Safety and Effectiveness of Total Thyroidectomy and Its Comparison with Subtotal Thyroidectomy and Other Thyroid Surgeries: A Systematic Review

Diseases associated with the thyroid gland are one of the most frequently seen endocrine disorders across the globe. Total thyroidectomy is currently the preferred treatment for many thyroid diseases. Controversies exist among surgeons regarding safety of total thyroidectomy due to the risk associated with it like postoperative hypoparathyroidism or recurrent laryngeal nerve damage. Since, in the recent years, the incidence of thyroidectomy is in increasing trend in south Indian population, this review aims to study the available data regarding the appropriateness and safety of total thyroidectomy and compares it with subtotal thyroidectomy and other thyroid surgeries. This is a retrospective comprehensive review of various articles and publications regarding total and partial thyroidectomy performed across the world. Many retrospective studies and few prospective studies suggest that the incidence of transient hypocalcemia is higher after total thyroidectomy than after subtotal thyroidectomy, but the incidence of other complications including recurrent laryngeal nerve palsy and postoperative hematoma is not significantly different between the two procedures. Hence in our review we found that total thyroidectomy is safe and cost effective with low complication rates and provides little significant advantage of being safer procedure compared to subtotal thyroidectomy

The communication of a secondary care diagnosis of autoimmune hepatitis to primary care practitioners: a population-based study

Background Autoimmune Hepatitis is a chronic liver disease which affects young people and can result in liver failure leading to death or transplantation yet there is a lack of information on the incidence and prevalence of this disease and its natural history in the UK. A means of obtaining this information is via the use of clinical databases formed of electronic primary care records. How reliably the diagnosis is coded in such records is however unknown. The aim of this study therefore was to assess the proportion of consultant hepatologist diagnoses of Autoimmune Hepatitis which were accurately recorded in General Practice computerised records. Methods Our study population were patients with Autoimmune Hepatitis diagnosed by consultant hepatologists in the Queens Medical Centre, Nottingham University Hospitals (UK) between 2004 and 2009. We wrote to the general practitioners of these patients to obtain the percentage of patients who had a valid READ code specific for Autoimmune Hepatitis. Results We examined the electronic records of 51 patients who had biopsy evidence and a possible diagnosis of Autoimmune Hepatitis. Forty two of these patients had a confirmed clinical diagnosis of Autoimmune Hepatitis by a consultant hepatologist: we contacted the General Practitioners of these patients obtaining a response rate of 90.5% (39/42 GPs). 37/39 of these GPs responded with coding information and 89% of these patients (33/37) used Read code J638.00 (Autoimmune Hepatitis) to record a diagnosis. Conclusions The diagnosis of Autoimmune Hepatitis made by a Consultant Hepatologist is accurately communicated to and electronically recorded by primary care in the UK. As a large proportion of cases of Autoimmune Hepatitis are recorded in primary care, this minimises the risk of introducing selection bias and therefore selecting cases using these data will be a valid method of conducting population based studies on Autoimmune Hepatitis

Prediction of survival among patients receiving transarterial chemoembolization for hepatocellular carcinoma: A response-based approach

Background and aims: The heterogeneity of intermediate-stage hepatocellular carcinoma (HCC) and the widespread use of transarterial chemoembolization (TACE) outside recommended guidelines have encouraged the development of scoring systems that predict patient survival. The aim of this study was to build and validate statistical models that offer individualized patient survival prediction using response to TACE as a variable. Approach and results: Clinically relevant baseline parameters were collected for 4,621 patients with HCC treated with TACE at 19 centers in 11 countries. In some of the centers, radiological responses (as assessed by modified Response Evaluation Criteria in Solid Tumors [mRECIST]) were also accrued. The data set was divided into a training set, an internal validation set, and two external validation sets. A pre-TACE model ("Pre-TACE-Predict") and a post-TACE model ("Post-TACE-Predict") that included response were built. The performance of the models in predicting overall survival (OS) was compared with existing ones. The median OS was 19.9 months. The factors influencing survival were tumor number and size, alpha-fetoprotein, albumin, bilirubin, vascular invasion, cause, and response as assessed by mRECIST. The proposed models showed superior predictive accuracy compared with existing models (the hepatoma arterial embolization prognostic score and its various modifications) and allowed for patient stratification into four distinct risk categories whose median OS ranged from 7 months to more than 4 years. Conclusions: A TACE-specific and extensively validated model based on routinely available clinical features and response after first TACE permitted patient-level prognosticatio

