Incidental parathyroidectomy during thyroid resection: incidence, risk factors, and outcome

Thyroidectomy is a commonly performed procedure for thyroid problems. Inadvertent removal of the parathyroid glands is one of its recognized complications, which occurs more frequently in certain high-risk patients. The aim of this study was to identify the incidence, risk factors, and clinical relevance of incidental parathyroidectomy during thyroid surgery. A retrospective review of thyroid operations performed at a tertiary referral hospital between January 2004 and December 2008. Pathology reports were reviewed to identify the specimens that included parathyroid tissue and underlying thyroid pathology. Postoperative calcium levels were reviewed in these patients. During the study period, 287 thyroidectomies were performed and 47 [16.4%] patients had incidentally removed parathyroid glands. Risk factors for inadvertent parathyroid resection included total thyroidectomy [P=.0001], Hashimoto thyroiditis [P=.004], and extrathyroidal spread [P=.0003]. Postoperative hypocalcemia occurred in 18 [38.3%] of the patients in whom the parathyroid gland was removed inadvertently and in 48 [20%] of the rest of the patients [P=.0123]. The incidence of incidental removal of parathyroid tissue during thyroidectomy is 16.4%. Total thyroidectomy, extrathyroidal extension of the tumor, and thyroiditis were found to be the risk factors. Hypocalcemia was significantly higher among patients who had inadvertent parathyroidectomy

Endometriosis of the appendix: a trap for the unwarey

The anatomic variations of the appendix along with a wide spectrum of appendiceal affections frustrate the accurate diagnosis of appendicitis. Isolated endometriosis of the appendix is rare and its presentation as acute appendicitis is even uncommon[1] Endometriosis affects the intestinal tract in 15-30% of patients with pelvic endometriosis[2]. The correct diagnosis is often delayed because intestinal endometriosis may masquerade clinically as regional enteritis, ischemic enteritis or colitis, diverticulitis or neoplasm[3,4]. The incidence of endometriosis of the appendix is reported to be just under 1% of the total endometriosis cases[5,6] but because of its propensity to manifest with a wide spectrum of sitespecific presentations, appendiceal endometriosis should be a diagnostic consideration in the evaluation of pre menopausal women with gastrointestinal complaints[7]. This case report presents a lady with vague abdominal pain and ultimately was found to have endometriosis of the appendix at King Khalid University Hospital Riyadh, Kingdom of Saudi Arabia [K.S.A]

Gallbladder carcinoma: is it a rare disease in our community?

Gallbladder carcinoma has an unusual geographic and demographic distribution. It is more common in certain geographic areas and its incidence varies in different ethnic groups even within the same country. The aim of our study was to gauge the magnitude of the problem in a group of our patients. The hospital and histopathological records of 549 patients who underwent cholecystectomy in our institute in the period from January 1996 to December 2001 were retrospectively reviewed. There was a predominance of female patients undergoing cholecyslectomy [male to female ratio 1:4]. The mean age was 38.2 years. The histological results did not show any evidence of malignancy of the gallbladder in the patients studied. The incidence of gallbladder carcinoma in patients undergoing cholecystectomy in King Khalid University Hospital, Saudi Arabia, is low. Possible explanations are absence of industrial carcinogens, low incidence of smoking among women and relatively younger age of the group of patients who underwent cholecystectomy

Laparoscopic cholecystectomy: the outcome with minimal conversion rate: Experience in a district hospital

Since introducing laparoscopic cholecystectomy [LC] different centres have reported different conversion rate [CR] to open cholecystectomy [OC] and different reasons for conversion. To evaluate the role of LC in the treatment of symptomatic gallstones and establish the outcomes of this treatment modality in general, looking especially into the rate of conversion to OC, at a district hospital. Patients and methods: From July 1992-July 1998, 751 patients who underwent LC were retrospectively reviewed. All patients with symptomatic gallstones were offered LC with no exclusion criteria apart from anaesthetic opinion. No attempts were made at selection of patients for LC There were 751 patients with symptomatic gallstones [617 females, 134 males] underwent LC. Chronic cholecystitis represented the majority of cases [83%]. The mean operative time was 65.52 minutes; pre-operation and main hospital stay was 2.46 days. our total conversion rate was 0.9% and 0.4% if malignancy of the gallbladder is excluded. In comparison to the published data, there was obvious lower conversion, rate, which was neither associated with increased morbidity nor mortality Laparsocopic cholecystectomy is a reliable, safe and cost effective treatment modality for symptomatic gallstones. With growing experience in laparoscopic technique, proper settings and harmony of the operating team, it is possible to bring the conversion rate to OC to the minimum without any increment in mortality or morbidity