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ENDOCRINE IMAGE
Vikas Jain

Beahrs’ Triangle: The Surgical Anatomy

[Year:2017] [Month:January-April] [Volumn:9 ] [Number:1] [Pages:35] [Pages No:35][No of Hits : 1685]


ABSTRACT

Thyroidectomy is a commonly performing surgery worldwide with known complications of recurrent laryngeal nerve injury (RLN) and vocal cord paralysis. To avoid RLN palsy, various methods of RLN identification have been defined, one of which is called as defining Beahrs’ triangle.

Keywords: Beahrs’ triangle, Landmark, Thyroidectomy.

How to cite this article: Jain V. Beahrs’ Triangle: The Surgical Anatomy. World J Endoc Surg 2017;9(1):35.

Source of support: Nil

Conflict of interest: None


 
CASE REPORT
Ashu Singh, Deep Shikha, Shipra Agarwal, Nita Khurana, Shyam Lata Jain, NS Hadke

Multiple Retroperitoneal Paragangliomas: An Uncommon Entity

[Year:2017] [Month:January-April] [Volumn:9 ] [Number:1] [Pages:35] [Pages No:20-23][No of Hits : 772]


ABSTRACT

Introduction: Paragangliomas are neuroendocrine tumors and occur commonly in head and neck region and less frequently in the retroperitoneum. Multifocal paragangliomas are even rarer and highly suggestive of familial disease. To the best of our search, there are only two case reports of multiple retroperitoneal paragangliomas with no known familial association. This is the third report of this kind in the English literature.

Case report: A young adult with no significant past or family history presented with abdominal pain and anorexia. Abdominal examination revealed a soft nontender mass in the right hypochondrium. Contrast-enhanced computed tomography showed multiple retroperitoneal mass lesions. A clinicoradiological diagnosis of multicentric Castleman’s disease/Lymphoma was made. Guided fine needle aspiration of the mass was suggestive of a neuroendocrine neoplasm. Tru-cut biopsy showed features of paraganglioma. Following this, the masses were excised and the diagnosis of paraganglioma was confirmed.

Conclusion: Multicentric retroperitoneal paragangliomas without any familial association are very rare with only two case reports in the English literature. Lack of symptoms makes the diagnosis difficult and also makes our case unique. Biopsy from paragangliomas and surgical intervention are known to cause life-threatening complications, such as profuse bleeding and abrupt changes in blood pressure. Hence, paragangliomas should be considered as a possibility, even if a remote one, in case of multicentric retroperitoneal tumors. This case also highlights the importance of cytology in the early diagnosis of retroperitoneal masses.

Keywords: Multiple, Paragangliomas, Retroperitoneal.

How to cite this article: Singh A, Shikha D, Agarwal S, Khurana N, Jain SL, Hadke NS. Multiple Retroperitoneal Paragangliomas: An Uncommon Entity. World J Endoc Surg 2017;9(1):20-23.

Source of support: Nil

Conflict of interest: None


 
HOW WE DO IT
Anish Kolly, Vijaya Sarathi, Sapana Bothra, Aromal Chekavar, Mayilvaganan Sabaretnam, Amit Agarwal

Hypocalcemia: What a Surgeon should know.

[Year:2017] [Month:May-August] [Volumn:9 ] [Number:2] [Pages:41] [Pages No:72-77][No of Hits : 669]


ABSTRACT

Hypocalcemia is one of the sequelae following thyroidectomy (TT) and becomes a complication when it becomes permanent. Parathyroid preservation is a crucial step in the skillful operative procedure of TT. When due care is not taken, the surgeon and the treating physician are faced with the issue of treating the dreaded complication of permanent hypocalcemia. In this article, we address the issue of hypocalcemia following thyroid surgery and its management.

Keywords: Hypocalcemia, Parathyroid, Thyroidectomy.

How to cite this article: Kolly A, Sarathi V, Bothra S, Chekavar A, Sabaretnam M, Agarwal A. Hypocalcemia: What a Surgeon should know. World J Endoc Surg 2017;9(2):72-77.

Source of support: Nil

Conflict of interest: None


 
How I Do It
Gyan Chand, SK Mishra

Transoral Endoscopic Thyroid Surgery through Vestibular Approach

[Year:2016] [Month:May-August] [Volumn:8 ] [Number:2] [Pages:52] [Pages No:179-182][No of Hits : 1644]


ABSTRACT

Scarless neck surgery for thyroid became popular after the advancement of endoscopic and robotic thyroid surgery. Different approaches have been practiced for endoscopic thyroid surgery in different parts of the world.

Keywords: Endoscopic thyroid surgery, Endoscopic thyroid surgical techniques, Transoral thyroid surgery.

How to cite this article: Chand G, Mishra SK. Transoral Endoscopic Thyroid Surgery through Vestibular Approach. World J Endoc Surg 2016;8(2):179-182.

Source of support: Nil

Conflict of interest: None


 
15th Biennial Congress of the Asian Association of Endocrine Surgeons, April 2016

Poster Presentation on Adrenal, Pituitary, and Other Endocrine Glands, Parathyroid Gland, Thyroid Gland

[Year:2016] [Month:January-April] [Volumn:8 ] [Number:1] [Pages:136] [Pages No:55-127][No of Hits : 867]


ABSTRACT

BACKGROUND AND AIMS

Gastrointestinal and pancreatic neuroendocrine tumors (NET) are classified as low grade (G1), intermediate grade (G2), and high grade (G3) by mitotic rate and/or Ki-67 index. The basic treatment for neuroendocrine carcinoma (NEC, G3) with remote metastasis is platinum-based systemic chemotherapy. In contrast, for patients with NET G1 or G2 with remote metastasis, multidisciplinary treatment is necessary in order to prolong patients’ survival and relieve symptoms. We report here a patient with pancreatic G1 gastrinoma and its multiple liver metastases.

METHODS

The patient was a 42 years old male who had been suffering from diarrhea for 2 years, and his serum level of gastrin was as high as 4200 pg/mL before treatment. Needle biopsy of the liver proved the tumor was positive for chromogranin A, gastrin, and somatostatin receptor type 2A.

RESULTS

First, we chose an induction drug therapy with sunitinib and octreotide. The size of the liver tumors decreased dramatically and the serum gastrin level became lower than 500 pg/mL. About 1 year after diagnosis, we performed distal pancreatectomy and right hepatic lobectomy. After surgery, the serum gastrin level was normalized, and the activity of daily living (ADL) of the patient was much improved by the consecutive therapies. During the 2-year postoperative follow-up time, the course was favorable and no recurrent lesion was found.

CONCLUSION

Even when there are remote metastases, multidisciplinary treatment including surgical resection should be considered for G1/G2 NET. Further, it should be necessary to study in a larger number of patients if perioperative drug therapy for G1/G2 NET with remote metastases is effective.


 
ORIGINAL ARTICLE
Anish J Cherian, Pooja Ramakant, Thomas V Paul, Deepak T Abraham, MJ Paul

Next-day Parathyroid Hormone as a Predictor of Post-thyroidectomy Hypocalcemia

[Year:2016] [Month:September-December] [Volumn:8 ] [Number:3] [Pages:31] [Pages No:203-207][No of Hits : 720]


ABSTRACT

Aim: Total thyroidectomy is significantly complicated by parathyroid dysfunction and hypocalcemia. These aspects impact the decision regarding the timing of discharge and quantum of calcium supplementation required. Therefore, we aimed at evaluating the accuracy of next-day parathyroid hormone (PTH) level as a predictor of post-thyroidectomy hypocalcemia. Secondly, we aimed at establishing our institution’s postoperative PTH level, which can accurately predict the development of post-thyroidectomy hypocalcemia to help us ensure the safe and early discharge of patients.

Materials and methods: A prospective observational study of 50 continuous patients undergoing thyroidectomy was conducted at a tertiary hospital in South India. Postoperative blood samples were collected for estimation of PTH, calcium, albumin, and phosphorous. The data were collated and results analyzed using Stata I/C 10.1.

Results: A total of 30% (15/50) of the patients had postoperative hypocalcemia (serum calcium >8 mg/dL). Postoperative PTH was low (>8 pg/mL) in 40% (20/50) of patients. There was a significant association between PTH > 8 pg/mL and the presence of postoperative hypocalcemia (p = 0.029). The area under the receiver operating characteristic (ROC) curve was 0.7, and a next-day PTH of >6 pg/mL showed the highest sensitivity and specificity (83 and 60% respectively) for the development of postoperative hypocalcemia, with a positive predictive value (PPV) and negative predictive value (NPV) of 83 and 60 respectively.

Conclusion: The PTH assessment performed the day after surgery is an acceptable test to predict post-thyroidectomy hypocalcemia; PTH >6 pg/mL can be used as our institution’s cutoff value. Department protocols for calcium and vitamin D supplementation following total thyroidectomy may be formulated based on the appropriately timed local postoperative PTH value to assist safe and early discharge of patients.

Clinical significance: Discharge protocols for patients undergoing thyroidectomy may be formulated based on the postoperative PTH values, thus enabling safe and early discharge of patients.

Keywords: Calcium, Hypocalcemia, Observational study, Parathyroid hormone, Thyroidectomy.

How to cite this article: Cherian AJ, Ramakant P, Paul TV, Abraham DT, Paul MJ. Next-day Parathyroid Hormone as a Predictor of Post-thyroidectomy Hypocalcemia. World J Endoc Surg 2016;8(3):203-207.

Source of support: Dr MGR Medical University research grant; Fluid research grant – CMC, Vellore.

Conflict of interest: None


 
CASE REPORT
Daniel W Nelson, Melissa LoPinto, Charif Sidani, John I Lew

Large Substernal Thyroid Goiter Associated with Saddle Pulmonary Embolism

[Year:2016] [Month:September-December] [Volumn:8 ] [Number:3] [Pages:31] [Pages No:214-216][No of Hits : 609]


ABSTRACT

A 75-year-old woman with a longstanding history of a substernal thyroid goiter presented with acute shortness of breath, and she was intubated due to respiratory distress. Computed tomography (CT) scan revealed a compressive substernal goiter with associated vascular compression, axillosubclavian thrombosis, and saddle pulmonary embolism. Weight-based heparin was immediately administered, and the patient subsequently underwent successful thyroidectomy via a cervical incision. This case report of a rare saddle pulmonary embolism associated with a substernal thyroid goiter underscores the importance of early elective thyroidectomy. Successful management of these potentially devastating pulmonary emboli (PE) associated with large substernal goiters is possible.

