Objective: To evaluate the effectiveness of the risk of malignancy index 5 (RMI5)-a new indicator in differentiating benign and malignant ovarian masses. To compare RMI5 with RMI1, RMI2, RMI3, RMI4, and the individual parameters (CA125, ultrasound score, and menopausal status). Materials and methods: It is a 5-year retrospective record analysis of women admitted with ovarian masses. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), diagnostic accuracy of RMI1, RMI2, RMI3, RMI4, RMI5, and CA125, ultrasound score, and menopausal status were calculated. Results: Risk of malignancy index 5 is a better indicator of malignancy compared to the other indices. This study confirms that the five RMI indices were more accurate than menopausal status, CA125 level, and ultrasound score separately. RMI2 and RMI5 had p = 0.047 and 0.034, respectively, and hence were more accurate as compared to other indices by univariate analysis. Risk of malignancy index 5 had sensitivity and specificity of 61.5% and 93.17%, respectively, at a cutoff of 25. CA125 has better sensitivity of 80% in detecting malignant ovarian tumors than other individual parameters. Conclusion: Risk of malignancy index 5 better discriminates malignant from benign ovarian masses as compared to other malignancy indices.

Background: The external branch of the Superior Laryngeal nerve (EBSLN) is at high risk of injury in surgery for large multi-nodular goitre (MNG) since the upper pole is high in the neck, well cephalad to the EBSLN. We present a technique of drawing the lobe caudally by retrograde thyroidectomy in order to minimize nerve injury. Design & method: All patients having surgery for benign MNG were included. Cases with previous thyroid surgery, malignant and toxic disease were excluded. The thyroid lobe was mobilized from its inferior aspect and capsular dissection performed cephalad with bipolar cautery, lifting the gland off the trachea while separating it from the parathyroids and branches of the inferior thyroid vessels. The ligament of Berry is divided and the entire lobe freed, attached only by the superior pedicle which is drawn caudally well below the EBSLN prior to ligation. Patients were followed for voice change at 24 hours, 7 days and 3 months. Results: Ninety-one consecutive lobectomies were done in 60 patients, 31 bilateral. Forty-four (73%) patients had voice change at 24 h, 10 (11%) at 7 days and 1 at 3 months. The patient with persistent voice change complained of change in tone but not volume; vocal cords were normal on indirect laryngoscopy. Conclusion: Retrograde thyroidectomy is recommended for large MNG where the EBSLN lies well below the upper pole; it minimizes risk to the nerve.

Objective: To find out the frequency of various types thyroid carcinomas and their management in tertiary care hospital of Bengaluru. Study design: Retrospective study. Place &Duration of study: Department of General Surgery, KIMS Hospital and Research Centre, Bangalore. 2016 -2021. Methodology: All patients with well differentiated thyroid carcinoma and medullary thyroid carcinoma were included in the study. Patients with anaplastic carcinoma were excluded. Written and informed consent were taken from the patients and data was recorded on a pre-designed form. Results: One hundred and twenty four patients were included in this study. Eighty four patients were female and fourty male with female to male ratio of 2:1. Papillary carcinoma was found to be the most frequent thyroid carcinoma encountered (n=78 – 62.90%) followed by follicular and medullary carcinoma, 34 (27.42%) and 12 (9.67%) respectively. Various surgical procedures were done to deal with these malignancies, that included total thyroidectomy (n=68 – 54.84%), total thyroidectomy plus modified radical neck dissection (n=18 – 14.51%) completion thyroidectomy (n=32 – 25.81%), completion thyroidectomy with modified radical neck dissection (n=4 – 3.22%), and modified radical neck dissection (MRND) alone in (n= 2 -1.65%) patients. Conclusions: Papillary carcinoma was the most common thyroid malignancy encountered. Frequency of medullary carcinoma was found almost equal to the follicular carcinoma.

<p class="abstract">Vagal nerve schwannomas are rare parapharyngeal tumours which was first described by Figi in 1933. Hoarseness is the most common symptom. Occasionally, a paroxysmal cough may be produced on palpating the mass. This is a clinical sign, unique to vagal schwannoma. Presence of this sign, along with a mass located on the medial border of the sternocleidomastoid muscle, should make clinicians suspicious of vagal nerve sheath tumours. However, in our case, the patient presented to us with a swelling in the neck and no other symptoms. MRI in the pre-operative work-up is helpful in defining diagnosis and in evaluating the extent and the relationship. A careful intracapsular enucleation with nerve-sparing technique remains the treatment of choice in order to avoid nerve injury which can lead to vocal cord paralysis. Horner’s syndrome following cervical surgeries is a rare phenomenon. Its occurrence following excision of a vagal schwannoma can occur due to direct injury to cervical sympathetic chain during excision or indirect injury due to traction on the sympathetic chain. Here is a case report of a patient diagnosed with left vagal scwanomma who developed horner’s syndrome post operatively.</p>