Influence of common clinical variables on intraoperative parathyroid hormone monitoring during surgery for primary hyperparathyroidism. J Endocrinol Invest 2020; 43:1205-1212. [PMID: 32124267 DOI: 10.1007/s40618-020-01201-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Accepted: 02/17/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND Intraoperative monitoring of parathyroid hormone (IOPTH) is a reliable method of predicting the cure of primary hyperparathyroidism (PHPT). The aim of this study is to assess whether common clinical variables (CCV) frequently encountered in patients with PHPT may affect the magnitude of PTH drop or the likelihood of patients meeting the intraoperative cure criterion. DESIGN Patients who were surgically cured from PHPT caused by single gland disease (SGD) and had full IOPTH protocol (4 measurements) were stratified according to age, gland weight, renal function, vitamin D status and severity of hypercalcemia. The percentage of IOPTH drop and the frequency of patients who had true positive IOPTH test results were compared among groups. RESULTS 762 patients had surgery for PHPT, of whom 746 were (98%) cured. Of these 746 patients, 511 who had SGD and a full IOPTH protocol were included in this study. The median IOPTH drop was significantly higher among younger patients, those with severe hypercalcaemia at 5, 10, 15 min after gland excision, giant glands (at 5-min only), patients with vitamin D deficiency (at 10, 15 min), and those with normal renal function (at 15 min only). The likelihood of the patients meeting the intraoperative cure criterion was not significantly affected among the groups except in patients with mild hypercalcaemia, who were significantly less likely to have 50% IOPTH drop than those with severe hypercalcaemia at all time points. The frequency of mildly hypercalcaemic patients who met cure criterion was significantly improved by extending measurement to 15 min. CONCLUSIONS IOPTH monitoring has the ability to mitigate the variability of IOPTH kinetics associated with most clinical variables. Mildly hypercalcemic patients in particular may benefit from waiting for 15-min measurement before any surgical decision is made.
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Affiliation(s)
- M S Shawky
- Centre for Endocrine Surgery, University College London Hospital and London Clinic, 250 Euston Road, London, NW1 2PG, UK.
- Department of General Surgery, Alexandria University, Alexandria, Egypt.
| | - M F Sakr
- Department of General Surgery, Alexandria University, Alexandria, Egypt
| | - A S Nabawi
- Department of General Surgery, Alexandria University, Alexandria, Egypt
| | - T E Abdel-Aziz
- Centre for Endocrine Surgery, University College London Hospital and London Clinic, 250 Euston Road, London, NW1 2PG, UK
- Department of General Surgery, Alexandria University, Alexandria, Egypt
| | - M C De Jong
- Centre for Endocrine Surgery, University College London Hospital and London Clinic, 250 Euston Road, London, NW1 2PG, UK
| | - V Rozalén García
- Centre for Endocrine Surgery, University College London Hospital and London Clinic, 250 Euston Road, London, NW1 2PG, UK
| | - F Lam
- Department of Clinical Biochemistry, University College London Hospital, London, UK
| | - C Soromani
- Department of Clinical Biochemistry, University College London Hospital, London, UK
| | - J Smart
- Department of Anaesthesia, University College London Hospital, London, UK
| | - J W Honour
- Department of Clinical Biochemistry, University College London Hospital, London, UK
| | - T R Kurzawinski
- Centre for Endocrine Surgery, University College London Hospital and London Clinic, 250 Euston Road, London, NW1 2PG, UK
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Shawky MS, Martin H, Hugo HJ, Lloyd T, Britt KL, Redfern A, Thompson EW. Mammographic density: a potential monitoring biomarker for adjuvant and preventative breast cancer endocrine therapies. Oncotarget 2018; 8:5578-5591. [PMID: 27894075 PMCID: PMC5354931 DOI: 10.18632/oncotarget.13484] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 10/08/2016] [Indexed: 11/25/2022] Open
Abstract
Increased mammographic density (MD) has been shown beyond doubt to be a marker for increased breast cancer risk, though the underpinning pathobiology is yet to be fully elucidated. Estrogenic activity exerts a strong influence over MD, which consequently has been observed to change predictably in response to tamoxifen anti-estrogen therapy, although results for other selective estrogen receptor modulators and aromatase inhibitors are less consistent. In both primary and secondary prevention settings, tamoxifen-associated MD changes correlate with successful modulation of risk or outcome, particularly among pre-menopausal women; an observation that supports the potential use of MD change as a surrogate marker where short-term MD changes reflect longer-term anti-estrogen efficacy. Here we summarize endocrine therapy-induced MD changes and attendant outcomes and discuss both the need for outcome surrogates in such therapy, as well as make a case for MD as such a monitoring marker. We then discuss the process and steps required to validate and introduce MD into practice as a predictor or surrogate for endocrine therapy efficacy in preventive and adjuvant breast cancer treatment settings.