Keywords: Cervical thyroidectomy, Saddle pulmonary embolism, Substernal goiter, Thromboemboilc disease.

How to cite this article: Nelson DW, LoPinto M, Sidani C, Lew JI. Large Substernal Thyroid Goiter Associated with Saddle Pulmonary Embolism. World J Endoc Surg 2016;8(3):214-216.

Source of support: Nil

Conflict of interest: None


 
Original Article
Duminda DMC Dissanayake, Ranil F Fernando, Iresha J Dissanayake

Lateral approach to Thyroid (LATT): A Good Technique for Re-operative Thyroid Surgery

[Year:2016] [Month:May-August] [Volumn:8 ] [Number:2] [Pages:52] [Pages No:141-142][No of Hits : 591]


ABSTRACT

Introduction: Thyroidectomy is the commonest endocrine surgical procedure undertaken throughout the world. Redo thyroidectomies are challenging procedures with a higher morbidity rate. Lateral approach to thyroid (LATT) is a good alternative to the standard midline exploration. The key to the technique is the development of the natural tissue plane between the strap muscle and the ipsilateral sternocleidomastoid muscle to explore the thyroid bed. A study was carried out to assess the efficacy, safety, and complication of LATT.

Materials and methods: Data on patients undergoing LATT in professorial surgical unit, Ragama from 2008 to 2015, were collected prospectively and analyzed. All procedures were done by a single surgeon.

Results: A total of 36 LATTs were done. Data from 32 people were collected, as 4 patients lost follow-up; 29 (90.6%) were females and 3 (9.4%) were males. Their age ranges between 28 and 61 (median 43.37). Three (9.4%) LATTs for parathyroid explorations and out of it one (3.1%) for redo parathyroid explorations were done. Nine (28.1%) cases were redo thyroidectomies and 18 (56.2%) were done with mini incision with lateral approach. Hemithyroidectomies were performed on 28 (87.5%) patients. Bilateral explorations were done on three (9.4%) patients and four (12.5%) lateral approaches were done for completion thyroidectomies for follicular malignant lesions. Transient clinical hypocalcemia was noticed in four (12.5%) patients and one (3.1%) developed hoarseness of voice, which was temporary; and none of them had complications like hematoma and postsurgical stridor.

Conclusion: Lateral approach to thyroid is a safe alternative to the standard approach for reexplorative thyroid surgery.

Keywords: Lateral approach, Reoperative, Thyroid.

How to cite this article: Dissanayake DDMC, Fernando RF, Dissanayake IJ. Lateral approach to Thyroid: A Good Technique for Reoperative Thyroid Surgery. World J Endoc Surg 2016;8(2):141-142.

Source of support: Nil

Conflict of interest: None


 
Review Article
Anish Cherian, Pooja Ramakant, Mazhuvanchary Jacob Paul, Deepak Thomas Abraham

Management of Chyle Leak in the Neck Following Thyroid Cancer Surgery: A Single Center Experience

[Year:2015] [Month:January-April] [Volumn:7 ] [Number:1] [Pages:27] [Pages No:6-9][No of Hits : 2118]


ABSTRACT

Introduction: Surgery for thyroid cancers often necessitates a neck dissection. This is usually a safe procedure, but can be associated with complications. Chyle leak is one such complication, fortunately rare. There is a dearth of literature with regard to the management of chyle leak in the neck. We present a single center experience in the management of chyle leak in the neck, to improve the understanding of its management.

Materials and methods: A retrospective analysis of patients with thyroid cancer, managed between January 1st 2005 and December 31st 2011, in a single institution was performed. Among these, patients with chyle leak were identified. All pertinent data collected and results analyzed using STATA (v10).

Results: Three hundred and seventy-three/eight hundred and twenty-one (45.4%) patients surgically managed for thyroid cancer underwent a neck dissection. Thoracic duct injury was recog- nized and managed intraoperatively in 20/373 (5.4%) patients. The leak was prevented in the majority (66.6%) of patients in whom a combination of methods were employed. 25/373 (6.7%) patients were diagnosed and managed for chyle leak postoperatively. Seven patients required re-exploration. This included patients with low output chyle leaks who may have settled in a week to 10 days with conservative management. A combination of techniques was successful in the majority (71.4%). The remaining patients were successfully managed conservatively.

Conclusion: We conclude that using a combination of methods to manage thoracic duct injury may be better than using a single modality alone. Early re-exploration was more economical and acceptable for a subset of our patients, as they come from long distances at personal cost.

Keywords: Thyroidectomy, Chyle leak, Thyroid cancer, Modified radical neck dissection.

How to cite this article: cherian a, Ramakant P, Paul MJ, Abraham DT. Management of Chyle Leak in the Neck Following Thyroid Cancer Surgery: A Single Center Experience. World J Endoc Surg 2015;7(1):6-9.

Source of support: Nil

Conflict of interest: None


 
Case Report
Heather Player, Robert Babkowski, Xiang Dong

A Cautionary Case: Adrenal Insufficiency after Unilateral Adrenalectomy for Adrenocortical Carcinoma

[Year:2015] [Month:January-April] [Volumn:7 ] [Number:1] [Pages:27] [Pages No:17-20][No of Hits : 1613]


ABSTRACT

Subclinical Cushing’s syndrome among patients with incidentally discovered adrenal masses has been well documented in the literature. This population does not exhibit the classic signs of Cushing’s syndrome, but nonetheless present with postoperative adrenal insufficiency after unilateral adrenalectomy of nonfunctioning incidentalomas. Further, the results of extensive preoperative testing do not correlate with postoperative hypoadrenalism with adequate sensitivity. The patient is an 84-year-old male, who presented with vague complaints of abdominal pain and fatigue, with computed tomography (CT) scan demonstrating an enlarging left adrenal gland up to 5.5 cm. The patient had no evidence of hypothalamic-pituitary-adrenal axis dysfunction based on history, physical examination and preoperative testing. Thus, the lesion was presumed nonfunctional and was excised laparoscopically. Pathology demonstrated an unfortunate diagnosis of adrenocortical carcinoma (ACC). On postoperative day 1, the patient exhibited hypotension and hypoglycemia, with a cortisol level of 0.3 mg/dl. The patient responded to hydrocortisone, supporting the presumed diagnosis of hypoadrenalism. ACC is a rare and aggressive tumor, with only 300 documented cases per year in the United States. Thus, there is a paucity of data related to pre- and postoperative management. Since a third of the patients present with nonfunctioning tumors, postsurgical care are based on literature from nonfunctional incidentalomas until further research establishes guidelines. Our experience with acute hypoadrenalism after unilateral adrenalectomy in the setting of ACC suggests the need for routine postoperative testing of cortisol levels.

Keywords: Adrenocortical carcinoma, adrenal insufficiency, Adrenalectomy, Steroid replacement, Hypoadrenalism.

How to cite this article: Player H, Babkowski R, Dong X. A Cautionary Case: Adrenal Insufficiency after Unilateral Adrenalectomy for Adrenocortical Carcinoma. World J Endoc Surg 2015;7(1):17-20.

Source of support: Nil

Conflict of interest: None


 
Original Article
Pinar Yazici, Mehmet Mihmanli, Emre Bozdag, Nurcihan Aygun, Mehmet Uludag

Location of Parathyroid Adenomas in Primary Hyperparathyroidism: Where to look?

[Year:2015] [Month:January-April] [Volumn:7 ] [Number:1] [Pages:27] [Pages No:1-5][No of Hits : 1255]


ABSTRACT

Purpose: Preoperative localization studies for parathyroid adenomas are very essential to perform minimal invasive parathyroidectomy (MIP) with decreased operative time and potential complications. Although most of these studies based on radiological imaging, intraoperative assessment provides the most accurate anatomical description of the location of parathyroid adenomas. In this study, we aim to evaluate the surgical variations of locations of parathyroid adenomas in patients performed parathyroid surgery for primary hyperparathyroidism (PHPT).

Materials and methods: Between January 2010 and December 2013, 243 patients (201 women/42 men) who underwent parathyroid surgery due to phPT were included. A total of 254 parathyroid adenomas were detected. Demographic features, preoperative work-up, surgical approach, types of procedures and postoperative complications were noted. Locations of parathyroid adenomas were recorded from operative notes. Statistical analysis was performed using t-test and chi-square. continuous data are expressed as mean ± standard deviation.

Results: With regard to the most frequently observed, location of adenomas were as follows; right inferior (n = 89, 37.7%), left inferior (n = 78, 33%), right superior (n = 44, 18.6%), left superior (n = 25, 10.5%) and ectopic locations (n = 18). Ectopic adenomas were mostly located in the thymus (n = 9) and intrathyroidal tissue (n = 6) at a rate of 83%. Postoperative hypocalcemia (11%) was mostly seen in those with parathyroid adenoma located around the inferior lobes of the thyroid (86%) and undergoing bilateral neck exploration (75%).

Conclusion: The most of the parathyroid adenomas were found in orthotopic position and located around the lower pole of the thyroid gland. Ectopic adenomas were mostly located in thymus or intrathyroidal. Postoperative hypocalcemia was also higher in those with parathyroid adenoma located around the inferior lobe of the thyroid.

Keywords: Parathyroid anatomy, Primary hyperparathyroidism, Parathyroid adenoma, Surgical Approach.

How to cite this article: Yazici P, Mihmanli M, Bozdag E, Aygun N, Uludag M. Location of Parathyroid Adenomas in Primary Hyperparathyroidism: Where to look? World J Endoc Surg 2015;7(1):1-5.

Source of support: Nil

Conflict of interest: None


 
MINI REVIEW
Sabaretnam Mayilvaganan, Naval Bansal, Navneet Tripathi, Ashwini Reddy, Amit Agarwal

Tubercle of Zuckerkandl

[Year:2015] [Month:May-August] [Volumn:7 ] [Number:2] [Pages:25] [Pages No:33-35][No of Hits : 1231]


ABSTRACT

Endocrine Surgeon must have intimate knowledge about all anatomic variations of thyroid gland for performing safe thyroid surgery. Tubercle of Zuckerkandl is a posterior extrusion of the lateral thyroid lobes and it is a pointer to the recurrent laryngeal nerve and inferior parathyroid glands. We have discussed pertinent issues regarding tubercle of Zuckerkandl in this mini review.

Keywords: Pointer, Recurrent laryngeal nerve, Tubercle of Zuckerkandl.

How to cite this article: Mayilvaganan S, bansal N, Tripathi N, Reddy A, Agarwal A. Tubercle of Zuckerkandl. World J Endoc Surg 2015;7(2):33-35.

