Comparison of indocyanine green angiography vs intraoperative parathyroid hormone in early prediction of risk of post-thyroidectomy hypocalcemia: a prospective cohort study.

Introduction: Indocyanine green (ICG) angiography is the 'real-time intraoperative imaging' technique used to reduce the chances of hypoparathyroidism in post-thyroidectomy patients. In our study, the authors predicted the risk of early post-thyroidectomy hypocalcemia by intraoperative evaluation of parathyroid gland perfusion by ICG angiography. Materials and methods: In patients who underwent total thyroidectomy, ICG angiography was done using the SPY PHI imaging system (Stryker). Post-thyroid specimen removal, scoring of parathyroids was done in spy contrast mode. All 4 or <4 visualized parathyroids were scored for vascularity with the highest score of 8. Serum ionized calcium was done 6 h postsurgery and on the morning and evening of postoperative days 1 and 2. Calcium supplements were given to only those who developed clinical or severe biochemical hypocalcemia. Results: Out of 60, postoperative hypocalcemia was noted in 41 patients. Total ICG score ≤5 was seen in 34 patients, out of which 28 developed postoperative hypocalcemia showing PPV 82.3% and diagnostic accuracy of 68.3% while iPTH (4.28 pmol/l) showed PPV 76.7 and diagnostic accuracy 70 %. In eight patients, none of the glands was scored as 2 (White) and all these patients developed hypocalcemia requiring calcium infusion. Conclusion: The absence of visualization of at least 1 well-perfused (score 2) gland on ICG angiography is highly predictive of hypocalcemia and the majority of patients with total ICG score ≤5 developed hypocalcemia in the immediate postoperative period. ICG is a good predictor of the absence of hypoparathyroidism after thyroidectomy and is comparable to iPTH in the prediction of post-thyroidectomy hypocalcemia.

Laparoscopic Transperitoneal Adrenalectomy for Adrenal Tumors in Children: Technical Considerations and Surgical Experience.

Aims: This study aimed to review our surgical experience of laparoscopic adrenalectomy (LA) for adrenal masses in the pediatric age group. Materials and Methods: The electronic medical records of all patients younger than 18 years of age who underwent LA between 2016 and 2023 were retrospectively reviewed. Children with adrenal tumors localized to the site of origin without evidence of encasement of major vasculature or involvement of adjacent organs were considered for LA. Patients with diagnosis of malignant adrenal tumor on preoperative work-up underwent open adrenalectomy. Data were collected regarding demography, clinical presentation, hormonal workup, imaging, duration of surgery, transfusion requirement, conversion rate, postoperative recovery, duration of intravenous (i.v.) analgesia and hospital stay, pathology, complications, and status at follow-up. Results: Between 2016 and 2023, LA adrenalectomy was performed in 11 patients (6 boys and 5 girls) with a mean age of 46.3 (8-120) months. A functional tumor was detected in 6 (54.5%) children, manifesting clinically with Cushing's syndrome (3), virilization (1), feminization (1), or Conn's syndrome (1). Seven (63.6%) tumors originated from the right adrenal, and 4 (36.4%) from the left adrenal gland. The mean tumor weight and size was 49.1 (10-80) g and 5.6 (3-8) cm, respectively. Histopathology included adrenal adenoma (5), ganglioneuroma (3), ganglioneuroblastoma (1), myelolipoma (1), and intermediate adrenocortical tumor (1). The mean surgery duration was 186.6 (120-265) minutes. Intraoperative blood transfusion was required in 2 (18.2%) patients and none required conversion. Full feeds were resumed at 42.7 (24-60) hours, i.v. analgesia requirement was for 54.5 (36-72) hours and mean hospital stay was 5.1 (3-8) days. All patients were symptom-free with no recurrence at mean follow-up period of 50.6 (3-83) months. Conclusions: In children with well-circumscribed, localized, and noninvasive adrenal tumors, LA is feasible, effective, and safe with all advantages of minimally invasive surgery.

What makes women receptive to breast self-examination, animation, or simulation? - a comparative study.

