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Article: Surgicel® Granuloma Mimicking Recurrent Thyroid Tumor After Thyroidectomy: A Case Report and Literature Review.

Alameer, Ehab

2023 Volume 15, Issue 10, Page(s) e46587

Abstract: Oxidized regenerated cellulose, commonly known by the brand name Surgicel®, is a hemostatic agent widely used in various surgical procedures. While it is generally considered safe and effective, there have been reports of complications associated with ... ...

Abstract	Oxidized regenerated cellulose, commonly known by the brand name Surgicel®, is a hemostatic agent widely used in various surgical procedures. While it is generally considered safe and effective, there have been reports of complications associated with its use, including the formation of pseudotumoral lesions. This article presents a case of a patient who developed a Surgicel® granuloma in the thyroid bed, mimicking a recurrent tumor. Surgicel® is known to cause a chronic inflammatory reaction, leading to foreign body giant cell formation and fibroblastic proliferation. Fine-needle aspiration (FNA) cytology is a valuable diagnostic tool for identifying pseudotumoral lesions caused by oxidized cellulose. The characteristic appearance of oxidized cellulose fragments and the presence of a granulomatous reaction can help distinguish these lesions from tumor recurrence or abscesses. To prevent Surgicel® granuloma, it is recommended to use the minimal amount necessary to achieve hemostasis. It is also important to document its use in the operative report. In cases where a recurrent mass lesion is suspected postoperatively, a comprehensive medical history, imaging studies, and FNA are essential for accurate diagnosis and management. This case report highlights the importance of considering Surgicel®-induced granuloma in the differential diagnosis of recurrent thyroid-bed tumors. A correct diagnosis can help avoid unnecessary aggressive interventions, particularly in cancer patients.
Language	English
Publishing date	2023-10-06
Publishing country	United States
Document type	Case Reports
ZDB-ID	2747273-5
ISSN	2168-8184
ISSN	2168-8184
DOI	10.7759/cureus.46587
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: Predictors and Preventive Strategies of Bleeding After Thyroid Surgery.

Ezzy, Mohsen / Alameer, Ehab

Cureus

2023 Volume 15, Issue 10, Page(s) e47575

Abstract: Postoperative compressive neck hematoma occurs in approximately 0.1% to 1.7% of cases, most occurring within the first six hours after surgery. Thyroid pathology, patient predisposition, and surgical technique are major risk factors for postoperative ... ...

Abstract	Postoperative compressive neck hematoma occurs in approximately 0.1% to 1.7% of cases, most occurring within the first six hours after surgery. Thyroid pathology, patient predisposition, and surgical technique are major risk factors for postoperative hematoma. This narrative review describes current perspectives on predicting and preventing bleeding following thyroid surgery. Predictors of bleeding after thyroid surgery include patient-related factors such as male sex and age, surgery-related factors like total thyroidectomy and operations for thyroid malignancy, and surgeon-related factors. Hemostasis is the primary focus after preserving critical structures in thyroid surgery. The clamp-and-tie technique has been the standard method for dividing the thyroid gland's main vascular pedicles for many years. Bipolar electrocautery has been used for vessels of small size. However, advanced bipolar and ultrasound energy and hybrid devices are now available options that may reduce operative time without increasing costs or complications. In cases where small bleeders close to critical structures are present and the clamp-and-tie technique is not feasible, hemostatic agents are commonly used. Drains do not appear to provide any significant benefits in preventing the sequelae of bleeding after thyroid surgery.
Language	English
Publishing date	2023-10-24
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	2747273-5
ISSN	2168-8184
ISSN	2168-8184
DOI	10.7759/cureus.47575
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Article ; Online: Monitoring Thyroglobulin Following Total Thyroidectomy After Lobectomy-Reply.

Alameer, Ehab / Eagan, Alana / Ganly, Ian

JAMA otolaryngology-- head & neck surgery

2024 Volume 150, Issue 4, Page(s) 357–358

MeSH term(s)	Humans ; Thyroglobulin ; Thyroidectomy/adverse effects ; Thyroid Neoplasms/surgery ; Thyrotropin ; Retrospective Studies ; Neoplasm Recurrence, Local
Chemical Substances	Thyroglobulin (9010-34-8) ; Thyrotropin (9002-71-5)
Language	English
Publishing date	2024-02-29
Publishing country	United States
Document type	Journal Article
ZDB-ID	2701825-8
ISSN	2168-619X ; 2168-6181
ISSN (online)	2168-619X
ISSN	2168-6181
DOI	10.1001/jamaoto.2024.0004
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Article: A Case Report of Laparoscopic Left-Sided Appendectomy in a Child With Situs Inversus.

