Organizational change using a novel, structured plan for justice, equity, diversity, and inclusion (JEDI) in an academic surgical department.

Introduction: Ethnic, gender-based, socioeconomic, and racial inequities persist in academic medical centers across the United States. Integration of principles of justice, equity, diversity, and inclusion (JEDI) with policies, procedures and organizational culture remains a challenge for many departments of Surgery.

Methods: Starting in June of 2021, we implemented a structured justice, equity, diversity, and inclusion plan with the goal of enhancing organizational and cultural change within our department.

Fumarate Hydratase Variants and Their Association With Paraganglioma/Pheochromocytoma.

Objective: To clarify the link between germline variants in fumarate hydratase (FH), hereditary leiomyomatosis and renal cell cancer (HLRCC), and paraganglioma (PGL) and pheochromocytoma (PCC) we utilize a well-annotated hereditary cancer testing database.

Methods: Records of 120,061 patients receiving germline testing were obtained. FH variants were classified into 4 categories: autosomal dominant (AD) HLRCC variants, autosomal recessive (AR) fumarase deficiency (FMRD), variants, previously reported as PGL/PCC FH variants, and variants of unknown significance (VUS) not previously associated with PGL/PCC (NPP-VUS).

Thyroid Cancer and Pesticide Use in a Central California Agricultural Area: A Case Control Study.

Objective: To examine environmental factors that influence risk of thyroid cancer.

Methods: We performed a case-control study utilizing thyroid cancer cases from the California Cancer Registry (1999-2012) and controls sampled in a population-based manner. Study participants were included if they were diagnosed with thyroid cancer, lived in the study area at their time of diagnosis, and were ≥35 years of age.

Three Patients with Lithium-Associated Hyperparathyroidism: Literature Review Regarding Medical and Surgical Management.

Lithium (Li) carbonate has been established as a mood stabilizer and an efficacious treatment for bipolar disorder since its discovery by Dr. John Cade in 1948. Li interacts significantly with organ systems and endocrine pathways.

Sustained Growth of a University-Based Endocrine Surgery Program Over 10 Years.

Background: Endocrine surgery continues to mature as a subspecialty field. We describe the clinical performance of an academic endocrine surgery program (ESP) over its first 10 years.

Methods: We examined all endocrine procedures performed during the 10-year period (2006-2015) following the inception of the ESP.

Adipocyte Browning and Higher Mitochondrial Function in Periadrenal But Not SC Fat in Pheochromocytoma.

Context: Patients with pheochromocytoma (pheo) show presence of multilocular adipocytes that express uncoupling protein 1 within periadrenal (pADR) and omental (OME) fat depots. It has been hypothesized that this is due to adrenergic stimulation by catecholamines produced by the pheo tumors.

Objective: To characterize the prevalence and respiratory activity of brown-like adipocytes within pADR, OME, and SC fat depots in human adult pheo patients.

Increased rates of advanced thyroid cancer in California.

Background: We have noted an unusually high rate of advanced thyroid cancers presenting from across California. We examined the rates of thyroid cancer presentation throughout California for potential geographic clustering.

Materials And Methods: A total of 26,983 patients with a new diagnosis of thyroid cancer (1999-2008) were abstracted from the California Cancer Registry and the Office of Statewide Health Planning and Development registry.

Medical Students' Perceptions of Surgeons: Implications for Teaching and Recruitment.

Objective: The purpose of this study was to assess first-year medical students' implicit perceptions of surgeons, focusing on the roles of gender and demeanor (communal = supportive, associated with women; agentic = assertive, associated with men).

Design: Survey study. Each survey had 1 of 8 possible scenarios; all began with a short description of a surgeon who was described as accomplished and well trained, then varied by surgeon gender (male/female), surgeon demeanor (agentic/communal), and type of surgery (breast cancer/lung cancer).

Dynamic Parathyroid Computed Tomography (4DCT) Facilitates Reoperative Parathyroidectomy and Enables Cure of Missed Hyperplasia.

Background: Four-dimensional computed tomography (4DCT) is an emerging imaging modality in the evaluation of primary hyperparathyroidism (PHPT). We assessed the role of 4DCT in patients presenting for reoperative parathyroidectomy.

Methods: A prospective database of patients with persistent or recurrent PHPT undergoing reoperative parathyroidectomy during the years 2006-2014 was analyzed.

Surgery is associated with improved survival for adrenocortical cancer, even in metastatic disease.

Background: Adrenocortical carcinoma (ACC) is a rare but lethal tumor. Predictors of survival include earlier stage at presentation and complete operative resection. We assessed effect of treatment and demographic variables on survival.

Reproductive outcomes and nononcologic complications after radioactive iodine ablation for well-differentiated thyroid cancer.

Background: Radioactive iodine (RAI) ablation is frequently performed after initial surgery for well-differentiated thyroid cancer (WDTC). We examined the frequency and timing of childbirth as well as nononcologic complications after RAI ablation for WDTC on a population level.

Methods: A retrospective cohort study of 25,333 patients (18,850 women) with WDTC was performed using the California Cancer Registry and California Office of Statewide Health Planning and Development database, 1999-2008.

Trends in the frequency and quality of parathyroid surgery: analysis of 17,082 cases over 10 years.

Objective: To examine trends in the frequency and quality of surgery for primary hyperparathyroidism (PHPT) in California during the period of 1999 to 2008.

Background: The quality of surgery for PHPT can be measured by the complication rate and the success rate of surgery. A fraction of patients with failed initial surgery undergo reoperation.