Background: Breast self-examination (BSE) plays an important role in the early diagnosis of breast cancer in India owing to the stigma attached to cancer. The authors compared the efficacies of animation video versus simulation techniques in BSE. Methods: Women with no previous history of conditions affecting the breasts were included in this prospective observational study and divided into an animation or simulation arm. The latter was further divided into three subgroups as per the simulation models used : the German (Delta Healthcare), British (Health Edco), and Indian (low-cost, validated) models used for teaching BSE. The hybrid animation video had a 9 min runtime with a lecture on BSE and a virtual character performing BSE. In both the arms, participants filled in a validated modified patient satisfaction questionnaire. Results: A total of 500 women participated. The mean age of the participants in the animation video arm was 20.21±3.88 years and 19.34±2.27, 22.94±9.6, and 18.97±1.31(20.41±5.99) years in the Indian, German, and British simulation models arm, respectively. The age difference between the two arms was statistically significant (P<0.05). Both animation video and simulation models were found to be useful by the participants. The participants' response to animation video being a better organized tool for learning BSE was statistically significant (90.48±7.98 vs. 84.02±15.09 P≤0.001) when compared to simulation models. The younger women (≤20 years) found these tools significantly more useful than those aged >20 years. Conclusions: All models had good efficiency and utility as learning tools for BSE. However, large studies in BSE set up with combination models are needed.

Validation of cost-effective model for breast self-examination.

The incidence of breast cancer is increasing in India; it predominantly affects women in their 30s and 40s. The disease burden is very high given the high incidence of triple-negative disease in a large portion of the population. Early detection can save lives and aid in breast conservation surgery. Breast self-examination (BSE) is a valid tool for early breast cancer detection. If performed with the help of a simulation model that resembles a given culture and tradition, it can result in good outcomes from screening programs. We designed and validated an Indian model for BSE and reported the feasibility of this model. Materials and methods: We designed an Indian model for the BSE based on the cultural mindset of Indian women. The design was finalized, and the model was constructed. It was then compared with preexisting international models and validated by in-depth interviews with validation experts from various fields involved in breast cancer management. Minor design revisions were made, followed by testing and re-testing. Finally, it was ready for public use. Results: The in-depth interview was conducted using a validated modified animation multimedia questionnaire. The majority of the validation experts had used stimulation models before, and all stated that it could help teach women about BSE, and it was comparable with other preexisting internationally validated models (91.33±4.98%). Conclusion: Using a breast model, women can learn to detect breast cancer as early as possible, and this can lead to good outcomes. We designed the model using easily available, cheap, and safe materials to keep it as realistic and useful as possible. The Indian BSE model can be used by Indian women to learn to detect breast lumps early. It is easily reproducible and cost-effective.

PHPT with Pancreatitis: Atypical Presentation of PHPT.

Background: Primary hyperparathyroidism (PHPT) is rarely associated with the occurrence of acute or chronic pancreatitis, requiring complex perioperative management. This study aimed to assess the prevalence and disease characteristics of pancreatitis in PHPT. Materials and Methods: This study is a clinicopathological analysis of the medical records of patients who were diagnosed with PHPT with pancreatitis between 1989 and 2021 in the Endocrine Surgery department, SGPGI, Lucknow. Results: Out of 548 PHPT cases, 44 (8.03%) were found to be associated with pancreatitis. The mean age was 33.57 years (15-65 years); 5 were ≤20 years, while 26 were ≤30 years of age. There were 27 males and 17 females. Twenty-one cases were of acute (11 acute, nine recurrent acute, one acute on chronic), whereas 23 were of chronic pancreatitis (six chronic calcific pancreatitis). The major clinical presentation of PHPT with pancreatitis was abdominal pain (65.91%). The mean number of attacks per patient in recurrent acute pancreatitis was two. Mean PTH levels were 68.19 pmol/L. The mean tumor size (in the largest dimension) was 2.79 ± 1.4 cm while the mean tumor weight was 4.91 g. Nephrolithiasis was associated with 25 cases. An association with multiple endocrine neoplasia type 1 syndrome was seen in one case. The final histopathological diagnosis was parathyroid carcinoma in two, hyperplasia in three, and parathyroid adenoma in 39 cases. Normocalcemia was seen in 27.2%, hypercalcemic crisis in 15.9%, and 25% of patients required semi-emergency parathyroidectomy. The outcome was favorable in all, as none had any further attacks of pancreatitis. Conclusion: In our study, the prevalence of pancreatitis in PHPT cases was 8.03%. The majority of patients were young. Normocalcemia was seen in 12 patients, so even if calcium levels are normal, PHPT should be suspected in young patients with pancreatitis. Parathyroidectomy resulted in the complete resolution of symptoms of pancreatitis in all 44 patients.

WhatsApp-Based virtual consultation in clinical practice during COVID times: A prospective institutional study.