Source of support: Nil

Conflict of interest: None


 
Case Report
Ramesh Maturi, Hemanth Makineni, Sri Santhosh Keerthi Marri

A Unique Case of O steitis Fibrosa Cystica with Postoperative Hungry Bone Syndrome and Hypocalcemic Cardiac Failure

[Year:2015] [Month:January-April] [Volumn:7 ] [Number:1] [Pages:27] [Pages No:10-13][No of Hits : 1150]


ABSTRACT

Osteitis fibrosa cystica, a manifestation of severe hyperparathyroidism presenting with crippling bone deformities is a rare presentation these days. We report a case of 40-year-old male patient who presented with generalized aches and pains and bony deformities. Radiographs showed diffuse osteopenia, brown tumors and pathological fractures of phalanges but common manifestations associated with hyperparathyroidism like pancreatic calcifications and nephrolithiasis were absent. Serum calcium and parathyroid hormone levels were elevated while ultrasound imaging of neck showed the presence of a left lower parathyroid adenoma and was confirmed by Tc99- sestamibi scan. Large parathyroid lesion along with high calcium levels and severely elevated PTH puts this patient in high-risk category for postoperative hungry bone syndrome leading to severe hypocalcemia postoperatively. Hypocalcemia usually results in neuromuscular irritability manifesting as paresthesia, Chvostek and Trousseau sign, carpopedal spasm and even convulsions in severe cases. However, our patient had none of the common manifestations, but developed hypocalcemic cardiac failure postoperatively. Case history and management of case is presented.

Keywords: Hyperparathyroidism, Parathyroid adenoma, Hypocalcemia, Hypocalcemic cardiac failure, Hungry bone syndrome.

How to cite this article: Maturi R, Makineni H, Marri SSK. A Unique Case of Osteitis Fibrosa Cystica with Postoperative Hungry Bone Syndrome and Hypocalcemic Cardiac Failure. World J Endoc Surg 2015;7(1):10-13.

Source of support: Nil

Conflict of interest: None


 
How We Do It
Prabhaker Mishra, Sabaretnam Mayilvaganan, Amit Agarwal

Statistical Methods in Endocrine Surgery Journal Club

[Year:2015] [Month:January-April] [Volumn:7 ] [Number:1] [Pages:27] [Pages No:21-23][No of Hits : 1059]


ABSTRACT

Endocrine surgery is a relatively newer surgical subspecialty with few dedicated endocrine surgery departments and journals. To understand the published literature, knowledge of some common statistical methods are not only useful but also significant to publish own research successfully. This paper present a brief review of common statistical methods, used for data analysis in conducting medical research.

Keywords: endocrine surgery, statistical methods, journal club, normal data, parametric test, survival analysis, regression analysis, roc curve.

How to cite this article: Mishra P, Mayilvaganan S, Agarwal A. Statistical Methods in Endocrine Surgery Journal Club. World J Endoc Surg 2015;7(1):21-23.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL ARTICLE
Baki Tastan, Alper Dogu, Yusuf Sevim

Thyroid Cancer in Patients with Hyperthyroidism

[Year:2015] [Month:May-August] [Volumn:7 ] [Number:2] [Pages:25] [Pages No:29-32][No of Hits : 951]


ABSTRACT

Background and objective: Malignant tumors of the thyroid gland are the most common of the endocrine malignancies. Although, patients with thyroid cancer have high 5 years survival rate, thyroid cancer is the most seen cause of mortality among cancers of the endocrine organs. The incidence of thyroid cancer in hyperthyroid patients varies from 0.1 to 21% in the literature. We aimed in this study to analyze the frequency of coexisting thyroid cancer and hyperthyroidism in our experience.

Results: Total 230 patients, who were operated for hyperthyroidism without the suspicion of thyroid malignancy between January 2005 and September 2010 were included in our study. Toxic multinodular goiter, toxic adenoma and Graves’ disease were diagnosed preoperatively in 187, 16 and 27 patients respectively. Histopathological thyroid malignancy was detected in 13 patients (5.7%).

Conclusion: Thyroid cancer with variable incidence up to 21% should be remembered in differential diagnosis of hyperthyroid patients.

Keywords: Graves’ disease, Hyperthyroidism, thyroid cancer.

How to cite this article: Tastan B, Dogu A, Sevim Y. Thyroid Cancer in Patients with Hyperthyroidism. World J Endoc Surg 2015;7(2):29-32.

Source of support: Nil

Conflict of interest: None


 
Endocrine Image
Dhalapathy Sadacharan, Shriraam Mahadevan, Krishnan Ravikumar, Sankaran Muthukumar

Primary Pigmented Nodular Adrenocortical Disease: A Rare Cause of Cushing’s Syndrome

[Year:2015] [Month:January-April] [Volumn:7 ] [Number:1] [Pages:27] [Pages No:24-25][No of Hits : 818]


ABSTRACT

Primary pigmented nodular adrenocortical disease (PPNAD) is one of the rare cause of adrenocorticotropic hormone (ACTH) independent Cushing’s syndrome. More than 90% of the reported PPNAD have been associated with Carney’s complex. Primary pigmented nodular adrenocortical disease is one of the major criteria for the diagnosis of Carney’s complex (CNC). We report a case of PPNAD which is not associated with CNC.

Keywords: Cushing’s syndrome, Primary pigmented nodular adrenocortical disease, Bilateral adrenalectomy.

How to cite this article: Sadacharan D, Mahadevan S, Ravikumar K, Muthukumar S. Primary Pigmented Nodular Adrenocortical Disease: A Rare Cause of Cushing’s Syndrome. World J Endoc Surg 2015;7(1):24-25.

Source of support: Nil

Conflict of interest: None


 
Letter-To-Editor
Sabaretnam Mayilvaganan, Amit Agarwal

Safety and Cost Efficiency in Thyroid Surgery

[Year:2015] [Month:January-April] [Volumn:7 ] [Number:1] [Pages:27] [Pages No:26-27][No of Hits : 815]


ABSTRACT

Dear editor,
We read with interest the article ‘safety and cost efficiency in thyroid surgery’ by Young-Chul OT and Gough I.1 We congratulate the authors on their work which is aimed toward reducing the cost and also providing a safe approach with acceptable clinical indicators for the outcome of thyroid surgery. This is more so relevant in the developing world, where the endocrine surgeon has to balance between the usage of newer technology as well as curtailing the cost of the procedure. Sutureless thyroidectomy using vessel sealing devices which have become a routine in most centers.2


 
CASE REPORT
Basant Kumar, Vijai D Upadhyaya, Ram Nawal Rao, Sheo Kumar

Ganglioneuroblastoma as Vasoactive Intestinal Polypeptide-secreting Tumor: Rare Case Report in a Child

[Year:2015] [Month:May-August] [Volumn:7 ] [Number:2] [Pages:25] [Pages No:47-50][No of Hits : 736]


ABSTRACT

Pathologically elevated vasoactive intestinal polypeptide (VIP) plasma levels cause secretory diarrhea with excessive loss of water and electrolyte and is characterized by the typical symptoms of hypokalemia and metabolic acidosis. It rarely occurs in patients with non-pancreatic disease. Despite the clinical severity, diagnosis of a VIP-secreting tumor is often delayed. We herein present a 14-month-old boy having prolonged therapy-resistant secretory diarrhea, persistent hypokalemia with tissue diagnosis of ganglioneuroblastoma and raised plasma VIP-levels.

Keywords: Ganglioneuroblastoma, Secretory diarrhea, VIPoma.

How to cite this article: Kumar B, Upadhyaya VD, Rao RN, Kumar S. Ganglioneuroblastoma as Vasoactive Intestinal Polypeptide-secreting Tumor: Rare Case Report in a Child. World J Endoc Surg 2015;7(2):47-50.

Source of support: Nil

Conflict of interest: None


 
Case Report
Krishnan Ravikumar, Dhalapathy Sadacharan, RV Suresh

Surgical Delight: Nonrecurrent Laryngeal Nerve

[Year:2015] [Month:January-April] [Volumn:7 ] [Number:1] [Pages:27] [Pages No:14-16][No of Hits : 734]


ABSTRACT

Introduction: A nonrecurrent course is an unusual anatomic variation of the recurrent laryngeal nerve. It is seen usually on the right side, and it is very rare on the left side. Nonrecurrent laryngeal nerve if present is mostly associated with vascular anomalies.

Case report: A 55-year-old female was referred to us with thyrotoxic symptoms for a period of 6 months. She was rendered euthyroid with antithyroid medications. After complete evaluation, she was posted for total thyroidectomy. Intraoperatively, right recurrent nerve could not be identified in usual position. On careful dissection, a nonrecurrent laryngeal nerve was identified. The recurrent laryngeal nerve on the left side showed normal course. The intraoperative and postoperative period were uneventful. Postoperative vocal cord status was normal.

Conclusion: This case was presented for its rarity and to stress the need for orderly meticulous surgical dissection.

Keywords: Nonrecurrent laryngeal nerve, Recurrent laryngeal nerve, Inferior laryngeal nerve.

How to cite this article: Ravikumar K, Sadacharan D, Suresh Rv. Surgical Delight: Nonrecurrent Laryngeal Nerve. World J Endoc Surg 2015;7(1):14-16.

Source of support: Nil

Conflict of interest: None


 
HOW I DO IT
Dimitrios Linos

Minimally Invasive Non-Endoscopic Thyroidectomy: A Very High in the Neck Thyroidectomy Incision

[Year:2015] [Month:May-August] [Volumn:7 ] [Number:2] [Pages:25] [Pages No:51-52][No of Hits : 712]


ABSTRACT

We propose the adoption of a very high in the neck thyroi- dectomy incision, as high as the cricoid and/or thyroid cartilage, placed in an existing skin crease. This is a minimally invasive non-endoscopic thyroidectomy (MINET) approach that allows a safer, easier and more complete thyroidectomy.

Keywords: Incision, Neck, Thyroid.

How to cite this article: Linos D. Minimally Invasive Non- Endoscopic Thyroidectomy: A Very High in the Neck Thyroidectomy Incision. World J Endoc Surg 2015;7(2):51-52.

