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   Table of Contents - Current issue
May-June 2020
Volume 53 | Issue 3
Page Nos. 81-122

Online since Saturday, May 30, 2020

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Complications following thyroidectomy for benign thyroid diseases and their correlation with clinical, anatomical, and biochemical parameters p. 81
Aswin Prabhakaran, Riju Ramachandran, Pradeep Jacob, Misha J C Babu, Gopalakrishnan C Nair
Background: Hypocalcemia and recurrent laryngeal nerve (RLN) palsy are common complications following thyroidectomy. The study was designed to assess the effect of preoperative clinical and biochemical features and the intraoperative anatomical features on the rate of complications following total thyroidectomy (TT) for benign thyroid disease. Materials and Methods: The prospective observational study was conducted on patients undergoing TT for benign thyroid diseases. All patients underwent complete assessment followed by the estimation of thyroid function (free T4 and thyroid-stimulating hormone). Ultrasound imaging of the neck and guided aspiration from the suspicious area for cytology were performed routinely. All patients were followed for minimum 6 months. Parameters used for the analysis included demographic features, feel of the gland, presence of adhesions to surrounding soft tissue, presence of retrosternal extension, and anatomical features of laryngeal nerves and parathyroid glands. Results: One hundred and twenty-five eligible candidates were included in the study and temporary hypocalcemia and temporary RLN palsy occurred in 48 (38%) and 9 (6.5%) patients, respectively. None of the patients had permanent complications. Failure to identify all four parathyroids was associated with a higher incidence of hypocalcemia (P < 0.001). Anatomical variation of RLN such as prelaryngeal branching and anterior relation to inferior thyroid artery were associated with a higher incidence of RLN palsy (P < 0.001). Conclusion: Meticulous surgical dissection and thorough knowledge of anatomy prevent the development of both hypocalcemia and RLN palsy in TT for benign thyroid disorders.
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Comparison case number of E-Da hospital neurosurgical residency training in spine and peripheral nerve cases to America's national data p. 87
Yu-Ying Wu, Te-Yuan Chen, Po-Yuan Chen, Kang Lu, Cheng-Loong Liang, Wei-Jie Tzeng, Cien-Leong Chye, Hao-Kuang Wang, I-Fan Lin
Background: The purpose of this study was to evaluate the trends in adult spinal cases performed by E-Da hospital graduating neurological surgery residents, then comparing the case volumes against the national means in the US. Materials and Methods: The E-Da surgical case volumes were extracted using the hospital billing system for the years 2008–2017. These logs were coded according to the Accreditation Council for Graduate Medical Education guideline, providing a fair comparison against US national means. Linear regression analyses were conducted to identify changes in spinal categories. Finally, an unpaired student t-test was performed to compare E-Da case volumes to America's national means. Results: An average of 781.5 total spinal procedures were performed in the past 4 years of residency training for each of the four graduated E-Da neurosurgical residents, with the individual total caseload increasing by 38.07 cases each year (r2 = 0.40). The US national average was 427.72 spinal procedures for each of the 877 graduating residents, increasing by 19.96 cases every year (r2 = 0.95). E-Da has significantly more thoracic/lumbar instrumentation fusion procedures (mean 486.00 ± 90.27) and anterior cervical approach for decompression/stabilization and fusion procedures (mean 182.75 ± 42.91) than the US (means 145.95 ± 3.07 and 72.66 ± 4.62, respectively). The US has significantly more lumbar discectomy procedures (mean 125.70 ± 2.89), posterior cervical approach for decompression/stabilization and fusion procedures (mean 56.98 ± 3.73) and peripheral nerve procedures (mean 26.2 ± 0.79) than E-Da (means 64.5 ± 8.54, 39.75 ± 4.99, and 8.50 ± 5.07, respectively). Conclusion: Neurosurgical residents' surgical case exposures to different spinal categories were very different in E-Da and the US. Case entry logs provide valuable information nationally and internationally.
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The clinical significance of ARID1A mutations in gastric cancer patients p. 93
Chia-Hung Wu, Chien-Hsun Tseng, Kuo-Hung Huang, Wen-Liang Fang, Ming-Huang Chen, Anna Fen-Yau Li, Chew-Wun Wu
Background: ARID1A is a key component of the SWI/SNF chromatin remodeling complex, which has been identified in various cancers. Loss of ARID1A expression is correlated with poor prognosis in gastric cancer (GC); however, the clinical relevance of ARID1A mutations in GC has not yet been reported. Materials and Methods: A total of 518 GC patients receiving gastrectomy were enrolled. The analysis of 13 mutations of the ARID1A gene using mass spectrometric single-nucleotide polymorphism genotyping technology was conducted. The clinicopathological features of GC with and without ARID1A mutations were compared. Results: Among the 518 GC patients, 59 (11.4%) had ARID1A mutations. For diffuse-type GC, patients with ARID1A-mutated tumors were older and had fewer poorly differentiated tumors, fewer incidence of Epstein–Barr virus infection, a higher likelihood of ARID1A expression loss, more microsatellite instability-high tumors, a lower prevalence of peritoneal recurrence, and better survival rates than those with ARID1A nonmutant tumors. For intestinal-type GC, patients with ARID1A-mutant tumors had more PI3K/AKT pathway genetic mutations than patients with ARID1A nonmutant tumors. Multivariate analysis showed that ARID1A mutations are an independent prognostic factor in diffuse-type GC. Conclusion: ARID1A mutations are associated with a better prognosis in diffuse-type GC.