Background: As the novel coronavirus disease 2019 (COVID-19) continues its pandemic surge globally, the attention toward the treatment of non-COVID diseases has become difficult. Software-based systems and social media platforms could provide alternatives for ensuring regular health-care non-COVID diseases. In this context, we evaluated our own experience with virtual consultation (VC) for the management of endocrine surgical patients during the current COVID pandemic. Materials and Methods: This prospective study was conducted in the endocrine surgery department spanning 4 months from April to July 2020. We employed WhatsApp-based group video conferencing for VC with both new and follow-up outpatients. We evaluated the satisfaction quotient of patients, regarding the three types of consultations (no consultation, VC, and direct consultation) on an ordinal scale of three modes of consultation. Results: Virtual consultation was performed with 102 new and 285 follow-up patients. Goiters, clinical findings, and wounds/scars (in post-operative cases) were evaluated virtually. Dosage of thyroxine replacement, calcium supplementation, and other medications was prescribed based on findings and history. Patients who needed surgery (25/102 cases) were given appropriate appointment. More than 82% of the patients in both groups preferred VC during this COVID pandemic. Conclusions: More than 82% of both new and follow-up patients preferred VC over direct or no consultation during this COVID pandemic. Our findings suggest that VC through social media platforms is capable of ensuring appropriate treatment and follow-up for endocrine diseases.

RésuméContexte: Alors que la nouvelle maladie à coronavirus 2019 (COVID-19) poursuit sa poussée pandémique à l'échelle mondiale, l'attention portée au traitement des maladies non-COVID est devenue difficile. Les systèmes logiciels et les plates-formes de médias sociaux pourraient fournir des alternatives pour garantir soins de santé courants maladies non COVID. Dans ce contexte, nous avons évalué notre propre expérience de consultation virtuelle (VC) pour la gestion des patients en chirurgie endocrinienne pendant la pandémie actuelle de COVID. Matériels et méthodes: Cette étude prospective a été menée dans le service de chirurgie endocrinienne s'étendant sur 4 mois d'avril à juillet 2020. Nous avons utilisé la visioconférence de groupe basée sur WhatsApp pour VC avec les nouveaux patients et les patients de suivi. Nous avons évalué le quotient de satisfaction des patients, concernant les trois types de consultations (pas consultation, CV et consultation directe) sur une échelle ordinale de trois modes de consultation. Résultats: Une consultation virtuelle a été effectuée avec 102 nouveaux patients et 285 patients suivis. Les goitres, les signes cliniques et les plaies/cicatrices (dans les cas postopératoires) ont été évalués virtuellement. Le dosage du remplacement de la thyroxine, de la supplémentation en calcium et d'autres médicaments a été prescrit en fonction des résultats et des antécédents. Les patients qui chirurgie nécessaire (25/102 cas) ont reçu un rendez-vous approprié. Plus de 82 % des patients des deux groupes ont préféré la CV au cours de cette Pandémie de covid. Conclusions: plus de 82 % des nouveaux patients et des patients de suivi ont préféré la CV à la consultation directe ou à l'absence de consultation pendant cette période. Pandémie de covid. Nos résultats suggèrent que la CV via les plateformes de médias sociaux est capable d'assurer un traitement et un suivi appropriés pour les maladies endocriniennes. Mots-clés: COVID, endocrinien, suivi, chirurgie, thyroïde.

Prognostic Impact of Focal Poorly Differentiated Areas in Follicular Differentiated Thyroid Cancer: Is It a Distinct Entity from Poorly Differentiated Thyroid Cancer?

Poorly differentiated thyroid cancer (PDC) and especially poorly differentiated areas (PDA) within follicular cell-derived differentiated thyroid cancer are ill-defined clinicopathological entities. We report our experience on their comparative prognostic outcomes This is a retrospective study of 61 patients (PDC = 29; PDA = 32) from Endocrine and Metabolic Surgery Department (2009 to 2017). Clinical and follow-up details are collected and digitally tabulated from departmental database. Gender ratio was M:F = 1:1.3 and 1:1.6. Mean age was 51 ± 12 years (16-76) and 54 ± 10.5 years (36-81) in PDA and PDC, respectively. Mean tumour size (4.6 ± 0.9 cm; 4.9 ± 1.2 cm), extrathyroidal invasion (59%; 73%) and regional lymphadenopathy were 50% and 55% in PDA and PDC, respectively. Total thyroidectomy was possible in 94% of PDA and in only 77% of PDC. Radioiodine ablation was utilised in 65% (PDA); 29% (PDC). With mean follow-up of 64 ± 23.5 months (12-103) in PDA and 37 ± 22 months (6-94) in PDC, nodal recurrence (PDC = 29%; PDA = 22%) and systemic metastasis was 41% in PDC (synchronous = 24%; metachronous = 17%); 19% in PDA (synchronous = 16%; metachronous = 3%). Five-year event-free survival (EFS) and overall survival (OS) was 90% and 93% in PDA, and 42% and 44% in PDC, respectively. Our study shows that PDA is a separate clinicopathological entity with significantly positive prognosis compared to PDC.