Source of support: Nil

Conflict of interest: None


 
Research Article
Pramodh Chandrasinghe, Ranil Fernando, Sumal Nandasena, Arunasalam Pathmeswaran

Epidemiology of Goiters in Sri Lanka with Geographic Information System Mapping: Population-based Cross-sectional Study

[Year:2015] [Month:September-December] [Volumn:7 ] [Number:3] [Pages:25] [Pages No:55-59][No of Hits : 690]


ABSTRACT

Background: Sri Lanka is considered an endemic region for goiter. Early researchers have suggested the existence of a goiter belt based on rainfall pattern. Subsequent studies done in school children have challenged this theory. Current study is a community-based cross-sectional study done to assess the epidemiology of goiters. Geographic information system (GIS) mapping of the goiter prevalence is developed for the first time in Sri Lanka.

Methods: Study subjects were selected using a multi-staged cluster sampling with probability proportionate to size (PPS) method. Examination for the presence of goiters was done by two trained investigators and graded. ArcGIS 10 software was used for geostatistical analysis and developing a map by interpolating the data collected for the first time in Sri Lanka.

Results: A total of 5200 individuals (female-66%, median age-38 years; range 10-92 years) were assessed and 426 goiters were detected. The adjusted prevalence rate of goiters was 6.8%. Kriging interpolation method was used to develop the most appropriate epidemiological map clustering of high prevalence areas with scattered pockets of high prevalence was observed. Current map does not show a prevalence pattern in relation to the rainfall or elevation above sea level as proposed in the past.

Conclusion: Goiter prevalence in Sri Lanka appears to be different from earlier proposed patterns. Use of GIS has contributed to develop a comprehensive epidemiological map of goiters demonstrating the absence of an endemic goiter belt in the wet zone as proposed earlier.

Keywords: Epidemiology, GIS mapping, Goiter prevalence.

How to cite this article: Chandrasinghe P, Fernando R, Nandasena S, Pathmeswaran A. Epidemiology of Goiters in Sri Lanka with Geographic Information System Mapping: Population-based Cross-sectional study. World J Endoc Surg 2015;7(3):55-59.

Source of support: National Science Foundation. Grant no: 2006/04.

Conflict of interest: None


 
Original Article
Narendra Krishnani, Niraj Kumari, Rajneesh K Singh, Pooja Shukla

The Dominant Somatostatin Receptor in Neuroendocrine Tumors of North Indian Population

[Year:2015] [Month:September-December] [Volumn:7 ] [Number:3] [Pages:25] [Pages No:60-64][No of Hits : 641]


ABSTRACT

Introduction: Neuroendocrine tumors (NET) express different types of somatostatin receptors (SSTRs) that bind to synthetic analogs with variable affinity. It is important to know the expression profile of SSTRs to predict biological effect of somatostatin analogues. We studied SSTR2 and SSTR5 expression by immunohistochemistry (IHC) to assess the dominant subtype in NETs and correlate the expression with histological prognostic parameters.

Materials and methods: Fifty-three consecutive cases of NET from all sites were evaluated for SSTR2 and SSTR5 expression by IHC. The expression was correlated with histological features of NETs.

Results: Forty-four cases were resected specimens and 9 were small biopsies. Nine of 53 cases (16.9%) were functional tumors. There were 24 NETs from gastrointestinal tract (GIT), 19 from pancreas and 10 from miscellaneous sites. Overall SSTR expression was seen in 43 NETs (79.2%). Somatostatin receptor 2 was expressed in 30 cases (56.6%) and SSTR5 in 39 cases (73.6%). Somatostatin receptor 2 expression showed near significant negative correlation with tumor grade and lymph node metastasis (p = 0.05). Somatostatin receptor 5 expression showed significant negative correlation with lymph node metastasis (p = 0.008) and tumor size (p = 0.02). Anatomic location and tumor necrosis were not significantly different. Somatostatin receptor 5 was dominant subtype expressed in all NETs with intense expression.

Conclusion: Somatostatin receptor 5 expression was the dominant subtype and expressed in small sized tumors. Somatostatin receptor 2 was expressed more in low grade NETs. Somatostatin analogs can be effective both in functional and nonfunctional NETs and can be useful in both resectable and nonresectable or metastatic tumors.

Keywords: Neuroendocrine tumors, Somatostatin analog, SSTR2, SSTR5.

How to cite this article: Krishnani N, Kumari N, Singh RK, Shukla P. The Dominant Somatostatin Receptor in Neuroendocrine Tumors of North Indian Population. World J Endoc Surg 2015;7(3):60-64.

Source of support: Nil

Conflict of interest: None


 
How We Do It
Sabaretnam Mayilvaganan, Aromal Chekavar, Rakesh Kapoor, Amit Agarwal

Conservative Management of Chyle Leak following Thyroid Surgery

[Year:2015] [Month:September-December] [Volumn:7 ] [Number:3] [Pages:25] [Pages No:76-78][No of Hits : 621]


ABSTRACT

Lymphatic injury leading to chyle leak is a potential complication that may arise following thyroid surgery especially when there is a high nodal burden. Although the incidence of chyle leak post surgery is low (1 to 4%), this complication can present significant challenges to both the surgeon and patient. Multiple approaches to the treatment of chyle leak have emerged, including nutrition, surgical, and pharmacological therapies. Although there are strong feelings among clinicians about the use of bowel rest, parenteral nutrition, or a low-fat enteral formula for the treatment of chyle leak, definitive evidence supporting any nonsurgical methods vs surgical approach is lacking. The lack of a clear consensus on the optimal management of chyle leaks makes this problem more challenging for the treating surgeon.

Keywords: Chyle leak, Conservative management, Thyroid surgery.

How to cite this article: Mayilvaganan S, Chekavar A, Kapoor R, Agarwal A. Conservative Management of Chyle Leak following Thyroid Surgery. World J Endoc Surg 2015;7(3):76-78.

Source of support: Nil

Conflict of interest: Sabaretnam Mayilvaganan and Aromal Chekavar have contributed equally to this manuscript.


 
CASE REPORT
Rajan Garg, Ankur Mandelia, Sandeep Agarwala, Veereshwar Bhatnagar, MK Singh, Manisha Jana

Antenatally Diagnosed Suprarenal Cystic Teratoma

[Year:2015] [Month:May-August] [Volumn:7 ] [Number:2] [Pages:25] [Pages No:44-46][No of Hits : 620]


ABSTRACT

A two months old female child presented to us with an antenatal diagnosis of left suprarenal mass. Laparotomy revealed a large cystic mass in the left suprarenal location which was completely excised. The histological diagnosis was a mature, cystic teratoma. Although, the diagnosis of adrenal teratoma is rare, it should be considered in the differential diagnosis of antenatally diagnosed suprarenal lesions.

Keywords: Adrenal teratoma, antenatal diagnosis, suprarenal teratoma.

How to cite this article: Garg R, Mandelia A, Agarwala S, Bhatnagar V, Singh MK, Jana M. Antenatally Diagnosed Suprarenal Cystic Teratoma. World J Endoc Surg 2015;7(2):44-46.

Source of support: Nil

Conflict of interest: None


 
Review Article
Rajeev Parameswaran, Dedrick Kok Hang Chan, Poon Li Mei Michelle, Shi Wang

Primary Adrenal Diffuse Large B-cell Lymphoma: A Mini Review

[Year:2015] [Month:September-December] [Volumn:7 ] [Number:3] [Pages:25] [Pages No:65-68][No of Hits : 605]


ABSTRACT

Background: Primary adrenal diffuse large B-cell lymphoma are aggressive high grade lymphomas affecting elderly gentlemen and mostly present with bilateral enlarged adrenal masses associated with B symptoms, adrenal insufficiency and elevated lactate dehydrogenase. When imaged with CT or ultrasound, these lesions usually appear as heterogeneous complex large masses with low density. They appear metabolically active on PET scan. Confirmatory diagnosis is established by image guided biopsy or surgical excision. Treatment is usually with rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone (R-CHOP) or CHOP like regimes. Surgery has very limited role, if any in the management of this condition. The prognosis is generally poor with only about a third of patients achieving partial or complete remission following treatment. A concise review of the literature (PubMed database; 1990-2014) on the clinical management of primary adrenal lymphoma along with a case example is discussed.

Keywords: Adrenal, Adrenal tumor, Lymphoma.

How to cite this article: Parameswaran R, Chan DKH, Michelle PLM, Wang S. Primary Adrenal Diffuse Large B-cell Lymphoma: A Mini Review. World J Endoc Surg 2015;7(3):65-68.

Source of support: Nil

Conflict of interest: None


 
Editorial
R Harsvardhan

Patient Safety vis-a-vis Safe Surgery: The Road Less traveled

[Year:2015] [Month:January-April] [Volumn:7 ] [Number:1] [Pages:27] [Pages No:v-vii][No of Hits : 538]


ABSTRACT

Patient Safety vis-à-vis Safe Surgery: The Road Less traveled

In October 2004, the World Health Organization (WHO) launched the World Alliance for patient safety in response to World Health Assembly Resolution 55.18 urging WHO and member states to pay the closest possible attention to the problem of patient safety. The Alliance raised awareness and political commitment to improve the safety of care and supports member states to develop patient safety policy and practice.


 
CASE REPORT
Aoife Lowery, Charles Vanbrugghe, Claudio Golffier, Frederic Sebag, Jean Francois Henry

Recurrent Primary Hyperparathyroidism: A Diagnostic Challenge in a Supernumerary Intrathyroidal Dormant Adenoma

[Year:2015] [Month:May-August] [Volumn:7 ] [Number:2] [Pages:25] [Pages No:39-43][No of Hits : 520]


ABSTRACT

Introduction: Recurrent primary hyperparathyroidism is a rare entity and presents a significant surgical challenge.

Presentation of case: We present the case of a 53-year-old female with recurrent primary hyperparathyroidism, which was caused by the very rare occurrence of a metachronous parathyroid adenoma in a supernumerary intrathyroidal parathyroid.

Discussion: This unique case highlights the challenges that arise in the evaluation of recurrent hyperparathyroidism in which even a thorough preoperative evaluation including radiographic, nuclear medicine studies and fine needle aspiration cytology did not facilitate a definitive preoperative diagnosis.

Conclusion: The management approach for these patients requires meticulous planning, experience and appropriate use of intraoperative adjuncts to guide surgical strategy.

Keywords: Hyperparathyroidism, Parathyroid, Radiographic study.

How to cite this article: Lowery A, Vanbrugghe C, Golffier C, Sebag F, Henry JF. Recurrent Primary Hyperparathyroidism: A Diagnostic Challenge in a Supernumerary Intrathyroidal Dormant Adenoma. World J Endoc Surg 2015;7(2):39-43.

