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Background: Thyroid neoplasm includes both benign and malignant tumors arising in the thyroid gland. Although thyroid cancer accounts for less than 1% of all cancers, the challenge to clinicians is to identify the minority of thyroid nodules that harbor malignancy. There are a number of well-established predictors of malignancy in thyroid nodules. More recently a few studies have suggested that higher concentration of thyroid stimulating hormone (TSH), even within the normal range are associated with subsequent diagnosis of thyroid cancer in patients with thyroid nodules and even higher serum TSH levels have been found associated with advanced stages of thyroid cancer. Methods: A prospective study was conducted on 220 cases without overt thyroid dysfunction attending Department of general surgery, Pushpagiri institute of medical science, Thiruvalla. Results: In our study incidence of malignancy of thyroid carcinoma was highest in patients with serum TSH concentrations, in range of 3.5 mIU/l-5.25 mIU/l, 55 patients out of 220 patients. Individually, incidence of papillary carcinoma (PC) (36/55 patients), follicular carcinoma (FC) (17/55 patients) and Hurthle cell carcinoma (HCC) (2/55 patients) were more in patients with higher TSH. So, from the study it can be clearly state that elevated TSH can be used as an independent predictor of thyroid malignancy. Higher TSH values are associated with papillary thyroid carcinoma.Conclusions: An elevated TSH can be used as an independent predictor of thyroid malignancy, especially for anticipating a probability of papillary carcinoma of thyroid.

Background: This was a report of a movement of the recurrent laryngeal nerve which can be demonstrated during thyroid surgeries which can be used for locating the nerve, or identifying it if already exposed and causing confusion with other nearby structures or when alone too.Methods: The nerve is located by observing for a superior-inferior movement of the recurrent laryngeal nerve transmitted by the loose areolar tissue over it and dissecting over this site to locate the nerve right underneath it. This was by direct observation of the movement which will be there so long as the thyroid is held retracted to the opposite side and is not separated from the thyroid at the tissues that constitute the condensation of pre-tracheal fascia called the Berry’s ligament.Results: The recurrent laryngeal nerve originates from the vagus and loops posteriorly and then upwards around the arch of aorta on the left side and the subclavian artery on the right side. When the thyroid gland is retracted away and thus the nerve put on slight stretch, a superior-inferior to and fro- movement of the nerve can be seen. This movement can be used for identification and dissection of the nerve along its course.Conclusions: A review of literature has been done and it is clear that this movement has not been hitherto identified or published

Background: Pilonidal sinus disease is a chronic infection of the natal cleft commonly affecting young adults. Out of the standard operative techniques, the Karydakis procedure is a relatively simple procedure associated with low rates of wound complications and recurrence. In this study we present a modified version of the Karydakis procedure to treat less extensive disease, which enables better skin closure without cavitation and tension.Methods: Patients with uncomplicated pilonidal sinus who presented to our centre during the period from April 2015 to March 2019 were prospectively enrolled. Patients with recurrent or complex sinus disease were excluded. In those enrolled, our modified Karydakis procedure was performed. In this method, after excision a flap of skin and subcutaneous tissue was raised to one side and sutured across the midline by advancement in layers.Results: 34 patients underwent our modified Karydakis procedure. 91% (31/34) of patients had uncomplicated recovery and could return to work after two weeks. There were minimal post-operative complications, in the form of erythema around the wound (8.8%), wound discharge (5.9%), seroma (5.9%) and infection (2.9%). No patient developed wound dehiscence or flap necrosis. There were excellent cosmetic results and no recurrence at one year post-surgery.Conclusions: Our modification of the Karydakis procedure is a simple and effective surgery for the management of uncomplicated pilonidal sinus disease which achieves good results.

Liposarcomas constitute approximately 15% of all sarcomas among the mesenchymal neoplasms. They usually arise in the lower extremities or in the retroperitoneum but have been reported in sites such as abdomen, vulva and buttocks. Primary mediastinal liposarcomas are rare with less than 100 cases reported worldwide so far. We present an interesting case of primary myxoid LPS of the posterior mediastinum with presenting complaints, imaging diagnosis and management with a review of the current literature.

Inflammation of the vulva can present as a manifestation of a localized problem or as part of a systemic disorder. Granulomatous vulvitis is a rare inflammatory condition that has histologic similarities to Crohn disease. Clinically, it presents with painless, chronic relapsing erythema, and edema, typically affecting the genital area. We report a case of extensive granulomatous vulvitis in a patient with no gastrointestinal evidence of Crohn disease. We describe difficulties with diagnosis and limitations in the treatment of isolated vulval granulomatous disease and aim to promote earlier recognition of the disease.

Leukemia is a malignancy of the bone marrow and blood. It is the most common childhood cancer in India. Advances in the treatment regimens have greatly increased the chances of survival. Both the disease and its treatment change the oral environment. In some cases, oral manifestations are the presenting feature of the disease and it will be the dentist′s responsibility to identify the underlying disorder and guide the diagnosis of the patient. Hence, the aim of present article is to review the literature concerning the oral health of children with acute lymphoblastic leukemia (ALL).

Metastasis to the uterine corpus is uncommon and secondary colorectal tumours of the endometrium are rare. We describe a uterine tumour with components of both primary endometrial and metastatic colorectal carcinomata. In this case, a 72-year-old obese woman presented with a 2-week history of postmenopausal bleeding per vaginum and weight loss. She had an abdominoperineal resection 3 years previously for a Dukes stage B rectal carcinoma. A transvaginal ultrasonography showed a thickened endometrium. Histology immunophenotyping showed a CK7+, CK20+, CA125- and CEA+ colorectal metastasis (a profile consistent with her previous cancer) associated with a primary CK7+, CK20-, CA125+ and CEA- endometroid endometrial adenocarcinoma. We conclude this represents endometrial metastasis of colorectal carcinoma with coincident primary endometrial adenocarcinoma. We speculate as to whether the endometrial carcinoma arose de novo or was induced by the colorectal metastasis, or whether the primary endometrial tumour provided a fertile site for the colorectal metastasis.