Jency Mathews - Academia.edu (original) (raw)

Papers by Jency Mathews

Journal of Clinical and Diagnostic Research, 2018

Introduction: Surgery is the backbone for treatment of thyroid malignancy. Total thyroidectomy wi... more Introduction: Surgery is the backbone for treatment of thyroid malignancy. Total thyroidectomy with or without neck dissection is standard of care. Thereafter adjuvant treatment, usually radioiodine, depends upon risk stratification of the patient. Common complications of total thyroidectomy are hypocalcaemia and voice change. Aim: To find out incidence and risk factors for hypocalcaemia and voice change after surgery for carcinoma thyroid. Materials and Methods: The present study was a prospective observational study. It included all patients who had undergone total thyroidectomy with or without neck dissection for carcinoma thyroid within a period of October 2010 to June 2011. Fifty patients were included in the final analysis. Complications, mainly hypocalcaemia, voice change, following surgery were studied. Results: The present study included a total of 50 patients, 34 were female and 16 male. Hypocalcaemia was seen in 24 patients. Twenty one had temporary and three had permanent hypocalcaemia. Central compartment neck dissection was found to be significantly associated with hypocalcaemia. Six week, after surgery 14 patients complained of perceptual voice dysfunction, of these 11 had complained of fatigue. At the end of one year, only one patient had voice dysfunction. Conclusion: Most of the complications following thyroidectomy are temporary; usually patients recover well from hypocalcaemia and voice changes. Incidence and severity are said to be more with malignant thyroid compared to thyroidectomy for benign aetiology. Most studies in literature regarding complications of the thyroidectomy include both benign and malignant cases. The present study includes all patients with proven or suspicious of malignancy, in an attempt to have, a homogenous group with regard to aetiology.

International journal of reproduction, contraception, obstetrics and gynecology, Oct 23, 2019

Uterine cancer shows an increasing trend in India among both urban and rural populations. It is a... more Uterine cancer shows an increasing trend in India among both urban and rural populations. It is already the most common gynaecological malignancy in developed countries. 1 Surgical staging of uterine cancers is the gold standard unchanged by advances in imaging or adjuvant treatment. The standard surgical staging procedure in the non-metastatic setting includes a peritoneal cytology, total hysterectomy with bilateral salpingo-oophorectomy, pelvic and para-aortic node dissections and omentectomy in addition any tumor deposits excision. 2 But the extent of procedures required for adequate staging of uterine cancers has always been debated. Early stage endometrial cancer has a good prognosis and ABSTRACT Background: momentum to select patients who will benefit from the extensive procedures. However, the parameters used for risk stratification have variable accuracy outside of tertiary cancer centres. This study looks into the accuracy of risk stratification using preoperative histology, MRI and Ca 125 levels and the oncological outcomes after tailoring surgical staging based on the risk stratification by combining the three variables in a suburban centre with a growing cancer population. Methods: This prospective observational cohort study was undertaken in a suburban cancer center in Pushpagiri Medical College, Tiruvalla, Kerala between June 2014 and December 2018. All patients underwent surgical staging with hysterectomy and salpingo oophorectomy as the least procedure. Lymphadenectomy was tailored according to the preoperative risk grouping and changed only in the presence of gross findings at surgery. Adjuvant treatment and follow up data obtained and collected in Microsoft Excel and analysed using statistical software SPSS version 22. Results: Of 47 patients recruited for the study, 35 patients were available for final analysis. Preoperative histology was accurate in 73%. There was 20 % overestimation and 8% underestimation. Ca 125 levels were elevated in 15%. MRI had an overall sensitivity of 74% and specificity of 60%. When MRI, Ca125 and histology were combined together, there was patients were deemed to be high risk. On final risk grouping, 9 patients were down staged and none were upstaged. Conclusions: Preoperative histology, MRI and ca 125 levels have moderate accuracy individually as preoperative risk determinates. The three parameters combined together show high specificity and PPV for preoperative risk stratification and the risk stratification has not been detrimental with respect to oncological outcomes of recurrence.

