A Nationwide Survey to Assess the Practices and Patterns of Use of Intraoperative Nerve Monitoring During Thyroid Surgery Among Surgeons in India

There is still equipoise for the routine use of intraoperative nerve monitoring (IONM) for thyroid surgeries; however, some surgeons tend to use it for various reasons. In our study, we did a national survey to assess the patterns and practice of the use of IONM among surgeons during thyroid surgery in India. A questionnaire survey was sent to surgeons (head and neck surgical oncologists, general surgical oncologists, endocrine surgeons and otolaryngologists) in different zones in India via email, and their responses were analysed. One hundred and one responses were received. The majority of the respondents were head and neck surgical oncologists (n = 56, 55.4%). Forty-three (42.6%) respondents used IONM during thyroid surgeries in this survey. Surgeons with ≤ 15 years of experience performing thyroid surgeries (p = 0.02) and surgeons performing > 50 thyroid surgeries also tended to use IONM. Mostly IONM was used for surgeries on thyroid malignancies (p = 0.016). The respondents used IONM for more than one reason such as medicolegal purposes and surgeon comfort among others. IONM was most often used during redo surgeries (n = 46, 45.5%) and in patients with already one fixed cord (n = 39, 38.6%). The majority felt IONM was not cost-effective (n = 53, 52.5%). The use of IONM during thyroid surgery in our survey was nearly 43%. It was used mostly for surgery for thyroid malignancies, and it was found to be used for more than one reason and indications such as redo surgeries (most commonly).

Supplementary Information

The online version contains supplementary material available at 10.1007/s13193-023-01818-5.

Shallow versus deep endotracheal suctioning in young rabbits: pathologic effects on the tracheobronchial wall

The traditional technique for endotracheal suctioning of intubated neonates consists of inserting a catheter until resistance is met, withdrawing slightly, and applying suction. The extent of tissue damage caused by the traditional (deep) technique v that caused by an alternative shallow technique was studied with an animal model. Six 3-week-old rabbits were anesthetized, intubated, and suctioned every 15 minutes for six hours by neonatal intensive care unit nurses who were unaware of the study purpose. Three rabbits were suctioned by means of the deep technique, whereas the other three received shallow suctioning achieved by inserting the catheter no further than a premeasured distance. Light microscopy showed significantly increased necrosis and inflammation following deep suctioning. Electron microscopy revealed greater loss of cilia and increased mucus with the deep technique. To confirm our initial assumption that the deep technique is still used extensively by neonatal intensive care units throughout the country, a mail survey was conducted. Of the 405 (43%) neonatal intensive care unit physicians who responded, 82% reported frequent or exclusive use of the deep technique for routine suctioning. In this study, the fact that deep suctioning results in significantly more tracheobronchial pathology than does a shallow, premeasured technique is shown. It is recommended that nurseries change their current practice and adopt the shallow technique for routine suctioning of intubated neonates.

Myocardial contrast echocardiography without significant hemodynamic effects or reactive hyperemia: a major advantage in the imaging of regional myocardial perfusion

All agents used for myocardial contrast echocardiography to date produce adverse hemodynamic effects and alter coronary blood flow. It was hypothesized that because 5% human albumin, when sonicated for use as a contrast agent, is neither hyperosmolar nor a calcium chelator, it would not have significant effects on coronary blood flow, left ventricular function or systemic hemodynamics. Albumin microbubbles of two distinct sizes (mean size 2.9 and 5.8 micron) were produced and compared with nonsonicated albumin, nonsonicated Renografin, sonicated Renografin and hand-agitated Renografin for their effects on hemodynamics, coronary blood flow and regional left ventricular systolic thickening in 15 open chest anesthetized dogs. None of the albumin solutions significantly altered left atrial, left ventricular systolic and end-diastolic and mean aortic pressures. These agents did not cause a coronary hyperemic response or alter left ventricular systolic thickening, but slightly lowered the peak positive left ventricular maximal rate of rise in pressure (dP/dt) (-4.1 +/- 5.4%, p less than 0.01). In contrast, all the Renografin solutions caused significant changes in all these variables (p less than 0.02). In six dogs. albumin solutions did not alter these variables even in the presence of critical coronary stenosis. The contrast opacification produced by 5.8 micron albumin microbubbles was equivalent to that produced by sonicated Renografin. Compared with an equivalent amount of saline and nonsonicated albumin solutions, 10 ml of sonicated albumin did not produce any evidence of infarction, embolization or hemorrhage in the myocardium, brain or kidneys of rabbits.(ABSTRACT TRUNCATED AT 250 WORDS)

