Non-recurrent inferior laryngeal nerve: a case report

The incidence of Non-recurrent laryngeal nerve (NRLN) is reported to be 0.6%-0.8% on the right side and in 0.004% on the left side. Damage to this nerve during thyroidectomy may lead to vocal cord complications and should therefore be prevented. A middle-aged woman with a nodular goiter who underwent subtotal thyroidectomy for multinodular colloid goiter. We encountered a non-recurrent laryngeal nerve on the right side in a patient during surgery. We were not able to find the inferior laryngeal nerve in its usual position using the customary anatomical landmarks. Instead, it was emerging directly from the right vagus nerve at a right angle and entering the larynx as a unique non-bifurcating nerve. Nonrecurrent inferior laryngeal nerve incidence is very rare, but when present, increases the risk of damage during thyroidectomy. Hence, it is very important to be aware of the anatomical variations of the inguinal lymph node (ILN) and the use of safe meticulous dissection while looking for the nerve during thyroidectomy. The use of Intra-operative neuro-monitoring (IONM) if available in thyroid surgery allows the surgeon to recognize and differentiate branches of the inferior laryngeal nerve (ILN) from sympathetic anastomoses, as well as NRLN during surgery.

Acute pancreatitis and relative polycythaemia: a case series

Relative polycythaemia is an apparent rise in erythrocyte level in the blood. However, the underlying cause is reduced blood plasma. Relative polycythaemia is often caused by loss of body fluids seen in conditions such as burns, dehydration and stress manifesting itself as a raised Haemoglobin or haematocrit. This case series presents a clinical summary of three patients with acute pancreatitis (AP) and relative polycythaemia due to reduction in plasma volume as a result of intravascular volume depletion as demonstrated by increase in haemoglobin and haematocrit.  Haem concentration may be considered as a marker for acute severe pancreatitis and correcting the volume depletion by adequate fluid improves the outcome of AP as seen in all our three patients.

A Pre-Operatively Diagnosed Abdominal Cocoon.

Abdominal Cocoon or idiopathic encapsulating peritonitis is a rare cause of intestinal obstruction. It more commonly occurs in young adolescent girls and the diagnosis is usually made at laparotomy. Recent case reports suggest that it is not uncommon in males and pre-operative diagnosis is possible by radiological investigations. We present a case of abdominal cocoon in an adult male, pre-operatively diagnosed by ultrasound and computerized tomography.

Risk factors predicting operative mortality in perforated peptic ulcer disease.

Following the introduction of H2-blockers and proton pump inhibitors, there has been a sharp decrease in elective peptic ulcer surgery. However, emergency operations for complications such as perforation are on the rise. This study was undertaken to review the factors which determine mortality following emergency surgery for peptic ulcer perforation. A prospective study of all patients who underwent surgery at our institute for peptic ulcer perforation between September 1999 and August 2001 was carried out. One hundred seventy-four patients underwent surgery for perforated peptic ulcer. Risk of death was related to age more than 60 years, shock at presentation, delay more than 24 hours prior to surgery and size of perforation more than 5 mm. Perforated peptic ulcer disease remains a frequent clinical problem associated with a significant postoperative mortality.

Recurrent gastric trichobezoar.

Trichobezoars are concretions of ingested hair that are found in the stomach. Recurrence of this condition has not been reported. We report an 18-year-old girl with recurrent trichobezoar; this emphasizes the need for counseling in these patients.

Value of core needle biopsy in the diagnosis of soft tissue tumours.

We performed a prospective study to determine the accuracy of core needle biopsy in the diagnosis and grading of soft tissue tumours and to study the morbidity of core needle biopsy. Forty one cases of soft tissue tumours, 24 of them malignant and 17 benign, were biopsied with an 18G core needle. Core needle biopsy reports were compared with the final histopathological report after definitive procedure or incisional biopsy. 85.3% of core biopsies yielded adequate sample. Core needle biopsy had a sensitivity of 90%, specificity of 100%, positive predictive value of 100% and a negative predictive value of 88.23%. Overall accuracy for diagnosis of malignancy was 94.28%, 77.7% of tumours were correctly subtyped and none of them were histologically graded. There was no immediate complication of haemorrhage in any of the cases. Thus, we conclude that core needle biopsy is equivalent to incisional biopsy in diagnostic accuracy and being simple, less expensive and unlikely to compromise further management, can be used in place of open biopsy of soft tissue tumours.