Source of support: Nil

Conflict of interest: None


 
CASE REPORT
Kanika Rana, Nikhil Arora, Vikram Wadhwa, Eishaan Bhargava

Lingual Thyroid with Hyperthyroidism in a Child: A Rare Presentation

[Year:2015] [Month:May-August] [Volumn:7 ] [Number:2] [Pages:25] [Pages No:36-38][No of Hits : 516]


ABSTRACT

Lingual thyroid is the most common presentation of ectopic thyroid tissue (ETT). It is a rare condition presents in about 1 in 100,000 populations, more commonly is seen in females. It is even rarer in children. It is mainly associated with euthyroid or hypothyroid status; hyperthyroidism is rarely seen. Its management varies from surgical excision to medical management. Here, we present a case of lingual thyroid presenting with hyperthyroidism and its management.

Keywords: Children, Hyperthyroidism, Lingual, Thyroid.

How to cite this article: Rana K, Arora N, Wadhwa V, Bhargava E. Lingual Thyroid with Hyperthyroidism in a Child: A Rare Presentation. World J Endoc Surg 2015;7(2):36-38.

Source of support: Nil

Conflict of interest: None


 
Case Reports
Sabaretnam Mayilvaganan, Amit Agarwal

Management of post-thyroidectomy tracheomalacia

[Year:2014] [Month:May-August] [Volumn:6 ] [Number:2] [Pages:29] [Pages No:96-98][No of Hits : 3677]


ABSTRACT

Tracheomalacia is a heterogeneous and complex entity with no universally accepted definition and stratification. Historically, it is considered that patients with very large goiters are at risk of developing post-thyroidectomy tracheomalacia (PTTM). PTTM is a rare phenomenon and can be managed by either Noninvasive or invasive options.

Keywords: Tracheomalacia, Tracheostomy, Thyroid surgery.

How to cite this article: Mayilvaganan S, Agarwal A. Management of post-thyroidectomy tracheomalacia. World J Endoc Surg 2014;6(2):96-98.

Source of support: Nil

Conflict of interest: None


 
Review Article
Ranil Fernando, Anuradha Rajapaksha, Narada Ranasinghe, Duminda Gunawardana

Embryological Remnants of the Thyroid Gland and their Significance in Thyroidectomy

[Year:2014] [Month:September-December] [Volumn:6 ] [Number:3] [Pages:28] [Pages No:110-112][No of Hits : 3608]


ABSTRACT

Thyroid gland has three main embryological remnants: pyramidal lobe, tubercle of Zuckerkandl and thyrothymic remnants. They are commonly missed or misidentified during dissection. Each of these remnants plays a critical role in thyroidectomy as they help to identify the relevant anatomy and therefore help prevent accidental damage to other structures in close proximity during dissection.
In this article, we describe the current knowledge of each of these remnants and their significance in thyroidectomy.

Conclusion: It is important that all these remnants are objectively looked for and removed during surgery in order to prevent recurrences.

Keywords: Thyroid surgery, Thyroidectomy, Goiter.

How to cite this article: Fernando R, Rajapaksha A, Ranasinghe N, Gunawardana D. Embryological Remnants of the Thyroid Gland and their Significance in Thyroidectomy. World J Endoc Surg 2014;6(3):110-112.

Source of support: Nil

Conflict of interest: None


 
CASE REPORT
Elena M Wagner, Santhi Ganesan, Christopher R McHenry

Invasive Tall Cell Variant of Papillary Cancer originating from the Pyramidal Lobe of the Thyroid Gland with Extension to the Base of the Tongue

[Year:2014] [Month:January-April] [Volumn:6 ] [Number:1] [Pages:70] [Pages No:7-10][No of Hits : 1739]


ABSTRACT

A pyramidal lobe of the thyroid gland is a common anatomic variant. However, primary malignancy of the pyramidal lobe is rare with the exception of cancer in a thyroglossal duct cyst. A 61-year-old morbidly obese woman presented with a 30 lb. weight loss and a large asymptomatic submental neck mass that extended to the base of her tongue. The mass was invading the hyoid bone and the sternohyoid muscles. The patient had a short thick neck and “double chin,” which lead to delay in recognition of the neck mass. Further workup and final pathology revealed a locally invasive, tall cell variant of papillary cancer arising from the pyramidal lobe of the thyroid gland with regional and systemic metastases. To our knowledge, this is only the second case of a thyroid cancer arising from a pyramidal lobe reported in the literature. Primary thyroid cancer arising from the pyramidal lobe should be considered in the differential diagnosis of a midline neck mass.

Keywords: Papillary thyroid cancer, Invasive tall cell variant, Pyramidal lobe.

How to cite this article: Wagner EM, Ganesan S, McHenry CR. Invasive Tall Cell Variant of Papillary Cancer originating from the Pyramidal Lobe of the Thyroid Gland with Extension to the Base of the Tongue. World J Endoc Surg 2014;6(1):7-10.

Source of support: Nil

Conflict of interest: None


 
ABSTRACTS

14th Biennial Congress of the Asian Association of Endocrine Surgeons, March 2014

[Year:2014] [Month:January-April] [Volumn:6 ] [Number:1] [Pages:70] [Pages No:11-70][No of Hits : 1658]


ABSTRACT

1. Predictor for Prolonged Hospital Stay Post Total Parathyroidectomy in Tertiary Parathyroidism

Introduction

Prolonged hospital stay due to hypocalcemia is the most common cause after total parathyroidectomy surgery for tertiary hyperparathyroidism. Parameters like levels of alkaline phosphatase (ALP), parathyroid hormone (PTH), and posphate (PO4) were measured preoperatively. The purpose of this study was to determine whether any of these parameters could be a predictor for prolonged hospitalization in these patients.


 
Review Article
Nelson George, Megha Changtoo, Aru Singh, Praveen Kumar, Srinivasan Muthuswamy, Bandana Chakraborthy

Hormonal Regulation of Calcium Signaling in Endocrine Cancers

[Year:2014] [Month:May-August] [Volumn:6 ] [Number:2] [Pages:29] [Pages No:77-80][No of Hits : 1572]


ABSTRACT

The calcium ion (Ca2+) plays a fundamental role in a number of physiological functions including bone formation, muscle contraction, secretion, enzyme cofactor, stabilization of membrane potentials, blood coagulation, etc. Calcium is homeostatically regulated by hormones that determines calcium balance within the body. The hormones PTH, 1,25-(OH)2D3 and calcitonin are altered in endocrine cancers which are in turn regulated by calcium. The main focus of this review is how hormones can regulate calcium homeostasis in endocrine cancers.

Keywords: Endocrine cancers, Calcium homeostasis, Hormones Pth, 1,25-(Oh) 2D3 and calcitonin.

How to cite this article: George N, Changtoo M, Singh A, Kumar P, Muthuswamy S, Chakraborthy B. Hormonal Regulation of Calcium Signaling in Endocrine Cancers. World J Endoc Surg 2014;6(2):77-80.

Source of support: Nil

Conflict of interest: None


 
Case Reports
Kamilla Mahkamova, Barney J Harrison

Functional Retroperitoneal Neuroblastoma and Ganglioneuroblastoma in Adults

[Year:2014] [Month:May-August] [Volumn:6 ] [Number:2] [Pages:29] [Pages No:89-95][No of Hits : 1553]


ABSTRACT

Ganglioneuroblastoma and neuroblastoma are malignant catecholamine-secreting tumors arising from neural crest tissue. Thirty-eight cases of functional retroperitoneal extra-adrenal neuroblastoma and ganglioneuroblastoma in adults are reported in English literature. These tumors behave more aggressively in adults compared to children and have very poor prognosis. We report four adults who presented with retroperitoneal extraadrenal ganglioneuroblastoma and neuroblastoma between 2008 and 2012. Median age at presentation was 28.5 years (21-40 years). One patient was in late stages of pregnancy. Three patients presented with local pressure effects from the tumor and one patients manifested clinical features of catecholamine excess. Biochemical analysis showed raised urinary dopamine excretion in all our patients. Urinary noradrenaline and metanephrines were elevated in three cases. Computed tomography/ magnetic resonance imaging/meta-iodobenzylguanidine (CT/MRI/MIBG) confirmed stage IIB disease in one patient, stage III disease one patient and stage IV in two cases. Preoperative biopsy confirmed diagnosis in two cases. Complete surgical resection was performed in patient with stage II B disease and partial surgical resection was feasible in other cases. Histological diagnosis was ganglioneuroblastoma in two cases and neuroblastoma in two cases. Meta-iodobenzylglunidine/ radiotherapy and chemotherapy were used for residual disease. Urinary catecholamines and metanephrines normalized after complete tumor resection but remained elevated in residual disease. Survival for neuroblastoma was 15 and 21 months after the surgery and 29 months for ganglioneuroblastoma. One patient remains free of disease at 6 months. Functioning ganglioneuroblastoma and neuroblastoma are rare in adults and only one other case ganglioneuroblastoma in pregnancy is reported in the world literature. Measurement of plasma/urinary excretion of catecholamines and their precursors and metabolites is helpful for diagnosis of neuroblastoma and ganglioneuroblastoma. Due to late presentation surgical resection is unlikely to be curative. Three of our patients developed local recurrence of disease. Urinary/plasma assay are used for monitoring disease relapse. Long-term survival is unusual.

Keywords: Neuroblastoma, Ganglioneuroblastoma, Catecholamine- secreting tumors, Extra-adrenal tumors, Adults.

How to cite this article: Mahkamova K, Harrison BJ. Functional Retroperitoneal Neuroblastoma and Ganglioneuroblastoma in Adults. World J Endoc Surg 2014;6(2):89-95.

Source of support: Nil

Conflict of interest: None


 
Original Article
PRK Bhargav

Heterogenous Morphologic forms of Goiter in Autoimmune thyroid disease: An Insight based on a Prospective Surgical series of 88 cases

[Year:2014] [Month:May-August] [Volumn:6 ] [Number:2] [Pages:29] [Pages No:71-76][No of Hits : 1544]


ABSTRACT

Two commonest forms of autoimmune thyroid disease (AITD) are Graves’ disease (GD) and Hashimoto’s thyroiditis (HT) with a diffuse goiter. The nature of goiter apart from clinical presentation is crucial in the management of AITD. But, the goiter is not always diffuse, leading to diagnostic confusion. In this context, we conducted a prospective study on the goiter morphology in AITD. This is a prospective study conducted in Endocrine Surgery department of a teritiary care teaching hospital in South India over a period of 1 year. The cohort is a surgical series of 88 cases of AITD (GD = 53; HT = 35). Morphology of all the ex vivo specimens were studied, documented and correlated with clinical and radiological forms of goiter. Sex ratio was M:F = 74:14. Mean age for GD = 30.7 years (17-46) and HT = 38.2 years (31-52). In GD, the morphology was diffuse = 34; Unilateral hyperplasia (ULH) = 9; atrophic = 4; nodular = 5 and Marine Lenhart syndrome = 1. In HT, diffuse = 16; ULH = 10 and nodular goiter = 9. The correlation between the radiology and goitrous morphology was statistically significant and more concordant than clinico-morphological correlation. Autoimmune thyroid disease has heterogenous goitrous forms. Macroscopic morphological evaluation of goiter complements the clinicoradiological-pathological diagnosis of AITD leading to optimal diagnosis, counseling, follow-up.