Archives of International Surgery, 2018

Background: Multiple techniques have been established for the insertion of totally implantable ch... more Background: Multiple techniques have been established for the insertion of totally implantable chemotherapy ports. Cephalic vein cut down technique is considered a safe technique with reasonable success. The surgical team implanting the chemoports and the nursing team handling them have a learning curve. This prospective observational cohort study aimed to document the techniques used for the implantation, the success and failure of cephalic vein cut down technique, the intraoperative and delayed complications of chemoport implantation, and the ease and difficulties of the nursing personnel in subsequent handling of the chemoports. Patients and Methods: All consecutive patients undergoing surgical implantation of chemoports between September 2015 and December 2017 were included in this study. Chemoport implantation was first attempted in the cephalic vein by cut down technique followed by closed Seldinger method in the subclavian or internal jugular vein. Surgical details were recorded and further access of the chemoport by the nursing personnel was monitored. Any difficulty in access or use of the chemoports was noted and help sought. All data were collected prospectively and analysed. Results: Thirty chemoport implantations and 280 chemoport cannulations were performed during the study period. Cephalic vein cut down technique was performed in 28 (96%) patients. Cephalic vein implantation of chemoport was successful in 14 (50%) patients. Obliterated vein, small luminal diameter and adverse anatomy were reasons for failure. Patients who had not previously received chemotherapy had a cephalic vein success rate higher than those who had, with an odds ratio of 2.4. Chemoport access by nursing personnel was easy in 92% patients. No blood return was seen in 7%. Conclusion: Cephalic vein cut down technique was successful in 50% patients. It was less successful in patients who have previously been treated with chemotherapy. No blood return on access was the commonest cause for concern while handling chemoports. An algorithm for the preference of veins to be used and an institutional protocol for chemoport access and use increase safety and efficiency.

Kerala Surgical Journal, 2022

Indian Journal of Surgical Oncology

JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH, 2018

Introduction: Surgery is the backbone for treatment of thyroid malignancy. Total thyroidectomy wi... more Introduction: Surgery is the backbone for treatment of thyroid malignancy. Total thyroidectomy with or without neck dissection is standard of care. Thereafter adjuvant treatment, usually radioiodine, depends upon risk stratification of the patient. Common complications of total thyroidectomy are hypocalcaemia and voice change. Aim: To find out incidence and risk factors for hypocalcaemia and voice change after surgery for carcinoma thyroid. Materials and Methods: The present study was a prospective observational study. It included all patients who had undergone total thyroidectomy with or without neck dissection for carcinoma thyroid within a period of October 2010 to June 2011. Fifty patients were included in the final analysis. Complications, mainly hypocalcaemia, voice change, following surgery were studied. Results: The present study included a total of 50 patients, 34 were female and 16 male. Hypocalcaemia was seen in 24 patients. Twenty one had temporary and three had permanent hypocalcaemia. Central compartment neck dissection was found to be significantly associated with hypocalcaemia. Six week, after surgery 14 patients complained of perceptual voice dysfunction, of these 11 had complained of fatigue. At the end of one year, only one patient had voice dysfunction. Conclusion: Most of the complications following thyroidectomy are temporary; usually patients recover well from hypocalcaemia and voice changes. Incidence and severity are said to be more with malignant thyroid compared to thyroidectomy for benign aetiology. Most studies in literature regarding complications of the thyroidectomy include both benign and malignant cases. The present study includes all patients with proven or suspicious of malignancy, in an attempt to have, a homogenous group with regard to aetiology.

International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 2019

Background: momentum to select patients who will benefit from the extensive procedures. However, ... more Background: momentum to select patients who will benefit from the extensive procedures. However, the parameters used for risk stratification have variable accuracy outside of tertiary cancer centres. This study looks into the accuracy of risk stratification using preoperative histology, MRI and Ca 125 levels and the oncological outcomes after tailoring surgical staging based on the risk stratification by combining the three variables in a suburban centre with a growing cancer population.Methods: This prospective observational cohort study was undertaken in a suburban cancer center in Pushpagiri Medical College, Tiruvalla, Kerala between June 2014 and December 2018. All patients underwent surgical staging with hysterectomy and salpingo oophorectomy as the least procedure. Lymphadenectomy was tailored according to the preoperative risk grouping and changed only in the presence of gross findings at surgery. Adjuvant treatment and follow up data obtained and collected in Microsoft Excel...

