Minimally invasive video-assisted thyroidectomy versus conventional thyroidectomy for benign thyroid disease

Minimally invasive video-assisted thyroidectomy [MIVAT] has been demonstrated to be a safe procedure with additional advantages regarding cosmetic results and postoperative outcome. The present study was conducted to define the advantages and disadvantages of MIVAT as compared to conventional thyroidectomy [CT]. Between January 2008 and January 2010, 28 patients underwent MIVAT. A similar number of patients who underwent conventional thyroidectomy [CT] before the introduction of the MIVAT technique at our department were chosen with the same inclusion criteria used for MIVAT and served as matched controls. The eligibility criteria for both groups was thyroid nodules<35 mm, thyroid volume<25 ml, no thyroiditis, no malignancy, and no previous cervical conventional surgery or irradiation. No differences were found between both groups in terms of age, gender, thyroid volume, maximum nodule diameter, indication for surgery and postoperative complications MIVAT provided a significantly smaller cervical incision, less postoperative pain and parenteral analgesics during the first postoperative day, better cosmetic results, and shorter hospital stay than patients who underwent CT. Operative time was, however, significantly [P=0.001] longer with MIVAT than with CT [75 +/- 18 min versus 55 +/- 12 min, respectively]. The MIVAT technique, in selected patients, seems to be a valid option for thyroidectomy with postoperative complications similar to CT. Though with a longer operative time, MIVAT may even be preferable to CT, because of its significant advantages, in terms of better cosmetic result, less postoperative pain, and shorter hospital stay

Assessment of targeted parathyroidectomy for solitary adenoma without intra-operative parathyroid hormone monitoring

Minimally invasive parathyroidectomy has become the first surgical option for patients with primary hyperparathyroidism [HPT]. Preoperative localization study using Technetium-99m sestamibi [MIBI] scan is mandatory. The present study was conducted to analyze our series of targeted parathyroidectomies for solitary adenoma without the use of intraoperative parathyroid hormone monitoring [IPHM]. In a 5-year period [2005-2010], 50 patients underwent unilateral neck exploration for HPT at Ahmadi hospital, Kuwait. After biochemical diagnosis, a technetium 99m sestamibi scan and cervical ultrasonography were performed preoperatively for all patients. Histopathologic examination was used to confirm parathyroid tissue in all patients. Data regarding patient demographics, surgical details, results, and complications were analyzed. Patients were followed-up regularly for a mean of 48.5 months [range 6-66 months]. There were 37 women and 13 men, with a mean age of 52 years [range 25-71 years]. Mean preoperative calcium was 12.3 mg/dL [range 11.0-15.1 mg/dL], and PTH was 352 pg/mL [range 115-2,131 pg/mL]. Mean operative time was 47 minutes [range 35-90 minutes], and the mean parathyroid weight was 1.1 g[range 0.21-1.8 g]. Mean hospital stay was 2 days [range 1-7 days]. MIBI scan correctly localized the abnormal gland in 47 patients [94%] and three patients [6%] required contralateral exploration. There were no operative mortalities or complications. Postoperatively, there was two operative hematomas [4%]. All patients became normo-calcemic, at 24 hours postoperatively and 46 patients [92%] were asymptomatic at one year. Based on the data presented, it may be concluded that selected patients with solitary parathyroid adenomas, localized preoperatively by MIBI scan be safely and successfully treated with targeted parathyroidectomy without the use of IPHM

Assessment of a dual-facing mesh in prevention of adhesions following ventral hernia repair

The present prospective clinical study was conducted to assess the value of the dual-facing mesh in prevention of adhesion formation after ventral hernia repair. Forty patients admitted to the Ahmadi Hospital, Kuwait, during 2006-2007, with umbilical hernia or incisional hernia underwent laparoscopic hernioplasty with intra-peritoneal placement of a DualMesh. Data regarding patient demographics, operative details, postoperative pain score, hospital stay, and time to return to normal physical activity were all prospectively collected. Postoperative complications [specific to meshadhesions or non-specific] and recurrence were also recorded. All patients were regularly followed-up every two weeks for the first three months postoperatively, and at three-month intervals thereafter for a mean of 24 months [range 15-39 months]. There were 28 women [70%] and 12 men [30%] with a mean age of 51 years [range 33-72 years]. The mean body mass index [BMI] was 27.68 [range 22-35]. Hypertension, diabetes mellitus, and bronchial asthma were the most common co-morbidities. The mean diameter of hernial defect was 5.2 cm [range 2-12 cm]. There were 18 paraumbilical, 13 recurrent and nine incisional hernias. About one third of patients [n=13, 32.5%] had multiple hernia defects. The mean operative time was 105 +/- 42 minutes [range 75-185 minutes]. There were no mortalities, and no visceral or other intra-operative complications. Postoperative pain resolved gradually over time. The mean postopcrative hospital stay was 4.2 days [range 1-10 days]. Patients were able to resume their normal physical activities after a mean of 17 days [range 10-31 days]. There were no major post-operative complications and the overall complication rate was 15% [six patients] in the form of seroma [7.5%], prolonged suture site pain [2.5%], flank hematoma [2.5%], and trocar site wound infection [2.5%]. There was a single recurrence at seven months, yielding a two-year recurrence rate of 2.5%. From the data presented it may be concluded that laparoscopic repair of ventral hernia with intra-peritoncal placement of the DualMesh confers the advantages of minimal access surgery and appears to be technically feasible, safe and effective, with good clinical outcome of no intra-operative, or major postoperative complications, and a very low recurrence rate

