Anitha Guru

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

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

A peculiar liver with surgically and radiologically important variations: a case report

A peculiar liver was found in an adult male cadaver during a dissection class for undergraduate medical students. The quadrate lobe and fissure for the ligamentum teres were totally absent. Thus, the cystic notch on the inferior border was very broad and deep, and the fundus and body of the gall bladder popped out through this notch. The cystic duct terminated into the right hepatic duct at the porta hepatis instead of terminating into the common hepatic duct. Awareness of variations of the lobes and fissures may minimize a misdiagnosis of liver problems. The aim of the current study was to alert radiologists and surgeons about possible variations in the external appearance and anomalies of the lobes and fissures of the liver.

Bilateral vascular variations at the renal hilum: a case report.

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

Additional circular intercostal space created by bifurcation of the left 3rd rib and its costal cartilage: a case report

IntroductionIn the thorax there are normally 11 pairs of intercostal spaces: the spaces between adjacent ribs. The intercostal spaces contain intercostal muscles, intercostal nerves and vessels.Case presentationDuring a routine dissection for undergraduate medical students, we observed a variation involving the left 3rd rib and 3rd costal cartilage in the cadaver of a man of Indian ethnicity aged about 65 years. The left 3rd rib and its costal cartilage were bifurcated at their costochondral junction enclosing a small circular additional intercostal space. Muscle tissue covered by deep fascia was present in this circular intercostal space. The muscle in the circular intercostal space received its nerve supply from a branch of the 2nd intercostal nerve.ConclusionsKnowledge of such variations is helpful to surgeons operating on the anterior thoracic wall involving ribs and intercostal spaces. Knowing the possibility of the presence of an additional space between normal intercostal spaces can guide a surgeon through to a successful surgery.

Absence of retromandibular vein associated with atypical formation of external jugular vein in the parotid region.

Veins of the head and neck exhibiting anatomical variations or malformations are clinically significant. Anatomical variation in the external jugular vein is very common. However, anatomical variation in the retromandibular vein is rare. In this paper, we report a rare case of complete absence of the retromandibular vein. In the absence of the retromandibular vein, the maxillary vein divided into anterior and posterior divisions. The posterior division joined the superficial temporal vein to form an atypical external jugular vein, and the anterior division joined the facial vein to form an anonymous vein. In clinical practice, radiologists and surgeons use the retromandibular vein as a guide to expose the branches of the facial nerve during superficial parotidectomy. Therefore, absence of the retromandibular vein is a hurdle during this procedure and may affect the venous drainage pattern from the head and neck.

Atypical Arterial Supply to the Spleen by Polar Branches of Splenic Artery and Accessory Splenic Artery – A Case Report

Vascular anomalies of the spleen are usually asymptomatic. However, variant anatomy of splenic artery becomes clinically important, when the patients undergo diagnostic angiography for gastrointestinal bleeding or during transcatheter therapy. We report here a concurrent variant arterial pattern of the spleen. The splenic artery was unusually elongated and excessively tortuous. Prior to its normal termination into segmental arteries, it gave superior and inferior polar arteries which entered the spleen distal to corresponding ends of the splenic hilum. In addition to this, the spleen also received an additional blood supply from an accessory splenic artery arising from left gastro-epiploic artery. The accessory splenic artery entered the substance of the spleen through its lateral end. Presence of such kind of concurrent variant arterial pattern of spleen makes the surgeons obligatory to have prior knowledge to prevent bleeding during any surgical or radiological interventional procedures targeting the spleen, pancreas etc.

Unusual jejunal tributaries of the splenic vein and their surgical importance: a case report

Introduction: Knowledge of variations regarding the formation, termination and tributaries of the portal vein, superior mesenteric vein and splenic vein are very useful and of utmost importance for surgeons performing surgeries of the pancreas and duodenum. Normally, the jejunal veins are the tributaries of the superior mesenteric vein. We report here, a very unusual case where two proximal jejunal veins drained into the splenic vein instead of the superior mesenteric vein. Case Report: During the dissection classes for undergraduate medical students, we noted variations in the termination of the upper jejunal veins in an adult male cadaver who was approximately 65 years old. We found that the union of three veins formed the portal vein: the splenic vein, jejunal veins and the superior mesenteric vein. Conclusion: Familiarity with such anatomical variation provides useful information for surgeons performing abdominal surgical procedures.

A Strange Case of Double Annular Pancreas

CONTEXT The pancreas is a soft lobulated gland situated transversely across the upper part of the posterior abdominal wall. Its parts include the head, neck, body and tail. Annular pancreas is a rare condition where the head of the pancreas surrounds the second part of the duodenum like a ring. CASE REPORT We observed a rare type of double annular pancreas where the uncinate process encircled the third part of the duodenum. A process from the head of the pancreas encircled the junction between the first and second parts of the duodenum incompletely. There was a large artery running along the anterior border of the pancreas. The artery took origin from the superior mesenteric artery. CONCLUSION This case may be of interest to gastroenterologists and surgeons.

Anatomical Study of the Ulnar Nerve Variations at High Humeral Level and Their Possible Clinical and Diagnostic Implications

Background. Descriptive evaluation of nerve variations plays a pivotal role in the usefulness of clinical or surgical practice, as an anatomical variation often sets a risk of nerve palsy syndrome. Ulnar nerve (UN) is one amongst the major nerves involved in neuropathy. In the present anatomical study, variations related to ulnar nerve have been identified and its potential clinical implications discussed. Materials and Method. We examined 50 upper limb dissected specimens for possible ulnar nerve variations. Careful observation for any aberrant formation and/or communication in relation to UN has been carried out. Results. Four out of 50 limbs (8%) presented with variations related to ulnar nerve. Amongst them, in two cases abnormal communication with neighboring nerve was identified and variation in the formation of UN was noted in remaining two limbs. Conclusion. An unusual relation of UN with its neighboring nerves, thus muscles, and its aberrant formation might jeopardize the normal sensori-motor behavior. Knowledge about anatomical variations of the UN is therefore important for the clinicians in understanding the severity of ulnar nerve neuropathy related complications.

Morphometric Parameters of the Human Adult Kidney: An Anatomical Study

The purpose of this study was to determine the anatomic parameters of the kidney in adults. The Renal lengths, width at superior and inferior poles, thickness at the superior and inferior poles were measured in 151 adult cadaver kidneys.A digital vernier caliper was used for performing the measurements. The data were statistically analyzed. The mean renal length was 8.9 ± 0.9 cm on the right side and 9.1 ± 0.9 cm on the left side. The mean width of the superior pole of the right kidney was 4.9 ± 0.6 cm and the left kidney was 5 ± 0.7 cm. The width of inferior pole of the right and left kidneys were 4.8 ± 0.6 cm and 4.5 ± 0.7 cm respectively. The mean thickness of the superior pole of the right kidney was 3 ± 0.4 cm and left kidney was 3.2 ± 0.5 cm. The mean thickness of the inferior pole of the right and left kidneys were 3.1 ± 0.4 cm and 3.2 ± 0.5 cm respectively. There was no statistical significance with respect to the length of both the kidneys. However there was some data on width and thickness among th e right and left side showed the differe nce which was significant statistically. The present study has provided additional information on the renal morphometry which will be of use to the surgeons and radiologists.