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Objective: The most dreaded long-term complication of axillary lymph node dissection remains upper arm lymphedema. Our study has strategized the three most common identified causes of post treatment arm lymphedema, i.e., obesity, radiation, and neoadjuvant chemotherapy and tried to identify the histopathological and clinical or surgical factors which can predict arm lymphedema. Materials and Methods: This is a prospective observational study was conducted at a tertiary care referral centre in India, with strict inclusion criteria of BMI

Objective: To do a cross-cultural adaptation and validation of the translated Hindi version with Indian modification of the Japanese Orthopedic Association (In-mJOA-H) score for cervical myelopathy. Background: Indian modification of the Japanese Orthopedic Association (In-mJOA-H) score has never been translated and studied in any vernacular language. This is one of the biggest limitations in assessing disease severity where most of the population is speaking Hindi or other regional languages. Materials and Methods: A cross-sectional study of 193 patients, from November 2020 to May 2021, with cervical myelopathy or neck pain with radiculopathy was done. The acceptability, validity, responsiveness, reproducibility, and cross-cultural adaptation were evaluated for the Hindi version (In-mJOA-H). Results: A strong correlation was found between In-mJOA-H with the English version and its individual component of the English version Indian modification of the JOA scale (In-mJOA-E). Conclusion: Good acceptability, validity, responsiveness, and reproducibility were established for the Hindi version (In-mJOA-H) with Indian modifications and its correlation to the English version Indian modification of the JOA scale (In-mJOA-E).

Background: Majority of osteoporotic vertebral compression fractures (OVCFs) present with back pain and some of them with spinal deformity. PVP not only helps in pain relief but also the correction of spinal deformity with least postoperative morbidity. PVP through transpedicular approach is a minimally invasive procedure which can be done under local anesthesia, without muscle splitting, with short hospital stay and minimal complications compared to other techniques used. Aim: The aim of this study was to evaluate the functional outcomes following PVP in OVCFs under local anesthesia. Materials and Methods: This interventional study was conducted between November 2020 and October 2021 in the orthopedic department. This study included 40 patients with back pain with failure of conservative treatment for at least 3 weeks without nerve root compression sign with evidence of OVCFs on X-ray and Kummel sign positive who underwent PVP under local anesthesia. The Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) have been used for pre- and postoperative clinical assessment of the patients, and follow-up was done at 24 h, 1 month, and 6 months postoperatively. Results: Maximum patients were in the age group of 51–60 years, and 60% of the patients were females. Sixty-five percent of patients had lumbar vertebral fractures and 35% had dorsal vertebral fractures. The mean operative time of PVP was 34.78 min. The mean preoperative VAS and ODI scores were 7.03 and 42, respectively. The postoperative VAS and ODI scores were dramatically improved at each follow-up interval (P < 0.0001). The complications associated with the procedure were very less, in 5% of patients asymptomatic cement leakage was seen, 15% patients had pain at the needle site and in rest 80% no complication was seen. Conclusion: PVP has been shown to be a safe, effective, and minimally invasive alternative for the treatment of OVCFs. The procedure proved to be advantageous as it had shorter operative time, less blood loss, early recovery period, less postoperative work disability, lesser rate of complications, and scarring, clearly pointing toward a better acceptance of the percutaneous techniques.

Background: Many surgical approaches from conventional open discectomy, microdiscectomy, percutaneous endoscopic interlaminar discectomy, and transforaminal endoscopic discectomy have been used for the treatment of prolapsed intervertebral disc. Transforaminal endoscopic discectomy through a Kambin’s triangle is a minimally invasive procedure which can be done under local anesthesia, without muscle splitting, with short hospital stay and minimal complications compared to other techniques used. Aim: The aim of this study was to evaluate the functional outcomes following percutaneous transforaminal endoscopic discectomy (PTED) under local anesthesia for lumbar disc herniations. Materials and Methods: This interventional study was conducted between November 2020 and October 2021 in our Orthopaedics Department after the clearance of the Ethical Committee. This study included 54 patients with radicular pain for at least 3 weeks with a positive nerve root compression sign and who underwent PTED under local anesthesia. The Visual Analog Scale (VAS) and the Oswestry Disability Index (ODI) have been used for pre- and postoperative clinical assessment of the patients, and follow-up was done at 6 weeks, 3 months, 6 months, and 1 year postoperatively. Results: Maximum patients were in the age group of 61–70 years, and 65.2% of the patients were male. 68.2% of patients had lumbar disc herniation at L4-L5 level. The mean operative time of PTED was 70.6 min. Out of 16 cases of L5-S1 disc prolapse, 1 case was operated by making an iliac bone window due to the inaccessibility of disc space because of highly placed iliac crest. The mean preoperative VAS and ODI scores were 8.1 and 56.6, respectively. The postoperative VAS and ODI scores were dramatically improved at each follow-up interval (P < 0.0001). Out of 66 patients who underwent operation, 4 patients developed surgical site infection and 2 were found to have dysesthesia, and no serious complications were noted. Conclusion: PTED has been shown to be a safe, effective, and minimally invasive alternative for the treatment of lumbar disc herniation. PTED found to be favorable because it had a shorter operational time and less epidural scarring, allowing for simple revision procedures as needed. As a result, this points to a greater acceptability of endoscopic procedures and their possible widespread use in the future.