Stapled versus ligasure hemorrhoidectomy: a prospective randomized clinical trial

The present study was conducted to compare the efficacy and outcome of Ligasure hemorrhoidectomy [LH] and stapled hemorrhoidopexy [SH] for prolapsed hemorrhoids. Forty six patients with Grades III and IV hemorrhoids were randomized into 2 groups of 23 patients each; Group 1 patients underwent LH whereas group 2 patients underwent SH. Data regarding patient demographics, operative details, postoperative pain score, number of Parenteral analgesic injections, hospital stay, and time to return to work or normal physical activity were all prospectively collected. Early and late postoperative complications as well as recurrence of prolapse were also recorded. All patients were regularly followed-up every two weeks for the first 12 weeks postoperatively, and at 3-month intervals thereafter for a total period of 12 months. Patient demographics and clinical characteristics were similar between both groups. The mean operating time, postoperative pain score and Parenteral analgesics, hospital stay and time off work or normal activity were not statistically significant between the two groups [P>0.05]. Likewise, both groups had similar postoperative complications except for a residual prolapse that was observed, at 4 weeks postoperatively, in five patients [21.74%] in the SH group as compared to only one patient [4.34%] in the LH group [P=0.043]. Although prolapse recurrence, at one year, was also higher among the SH group as compared to the LH group [13.04% vs 4.34%, respectively], yet the difference was not statistically significant [P=0.216]. Both LH and SH are safe and effective procedures for the treatment of Grades III and IV hemorrhoids yielding comparable results and minimal side effects. Further, owing to their low postoperative pain, short hospital stay and rapid return to work, they offer an excellent therapeutic option for prolapsed hemorrhoids

Stem cell transplantation in hematological disorders: a developing country experience-impact of cost considerations

To describe the experience in setting up a bone marrow transplant program at Ain Shams University, Cairo, Egypt. Sixteen patients were transplanted at Ain Shams University Bone Marrow Transplantation unit from March 2005 to January 2008. Sixteen patients were transplanted with a median age of 25 years. Indications for transplantation were chronic myeloid leukemia, acute myeloid leukemia, aplastic anemia, acute lymphoblastic leukemia, and aggressive lymphoma. Seven donors and 6 patients were positive for cytomegalovirus immunoglobulin G [IgG] antibody [Ab] pretransplant. Only one patient was positive for toxoplasma IgG Ab and another had a high titre for toxoplasma IgM Ab pretransplant. Two donors and 2 recipients were positive for hepatitis B antibody markers; however, none were positive for hepatitis B virus DNA by polymerase chain reaction [PCR]. None of the patients or donors were positive for hepatitis C virus via PCR pre-transplant. Acute graft versus host disease [GVHD] was seen in 3 patients, while chronic GVHD was seen in 5 patients. Primary cause of death was recurrence in 2 patients and graft failure in one patient. Thirteen are alive and disease free with a median follow-up of 20 months. Although our unit is a relatively new unit, these results are comparable to those achieved in the Western world and cost a mean of US$250,000

Voice changes after thyroidectomy: role of external laryngeal nerve

To evaluate a technique to protect the external laryngeal nerve during thyroidectomy.Randomized controlled trial. Patients randomized into group A or B using closed envelops method. Alexandria university hospital is a teaching hospital. It is the referral center serving seven million people. Forty four consecutive patients admitted to Alexandria university hospital for thyroidectomy. Fourpatients had voice abnormalities on preoperative voice analysis. They were excluded. All patients underwent thyroidectomy. Group A had conventional mass ligature of the superior poleof thyroid gland while group B had individual ligation of the branches of the superior thyroid artery afteridentification of the external laryngeal nerve whenever possible. Abnormal readings on postoperative voice analysis and abnormal electromyogram of thecricothyroid muscles. Observers performing voice analysis tests were blinded as regards patient group. Postoperativeelectromyography of the cricothyroid revealed signs of nerve injury in five patients of group A but none in groupB. Multi-dimensional voice program, fundamental frequency range, fundamental frequency and maximum pressurelevel all showed significant postoperative change in group A but not of those in group B [level of confidence95%].Identification of external laryngeal nerve and/or ligation of the terminal branches of the superiorthyroid vessels seems to help prevent external laryngeal nerve injury

Stimulation of human spermatozoal penetration into cervical mucus by caffeine

The effect of caffeine in human spermatozoal penetration into cervical mucus was investigated. This penetration has been significantly stimulated by caffeine either when it is added to semen or to cervical mucus separately. It may be recommended to use caffeine as a pre- coital douching or with HAI in some cases of infertility with poor post coital testing