Keywords: Graves’ disease, Hashimoto’s thyroiditis, Autoimmune disease, Morphology, Goiter.

How to cite this article: Bhargav PRK. Heterogenous Morphologic forms of Goiter in Autoimmune thyroid disease: An Insight based on a Prospective Surgical series of 88 cases. World J Endoc Surg 2014;6(2):71-76.

Source of support: Nil

Conflict of interest: None


 
Case Reports
Shafiq Rahman Abdul Gaffoor Shabiyullah, Reyaz M Singaporewalla, Anil Dinkar Rao, Vijayadwaja Desai

Retroperitoneal Schwannoma mimicking a Large Adrenal Incidentaloma: Case Report and Review of Literature

[Year:2014] [Month:May-August] [Volumn:6 ] [Number:2] [Pages:29] [Pages No:81-84][No of Hits : 1415]


ABSTRACT

Schwannomas are rare tumors originating from Schwann cells of peripheral nerve sheath (neurilemma) of the ectoderm. They are also referred to as neurilemmomas and are generally benign, solitary tumors arising from cranial and peripheral nerves. Rarely, they arise from the retroperitoneum and adrenal medulla. Retroperitoneal schwannomas constitute about 0.5 to 5% of all schwannomas and of which most of them are benign in nature. Most patients are asymptomatic or have vague abdominal symptoms. On imaging, they are often mistaken for adrenal tumors due to their location and preoperative diagnosis is often difficult. Magnetic resonance imaging (MRI) is the investigation of choice to demonstrate these lesions and its relation to other structures. Total excision is recommended as malignancy, although rare cannot be ruled out preoperatively. We present a case of a large retroperitoneal schwannoma that mimicked an adrenal incidentaloma and was excised laparoscopically. The imaging characteristics and management strategy are discussed.

Keywords: Retroperitoneal schwannoma, adrenal incidentaloma, laparoscopic adrenalectomy.

How to cite this article: Shabiyullah SRAG, Singaporewalla RM, Rao AD, Desai V. Retroperitoneal Schwannoma mimicking a Large Adrenal Incidentaloma: Case Report and Review of Literature. World J Endoc Surg 2014;6(2):81-84.

Source of support: Nil

Conflict of interest: None


 
REVIEW ARTICLE
Gauranga Majumdar, Surendra Kumar Agarwal, Shantanu Pande, Bipin Chandra

Carney Complex

[Year:2014] [Month:January-April] [Volumn:6 ] [Number:1] [Pages:70] [Pages No:1-6][No of Hits : 1181]


ABSTRACT

The complex of myxomas, spotty skin pigmentation, and endocrine over activity or Carney complex (CNC) (MIM no. 160980) is an autosomal dominant disorder that was described in 1985 by Carney. The diagnosis of CNC is made if two of the main manifestations of the syndrome are present, these need to be confirmed by histology, biochemical testing, or imaging. Alternatively, the diagnosis is made when one of the criteria is present and the patient is a carrier of a known inactivating mutation of the PRKAR1A gene. Most cases of CNC are caused by inactivating mutations in the gene encoding one of the subunits of the protein kinase A (PKA) tetrameric enzyme, namely regulatory subunit type1 alpha (PRKAR1A), located at 17q22-24. Endocrine, dermatologic, and cardiac anomalies are the main manifestations of CNC. Skin abnormalities are present in almost 77% of the CNC patients. Variety of endocrine gland tumors are observed in CNC patients, namely growth hormone secreting pituitary adenoma (acromegaly), thyroid adenomas or carcinomas, testicular tumors (large cell calcifying sertoli cell tumors), and ovarian cyst. Cardiac myxoma is the most common primary tumor affecting the heart, accounting for nearly half of cardiac neoplasms. Approximately, 30-60% of CNC patients will develop cardiac myxoma, usually at much younger ages than the sporadic tumors. A high degree of suspicion, complete evaluation, genetic counseling is important aspect of management of Carney’s disease. Once confirmed, surgical removal remains the mainstay of treatment.

Keywords: CNC, Molecular genetics, Cardiac myxoma, Primary pigmented nodular adrenocortical disease, PRKAR1A gene.

How to cite this article: Majumdar G, Agarwal SK, Pande S, Chandra B. Carney Complex. World J Endoc Surg 2014;6(1):1-6.

Source of support: Nil

Conflict of interest: None


 
Case Report
Siddhartha Chakravarthy Nalukurthi, Johnraj Kishore, Inian Samarasam, Birla Roy Gnanamuthu, MJ Paul

Chylothorax Following Thyroid Surgery: A Report of two Cases and Review of Management Strategies

[Year:2014] [Month:September-December] [Volumn:6 ] [Number:3] [Pages:28] [Pages No:115-118][No of Hits : 1146]


ABSTRACT

Chylothorax is a rare complication following thyroid surgery. Management of this complication can be conservative or surgical. We report two cases of chylothorax following excision of retrosternal goiter and neck dissection. The relevant literature is reviewed regarding the management strategy, highlighting the importance of surgical anatomy.

Keywords: Chylothorax, Thyroidectomy, Management.

How to cite this article: Nalukurthi SC, Kishore J, Samarasam I, Gnanamuthu BR, Paul Mj. Chylothorax Following Thyroid Surgery: A Report of two Cases and Review of Management Strategies. World J Endoc Surg 2014;6(3):115-118.

Source of support: Nil

Conflict of interest: None


 
Case Reports
Yi Cai, Anna Kundel, William Young, Geoffrey Thompson

Paravesicular Paraganglioma manifesting as Chronic Hypertension and Hypertensive Crisis

[Year:2014] [Month:May-August] [Volumn:6 ] [Number:2] [Pages:29] [Pages No:85-88][No of Hits : 1134]


ABSTRACT

We describe a woman with a rare extra-adrenal pheochromocytoma who presented with a chronic hypertension and a hypertensive crisis initiated by an invasive cardiac catheterization procedure. We present a case report, review the relevant literature, and discuss management strategies. A 49-year-old woman with a 4-year history of hypertension experienced a hypertensive crisis following a catheterization procedure. Evaluation of the episode led to identification of a catecholaminesecreting pelvic paraganglioma as confirmed by 24-hour urine fractioned metanephrines and catecholamines as well as magnetic resonance imaging. The patient was carefully pharmacologically prepared for surgical resection. Paragangliomas may exhibit 30% inheritability, and the patient was counseled on genetic testing for early diagnosis of tumor in family members. Catecholamine-secreting paragangliomas are rare tumors that may present as hypertensive emergencies. Diagnosis relies on biochemical testing followed by imaging to avoid crisis induced by invasive procedures. Surgical excision is the treatment of choice, and pharmacological preparation for surgery begins at least 1 week prior to the procedure to ensure adequate adrenergic blockade. Following treatment for a paraganglioma, genetic testing should be recommended for early identification of affected family members.

Keywords: Paraganglioma, Hypertensive crisis, Extra-adrenal pheochromocytoma.

How to cite this article: Cai Y, Kundel A, Young W, Thompson G. Paravesicular Paraganglioma manifesting as Chronic Hypertension and Hypertensive Crisis. World J Endoc Surg 2014; 6(2):85-88.

Source of support: Nil

Conflict of interest: None


 
Review Article
Brajesh B Gupta, Sanjay S Changole, Vishal Nandagawali, Chandratej Chandrkant Kadam

Bilateral Pheochromocytoma with Hypertrophic Obstructive Cardiomyopathy: A Rare Case

[Year:2014] [Month:September-December] [Volumn:6 ] [Number:3] [Pages:28] [Pages No:107-109][No of Hits : 1085]


ABSTRACT

Pheochromocytomas are catecholamine-secreting tumors of neuroectodermal origin. Different clinical presentations, various preoperative and intraoperative complications and their potential to become malignant provide a challenge in diagnosing and managing these cases. We report a rare case of bilateral pheochromocytoma with hypertrophic obstructive cardiomyopathy. He was diagnosed with bilateral pheochromocytoma with hypertrophic obstructive cardiomyopathy presenting at the age of 15 years without evidence of multiple endocrine neoplasia type 2 (MEN-2), or any familial syndrome or metastasis and then offered a surgery which was first cancelled due to uncontrolled hypertension. He was then taking alpha blocker for 8 years until he was again admitted to our institute. After prior blood pressure control with alpha and beta blocker drugs, open bilateral adrenalectomy was done without any complications. intraoperative spikes in blood pressure was managed with short acting antihypertensives, such as esmolol and labetalol. Postoperatively, patient is given steroid and under follow-up to rule out malignancy and other complications.

Keywords: bilateral pheochromocytoma, hypertrophic obstructive cardiomyopathy, bilateral adrenalectomy.

How to cite this article: Gupta BB , Changole SS, Nandagawali V, Kadam CC. Bilateral Pheochromocytoma with Hypertrophic Obstructive Cardiomyopathy: A Rare Case. World J Endoc Surg 2014;6(3):107-109.

Source of support: Nil

Conflict of interest: None


 
Original Article
Oh Thomas Young-Chul, Ian Gough

Safety and Cost Efficiency in Thyroid Surgery

[Year:2014] [Month:September-December] [Volumn:6 ] [Number:3] [Pages:28] [Pages No:101-106][No of Hits : 1045]


ABSTRACT

Aim: Recent developments in technology aim to reduce operative time and improve safety, albeit at significant cost. Thyroidectomy is a common procedure worldwide and an assessment of costefficiency is important.

Materials and methods: An audit of prospectively collected data on all thyroidectomies performed by a single endocrine surgeon at two private hospitals from 2009 to 2013. The technique was a conventional open dissection emphasizing capsular dissection with ligature and ligaclip and without intraoperative nerve monitoring (IONM). The operative duration was compared to those reported in literature with the use of vessel sealing devices (VSDs). Estimated time-dependent operating theater cost was used to determine the amount of time saving required by VSDs to match the costefficiency of our technique.