Khudhayr, Essa A / Ali, Abdullah A / Alameer, Ehab

Cureus

2022 Volume 14, Issue 4, Page(s) e24426

Abstract: Acute appendicitis classically elicits right-sided abdominal pain. Abdominal pain in patients with situs inversus may create a diagnostic challenge. We share a case of a seven-year-old boy who presented to the emergency department with left lower ... ...

Abstract	Acute appendicitis classically elicits right-sided abdominal pain. Abdominal pain in patients with situs inversus may create a diagnostic challenge. We share a case of a seven-year-old boy who presented to the emergency department with left lower quadrant abdominal pain and tenderness. A chest x-ray showed dextrocardia and an abdominal ultrasound confirmed left-sided appendicitis. Diagnostic laparoscopy and appendectomy were uneventful. Thorough peri-operative evaluation and planning are key to a successful outcome in this rare condition.
Language	English
Publishing date	2022-04-23
Publishing country	United States
Document type	Case Reports
ZDB-ID	2747273-5
ISSN	2168-8184
ISSN	2168-8184
DOI	10.7759/cureus.24426
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Article ; Online: Partial Thyroidectomy With Incidental Metastatic Lymph Nodes.

Alameer, Ehab / Eagan, Alana / Scholfield, Daniel W / Woods, Robbie S R / Tuttle, R Michael / Wong, Richard J / Patel, Snehal G / Ganly, Ian

JAMA otolaryngology-- head & neck surgery

2023 Volume 150, Issue 1, Page(s) 49–56

Abstract: Importance: The need for completion thyroidectomy in patients with incidental metastatic lymph nodes after partial thyroidectomy is unclear.: Objective: To investigate the outcomes of patients with incidental metastatic lymph nodes following partial ... ...

Abstract	Importance: The need for completion thyroidectomy in patients with incidental metastatic lymph nodes after partial thyroidectomy is unclear. Objective: To investigate the outcomes of patients with incidental metastatic lymph nodes following partial thyroidectomy. Design, setting, and participants: A retrospective review of a prospectively maintained thyroid cancer database from 1985 to 2015 was carried out at a head and neck surgery practice at a tertiary referral cancer center. A total of 74 patients who underwent thyroid lobectomy or thyroid isthmusectomy between 1985 and 2015 and were found to have incidental metastatic lymph nodes on final pathologic analysis and were selected to be observed without immediate completion thyroidectomy were included. A separate group of additional 11 patients who underwent immediate completion thyroidectomy was also identified and reviewed. Main outcome and measure: Analysis took place from February to May 2022. Recurrence-free survival outcomes of patients found to have incidental metastatic lymph nodes on final pathologic analysis following partial thyroidectomy with no immediate completion thyroidectomy. Results: A total of 74 patients were observed, with a median (IQR) age of 39 (28-49) years; 44 (59%) were women. Sixty-four patients underwent thyroid lobectomy and 10 patients had isthmusectomy. Classic papillary thyroid carcinoma was the most common histologic type (34 [46%]). Vascular invasion and microscopic extrathyroidal extension were present in 11 patients (16%) and 22 patients (30%), respectively. Positive margins were identified in 5 patients (7.8%). Size of metastatic lymph nodes ranged between 0.07 cm and 1.2 cm. No extranodal extension was reported. A total of 52 patients (70%) were classified as intermediate risk for recurrence based on the American Thyroid Association risk stratification system. The median (IQR) follow up was 48.15 (15.4-86.1) months, during which only 1 patient had a regional recurrence. Another patient underwent delayed completion thyroidectomy for a contralateral lobe malignant abnormality. Recurrence-free survival, disease-specific survival, and overall survival were 97.4%, 100%, and 96.2%, respectively. A separate group of 11 patients who underwent immediate completion thyroidectomy were reviewed. These patients were more likely to have tall-cell papillary thyroid carcinoma (6 [55%] vs 13 [18%]), multifocality (9 [82%] vs 28 [41%]), microscopic extrathyroidal extension (8 [73%] vs 22 [30%]), and positive margins (3 [30%] vs 5 [7.8%]) compared with patients who were under observation only. Conclusion and relevance: Completion thyroidectomy may not be necessary in appropriately selected patients who are found to have incidental metastatic lymph nodes (N1a) after partial thyroidectomy for localized well-differentiated thyroid cancer.
MeSH term(s)	Humans ; Female ; Adult ; Middle Aged ; Male ; Thyroidectomy ; Thyroid Cancer, Papillary/pathology ; Carcinoma, Papillary/surgery ; Lymphatic Metastasis/pathology ; Thyroid Neoplasms/pathology ; Lymph Nodes/pathology ; Retrospective Studies ; Neoplasm Recurrence, Local/pathology
Language	English
Publishing date	2023-11-16
Publishing country	United States
Document type	Journal Article
ZDB-ID	2701825-8
ISSN	2168-619X ; 2168-6181
ISSN (online)	2168-619X
ISSN	2168-6181
DOI	10.1001/jamaoto.2023.3668
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Article ; Online: METASTATIC THYROID CANCER IN A MAN WITH TUMOR-FREE THYROID.