Histo-morphometric Analysis of an Idiopathic 'Kink' in the Transverse Colon

Presence of kinked transverse colon is not a very common phenomenon. Its presence may not cause physiological disturbance. However, at times when it requires endoscopy, the abrupt looped course of the transverse colon might set a risk of entrapment of the device, which in turn might lead to severe complications and undue discomfort to the patient. An idiopathic kink in the transverse colon of an adult male cadaver was noted and its morphometric and histopathological analysis was performed. The exact location and gross morphometric measurements of the kinks in the transverse colon was recorded. Small pieces of the colon at the regions of kinks were removed, processed, and stained with Haemetoxylin and Eosin, Alcian Blue- Periodic Acid Schiff (PAS) stain and Masson Trichrome stain for histopathological examination. Transverse colon presented with an abrupt loop towards its splenic end by the presence of proximal and distal kinks. Histopathological features of the mucosa at the areas of kink showed foci of surface erosions composed of parallelly placed tubular glands lined by columnar cells, interspersed by goblet cells. Submucosa was oedematous with few congested vessels. Presence of such unusual kink and the loop together may be the cause for forceful forward push of the device introduced into it during colonoscopy and might result in the damage of its mucosa

The communication of a secondary care diagnosis of autoimmune hepatitis to primary care practitioners: a population-based study

Abstract Background: Autoimmune Hepatitis is a chronic liver disease which affects young people and can result in liver failure leading to death or transplantation yet there is a lack of information on the incidence and prevalence of this disease and its natural history in the UK

Bilateral Vascular Variations at the Renal Hilum: A Case Report

Imaging technology with its advancement in the field of urology is the boon for the patients who require minimally invasive approaches for various kidney disorders. These approaches require a precise knowledge of the normal and variant anatomy of vascular structures at the hilum of the kidney in terms of their pattern of arrangement and division. The present paper describes a bilateral anomalous arrangement of the structures at the renal hilum as well as their peculiar branching pattern which is of clinical and surgical relevance. Multiple branching of the renal vessels was observed in both kidneys due to which the hila were congested. The right renal artery immediately after its origin divided into 2 branches. The upper branch represented an aberrant artery whereas the lower branch gave 5 divisions. The left renal artery also divided into 2 branches much before the hilum as anterior and posterior divisions. The anterior branch took an arched course and gave 6 branches. The posterior branch gave 3 terminal branches before entering the renal substance. In addition to anomalous hilar structures, normal architecture of both kidneys was altered and the hilum of the left kidney was found on its anterior surface

Unusually Looped and Muzzled Branches of Right Coronary Artery

Coronary artery disease (CAD) is the major cause of death in developed countries as it accounts on an average for 1 of every 5 deaths. Morphological variations of coronary arterial system is one of the causative factor for CAD. Anatomical knowledge of all possible variant patterns of coronary arterial system is imperative in the diagnostic and therapeutic approach of CAD. We report here a rare branching pattern of right coronary artery (RCA). The origin of RCA was normal but the course and branching pattern of it were atypical. RCA was not occupying its usual position in atrioventricular (coronary) sulcus and its course was incomplete. It gave a ventricular branch to right ventricle, which presented an unusual looping pattern. It terminated as right marginal artery following its muzzled appearance within the musculature of the ventricle

Possibly Active Persistent Thymus Found in a Human Adult Cadaver – A Morpho-histological Study

Thymus is a bilobed organ usually situated in the superior mediastinum. Thymus is normally active until puberty and as age advances it undergoes considerable fibro-fatty degeneration and is replaced by fatty tissue. We found a persistent thymus in an adult male cadaver aged 70 years approximately. It apparently looked healthy. Hence the objective of this study was to know the morpho-histology of a persistent human thymus gland. Associated with this we also found a concurrent absence of isthmus of thyroid gland. Thymus obtained was processed according to the standard procedures and sections were stained with Haematoxylin & Eosin stain to study the age related changes of the thymus gland. Stained sections of thymus revealed a normal, healthy architecture of lobes of thymus. Knowledge regarding these morpho-histological features of the persistent thymus is important for clinicians and radiologists for the differential diagnosis of any mediastinal mass or presence of ectopic thymic tissue before doing any investigative procedur

Scholars Journal of Medical Case Reports ISSN 2347-9507 (Print) Incomplete duplicated (bifid) left ureter -A case report

Abstract: The ureter is subjected to natural variation such as duplication. The partial duplication forming bifidity is one of its rare congenital anomalies. We report here a case of unilateral left bifid ureter encountered during cadaveric dissection. The bifidity in the present case was at its greater extent and in the form of Y shaped with superior and inferior segments. Proximally, both the segments arose from the renal hilum. At pelvic brim, superior segment crossed the inferior segment superficially from medial to lateral. Both the segments united in the lesser pelvis at the level of bifurcation of internal iliac artery, about 1.5 inches above its opening into urinary bladder. Bifid ureter may be associated with the renal stones and other pathological conditions like gonadal dysgenesis. Knowledge of bifid ureter with the extent of bifidity is important during diagnostic approaches of associated disorders. Since the ureter is closely related to neighbouring vessels and organs, its detailed anatomy is essential in surgical and radiological interventional approaches