Clinicopathological spectrum of operated thyroid lesions in a tertiary care centre : a cross sectional study

Background: Thyroid diseases are one of the most common endocrine disorders affecting the general population worldwide.They comprise a spectrum of entities causing systemic disease (Grave’s disease) or a localised abnormality in the thyroid gland such as nodular enlargement (goitre) or a tumour mass.The prevalence and pattern of these disorders depend on various factors including sex, age, ethnic and geographical patterns.Aim: To study the clinicopathological spectrum of thyroid lesions and the treatment outcome among the operated cases of thyroid. Variables in the spectrum includes age and sex distribution, mode of presentation, pre-operative  thyroid function, evaluation by  ultrasound, FNAC and final histopathology, postoperative complications and duration of hospital stay.Materials and Methods:This was a cross sectional study which included all patients who underwent surgery for  thyroid pathologies in the department of general surgery, at our teaching hospital from January 2016 to December 2017.150 patients were included in the study. Patients who underwent thyroid surgery but whose records were not complete for thyroid function tests, USG findings and FNA findings were excluded from the study. Results:The highest incidences (38.6%) of thyroid lesionswere found in age group of 46-60 years with female predominance (87.3%). Out of total 150 cases, 30 were malignant and 120 were benign lesions. Thyroid function test was carried out for all cases and out of them 84 were euthyroid. Most common clinical symptom was swelling in the neck which was present in all cases. Multinodular goitre was the most common radiological finding seen in 76.7% cases. Benign follicular nodule was the most common diagnosis in FNAC (80%).The most common surgery performed was Total thyroidectomy (71%).Papillary carcinoma was the most common malignant lesion in this study (29 cases) and it was associated with MNG in 55% of cases. The incidence of clinical hypocalcemia was 10.6% and RLN injury was 5%.The mean duration of hospital stay was 4 days.Conclusions: Multinodulargoitre was found to be the most common thyroid lesion in this study. Thyroid diseases showed definite female predominance, with most of them occurring in an age group of 36 - 60 years. Papillary carcinoma was the most common malignant lesion in this study.In our study USG neck showed a moderate agreement with final histopathology compared to FNAC in diagnosing malignant lesions preoperatively. USG guided FNAC may improve the diagnostic accuracy. Combined approach based on history, clinical examination, FNAC and ultrasound is required to make an accurate diagnosis

Systemic inflammatory response syndrome following laparoscopic repair of diaphragmatic injury: A case report

Trauma is a major cause of morbidity and mortality in the younger age group. Though diagnostic laparoscopy has been attempted in trauma earlier, with the advance in minimal access techniques, there is an increasing attempt at advancing the indications for laparoscopy in the setting of trauma. Though there are reports and studies on the successful use of laparoscopy in the setting of abdominal trauma, it is essential to remember that laparoscopy in trauma is associated with risks inherent in the procedure itself and also with higher incidence of missed injuries if used as a diagnostic tool