Souza, Spenser S / Alameer, Ehab S / Kandil, Emad / Lee, Grace S

AACE clinical case reports

2020 Volume 6, Issue 5, Page(s) e225–e229

Abstract: Objective: The objective of this report is to emphasize the importance of considering thyroid cancer in the differential diagnosis, when the origin of a metastatic boney lesion is indeterminate.: Methods: Diagnostic studies performed included a ... ...

Abstract	Objective: The objective of this report is to emphasize the importance of considering thyroid cancer in the differential diagnosis, when the origin of a metastatic boney lesion is indeterminate. Methods: Diagnostic studies performed included a thyroid function test, an ultrasound, and a computed tomography (CT) scan of the neck, biopsies of the bone, and thyroid lesions. Results: A 61-year-old man was found to have incidental sclerotic bone lesions in the lumbar region on CT scan performed in the setting of a prostate abscess induced sepsis. The bone biopsy suggested metastatic follicular thyroid carcinoma. Imaging studies of the neck showed markedly enlarged left greater than right thyroid nodules. A surgical specimen from the staged total thyroidectomy showed no evidence of thyroid malignancy, despite a thorough review of microscopic tissue sections at 5 μm. A whole body scan 2-months after radioactive iodine therapy demonstrated persistent uptake in the metastatic lesion at L4 and interval progression of widely metastatic disease. Conclusion: Metastatic thyroid cancer may be present without a histopathologic evidence of thyroid malignancy, albeit rarely. When the origin of a metastatic boney lesion is unclear, thyroid cancer should be included in the differential diagnosis.
Language	English
Publishing date	2020-09-21
Publishing country	United States
Document type	Case Reports
ISSN	2376-0605
ISSN (online)	2376-0605
DOI	10.4158/ACCR-2019-0464
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Article ; Online: Conventional Robotic Endoscopic Thyroidectomy for Thyroid Cancer.

Garstka, Meghan E / Alameer, Ehab S / Awwad, Saad Al / Kandil, Emad

Endocrinology and metabolism clinics of North America

2018 Volume 48, Issue 1, Page(s) 153–163

Abstract: The conventional robotic endoscopic remote access techniques detailed in this article have been discussed in a series of increasing volumes in the literature, including for the treatment of thyroid cancer. Lower-volume centers now perform most robotic ... ...

Abstract	The conventional robotic endoscopic remote access techniques detailed in this article have been discussed in a series of increasing volumes in the literature, including for the treatment of thyroid cancer. Lower-volume centers now perform most robotic thyroidectomies in the United States and are responsible for recent increases in utilization patterns despite higher complication rates. These trends highlight the importance of increasing surgeon exposure to and experience with these techniques in order to improve procedure safety. Additional large-volume, multicenter studies to define patients who will most benefit from these conventional robotic endoscopic procedures for thyroid cancer are needed.
MeSH term(s)	Endoscopy/methods ; Humans ; Robotic Surgical Procedures/methods ; Thyroid Neoplasms/surgery ; Thyroidectomy/methods
Language	English
Publishing date	2018-12-05
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	92116-6
ISSN	1558-4410 ; 0889-8529
ISSN (online)	1558-4410
ISSN	0889-8529
DOI	10.1016/j.ecl.2018.10.005
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Article ; Online: Effects of Parathyroidectomy on Normocalcemic Primary Hyperparathyroidism and the Role of Intraoperative PTH Measurement.