Results: There were 503 thyroidectomies with the expected mix of pathologies. There were zero permanent recurrent laryngeal nerve injuries (0.5% temporary, 746 nerves at risk), 0.6% permanent hypoparathyroidism (19.5% temporary, 308 completion and total thyroidectomies) and 0.6% hematoma. These outcomes compare favorably with published best practice. The median skin to skin operating time was 59 minutes for total and 35 minutes for hemithyroidectomies which are shorter than those reported with VSDs. The minimum time reduction required by VSDs to match the costefficiency of our technique was 27 minutes for hemithyroidectomy and 15 minutes for total thyroidectomy, which are longer than those reported in the literature.

Conclusion: Despite the current popularity of VSDs and the promotion of IONM, their routine use may not be justified. Technique is more important than technology.

Keywords: Thyroidectomy, Technique, Safety, Cost, Efficiency, Operative time.

How to cite this article: Young-Chul OT, Gough I. Safety and Cost Efficiency in Thyroid Surgery. World J Endoc Surg 2014;6(3):101-106.

Source of support: Nil

Conflict of interest: None


 
How We Do It
Mayilvaganan Sabaretnam, Navneet Tripati, Naval Bansal, Roma Pradhan, Amit Agarwal

Journal Clubs in Endocrine Surgery

[Year:2014] [Month:September-December] [Volumn:6 ] [Number:3] [Pages:28] [Pages No:123-126][No of Hits : 999]


ABSTRACT

Journal clubs are a medium to educate clinicians about the process of evidence based medicine. They are effective strategy to keep endocrine surgeons up to date with relevant literature. However, this exercise needs considerable expertise ,skill and dedication on the part of both the presenter and moderator to make it a successful one. We have addressed the methodology for an effective journal club.

Keywords: Journal club, Endocrine surgery, Articles.

How to cite this article: Sabaretnam M, Tripati N, Bansal N, Pradhan R, Agarwal A. Journal Clubs in Endocrine Surgery. World J Endoc Surg 2014;6(3):123-126.

Source of support: Nil

Conflict of interest: None


 
Case Report
NJ Nawarathna, NR Kumarasinghe, D Chandrasekara, P Rathnayake, BMRS Balasooriya, RJK Senevirathne

Thoracic Wall Metastasis from an Occult Thyroid Follicular Carcinoma

[Year:2014] [Month:September-December] [Volumn:6 ] [Number:3] [Pages:28] [Pages No:119-122][No of Hits : 977]


ABSTRACT

Occult thyroid carcinoma presenting with clinically apparent metastasis is rare and is a diagnostic challenge. Here, we report a 67-year-old male who presented with a left side chest wall mass resembling a soft tissue sarcoma of 1 year duration. The mass showed rapid enlargement at the latter end of its course, following an initial asymptomatic period. Imaging studies showed a soft tissue mass eroding into several ribs. Wide local excision with primary reconstruction was performed. Histological studies and immune staining revealed metastasis from a follicular thyroid carcinoma. Total thyroidectomy followed, confirming the diagnosis. Postoperatively, radioisotope ablation (I131) was done. A suppression dose of thyroxin was continued with regular thyroglobulin assays. Painful bone metastasis responded well to analgesics, bisphosphonates and external beam radiotherapy. Follicular carcinoma comprises 10 to 15% of thyroid malignancies. Localized thyroid carcinoma has a very good prognosis, 10 years survival rates reducing by 50% with metastatic disease. Commonly, thyroid cancer presents as detectable thyroid nodules, 25% having metastasis. In contrast, metastatic manifestations are reported in less than 5% of occult thyroid cancers.

Keywords: Follicular carcinoma, Occult thyroid carcinoma, Thoracic wall metastasis.

How to cite this article: Nawarathna NJ, Kumarasinghe NR, Chandrasekara D, Rathnayake P, Balasooriya BMRS, Senevirathne RJK. Thoracic Wall Metastasis from an Occult Thyroid Follicular Carcinoma. World J Endoc Surg 2014;6(3):119-122.

Source of support: Nil

Conflict of interest: None


 
Case Report
PRK Bhargav

Unusual presentation of Pheochromocytoma with Polyphagia

[Year:2014] [Month:September-December] [Volumn:6 ] [Number:3] [Pages:28] [Pages No:113-114][No of Hits : 831]


ABSTRACT

Pheochromocytoma is adrenal medullary tumor known to present in protean ways, especially in children. Here we describe a case of adrenal pheochromocytoma in young girl of 13 years presenting with polyphagia as a predominant symptom. She was successfully treated with laparoscopic adrenalectomy.

Keywords: Pheochromocytoma, Laparoscopic adrenalectomy, Polyphagia, Amaurosis fugax, Hypertension, Adrenal gland.

How to cite this article: Bhargav PRK. Unusual presentation of Pheochromocytoma with Polyphagia. World J Endoc Surg 2014;6(3):113-114.

Source of support: Nil

Conflict of interest: None


 
Case Reports
Prashant Lavania, Nikhil Singh, Richa Jaiman, Utkarsh Srivastava, Piyush Gupta

Lingual Thyroid

[Year:2014] [Month:May-August] [Volumn:6 ] [Number:2] [Pages:29] [Pages No:99][No of Hits : 817]


ABSTRACT

How to cite this article: Lavania P, Singh N, Jaiman R, Srivastava U, Gupta P. Lingual Thyroid. World J Endoc Surg 2014;6(2):99.

Source of support: Nil

Conflict of interest: None


 
Editorial
Narendra Krishnani

Parafibromin as a Tool of Screening in Parathyroid Neoplasms

[Year:2014] [Month:May-August] [Volumn:6 ] [Number:2] [Pages:29] [Pages No:v-vi][No of Hits : 749]


ABSTRACT

Parafibromin as a Tool of Screening in Parathyroid Neoplasms

Parathyroid carcinoma is the rare malignant form of primary hyperparathyroidism frequently associated with mortal outcome due to uncontrolled hypercalcemia. The diagnosis of benign and malignant parathyroid tumor depends strictly on certain morphological features or histologically documented metastasis. The diagnosis of parathyroid carcinoma thus requires either vascular or perineural invasion, invasive growth into adjacent tissues and/or metastases. The morphological features do not accurately predict the risk of malignancy and the tumor may already be incurable at the time of diagnosis. Therefore, the diagnosis of parathyroid carcinoma is often made in retrospection after surgery or sometimes after relapse.


 
Endocrine Image
Gauranga Majumdar, Surendra Agarwal, shantanu Pande, Bipin Chandra, Prabhat Tewari

Cardiac Myxoma in a case of Carney Complex

[Year:2014] [Month:September-December] [Volumn:6 ] [Number:3] [Pages:28] [Pages No:127-128][No of Hits : 637]


ABSTRACT

Keywords: Myxoma, Carney complex, Echocardiography, Surgical excision, Cardiac myxoma.

How to cite this article: Majumdar G, Agarwal S, Pande s, Chandra B, Tewari P. Cardiac Myxoma in a case of Carney Complex. World J Endoc Surg 2014;6(3):127-128.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL ARTICLES
Surender K Malhotra, Kiran Sharma, Vikas Saini

Pituitary Surgery and Anesthetic Management: An Update

[Year:2013] [Month:January-April] [Volumn:5 ] [Number:1] [Pages:32] [Pages No:1-5][No of Hits : 12365]


ABSTRACT

Out of all the brain tumors, 10% are pituitary tumors. Surgical interventions in this field have advanced and so have techniques of anesthesia and intensive care. Presenting features of the patients with pituitary tumors are often due to excessive or decreased secretion of hormones. Most commonly performed procedure is transsphenoidal pituitary surgery which requires skillful anesthetic technique as a number of associated comorbidities may exist. For a positive surgical result, a team consisting of endocrine surgeon, endocrinologist, neurosurgeon and anesthesiologist is a must. An emphasis is required on preoperative evaluation of airway, endocrinal and neurological status. The understanding of pathophysiology, perioperative anesthetic management, awareness of likely complications and postoperative care, results in successful outcome.

Keywords:Pituitary tumors, Anesthesia, Neurosurgery.

How to Cite this article: Malhotra SK, Sharma K, Saini V. Pituitary Surgery and Anesthetic Management: An Update. World J Endoc Surg 2013;5(1):1-5.

Source of support: Nil

Conflict of interest: None


 
CASE REPORTS
Mark J Heidenreich, Ryan M Antiel, Diana S Dean, David R Farley

Muscle Spasms after Thyroidectomy: What Went Wrong?

[Year:2013] [Month:January-April] [Volumn:5 ] [Number:1] [Pages:32] [Pages No:16-17][No of Hits : 8064]


ABSTRACT

Postoperative complications of thyroid surgery are generally limited, though not entirely rare. Cervical hematoma, recurrent laryngeal nerve damage and hypoparathyroidism are of greatest concern, with the latter being the most frequently encountered. We report a case of a Graves thyroid patient who experienced symptomatic hypocalcemia in a post-thyroidectomy setting. Episodes of paresthesia and tetany delayed the patient's hospital discharge, serving as a reminder of the potential morbidities thyroid surgery can entail.

Keywords:Thyroidectomy, Hypocalcemia, Tetany.

How to Cite this article: Heidenreich MJ, Antiel RM, Dean DS Farley DR. Muscle Spasms after Thyroidectomy: What Went Wrong? World J Endoc Surg 2013;5(1):16-17.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL ARTICLES
Kunal Pradip Verma, Alexandra Gorelik, Julie Ann Miller

Thyroid Surgery and Anticoagulation: Survey of Practice of Endocrine Surgeons in Australia

[Year:2013] [Month:January-April] [Volumn:5 ] [Number:1] [Pages:32] [Pages No:6-11][No of Hits : 5761]


ABSTRACT

Few studies specifically address management of venous thromboembolism (VTE) prophylaxis and bridging anticoagulation therapy in patients undergoing thyroid surgery. A survey about perioperative management of thromboprophylaxis was sent to Australian Endocrine Surgeons. Responses were tabulated and graphed; a p-value of <.05 was considered statistically significant. Survey responses showed a large broad spectrum of practice regarding thromboprophylaxis, bridging therapy and cessation of anticoagulant medication. While anticoagulant prophylaxis in thyroid surgery appears to be relatively safe, there is a theoretical risk of catastrophic bleeding complications; according to this survey of Australian Endocrine Surgeons, thromboembolic events are uncommon complications of thyroid surgery.

