The superficial ulnar artery is a rare variation of the upper limb arterial system that arises from the brachial or axillary artery and runs superficial to the muscles arising from the medial epicondyle [1-3]. The incidence is about 0.7 to 7% [1,4,5]. In our routine dissections we found a superficial ulnar artery, which crossed the cubital fossa superficial to the bicipital aponeurosis making it highly vulnerable to intra-arterial injection. This is a rare variation that every medical and nursing staff member should know about.
Expensive investigations such as CT do not appear to improve the diagnostic accuracy of appendicitis or prevent complications. This study suggests diagnostic and treatment algorithms in the SL hospital are more accurate and efficient in confirming appendicitis than those seen in the UK hospital under investigation.
Thyroid gland has three main embryological remnants: pyramidal lobe, tubercle of Zuckerkandl and thyrothymic remnants. They are commonly missed or misidentified during dissection. Each of these remnants plays a critical role in thyroidectomy as they help to identify the relevant anatomy and therefore help prevent accidental damage to other structures in close proximity during dissection. In this article, we describe the current knowledge of each of these remnants and their significance in thyroidectomy. Conclusion It is important that all these remnants are objectively looked for and removed during surgery in order to prevent recurrences. How to cite this article Fernando R, Rajapaksha A, Ranasinghe N, Gunawardana D. Embryological Remnants of the Thyroid Gland and their Significance in Thyroidectomy. World J Endoc Surg 2014;6(3):110-112.
Introduction Previous studies of goitre in Sri Lanka proposed the presence of a goitre belt, which was refuted subsequently. Epidemiology of goitre in the post iodization era needs re-evaluation.Objectives To describe the epidemiology of goitre in Sri Lanka.Methods A descriptive cross-sectional study was conducted in designated zones except in conflict areas in 2006/2007. An interviewer administered questionnaire was used and patients were evaluated clinically, biochemically and cytologically.Results Among 5200 participans 426 had goitre. Mean age was 36.3 (SD 17.3) years. Goitre was commonest in the age group 40-49 years with a female pre-ponderance. The prevalence was similar in all zones with pockets of high prevalence in each zone. Overall islandwide adjusted prevalence was 6.8% (95% CI = 6.0-7.6).
Introduction Thyroidectomy is the commonest endocrine surgical procedure undertaken throughout the world. Redo thyroidectomies are challenging procedures with a higher morbidity rate. Lateral approach to thyroid (LATT) is a good alternative to the standard midline exploration. The key to the technique is the development of the natural tissue plane between the strap muscle and the ipsilateral sternocleidomastoid muscle to explore the thyroid bed. A study was carried out to assess the efficacy, safety, and complication of LATT. Materials and methods Data on patients undergoing LATT in professorial surgical unit, Ragama from 2008 to 2015, were collected prospectively and analyzed. All procedures were done by a single surgeon. Results A total of 36 LATTs were done. Data from 32 people were collected, as 4 patients lost follow-up; 29 (90.6%) were females and 3 (9.4%) were males. Their age ranges between 28 and 61 (median 43.37). Three (9.4%) LATTs for parathyroid explorations and out of it one (3.1%) for redo parathyroid explorations were done. Nine (28.1%) cases were redo thyroidectomies and 18 (56.2%) were done with mini incision with lateral approach. Hemithyroidectomies were performed on 28 (87.5%) patients. Bilateral explorations were done on three (9.4%) patients and four (12.5%) lateral approaches were done for completion thyroidectomies for follicular malignant lesions. Transient clinical hypocalcemia was noticed in four (12.5%) patients and one (3.1%) developed hoarseness of voice, which was temporary; and none of them had complications like hematoma and postsurgical stridor. Conclusion Lateral approach to thyroid is a safe alternative to the standard approach for reexplorative thyroid surgery. How to cite this article Dissanayake DDMC, Fernando RF, Dissanayake IJ. Lateral approach to Thyroid: A Good Technique for Reoperative Thyroid Surgery. World J Endoc Surg 2016;8(2):141-142.
Background Total thyroidectomy is increasingly recognised as the preferred surgical option for benign diseases of the thyroid. One factor contributing towards this change in policy is reports of incidental carcinomas in the resected specimens. Methods This was a prospective study of patients, who underwent total thyroidectomy for benign diseases of the thyroid at the University Surgical Unit, Colombo North Teaching Hospital from January 2003 to December 2005. Results There were 68 patients (67 females) aged 28 to 67 years (mean 44.2 (SD=11.1). In 6 (8.8%) patients, histological examination of the post-operative specimen showed incidental carcinomas: 2 papillary, 2 medullary and 2 follicular carcinomas. There was no significant difference in age, clinical presentation and functional thyroid status of patients with incidental carcinomas and those with histologically confirmed benign diseases. Conclusions Occurrence of incidental thyroid cancers was 8.8% in this series, and they were difficult to predict pre-operatively. The policy of performing total thyroidectomy for benign disease of the thyroid obviates the need for further surgery if an incidental carcinoma is found.
Clinical Practice Guidelines are developed to be of assistance to health care professionals by providing guidance and recommendations for particular areas of practice. The Guidelines should not be considered inclusive of all proper approaches or methods, or exclusive of others. The Guidelines cannot guarantee any specific outcome, nor do they establish a standard of care. The Guidelines are not intended to dictate the treatment of a particular patient. Treatment decisions must be made based on the independent judgment of health care providers and each patient's individual circumstances. The Endocrine Society of Sri Lanka makes no warranty, express or implied, regarding the Guidelines and specifically excludes any warranties of merchantability and fitness for a particular use or purpose. The Society shall not be liable for direct, indirect, special, incidental, or consequential damages related to the use of the information contained herein. Endocrine Society of Sri Lanka thanks the Abbott Laboratories for the unrestricted grant to develop and publish the Thyroid Guidelines.
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