Atrial extension of mitral annular calcification mimicking intracardiac tumor

Liquefaction necrosis of mitral annular calcification occurs in 3% of autopsied cases. The liquified material can spread intramurally in various directions creating suspicious appearing mass lesions on chest x-ray or echocardiography. An incidential finding of an echogenic left atrial calcified mass in a 57-year-old woman was suspected to be an intracardiac tumor for which she underwent exploratory cardiotomy. Instead, culture-negative liquified pasty material was removed from the posterior left atrial wall adjacent to the calcified mitral annulus. This case illustrates that liquefaction necrosis of mitral annular calcification may spread to contiguous structures and masquerade as an intracardiac tumor. This relatively unknown aspect of mitral annular calcification should be considered in the differential diagnosis of echogenic left atrial mass lesions.

Sonographic findings in the prenatal diagnosis of cephalothoracopagus syncephalus. A case report

The ultrasonic intrauterine diagnosis of cephalothoracopagus, a form of conjoined twinning, can be made when a monochorionic monoamniotic gestation contains a single head and torso accompanied by eight limbs. This is the second reported case of the syncephalus variety of cephalothoracopagus twins associated with clomiphene citrate use; however, the association is believed to be coincidental rather than causative.

Pathologic features of familial visceral myopathy

Familial visceral myopathy is the most common cause of chronic primary (idiopathic) intestinal pseudo-obstruction. We studied four family groups with this disease and found that it has a characteristic morphologic appearance. Grossly, there is segmental dilatation of the alimentary tract, often involving multiple sites and most commonly producing a megaduodenum. Microscopically, the involved areas show a characteristic change consisting of degenerating muscle cells and fibrosis, which may involve the full thickness of the muscularis propria but is often more prominent in or limited to the external layer. Degenerating muscle cells appear pale, poorly defined, and fragmented. As residual thread-like remnants become surrounded by collagen or as muscle cells are destroyed, leaving apparent spaces surrounded by collagen, the longitudinal and circular muscles take on a vacuolated appearance easily recognized at low magnifications. Recognition of this change is greatly facilitated by use of a trichrome stain, and mild lesions may be recognized only with such stains. The nondilated segments of intestine show similar changes but of a less severe degree. Neural and vascular structures are apparently normal. Although the lesion most closely resembles progressive systemic sclerosis, the degenerating muscle cells and vacuolated appearance of the muscle serve to distinguish familial visceral myopathy from the latter entity.

Meningeal carcinomatosis 21 years following bronchiolo-alveolar carcinoma: diagnosis by cisternal CSF examination

An unusual case is described of pure meningeal carcinomatosis in the absence of other evidence of tumor occurring 21 years after lobectomy for a localized bronchiolo-alveolar carcinoma. The metastatic disease was confined to the leptomeninges and was documented only by a cisternal cerebrospinal fluid (CSF) examination. Four previous lumbar punctures had shown hypoglycorrachia as the only CSF abnormality.

Involvement of the thyroid gland in histiocytosis X

A 27 month old white male infant clinically suspected of having histiocytosis X had an enlarged hard hypofunctioning thyroid. A needle biopsy of the thyroid showed disruption of the thyroid architecture by an infiltrate consisting of large histiocytes admixed with eosinophils, neutrophils, and lymphocytes, confirming the clinical diagnosis of histiocytosis X.

Giant cell arteritis and Crohn's disease: an unreported association

This report describes a 16-yr-old patient with coexistant Crohn's disease and giant cell arteritis. The unusual features of the case include presence of giant cell arteritis of temporal arteritis type in the bowel wall, the young age of the patient, and the previously unreported association of these two pathologic processes.