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Affiliation(s)
- Michael S Shawky
- Department of Head and Neck and Endocrine Surgery, Faculty of Medicine, University of Alexandria, Egypt.,Department of Surgery, University College Hospital, London, UK
| | - Hilary Martin
- School of Medicine and Pharmacology, University of Western Australia, and Department of Medical Oncology, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Honor J Hugo
- Institute of Health and Biomedical Innovation and School of Biomedical Sciences, Queensland University of Technology, Australia.,Translational Research Institute, Brisbane, Australia
| | - Thomas Lloyd
- Department of Radiology, Princess Alexandra Hospital, Brisbane, Australia
| | - Kara L Britt
- The Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia.,Peter MacCallum Cancer Centre, Melbourne, Australia.,Department of Anatomy and Developmental Biology, Monash University, Melbourne, Australia
| | - Andrew Redfern
- School of Medicine and Pharmacology, University of Western Australia, and Department of Medical Oncology, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Erik W Thompson
- Institute of Health and Biomedical Innovation and School of Biomedical Sciences, Queensland University of Technology, Australia.,Translational Research Institute, Brisbane, Australia.,Department of Surgery, University of Melbourne, St Vincent's Hospital, Melbourne, Australia
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Shawky MS, Meyer-Rochow W. Aberrant Intrathyroid Tissue: a Report of Intrathyroid Lymph Node Metastasis and a Review of Literature. Indian J Surg 2017; 79:148-152. [PMID: 28442842 PMCID: PMC5386949 DOI: 10.1007/s12262-017-1594-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 01/13/2017] [Indexed: 11/28/2022] Open
Abstract
Aberrant histological elements have been infrequently reported to exist within the intact thyroid gland. In addition to distant metastases to the thyroid, a number of ectopic tissue rests and unusual cysts have been described within the thyroid gland. In this article, we report the presence of a true intrathyroid lymph node and describe the first reported case of intrathyroid lymph node metastasis of papillary thyroid cancer. Other reported aberrant intrathyroid tissues, possible pathophysiology, diagnostic features and surgical implications are also discussed.
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Affiliation(s)
| | - Win Meyer-Rochow
- Department of Surgery, Waikato Hospital, Hamilton, New Zealand
- Waikato Clinical Campus, Faculty of Medical and Health Science, University of Auckland, Auckland, New Zealand
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Abstract
Continuous development of quick parathyroid hormone assays has resulted in a corresponding expansion of their applications in the practical landscape. In-theatre measurement of the parathyroid hormone has long been recognized as a valuable adjunct in parathyroid surgery, with other applications being incorporated in thyroid surgery and out-of-theatre uses. Such widespread utilization of these assays has also brought the concept of point-of-care testing to the endocrine surgical patient. We have herein summarized the established and potential applications of these assays, emphasizing their importance in the point-of-care setting, highlighting the proper selection of the assay type for intraoperative hormone monitoring and spotlighting those applications which should be validated for use in the clinical setting and those which need to be investigated further.
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Affiliation(s)
- Michael S Shawky
- Department of Head and Neck and Endocrine Surgery, Faculty of Medicine, University of Alexandria, Alexandria, Egypt.
- Department of Surgery, University College Hospital, London, UK.
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Shawky MS, Ricciardelli C, Lord M, Whitelock J, Ferro V, Britt K, Thompson EW. Proteoglycans: Potential Agents in Mammographic Density and the Associated Breast Cancer Risk. J Mammary Gland Biol Neoplasia 2015; 20:121-31. [PMID: 26501889 DOI: 10.1007/s10911-015-9346-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Accepted: 10/16/2015] [Indexed: 12/28/2022] Open
Abstract
Although increased mammographic density (MD) has been well established as a marker for increased breast cancer (BC) risk, its pathobiology is far from understood. Altered proteoglycan (PG) composition may underpin the physical properties of MD, and may contribute to the associated increase in BC risk. Numerous studies have investigated PGs, which are a major stromal matrix component, in relation to MD and BC and reported results that are sometimes discordant. Our review summarises these results and highlights discrepancies between PG associations with BC and MD, thus serving as a guide for identifying PGs that warrant further research towards developing chemo-preventive or therapeutic agents targeting preinvasive or invasive breast lesions, respectively.