Archives of International Surgery, 2018

Background: Multiple techniques have been established for the insertion of totally implantable ch... more Background: Multiple techniques have been established for the insertion of totally implantable chemotherapy ports. Cephalic vein cut down technique is considered a safe technique with reasonable success. The surgical team implanting the chemoports and the nursing team handling them have a learning curve. This prospective observational cohort study aimed to document the techniques used for the implantation, the success and failure of cephalic vein cut down technique, the intraoperative and delayed complications of chemoport implantation, and the ease and difficulties of the nursing personnel in subsequent handling of the chemoports. Patients and Methods: All consecutive patients undergoing surgical implantation of chemoports between September 2015 and December 2017 were included in this study. Chemoport implantation was first attempted in the cephalic vein by cut down technique followed by closed Seldinger method in the subclavian or internal jugular vein. Surgical details were recorded and further access of the chemoport by the nursing personnel was monitored. Any difficulty in access or use of the chemoports was noted and help sought. All data were collected prospectively and analysed. Results: Thirty chemoport implantations and 280 chemoport cannulations were performed during the study period. Cephalic vein cut down technique was performed in 28 (96%) patients. Cephalic vein implantation of chemoport was successful in 14 (50%) patients. Obliterated vein, small luminal diameter and adverse anatomy were reasons for failure. Patients who had not previously received chemotherapy had a cephalic vein success rate higher than those who had, with an odds ratio of 2.4. Chemoport access by nursing personnel was easy in 92% patients. No blood return was seen in 7%. Conclusion: Cephalic vein cut down technique was successful in 50% patients. It was less successful in patients who have previously been treated with chemotherapy. No blood return on access was the commonest cause for concern while handling chemoports. An algorithm for the preference of veins to be used and an institutional protocol for chemoport access and use increase safety and efficiency.

Biomedical and Biotechnology Research Journal (BBRJ)

Journal of Clinical and Diagnostic Research, 2018

Introduction: Surgery is the backbone for treatment of thyroid malignancy. Total thyroidectomy wi... more Introduction: Surgery is the backbone for treatment of thyroid malignancy. Total thyroidectomy with or without neck dissection is standard of care. Thereafter adjuvant treatment, usually radioiodine, depends upon risk stratification of the patient. Common complications of total thyroidectomy are hypocalcaemia and voice change. Aim: To find out incidence and risk factors for hypocalcaemia and voice change after surgery for carcinoma thyroid. Materials and Methods: The present study was a prospective observational study. It included all patients who had undergone total thyroidectomy with or without neck dissection for carcinoma thyroid within a period of October 2010 to June 2011. Fifty patients were included in the final analysis. Complications, mainly hypocalcaemia, voice change, following surgery were studied. Results: The present study included a total of 50 patients, 34 were female and 16 male. Hypocalcaemia was seen in 24 patients. Twenty one had temporary and three had permanent hypocalcaemia. Central compartment neck dissection was found to be significantly associated with hypocalcaemia. Six week, after surgery 14 patients complained of perceptual voice dysfunction, of these 11 had complained of fatigue. At the end of one year, only one patient had voice dysfunction. Conclusion: Most of the complications following thyroidectomy are temporary; usually patients recover well from hypocalcaemia and voice changes. Incidence and severity are said to be more with malignant thyroid compared to thyroidectomy for benign aetiology. Most studies in literature regarding complications of the thyroidectomy include both benign and malignant cases. The present study includes all patients with proven or suspicious of malignancy, in an attempt to have, a homogenous group with regard to aetiology.