Utility of serum thyroglobulin measurements after prophylactic thyroidectomy in patients with hereditary medullary thyroid cancer.

Introduction: Prophylactic thyroidectomy can be curative for patients with hereditary medullary thyroid cancer (MTC) caused by RET proto-oncogene mutations. Calcitonin is a sensitive tumor marker used to follow patients. We suggest that thyroglobulin (Tg) levels should also be monitored postoperatively in these patients.

Risk-based ultrasound screening for thyroid cancer in obese patients is cost-effective.

Background: A higher body mass index (BMI) is associated with more advanced stages of thyroid cancer. Screening obese patients for thyroid cancer has been proposed but has yet to be examined for cost-effectiveness. The objective of this study was to assess the cost-effectiveness of ultrasound (US) screening of obese patients for thyroid cancer.

Thyroglobulin antibody levels do not predict disease status in papillary thyroid cancer.

Background: Thyroglobulin antibodies (TgAb) are present in approximately 20% of patients with papillary thyroid cancer (PTC) and invalidate the serum thyroglobulin (Tg) level as a tumour marker. We examined whether trends in the TgAb level could serve as a surrogate marker of disease status in the surveillance of patients with PTC.

Methods: All patients found to have a least one positive postoperative TgAb level (determined by the Beckman-Coulter Access Assay) after undergoing initial surgery for PTC from 2000 to 2010 at a single institution were included.

Racial and socioeconomic disparities in presentation and outcomes of well-differentiated thyroid cancer.

Context: Racial/ethnic minorities suffer disproportionate morbidity and mortality from chronic diseases.

Objective: Our objective was to assess racial and socioeconomic status (SES) disparities in well-differentiated thyroid cancer (WDTC) patients.

Design And Participants: We conducted a retrospective cohort study on 25 945 patients with WDTC (1999-2008) from the California Cancer Registry (57% white, 4% black, 24% Hispanic, and 15% Asian-Pacific Islander [API]).

Effect of reoperation on outcomes in papillary thyroid cancer.

Background: The influence of lymph node recurrences of papillary thyroid carcinoma (PTC) on overall prognosis is uncertain. We performed a population-based, longitudinal analysis to evaluate the impact of reoperation on mortality.

Methods: Patients who underwent initial operation for PTC >1 cm were abstracted from the California Cancer Registry database (1999-2008).

Three-phase parathyroid 4-dimensional computed tomography initial experience: inexperienced readers have high accuracy and high interobserver agreement.

Objective: Multiphase multidetector contrast-enhanced parathyroid CT (4-dimensional computed tomography [4D-CT]) is an emerging tool for evaluating patients with primary hyperparathyroidism. Our goal was to describe the initial performance of 2 inexperienced readers in interpretation of 4D-CT.

Methods: Twenty-three subjects who received 4D-CT and successful surgical exploration were studied (14 initial and 9 repeat explorations; 15 single-gland disease and 8 multigland disease) A staff neuroradiologist prospectively interpreted all studies, and a neuroradiology fellow retrospectively interpreted all studies; their results were compared with the surgical findings for each side of the neck separately.

Incidence and prevalence of primary hyperparathyroidism in a racially mixed population.

Context: The epidemiology of primary hyperparathyroidism (PHPT) has generally been studied in Caucasian populations.

Objective: The aim was to examine the incidence and prevalence of PHPT within a racially mixed population.

Design: A descriptive epidemiologic study was performed.

Endocrine surgery as a model for value-based health care delivery.

Background: Experts advocate restructuring health care in the United States into a value-based system that maximizes positive health outcomes achieved per dollar spent. We describe how a value-based system implemented by the University of California, Los Angeles UCLA Section of Endocrine Surgery (SES) has optimized both quality and costs while increasing patient volume.

Methods: Two SES clinical pathways were studied, one allocating patients to the most appropriate surgical care setting based on clinical complexity, and another standardizing initial management of papillary thyroid carcinoma (PTC).

Risk of advanced papillary thyroid cancer in obese patients.

OBJECTIVE To determine whether increasing body mass index (BMI) is associated with more aggressive disease and adverse surgical outcomes in patients with papillary thyroid cancer (PTC). DESIGN Retrospective review of a prospective database. SETTING Single academic tertiary care center.

Successful localization of recurrent thyroid cancer in reoperative neck surgery using ultrasound-guided methylene blue dye injection.

Background: Reoperation in the neck can be challenging and is associated with increased complication rates and operative times. Here we analyze our methylene blue dye injection method to localize reoperative neck pathology in patients with thyroid cancer and lymph node metastases.

Study Design: We retrospectively reviewed the records of all patients at a single university tertiary care center who had reoperative neck surgery for recurrent thyroid cancer between 2004 and 2009, and who also underwent intraoperative methylene blue dye injection.

Parathyroid carcinoma: update and guidelines for management.

Parathyroid carcinoma is one of the rarest known malignancies that may occur sporadically or as a part of a genetic syndrome. It accounts for approximately 1% of patients with primary hyperparathyroidism. The majority (90%) of parathyroid cancer tumors are hormonally functional and hypersecrete parathyroid hormone (PTH).

Population-level predictors of persistent hyperparathyroidism.

Background: Systematic study of outcomes of initial surgery for primary hyperparathyroidism (PHPT) has been limited by selection and self-reporting biases. To avoid these biases, we evaluated parathyroidectomy (PTx) outcomes within an integrated health care system encompassing 3.25 million enrollees.