Ashwini Aithal Padur

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.

Evaluation of cardiovascular disease in patients with systemic arterial hypertension in relation to age and sex: a retrospective study in a south Indian population

Abstract Background Systemic arterial hypertension manifests as constant elevation of blood pressure and is considered to be an important cardiovascular risk factor. Systemic evaluation of cardiovascular diseases in patients with systemic arterial hypertension is imperative for prevention. Objectives The objective of the present study was to investigate and inter-relate sex and age with systemic arterial hypertension and cardiovascular diseases. Methods Medical records of patients with systemic arterial hypertension and cardiovascular disease were evaluated. Data from the medical records were recorded in a prescribed protocol and the data were analyzed and correlated to the patients’ age and sex. Results A total of 170 medical records for patients who visited the cardiology department were reviewed. Of these, 50 patients had systemic arterial hypertension and 19 of this subset had cardiovascular diseases. When we correlated systemic arterial hypertension with age, we observed that patients in the 51-60 years age group were more prone to systemic arterial hypertension (36%). Most of the patients with both systemic arterial hypertension and cardiovascular disease were female and in the 61-70 years age group, while among males the highest rate of occurrence was seen in the 51-60 years age group. The correlation coefficient (r) was 0.62, indicating a moderate, positive, linear relationship between systemic arterial hypertension and cardiovascular disease. Conclusions A majority of patients with systemic arterial hypertension may develop cardiovascular disease and, as age increases, the tendency to develop hypertension also increases.

Variant Superficial Branch of Radial Artery along with Supplementary Tendons on the Dorsum of the Hand and Their Surgical Implications.

Variations of radial artery, in both its course and branching pattern in the anatomical snuffbox, are clinically significant for the plastic surgeons, cardiologists, and radiologists. Reports on its abnormal high origin and subsequent superficial course have been well documented. Herein, we report an unusual superficial branch of the radial artery given off before its entry into the palm by passing between the two heads of first dorsal interosseous. It eventually divided into princeps pollicis and radialis indicis arteries at the first web space of palm as a unique vascular variation. Apart from this, in the present case, the tendon of extensor digiti minimi and of extensor indicis divided into two parts. The split tendons of extensor digiti minimi were inserted to the dorsal digital expansion of the digitus minimus. However, lateral tendon of split extensor indicis was inserted along with the tendon of extensor digitorum to the index finger and the medial one was inserted along with the tendon of extensor digitorum to the middle finger. Unusual superficial branch of radial artery on the dorsum of the hand is vulnerable for an iatrogenic injury during surgical approaches in the region. Supplementary extensor tendons on the hand are one of the potential causes for the tenosynovitis.

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.

Determination of Spearman Correlation Coefficient to Evaluate the Linear Association of Dermal Collagen and Elastic Fibers in the Perspectives of Skin Injury

Background Difference in scar formation at different sites, in different directions at the same site, but with changes in the elasticity of skin with age, sex, and race or in some pathological conditions, is well known to clinicians. The inappropriate collagen syntheses and delayed or lack of epithelialization are known to induce scar formation with negligible elasticity at the site of damage. Changes in the elasticity of scars may be due to an unequal distribution of dermal collagen (C) and elastic (E) fibers. Materials and Methods Spearman correlation coefficients (r) of collagen and elastic fibers in horizontal (H) and in vertical (V) directions (variables CV, CH, EV, and EH) were measured from the respective quantitative fraction data in 320 skin samples from 32 human cadavers collected at five selected sites over extremities. Results Spearmans correlation analysis revealed the statistically significant (p < 0.01) strong positive correlation between CH and CV in all the areas, that is, shoulder joint area (r = 0.66), wrist (r = 0.75), forearm (r = 0.75), and thigh (r = 0.80), except at the ankle (r = 0.26, p = 0.14) region. Similarly, positive correlation between EH and EV has been observed at the forearm (r = 0.65, moderate) and thigh (r = 0.42, low) regions. However, a significant moderate negative correlation was observed between CV and EV at the forearm (r = −0.51) and between CH and EH at the thigh region (r = −0.65). Conclusion Significant differences of correlations of collagen and elastic fibers in different directions from different areas of extremities were noted. This may be one of the possible anatomical reasons of scar behavior in different areas and different directions of the same area.

Terminal bifurcation and unusual communication of left testicular vein with the left suprarenal vein

Abstract Variations of the testicular veins are relevant in clinical cases of varicocele and in other therapeutic and diagnostic procedures. We report herein on a unique variation of the left testicular vein observed in an adult male cadaver. The left testicular vein bifurcated to give rise to left and right branches which terminated by joining the left renal vein. There was also an oblique communication between the two branches of the left testicular vein. A slender communicating vein arose from the left branch of the left testicular vein and ascended upwards in front of the left renal vein and terminated into the left suprarenal vein. The right branch of the testicular vein received an unnamed adipose tributary from the side of the abdominal aorta. Awareness of these venous anomalies can help surgeons accurately ligate abnormal venous communications and avoid iatrogenic injuries and it is important for proper surgical management.

Unusual and Unique Variant Branches of Lateral Cord of Brachial Plexus and its Clinical Implications- A Cadaveric Study

INTRODUCTION Adequate knowledge on variant morphology of brachial plexus and its branches are important in clinical applications pertaining to trauma and surgical procedures of the upper extremity. AIM Current study was aimed to report variations of the branches of the lateral cord of brachial plexus in the axilla and their possible clinical complications. MATERIALS AND METHODS Total number of 82 upper limbs from 41 formalin embalmed cadavers was dissected. Careful observation was made to note the formation and branching pattern of lateral cord. Meticulous inspection for absence of branches, presence of additional or variant branches and presence of abnormal communications between its branches or with branches of other cords was carried out. RESULTS In the present study, we noted varied branching pattern of lateral cord in 6 out of 82 limbs (7%). In one of the limb, the median nerve was formed by three roots; two from lateral cord and one from medial cord. Two limbs had absence of lateral pectoral nerve supplemented by medial pectoral nerves. One of which had an atypical ansa pectoralis. In 2 upper limbs, musculocutaneous nerve was absent and in both cases it was supplemented by median nerve. In one of the limb, coracobrachialis had dual nerve supply by musculocutaneous nerve and by an additional branch from the lateral cord. CONCLUSION Variations of brachial plexus and its branches could pose both intraoperative and postoperative complications which eventually affect the normal sensory and motor functions of the upper limb.

Absence of the celiac trunk and trifurcation of the common hepatic artery: a case report

Abstract Anatomical variations of the celiac trunk and its branches are particularly important from a surgical perspective due to their relationships with surrounding structures. We report here a particularly rare variant involving absence of the celiac trunk in association with trifurcation of the common hepatic artery. These variations were found in an adult male cadaver. We perform a review of the literature and discuss the clinical and embryological significance of these variations. Recognition of celiac trunk and hepatic artery variations is of utmost importance to surgeons and radiologists because multiple variations can lead to undue complications.