Sonography of benign sacral teratoma in utero

Sacral teratoma is rarely diagnosed in utero. In the case presented, gray-scale sonography revealed a teratoma in utero, demonstrated the proportion of solid and cystic components, and identified calcification. These are important features, since solid tumors lacking calcification are usually malignant, and cystic or complex tumors as well as those with calcification are usually benign.

A perspective for pediatric surgeons: chronic idiopathic intestinal pseudoobstruction

Chronic idiopathic intestinal pseudoobstruction (CIIP) is a disorder of alimentary tract motility with onset of symptoms in adolescence or young adulthood, characterized by recurring attacks of abdominal pain, distention, vomiting, and constipation often leading to malnutrition and death. Starting with an adolescent patient, treated for a succession of life-threatening attacks of pseudoobstruction, the authors have identified CIIP in four generations of a Virginia family. Studies show characteristic dilation and diminished motility of the esophagus and intestine. Surgery's role in CIIP is palliative, and operation should only be offered when medical measures have failed to control symptoms.

Aortic dissection: surgical and nonsurgical treatments compared. An analysis of seventy-four cases at the University of Virginia

During the eleven year period from 1965 to 1976, aortic dissection was diagnosed in seventy-eight patients treated at the University of Virginia Medical Center. The seventy-four cases that comprise the present report were confirmed by aortography, surgery, or autopsy. Forty patients (54 per cent) were surgically treated by interruption of the origin of dissection and insertion of a Dacron prosthesis. The remaining thirty-four (46 per cent) were treated according to the Wheat regimen or by nonspecific supportive measures. The overall survival at one year was 28 per cent. One year survival for patients with type I dissections treated surgically was 19 per cent compared with 8 per cent one year survival for nonsurgically treated patients. Sixty per cent of patients with type II dissections treated surgically were alive at the end of one year, whereas no patients with type II dissection treated nonsurgically survived beyond one year. Half the patients with type III dissections treated surgically were alive at one year compared with 35 per cent of those nonsurgically treated. These data suggest that surgery is the treatment of choice for all types of aortic dissections, but particularly for type II. Patients with type I dissections have a very poor prognosis regardless of therapy.

Response kinetics of host and experimental solid tumour after adriamycin

The effects of adriamycin (Adr) on the solid-tumour model, hepatoma 3924A, and on critical organs of the host, were determined at intervals after single injections of 60 mg/m2 of the agent. A reduced rate of tumour growth was evident 4 days after treatment, continued to Day 11, and then returned to rates comparable to control values. On Day 11 tumour volumes of treated animals were 38% of control. During the period of reduced growth, 3H-TdR incorporation into tumour DNA and percentage labelled tumour cells were less than control values. DNA concentration in tumour was not affected by drug treatment, which differs from observations made in other studies employing 5-fluorouracil (FU). No evidence of significantly increased necrosis or fibrosis of the tumour was found after Adr. The Adr treatment caused loss of 60% of the tibial marrow by Day 4, as measured by total DNA content. Marrow DNA recovered to control levels between Days 7 and 11. Incorporation of 3H-TdR into heart DNA was reduced more than 40% during the first week after Adr treatment; enhanced incorporation was observed on Day 11, and control levels were attained by Day 17. No significant pathological evidence of cardiac toxicity was found 2-21 days after Adr but degeneration of myocardial cells and oedema was prominent at 14 weeks.

Avasucular necrosis of pheochromocytoma followed by spontaneous remission

Following an acute spontaneous hypertensive crisis and shock a patient with pheochromocytoma was found to have an exceedingly high catecholamine excretion rate. After this episode, the patient remained normotensive and urinary excretion of catecholamines returned to normal. During surgery, a large pheochromocytoma was found and removed that showed avascualr necrosis. In phenochromocytoma, a sudden and exceedingly high rate of catecholamine release may cause intense vasoconstriction both generally and within the tumor itself. In this patient, avascular tumor necrosis led to a spontaneous remission of clinical symptoms.

Pancreaticoduodenectomy in the treatment of congenital fibrosarcoma of the duodenum

A 2-mo-old female with congenital fibrosarcoma causing duodenal obstruction had a pancreaticoduodenectomy. She is doing well with the aid of oral pancreatic enzyme supplements 14 mo after her pancreaticoduodenectomy with no evidence of tumor recurrence or pancreatic endocrine dysfunction.