International journal of reproduction, contraception, obstetrics and gynecology, Oct 23, 2019

Uterine cancer shows an increasing trend in India among both urban and rural populations. It is a... more Uterine cancer shows an increasing trend in India among both urban and rural populations. It is already the most common gynaecological malignancy in developed countries. 1 Surgical staging of uterine cancers is the gold standard unchanged by advances in imaging or adjuvant treatment. The standard surgical staging procedure in the non-metastatic setting includes a peritoneal cytology, total hysterectomy with bilateral salpingo-oophorectomy, pelvic and para-aortic node dissections and omentectomy in addition any tumor deposits excision. 2 But the extent of procedures required for adequate staging of uterine cancers has always been debated. Early stage endometrial cancer has a good prognosis and ABSTRACT Background: momentum to select patients who will benefit from the extensive procedures. However, the parameters used for risk stratification have variable accuracy outside of tertiary cancer centres. This study looks into the accuracy of risk stratification using preoperative histology, MRI and Ca 125 levels and the oncological outcomes after tailoring surgical staging based on the risk stratification by combining the three variables in a suburban centre with a growing cancer population. Methods: This prospective observational cohort study was undertaken in a suburban cancer center in Pushpagiri Medical College, Tiruvalla, Kerala between June 2014 and December 2018. All patients underwent surgical staging with hysterectomy and salpingo oophorectomy as the least procedure. Lymphadenectomy was tailored according to the preoperative risk grouping and changed only in the presence of gross findings at surgery. Adjuvant treatment and follow up data obtained and collected in Microsoft Excel and analysed using statistical software SPSS version 22. Results: Of 47 patients recruited for the study, 35 patients were available for final analysis. Preoperative histology was accurate in 73%. There was 20 % overestimation and 8% underestimation. Ca 125 levels were elevated in 15%. MRI had an overall sensitivity of 74% and specificity of 60%. When MRI, Ca125 and histology were combined together, there was patients were deemed to be high risk. On final risk grouping, 9 patients were down staged and none were upstaged. Conclusions: Preoperative histology, MRI and ca 125 levels have moderate accuracy individually as preoperative risk determinates. The three parameters combined together show high specificity and PPV for preoperative risk stratification and the risk stratification has not been detrimental with respect to oncological outcomes of recurrence.

Archives of International Surgery, 2018

Background: Multiple techniques have been established for the insertion of totally implantable ch... more Background: Multiple techniques have been established for the insertion of totally implantable chemotherapy ports. Cephalic vein cut down technique is considered a safe technique with reasonable success. The surgical team implanting the chemoports and the nursing team handling them have a learning curve. This prospective observational cohort study aimed to document the techniques used for the implantation, the success and failure of cephalic vein cut down technique, the intraoperative and delayed complications of chemoport implantation, and the ease and difficulties of the nursing personnel in subsequent handling of the chemoports. Patients and Methods: All consecutive patients undergoing surgical implantation of chemoports between September 2015 and December 2017 were included in this study. Chemoport implantation was first attempted in the cephalic vein by cut down technique followed by closed Seldinger method in the subclavian or internal jugular vein. Surgical details were recorded and further access of the chemoport by the nursing personnel was monitored. Any difficulty in access or use of the chemoports was noted and help sought. All data were collected prospectively and analysed. Results: Thirty chemoport implantations and 280 chemoport cannulations were performed during the study period. Cephalic vein cut down technique was performed in 28 (96%) patients. Cephalic vein implantation of chemoport was successful in 14 (50%) patients. Obliterated vein, small luminal diameter and adverse anatomy were reasons for failure. Patients who had not previously received chemotherapy had a cephalic vein success rate higher than those who had, with an odds ratio of 2.4. Chemoport access by nursing personnel was easy in 92% patients. No blood return was seen in 7%. Conclusion: Cephalic vein cut down technique was successful in 50% patients. It was less successful in patients who have previously been treated with chemotherapy. No blood return on access was the commonest cause for concern while handling chemoports. An algorithm for the preference of veins to be used and an institutional protocol for chemoport access and use increase safety and efficiency.