Keywords:Anticoagulation, Complications, Prophylaxis, Thyroid surgery.

How to Cite this article: Verma KP, Gorelik A, Miller JA. Thyroid Surgery and Anticoagulation: Survey of Practice of Endocrine Surgeons in Australia. World J Endoc Surg 2013;5(1):6-11.

Source of support: Nil

Conflict of interest: None


 
HOW I DO IT
Malcolm H Wheeler

The Surgical Management of Retrosternal (Intrathoracic) Goiter

[Year:2013] [Month:January-April] [Volumn:5 ] [Number:1] [Pages:32] [Pages No:28-30][No of Hits : 4330]


ABSTRACT

Retrosternal (intrathoracic) goiter has a prevalence of 4 to 20% of patients undergoing thyroidectomy for multinodular goiter. Although it is a condition affecting the older patient with a peak incidence in the sixth decade, the majority should be treated surgically. With few exceptions the operation can be safely accomplished through a cervical approach, only a small minority (approximately 2%) needing a combined cervical/mediastinal procedure. The surgical steps for the routine case are described and also various technical maneuvers required to facilitate delivery and excision of the difficult large goiter.

Keywords:Thyroid, Retrosternal goiter, Surgical management.

How to Cite this article: Wheeler MH. The Surgical Management of Retrosternal (Intrathoracic) Goiter. World J Endoc Surg 2013;5(1):28-30.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL ARTICLE
Sudhir M Naik, Rajshekar Halkud, SD Madhu, Purshottam Chavan, KT Siddappa, Sumit Gupta, KC Sunil, Samskruthi Moorthy, Prashanth Sinha, Jagdish Sarvadyna

Ectopic Thyroid Tissue in the Thyroglossal Cyst Duct: Rare Clinical Entity with Review of Literature

[Year:2013] [Month:May-August] [Volumn:5 ] [Number:2] [Pages:32] [Pages No:39-44][No of Hits : 4157]


ABSTRACT

The ectopic thyroid tissue is a rare developmental abnormality during embryogenesis where the thyroid gland passes from floor of the primitive foregut to its final pretracheal position. Its very important to verify the presence of a normally located normally functioning thyroid gland, thus excluding the possibility of an ectopic thyroid gland which resembles a TDC. A 12-year-old female presented to us with swelling in the midline of the neck region since 1 year. The mass moved with swallowing and protrusion of the tongue. On aspiration biopsy, a colloid material with cyst was confirmed. Imaging showed no orthotopic thyroid tissue on sonography and scintigraphy. No surgical intervention was done and as the patient was hypothyroid, levothyroxine replacement was given and the patient was advised for followup regularly. Hormonal estimation to rule out hypothyroid status and thyroid scintigraphy to detect the ectopic tissue and to see the presence of the normal orthotopic thyroid are essential investigations in evaluating thyroglossal cyst. Surgery is the treatment of choice in symptomatic lingual thyroids, with a role for radioiodine ablation in recurrent disease. Head and neck surgeons should evaluate ectopic thyroid as a differential diagnosis while evaluating mass in the midline as well as lateral neck.

Keywords: Ectopic thyroid tissue, Thyroglossal duct cyst, Hypothyroid, Orthotopic thyroid tissue, Scintigraphy.

How to cite this article: Naik SM, Halkud R, Madhu SD, Chavan P, Siddappa KT, Gupta S, Sunil KC, Moorthy S, Sinha P, Sarvadyna J. Ectopic Thyroid Tissue in the Thyroglossal Cyst Duct: Rare Clinical Entity with Review of Literature. World J Endoc Surg 2013;5(2):39-44.

Source of support: Nil

Conflict of interest: None


 
HOW I DO IT
PRK Bhargav

Gasless Transaxillary Thyroidectomy: A Technique of Endoscopic Thyroidectomy

[Year:2013] [Month:May-August] [Volumn:5 ] [Number:2] [Pages:32] [Pages No:61-63][No of Hits : 3842]


ABSTRACT

Various endoscopic thyroidectomy (ET) techniques ranging from video-assisted, total endoscopic, transaxillary endoscopic, robotic and chest wall approaches have been reported for thyroid surgery. They can be broadly divided in to gas-dependent and gasless approaches. Here, we describe our technique of gasless transaxillary thyroidectomy with synergistic benefits of open and endoscopic thyroidectomies.

Keywords: Endoscopic thyroidectomy, Transaxillary route, Hypercarbia, Technique.

How to cite this article: Bhargav PRK. Gasless Transaxillary Thyroidectomy: A Technique of Endoscopic Thyroidectomy. World J Endoc Surg 2013;5(2):61-63.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL ARTICLE
Ashok M Shenoy, A Nanjundappa, Rajshekar Halkud, Purshottam Chavan, Sumit Gupta, Kunal Naidu, Sudhir M Naik

Retroesophageal Right Subclavian Artery with Nonrecurrent Laryngeal Nerve: Unique Variation of Surgical Importance

[Year:2013] [Month:May-August] [Volumn:5 ] [Number:2] [Pages:32] [Pages No:33-38][No of Hits : 2868]


ABSTRACT

A nonrecurrent laryngeal nerve (NRLN) is a rare anatomical variant and is not detected on routine preoperative imaging. NRLN is related with absence of the brachiocephalic trunk and aberrant retroesophageal course of the right subclavian artery (arteria lusoria) which is evident on contrast-enhanced computerized tomographic (CT) scan of the chest. We report three cases of NRLN accidentally documented during total thyroidectomies for papillary carcinoma of the thyroid. All the three NRLNs seen on the right side were of the type IB variety. All the three NRLN were seen with its direct branch from the vagus at the level of the isthmus entering the cricothyroid muscle 2.5 to 3 cm away from the vagus without a recurrent course. Reviewing of contrast-enhanced CT scan of the chest revealed retroesophageal right subclavian artery (arteria lusoria) a variation of type I variety was evident in all the three cases. NRLN is a rare anatomical variant and routine preoperative imaging studies are not indicated. The risk of injury to the nerve is nullified by routine dissection and identifying its course along the paratracheal region. NRLN is related with absence of the brachiocephalic trunk and aberrant (mainly retroesophageal) course of the right subclavian artery which is evident on contrast-enhanced CT scan of the chest. Expensive imaging modalities are not warranted to screen a variation which is less than 1%.

Keywords: Right subclavian artery, Nonrecurrent laryngeal nerve, Thyroidectomy, Arteria lusoria, Papillary carcinoma.

How to cite this article: Shenoy AM, Nanjundappa A, Halkud R, Chavan P, Gupta S, Naidu K, Naik SM. Retroesophageal Right Subclavian Artery with Nonrecurrent Laryngeal Nerve: Unique Variation of Surgical Importance. World J Endoc Surg 2013;5(2): 33-38.

Source of support: Nil

Conflict of interest: None


 
ENDOCRINE IMAGE
Sabaretnam Mayilvaganan, Pooja Ramakant, Deepak T Abraham, MJ Paul

Carotid Artery Encasement by Thyroid Carcinoma

[Year:2013] [Month:January-April] [Volumn:5 ] [Number:1] [Pages:32] [Pages No:31-32][No of Hits : 2514]


ABSTRACT

How to Cite this article: Mayilvaganan S, Ramakant P, Abraham DT, Paul MJ. Carotid Artery Encasement by Thyroid Carcinoma. World J Endoc Surg 2013;5(1):31-32.

Source of support: Nil

Conflict of interest: None


 
CASE REPORT
Pouya Iranmanesh, Marc Pusztaszeri, John Robert, Patrick Meyer, Boris Schiltz, Samira Mercedes Sadowski, Michel Olivier Goumaz, Frederic Triponez

Thyroid Carcinoma in Hot Nodules: Review of the Literature

[Year:2013] [Month:May-August] [Volumn:5 ] [Number:2] [Pages:32] [Pages No:50-54][No of Hits : 2386]


ABSTRACT

Thyroid hot nodules are virtually always considered benign. Rare cases of hot thyroid carcinoma exist. We briefly described a clinical case and performed a review of the literature. We performed an extensive research on medical databases, such as PubMed and compiled all published cases matching preset criteria defining true hot thyroid carcinomas as well as guidelines regarding their management. We analyzed 103 articles published over the past 50 years. We selected 16 articles, including 45 cases matching our criteria. The majority were follicular carcinomas. Papillary carcinomas were infrequently found in this setting. Recommended management and survival rates were similar to classical cold thyroid cancer. Although hot nodules should continue to be considered benign most of the time, rare cases of hot thyroid cancers exist and clinicians should not hesitate to ask for additional tests if they encounter any abnormal finding. This form of thyroid cancer can reasonably be managed the same way as the cold thyroid cancers.

Keywords: Thyroid cancer, Thyroid carcinoma, Thyroid surgery, Hot thyroid nodule.

How to cite this article: Iranmanesh P, Pusztaszeri M, Robert J, Meyer P, Schiltz B, Sadowski SM, Goumaz MO, Triponez F. Thyroid Carcinoma in Hot Nodules: Review of the Literature. World J Endoc Surg 2013;5(2):50-54.

Source of support: Nil

Conflict of interest: None


 
CASE REPORT
Vidya Bhushan Rangappa, Athira Ramakrishnan, AM Balasubramanya, Raja Ram

Bilateral Adductor Palsy: A Rare Complication during Routine Surgery

[Year:2013] [Month:September-December] [Volumn:5 ] [Number:3] [Pages:25] [Pages No:76-78][No of Hits : 2326]


ABSTRACT

Recurrent laryngeal nerve (RLN) palsy occurring following thyroidectomy is a known complication. The first thing that comes to the surgeons, mind in a case of bilateral recurrent laryngeal nerve palsy is tracheostomy to secure the airway. But here we present a very interesting and unusual case of bilateral adductor palsy, post total thyroidectomy. We also highlight on the fact that not always the surgeon is to be blamed and there are certain subtle other factors to be aware of.

Keywords: Vocal fold, Palsy, Adductor palsy, Thyroidectomy, Recurrent laryngeal nerve.

How to cite this article: Rangappa VB, Ramakrishnan A, Balasubramanya AM, Ram R. Bilateral Adductor Palsy: A Rare Complication during Routine Surgery. World J Endoc Surg 2013;5(3):76-78.

Source of support: Nil

Conflict of interest: None


 
CASE REPORTS
Avraham Ishay, Julia Carmeli, Ehud Rozner, Rafael Luboshitzky

Refractory Amiodarone-induced Thyrotoxicosis: The Surgical Option