Aphonia Following Bilateral Cervical Plexus Blocks for an Awake Hemithyroidectomy: A Case Report.

A 35-year-old female patient was scheduled for a left hemithyroidectomy. We performed bilateral cervical plexus blocks with ultrasound guidance for an awake thyroidectomy. Soon after the blocks, she developed a weak voice, which gradually progressed to complete aphonia. Due to her apprehension, general anesthesia was administered. After an uneventful surgery, the patient spontaneously regained her normal voice in the postoperative period. The case report describes a previously unreported complication of aphonia presumably due to bilateral recurrent laryngeal nerve blocks, which might have occurred from the infiltrated local anesthetic extravasating to the deeper planes through the cervical fascia.

Selfie-driven thyroid disease leads: A study on a unique sign and its utility in clinical practice.

Introduction: Taking a photograph of self alone or with a group called selfie, has become modern-day rage with spurt in smartphone technology. It has catapulted from a hobby into psychiatric ailment, especially among teens and young adults. Although it is considered a psychiatric ailment keeping them aloof from social interactions, we observed an inadvertent advantage in this process. In this context, we present some intriguing findings in this study. Materials and Methods: This retrospective study was based on compilation of 14 cases from endocrine surgery outpatient cum inpatient database collected over 2 years' period. The inclusion criteria are the chief complaint (CC) was noted only after watching the selfie picture and not otherwise; the CC leads them to consult physician; the picture was captured by oneself or other person who was also part of that image; and the CC leads to definitive diagnosis of thyroid disease requiring treatment. All other clinical, investigative, and treatment (medical and surgical) were studied. Results: In all, we had 14/5820 (0.0024%) cases meeting the above criteria. CC and later confirmed in pictures were four cases of Grave's disease associated ophthalmopathic exophthalmos, eight cases of goiter, and two cases of facial puffiness (myxedema related). All these CC helped in investigating for the diagnosis of Graves' disease (4), nodular goiter (8), and hypothyroidism (2) confirmed by appropriate investigations. Ten cases underwent thyroidectomy (two of the nodular goiter cases were papillary thyroid cancer) and four cases took conservative medical treatment. Conclusions: Although selfie is considered a modern-day lifestyle-induced psychiatric illness, it can inadvertently help in picking up thyroid diseases in earlier stages.

RésuméIntroduction: Prendre une photo de soi seul ou avec un groupe appelé selfie, est devenu une rage moderne avec une poussée dans le smartphone La technologie. Il est passé d'un passe-temps à une maladie psychiatrique, en particulier chez les adolescents et les jeunes adultes. Bien qu'il soit considéré comme un maladie psychiatrique les gardant à l'écart des interactions sociales, nous avons observé un avantage par inadvertance dans ce processus. Dans ce contexte, nous présentent des découvertes intéressantes dans cette étude. Matériels et méthodes: Cette étude rétrospective a été basée sur la compilation de 14 cas de Base de données de chirurgie endocrinienne ambulatoire et hospitalière collectée sur une période de 2 ans. Les critères d'inclusion sont la plainte principale (CC) a été noté seulement après avoir regardé la photo selfie et pas autrement; le CC les amène à consulter un médecin ; l'image a été capturée par soi-même ou une autre personne qui faisait également partie de cette image ; et le CC conduit au diagnostic définitif d'une maladie thyroïdienne nécessitant un traitement. Tous les autres clinique, d'investigation et de traitement (médical et chirurgical) ont été étudiés. Résultats : Au total, nous avons eu 14/5820 (0,0024%) cas répondant aux critères ci-dessus Critères. CC et confirmés plus tard en images étaient quatre cas d'exophtalmie ophtalmopathique associée à la maladie de Grave, huit cas de goitre, et deux cas de gonflement du visage (liés au myxoedème). Tous ces CC ont aidé à enquêter pour le diagnostic de la maladie de Graves (4), nodulaire goitre (8) et hypothyroïdie (2) confirmées par des examens appropriés. Dix cas ont subi une thyroïdectomie (deux des cas de goitre nodulaire étaient un cancer papillaire de la thyroïde) et quatre cas ont suivi un traitement médical conservateur. Conclusions : Bien que le selfie soit considéré comme un maladie psychiatrique induite par le mode de vie, il peut aider par inadvertance à contracter des maladies thyroïdiennes à un stade précoce. Mots-clés: endocrinien, exophtalmie, goitre, selfie, thyroide, thyroidectomie.