Kerala Surgical Journal, 2022

Indian Journal of Surgical Oncology

JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH, 2018

Introduction: Surgery is the backbone for treatment of thyroid malignancy. Total thyroidectomy wi... more Introduction: Surgery is the backbone for treatment of thyroid malignancy. Total thyroidectomy with or without neck dissection is standard of care. Thereafter adjuvant treatment, usually radioiodine, depends upon risk stratification of the patient. Common complications of total thyroidectomy are hypocalcaemia and voice change. Aim: To find out incidence and risk factors for hypocalcaemia and voice change after surgery for carcinoma thyroid. Materials and Methods: The present study was a prospective observational study. It included all patients who had undergone total thyroidectomy with or without neck dissection for carcinoma thyroid within a period of October 2010 to June 2011. Fifty patients were included in the final analysis. Complications, mainly hypocalcaemia, voice change, following surgery were studied. Results: The present study included a total of 50 patients, 34 were female and 16 male. Hypocalcaemia was seen in 24 patients. Twenty one had temporary and three had permanent hypocalcaemia. Central compartment neck dissection was found to be significantly associated with hypocalcaemia. Six week, after surgery 14 patients complained of perceptual voice dysfunction, of these 11 had complained of fatigue. At the end of one year, only one patient had voice dysfunction. Conclusion: Most of the complications following thyroidectomy are temporary; usually patients recover well from hypocalcaemia and voice changes. Incidence and severity are said to be more with malignant thyroid compared to thyroidectomy for benign aetiology. Most studies in literature regarding complications of the thyroidectomy include both benign and malignant cases. The present study includes all patients with proven or suspicious of malignancy, in an attempt to have, a homogenous group with regard to aetiology.

International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 2019

Background: momentum to select patients who will benefit from the extensive procedures. However, ... more Background: momentum to select patients who will benefit from the extensive procedures. However, the parameters used for risk stratification have variable accuracy outside of tertiary cancer centres. This study looks into the accuracy of risk stratification using preoperative histology, MRI and Ca 125 levels and the oncological outcomes after tailoring surgical staging based on the risk stratification by combining the three variables in a suburban centre with a growing cancer population.Methods: This prospective observational cohort study was undertaken in a suburban cancer center in Pushpagiri Medical College, Tiruvalla, Kerala between June 2014 and December 2018. All patients underwent surgical staging with hysterectomy and salpingo oophorectomy as the least procedure. Lymphadenectomy was tailored according to the preoperative risk grouping and changed only in the presence of gross findings at surgery. Adjuvant treatment and follow up data obtained and collected in Microsoft Excel...

Archives of International Surgery, 2018

Background: Multiple techniques have been established for the insertion of totally implantable ch... more Background: Multiple techniques have been established for the insertion of totally implantable chemotherapy ports. Cephalic vein cut down technique is considered a safe technique with reasonable success. The surgical team implanting the chemoports and the nursing team handling them have a learning curve. This prospective observational cohort study aimed to document the techniques used for the implantation, the success and failure of cephalic vein cut down technique, the intraoperative and delayed complications of chemoport implantation, and the ease and difficulties of the nursing personnel in subsequent handling of the chemoports. Patients and Methods: All consecutive patients undergoing surgical implantation of chemoports between September 2015 and December 2017 were included in this study. Chemoport implantation was first attempted in the cephalic vein by cut down technique followed by closed Seldinger method in the subclavian or internal jugular vein. Surgical details were recorded and further access of the chemoport by the nursing personnel was monitored. Any difficulty in access or use of the chemoports was noted and help sought. All data were collected prospectively and analysed. Results: Thirty chemoport implantations and 280 chemoport cannulations were performed during the study period. Cephalic vein cut down technique was performed in 28 (96%) patients. Cephalic vein implantation of chemoport was successful in 14 (50%) patients. Obliterated vein, small luminal diameter and adverse anatomy were reasons for failure. Patients who had not previously received chemotherapy had a cephalic vein success rate higher than those who had, with an odds ratio of 2.4. Chemoport access by nursing personnel was easy in 92% patients. No blood return was seen in 7%. Conclusion: Cephalic vein cut down technique was successful in 50% patients. It was less successful in patients who have previously been treated with chemotherapy. No blood return on access was the commonest cause for concern while handling chemoports. An algorithm for the preference of veins to be used and an institutional protocol for chemoport access and use increase safety and efficiency.

Biomedical and Biotechnology Research Journal (BBRJ)