Oesophagectomy is an established technique for treating oesophageal cancer. Pulmonary complications during the postoperative period can arise from intraoperative manipulation, thoracic structure injury, or anastomotic leaks. At our institution, it is standard practice to place a soft corrugated drain around the anastomosis in the neck to facilitate the drainage of any anastomotic leakage towards the skin. In this case report, a 55-year-old female underwent video-assisted oesophagectomy in the prone position after neoadjuvant chemoradiation. A corrugated drain was subsequently placed near the anastomosis site in the neck. On the third day postoperatively (POD 3), she developed a sudden pneumothorax and an air leak in the chest tube. Despite the placement of a second intercostal tube and normal findings on fibreoptic bronchoscopy, the air leak persisted. Unexpectedly, the air leak spontaneously ceased, and the lungs re-inflated after 24 hours. Upon analysis, it was discovered that the dressing over the neck drain, which had been changed on POD 3, did not completely cover the wound. This, combined with malpositioning, created a oneway valve effect, leading to pneumothorax. Therefore, the use of a corrugated neck drain following oesophagectomy may result in life-threatening pneumothorax and should either be airtight sealed with dressing or avoided.

Introduction: Thymoma comprises 20% of all mediastinal neoplasms and 50% of all primary tumours in the anterior compartment. Thymic surgery has undergone a paradigm shift in approach from being transcervical to video assisted. Video assisted thymectomies in selected patients can decrease the inherent morbidities of a trans-sternal approach, while achieving similar therapeutic benefits. Aim: To analyse the technical key points, morbidity and outcomes associated with video assisted thymectomy in early stage thymoma (Modified Masoaka stage I or II) with myasthenia gravis. Materials and Methods: The present study was a retrospective observational analysis of 24 patients with thymoma and Myasthenia Gravis Foundation of America (MGFA) class II to IV myasthenia gravis who underwent video assisted thoracoscopic thymectomy in institution from May 2013 to May 2018. All patients with thymomas which on Contrast Enhanced Computed Tomography (CECT) did not show infiltration of the surrounding structures and were

BACKGROUND: With increasing incidence of thyroid carcinoma, the optimal management of central lymph nodes remains an unanswered question although central neck nodes represent the most common site of recurrence. The aim of this study was to determine the morbidity of prophylactic central neck dissection in differentiated thyroid cancer and to evaluate histopathological correlation between nodal metastases and histological features. METHOD: This was a prospective, observational study of 2 years duration (May 2017 to May 2019) involving 30 patients with proven differentiated thyroid cancers and clinicoradiologically negative lymph node with no history of neck surgeries. They all underwent total thyroidectomy with bilateral central neck dissection. Surgical outcomes in the form of transient or permanent hypoparathyroidism, transient and permanent recurrent nerve palsy were assessed along with histopathological correlation of primary tumor with central node positivity. DISCUSSION: Classical histology (p = 0.05), >4 cm tumor size (p = 0.04), lymphovascular invasion (p = 0.04) and multifocality (p = 0.04) were all significantly associated with increased risk of central lymph nodal metastasis. The incidence of transient and permanent hypoparathyroidism was 36.3% and 10% respectively. Metastatic lymph node ratio of >60% is significantly associated with increased preablative serum thyroglobulin levels. Around 35% of the pT1 or T2 lesions were upstaged for postoperative radioiodine ablation CONCLUSION: An important role of prophylactic central neck dissection may lie in male patients, age > 45years, tumor size >4 cm, extrathyroidal extension, lymphovascular invasion and multifocality in accurate staging and can be performed with minimal morbidity at a high volume center.