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Shawky MS, Tan J, French R. Gastroduodenal Artery Aneurysm: A Case Report and Concise Review of Literature. Ann Vasc Dis 2015; 8:331-3. [PMID: 26730262 DOI: 10.3400/avd.cr.15-00086] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2015] [Accepted: 11/04/2015] [Indexed: 01/17/2023] Open
Abstract
Gastroduodenal artery (GDA) aneurysm is a rare but potentially fatal vascular disease, with chronic pancreatitis being reported as the commonest aetiological factor. Its main complication is rupture, which is not uncommon and carries high risk of mortality. Clinical suspicion and advanced imaging tools should be employed in a timely fashion to make a diagnosis before this ominous event. We report a case of successfully treated GDA aneurysm who presented with minor bleeding episodes before suffering a major bleed and briefly discuss this pathology in light of the existing literature.
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Affiliation(s)
- Michael S Shawky
- Department of Surgery, Waikato Hospital, Hamilton, New Zealand; Department of Head and Neck and Endocrine Surgery, Faculty of Medicine, University of Alexandria, Alexandria, Egypt
| | - Jeffrey Tan
- Department of Surgery, Waikato Hospital, Hamilton, New Zealand
| | - Rowan French
- Department of Surgery, Waikato Hospital, Hamilton, New Zealand
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Eweida AM, Nabawi AS, Elhammady HA, Marei MK, Khalil MR, Shawky MS, Arkudas A, Beier JP, Unglaub F, Kneser U, Horch RE. Axially vascularized bone substitutes: a systematic review of literature and presentation of a novel model. Arch Orthop Trauma Surg 2012; 132:1353-62. [PMID: 22643804 DOI: 10.1007/s00402-012-1550-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2012] [Indexed: 01/14/2023]
Abstract
INTRODUCTION The creation of axially vascularized bone substitutes (AVBS) has been successfully demonstrated in several animal models. One prototypical indication is bone replacement in patients with previously irradiated defect sites, such as in the mandibular region. The downside of current clinical practice, when free fibular or scapular grafts are used, is the creation of significant donor site morbidity. METHODS Based on our previous experiments, we extended the creation of an arterio-venous loop to generate vascularized bone substitutes to a new defect model in the goat mandibula. In this report, we review the literature regarding different models for axially vascularized bone substitutes and present a novel model demonstrating the feasibility of combining this model with synthetic porous scaffold materials and biological tissue adhesives to grow cells and tissue. RESULTS We were able to show the principal possibility to generate axially vascularized bony substitutes in vivo in goat mandibular defects harnessing the regenerative capacity of the living organism and completely avoiding donor site morbidity. CONCLUSION From our findings, we conclude that this novel model may well offer new perspectives for orthopedic and traumatic bone defects that might benefit from the reduction of donor site morbidity.
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Affiliation(s)
- A M Eweida
- Faculty of Medicine, Department of Head and Neck and Endocrine Surgery, University of Alexandria, ElKhartoom square, Elazarita, Alexandria, Egypt.
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Hosny G, Shawky MS. The treatment of infected non-union of the tibia by compression-distraction techniques using the Ilizarov external fixator. Int Orthop 1998; 22:298-302. [PMID: 9914932 PMCID: PMC3619583 DOI: 10.1007/s002640050264] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Circular external fixation using the Ilizarov apparatus combined with compression-distraction techniques was used to treat 11 patients with infected non-union and segmental bone loss of the tibia. The series comprised 8 males and 3 females, with an average age of 27 years (range 17-51 years). The average number of previous failed surgical attempts at union was 2 per patient (range 1 to 4). Three infected non-unions without shortening were treated with complete resection of the site and conversion of the diaphysis into a segmental defect. The functional results were excellent in 5, good in 3, fair in 2 and poor in one patient. No additional procedures were used in any of the patients.
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Affiliation(s)
- G Hosny
- Department of Orthopaedic Surgery, Benha Faculty of Medicine, Tanta El Gharbia, Egypt
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