American Research Journal of Medicine and Surgery

Mohamed B. M. Kotb, Mostafa T. Ahmed, Ibrahim A. Ibrahim. Abd-Elradi Abd-Elsalam Farghaly

Background: Thyroidectomy is one of the most surgical interventions in endocrine surgery. When the operation is performed in the respective surgical centers, the operation is safe with low morbidity and 0% mortality.
Patients and Methods: The study was a quasi-experimental study carried out at Assiut University Hospital. One hundred patients with benign and malignant goiter disorders underwent primary (not recurrent) total thyroidectomy. The patients were assigned into two groups: group 1 (interventional group) included 50 cases operated upon with methylene blue spraying technique and group 2 (control group) 50 cases established with the conventional technique. Methylene blue was sprayed over the thyroid lobe and perilober area. Parathyroides and recurrent laryngeal nerves were identified and evaluated.
Results: Recurrent laryngeal nerve was not stained and remained white in all cases while all other tissues were stained blue. Three minutes later, the parathyroid glands washed out the blue stain and regained their original yellow color. Thyroid gland wash-out time was ∼15 min.
Conclusion: Methylene blue spraying is a new technique that allows identification of both parathyroid glands and recurrent laryngeal nerves. This technique is safe, effective, and technically feasible.

Tricia Sandrine Lewis1, Yong Dong Feng2*, Fa Yong Hu2, Ling Wei Jia2

Introduction: In recent years, the incidence of esophageal junction cancer (EGJ) has increased. The management of Siewert type II remains undecided while total gastrectomy with distal esophagectomy is mostly recommended for type III. Data is still lacking from studies assessing proximal and total gastrectomy approaches without thoracotomy as the surgical management of these types of cancer.
Methods: Data was retrospectively collected on histopathological characteristics, short-term complications, hemoglobin, total protein, albumin and weight changes. 18 patients with type II, 15 patient type III underwent proximal gastrectomy-Double tract reconstruction (PG-DTR) and 17 patients and 10 patients with type II and III respectively, underwent total gastrectomy-Roux-en y (TG-RY). Patients were followed up every 3 months for one year. The Spitzer-index was used to assess quality of life (QOL) at months 3,6 and 12.
Results: There was no statistical significance for operation time, length of hospital stay, blood loss, and change in weight at 6 months after surgery. Changes in hemoglobin, total protein and albumin also failed to show statistical significance (P=0.517, P=0.885 & P=0.8237, respectively). Recurrence was seen in 18.5% and 21.2% of TG and PG group respectively.QOL was significantly better in PG-DTR (P=0.017).
Conclusions: This study failed to show any difference for intraoperative and short-term complications between the two procedures. PG-DTR might provide better QOL for patients with types II/III cancer. In addition to D2, Siewert II/III tumors of larger sizes may require extended lymphadenectomy. This study needs further verification with larger cohort, additional parameters, and extended follow up periods.

Young-Min Kim, MD

Sarcopenia is commonly defined as a decrease in muscle mass accompanied by low muscle strength, and is known to increase the risk of frailty, falls and disability. According to the European guidelines for sarcopenia revised in 2018, if sarcopenia is clinically suspected, the muscle strength should be checked to determine whether it is probable sarcopenia before diagnosing sarcopenia. Recent studies have shown that depression is associated with sarcopenia. To explore further, this study investigated the association of probable sarcopenia with depressive symptom severity. This Cross-sectional study was conducted using data from the Korean National Health and Nutrition Examination Survey (2014, 2016). In the KNHNE survey, 2062 participants aged 65+ who completed both the PHQ-test and the grip strength test were selected. PHQ-9 was categorized into 4 groups according to the score, and low grip strength was defined as less than 26 kg for men and 18 kg for women according to AWGS criteria. Age, BMI, waist circumference, smoking status, comorbidities and diets were assessed as covariates. When adjusted all the covariates, Age ([OR]=1.175; [CI]=1.123-1.229), history of stroke ([OR]=2.467; [CI]=1.094-5.564), carbohydrate intake ([OR]=1.004; [CI]=1.000-1.009) was significantly associated with probable sarcopenia in male group. Whereas, in female group, age ([OR]=1.130; [CI]=1.090-1.171), lipid intake ([OR]=0.962; [CI]=0.929-0.997) was significantly associated with probable sarcopenia. Moreover, as the PHQ-9 score increased, the odds ratio for probable sarcopenia increased in female group (mild ([OR]1.477; [CI]1.007-2.167), moderate ([OR]2.421; [CI]1.292-4.537), moderately severe ~ severe ([OR]3.095; [CI]1.441-6.646)). The risk of probable sarcopenia increases with the depressive symptom severity in Korean elderly women.