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BACKGROUND: Cervical paragangliomas (CPG) are slow-growing tumours, most of which are highly vascular, making surgical resection challenging. Preoperative embolisation of afferent arteries has been recommended to facilitate operative dissection, reduce perioperative blood loss, and shorten the duration of the operation. However, there is conflicting evidence on the benefits of preoperative embolisation on surgical outcomes, operative time, and bleeding. OBJECTIVES: The objective of this study was to compare the perioperative parameters and outcomes like duration of surgery, blood transfusion, duration of stay in the ICU, cranial nerve injuries, and postoperative stroke between patients who underwent excision of CPGs with and without preoperative embolisation. METHODS: This is a retrospective study conducted at the Division of Vascular Surgery, Sree Chitra Tirunal Institute of Medical Sciences and Technology, Thiruvananthapuram, Kerala, India. The study included a review of the medical records of 32 patients who underwent excision of CPGs. Patients who underwent surgical resection without preoperative embolisation (SR) were compared with those who underwent surgical resection with embolisation (SREMB). Statistical analysis was done in R statistical software (R Foundation for Statistical Computing, Vienna, Austria). Categorical variables were reported in absolute numbers and percentages continuous variables were compared with an unpaired Mann-Whitney U test. The chi-square test was used to compare the categorical data. RESULTS: Out of 32 patients included in this study, 13 (40.6%) patients were included in the SREMB group. Between the two groups, there were no significant differences in operative time (120 vs. 150 minutes; p = 0.59), blood transfusion requirement (0.69 vs. 0.37 units; p = 0.39) and ICU stays (1 vs. 1; p = 0.56). Postoperative cranial nerve injury was significantly more in the SREMB group (6 vs 1; p = 0.01) but stroke (0 vs 2; p = 0.50) was not statistically significant between the two groups. CONCLUSION: In this study, we found that there was insufficient evidence to support routine preoperative embolisation in CPG. Hence, preoperative embolisation should only be used in a very select group of patients.
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Background Coronaviruses, generally known to cause a mild degree of respiratory illness have in the recent past caused three serious disease outbreaks. The world is yet to be released from the grip of the most recent coronavirus disease 2019 (COVID-19) pandemic due to emerging mutant strains. Age, presence of comorbidities, clinical severity, and laboratory markers such as C-reactive protein and D-dimer are some of the factors being employed to prioritize patients for hospital care. It is known that comorbidities themselves are an outcome of inflammation and can induce a pro-inflammatory state. Our study aims to elucidate the influence of age and comorbidities on laboratory markers in patients with COVID-19. Methodology This is a single-center retrospective study of patients with a laboratory diagnosis of COVID-19 admitted to our hospital between September 21, 2020, and October 1, 2020. A total of 387 patients above the age of 18 years were included in the analysis and categorized based on the age-adjusted Charlson comorbidity index (ACCI) score into group A (score ≤4) and group B (score >4). Demographic, clinical, and laboratory factors as well as outcomes were compared. Results Group B exhibited higher intensive care unit admission and mortality, as well as statistically significant higher mean values of most laboratory markers. A correlation was also observed between the ACCI score and biomarker values. On comparison between the two groups regarding cut-offs predicting mortality for laboratory determinants, no consistent pattern was observed. Conclusions A correlation between age, the number of comorbidities, and laboratory markers was observed in our analysis of COVID-19-affected patients. Aging and comorbid conditions can produce a state of meta-inflammation and can thereby contribute to hyperinflammation in COVID-19. This can be an explanation for the higher risk of COVID-19-related mortality in older individuals and those with underlying comorbidities.