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Comparison of an intravertebral reduction device and percutaneous vertebroplasty for anatomical reduction with single-level vertebral compression fractures p. 101
Chi-Chen Huang, Shih-Huang Tai, Chao-Han Lai, E-Jian Lee
Background: The SpineJack, a third-generation percutaneous augmentation system, is designed to be left in the vertebral body to maintain the recovery of body height following treatment for vertebral compression fractures (VCFs). This study retrospectively compared SpineJack implantation with traditional percutaneous vertebroplasty (PVP) in terms of anatomic restoration in patients with single-level VCFs. Materials and Methods: Between January 2015 and December 2017, 74 patients with single-level VCFs underwent SpineJack implantations or PVP. The degree of pain relief was measured by a Visual Analog Scale score, and the vertebral kyphotic angle, Cobb's angle, the vertebral body height, and the vertebral body compression ratio (VBCR) were recorded preoperatively as well as immediately, 1 month, 3 months, and 1 year after surgery to evaluate anatomical restoration. Results: There were 42 patients in the SpineJack group and 32 patients in the PVP group. No significant difference in pain relief was observed between the two groups. The SpineJack group had better kyphotic angle (6.67° ± 4.38° vs. 9.86° ± 6.73°,P < 0.01) and Cobb's angle (12.28° ± 10.13° vs. 18.03° ± 9.66°,P < 0.01) corrections than the PVP group. The postoperative VBCR was also higher in the SpineJack group than in the PVP group (78.21% ± 19% vs. 67.05% ± 18.85%, P = 0.02). The complication rates did not differ between the groups. Conclusion: SpineJack implantation achieved better kyphosis correction and vertebral body height restoration than PVP. SpineJack implantation is safe and may not increase the risk of subsequent VCFs.
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Bile duct lavage and cholecystectomy: A single-stage operation for inspissated bile syndrome p. 109
Rahul Gupta, Arun Kumar Gupta, Ramesh Tanger, Anu Bhandari, Raj Kumar Gupta, Ashok Kumar Gupta
A 90-day-old infant with inspissated bile syndrome unresponsive to medical management is presented. The infant was born premature, low birth weight (1600 g) at 28 weeks, became jaundice few days after birth. He received neonatal intensive care therapy for 4 weeks. Investigations on admission revealed conjugated hyperbilirubinemia (total bilirubin – 8.26 mg/dl). Abdominal ultrasound and magnetic resonance cholangiopancreatography were suggestive of biliary atresia with nonvisualization of the gallbladder and common bile duct (CBD). Intraoperatively, cholecystotomy confirmed the presence of bile; placement of infant feeding tube in the infundibulum with saline irrigation confirmed CBD obstruction. After multiple gentle attempts with saline lavage, distal clearance was achieved, suggested by duodenal filling up with saline and by nasogastric aspiration. The patient passed colored (bile containing) stools with bile plugs on the 5th postoperative day. Bilirubin values returned to normal, and the outcome was favorable.
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Autoimmune pancreatitis type 2: Mimicking pancreatic cancer p. 113
Tien-An Lin, Tse-Ching Chen, Jeng-Hwei Tseng, Ta-Sen Yeh
Autoimmune pancreatitis (AIP) is a rare disease, which comprises two distinct forms of steroid response chronic pancreatitis. AIP type 2 with no association to IgG level and more confined to the pancreas makes it hard to differentiate with pancreatic cancer preoperatively. Here, we present two cases that were preoperatively diagnosed as pancreatic cancer but turn out to be AIP type 2. The first case is a 55-year-old male with epigastric pain, body weight loss and obstructive jaundice. He also had elevated liver enzyme, but tumor marker and IgG4 level were within normal range. The image studies showed the pancreatic head mass. The pylorus-preserving pancreaticoduodenectomy was performed. The second case is a 35-year-old female with epigastric pain and fever. The laboratory data were within the normal range except elevated C-reactive protein level. The magnetic resonance cholangiopancreatography showed a lobulated mass at the pancreatic tail with regional lymphadenopathy. The laparoscopic distal pancreatectomy with splenectomy was arranged for suspect pancreatic neoplasm. In summary, we had reviewed several studies and concluded several steps to help differential AIP to pancreatic cancer. This may help reduce the unnecessary pancreatic resection in the future.
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Primary Ewing's sarcoma of the jejunum presenting as sepsis p. 117
Hsiang-Jung Chen, Hong-Ming Chao, Junn-Liang Chang, Yen-Lin Chen, Chih-Chien Yen
Extraosseous Ewing's sarcoma (ES), also referred to as extraskeletal ES, is a rare tumor of primitive cells that occurs in children, adolescents, and young adults. This tumor mainly involves the soft tissue of the extremities and thorax. We report a case of extraskeletal ES of the jejunum without associated skeletal location. A 26-year-old woman with no medical history presented to the emergency department with a 3-day history of a fever along with nausea, vomiting, and abdominal pain. An abdominal contrast computed tomography scan revealed a homogeneous bowel mass size 8.5 cm × 4.3 cm × 6.1 cm in the lower abdomen with invasion of the ileum is noted. Extraluminal free air and abscess formation size 10.6 cm × 5.2 cm × 8.3 cm is noted, suggestive of bowel perforation. After the surgery, the specimen was sent to the pathology department for examination. We received one segmental jejunum (25 cm in length and 6 cm in diameter of the lumen) that weighed 450 g in total. Sections revealed an ill-ulcerative mass measuring 6 cm × 4 cm × 0.5 cm with gray-to-brown coloration and extensive necrosis with perforation; the mass was located 15 and 7 cm in length from the bilateral cut ends. In addition, focal vascular proliferation, and infiltrate deeply to the serosa with mesenteric enlarged lymph nodes were observed. Furthermore, the mesenteric regional lymph nodes show metastatic sarcoma. The definitive diagnosis was based on the findings of histomorphology, immunohistochemistry, and molecular pathology.
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Head-and-neck paragangliomas p. 121
Jamir Pitton Rissardo, Ana Letícia Fornari Caprara
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