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INTRODUCTION AND IMPORTANCE: Granular cell tumors are uncommon neoplasms. They appear in the skin, subcutaneous tissues, and many internal organs. It is essential to diagnose this disease because it mimics other tumors clinically. We report this case because of the rarity of tumors in Asians and the necessity of excision with clear margins. CASE PRESENTATION: A 55-year-old Indian woman reported swelling in the right side of the neck for six months and gradually increasing in size. Two years ago, she had a similar swelling excised from her neck. She had wide local excision of the tumor with wider margins in the plastic surgery department, and histopathology revealed a granular cell tumor with clear margins. She is undergoing close follow-up with history and physical examination with no evidence of disease recurrence. CLINICAL DISCUSSION: Granular cell tumors can have recurrences. These slow-growing tumors appear benign. Histopathological examination with careful assessment of high-risk features is vital in evaluating Granular cell tumors. Wide local excision with clear margins is the mainstay of treatment. CONCLUSION: Achieving clear margins in the head and neck area is sometimes tricky for granular cell tumors. Margin positivity is associated with a high risk of local recurrence and needs re-excision of the tumor for adequate local control.
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Background Hashimoto's thyroiditis (HT) is the commonest autoimmune thyroid pathology. It has been reported in increased numbers recently, probably due to the increase in autoimmune diseases across many parts of the world. It is sometimes found associated with other diseases as well as other diseases of the thyroid. There is an unproven association of this condition with thyroid cancer, particularly papillary thyroid carcinoma (PTC). Methods This was a retrospective study performed over a period of 5 years. The objectives of this study were to find out the prevalence of histopathologically proven HT in surgically resected thyroid glands for various indications and its association with other thyroid disorders, especially thyroid malignancies. Total 4,630 patients who underwent thyroidectomy during the study period and met the criteria for inclusion were considered for analysis. Results Histopathologically proven features of HT were present in 1,295 (28%) of the cases. Among these, 445 (34.36%) had only HT while 850 (65.66%) had HT along with other thyroid diseases. The most common disease associated with HT was multinodular goiter (44.2%), followed by PTC (15.2%). Patients with HT exhibited a higher rate of papillary cancer (16.7%) compared with patients without this pathology (13.8%). Statistically significant association between papillary cancer and HT was found among the female patients. Conclusion The prevalence of HT in patients undergoing thyroidectomy is high in the studied population. A statistically significant association exists between papillary thyroid cancer and thyroiditis among female patients. This could form the basis for further research along these lines.
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BACKGROUND: In adults, the majority of cases of intussusception are due to malignancy. AIMS: The aim of the study is to describe the pattern of intussusception in the adult population diagnosed and treated at a tertiary care center. SUBJECTS AND METHODS: Study Design: This is a retrospective cross-sectional study based on chart review, and data collection was made from the computer database and inpatient case records. Study Setting: Adult intussusception cases diagnosed and treated at a tertiary care referral center in South India. All inpatient case sheets including investigations and histopathology information on the computer database of all patients diagnosed with intussusception in the period of August 2012 to July 2016 were retracted based on a pretested and standardized form. Demographic data and other baseline data were summarized with descriptive statistics. SPSS software was used for data analysis. RESULTS: Of the 77 patients, 47 (61%) were male. The common presentations were abdominal pain (95%), vomiting (64%), and rectal bleeding (29%). Common examination findings were abdominal tenderness (45%), guarding (39%), and abdominal mass (38%). On ultrasonography, fifty (65%) patients had intussusception with ileocolic (25) as the most common type. Computed tomography abdomen was taken for 28 (36%) patients, in which 23 (82%) had intussusception with ileocolic (9) as the most common type. Surgery was done for 53 (69%) patients, and the most common procedure was right hemicolectomy (25) followed by resection and anastomosis of the small bowel (23). Intraoperatively, 42 (79%) patients had intussusception with ileocolic (23) as the most common type. Intraoperatively, 14 (26%) patients had a bowel gangrene. Biopsy-proven cause for intussusception was present in 46 patients, with malignancy (21) as the most common cause. The patients were on regular follow-up. Recurrence of intussusception occurred in six patients of the small bowel intussusception who had polyposis. CONCLUSIONS: Adult intussusception is often associated with malignancy. Hence, a formal resection without reduction is needed and surgery should be done following oncological principles.