Alameer, Ehab / Omar, Mahmoud / Hoof, Marcus / Shalaby, Hosam / Abdelgawad, Mohamed / Zora, Ghassan / Shama, Mohamed / Kandil, Emad

The American surgeon

2021 Volume 88, Issue 5, Page(s) 873–879

Abstract: Background: Normocalcemic primary hyperparathyroidism (NCpHPT) and normohormonal primary hyperparathyroidism (NHpHPT) are recently recognized variants of primary hyperparathyroidism. Current guidelines for the management hyperparathyroidism recognize ... ...

Abstract	Background: Normocalcemic primary hyperparathyroidism (NCpHPT) and normohormonal primary hyperparathyroidism (NHpHPT) are recently recognized variants of primary hyperparathyroidism. Current guidelines for the management hyperparathyroidism recognize NCpHPT as one of the areas that are recommended for more research due to limited available data. Methods: A retrospective review of patients who had parathyroidectomy between 2014 and 2019. We excluded patients with multiple endocrine neoplasia syndromes and secondary and tertiary hyperparathyroidism. Included patients were classified based on the biochemical profile into classic or normocalcemic hyperparathyroidism group. Collected data included demographics, preoperative localizing imaging, intraoperative parathyroid hormone levels, and postoperative cure rates. Results: 261 patients were included: 160 patients in the classic and 101 patients in the normocalcemic group. Patients in the normocalcemic group had significantly more negative sestamibi scans (n = 58 [8.2%] vs 78 [51.3%], Conclusion: Normocalcemic hyperparathyroidism is a challenging disease. Surgeons should be aware of the lower cure rate in this group, interpret intraoperative parathyroid hormone with caution, and have a lower threshold for bilateral neck exploration and 4 glands visualization.
MeSH term(s)	Humans ; Hyperparathyroidism, Primary/diagnostic imaging ; Hyperparathyroidism, Primary/surgery ; Parathyroid Glands ; Parathyroid Hormone ; Parathyroidectomy/methods ; Radionuclide Imaging ; Retrospective Studies
Chemical Substances	Parathyroid Hormone
Language	English
Publishing date	2021-11-14
Publishing country	United States
Document type	Journal Article
ZDB-ID	202465-2
ISSN	1555-9823 ; 0003-1348
ISSN (online)	1555-9823
ISSN	0003-1348
DOI	10.1177/00031348211048844
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Article: A case report on delayed diagnosis of perforated Crohn's disease with recurrent intra-psoas abscess requiring omental patch.

Gao, David / Medina, Melissa G / Alameer, Ehab / Nitz, Jonathan / Tsoraides, Steven

International journal of surgery case reports

2019 Volume 65, Page(s) 325–328

Abstract: Introduction: Intra-abdominal abscesses associated with Crohn's disease (CD) can rarely occur in the psoas muscle. An intra-psoas abscess is prone to misdiagnosis because its location mimics other diseases, like appendicitis and diverticulitis [1].: ... ...

Abstract	Introduction: Intra-abdominal abscesses associated with Crohn's disease (CD) can rarely occur in the psoas muscle. An intra-psoas abscess is prone to misdiagnosis because its location mimics other diseases, like appendicitis and diverticulitis [1]. Presentation of case: We present the case of a 25-year-old female with an 11-year history of CD, previously well-controlled on Remicade, who presented with right lower quadrant (RLQ) pain and CT findings of a right psoas abscess initially attributed to perforated appendicitis. Two percutaneous drainages pre-ileocecectomy, laparoscopic ileocecectomy, three percutaneous drainages post-ileocolectomy, and evidence of a recurrent abscess prompted diagnostic laparoscopy. The abscess was unroofed and debrided. A flap of omentum was used to fill the abscess cavity. A comprehensive literature search was performed using the terms 'Crohn's abscess', 'intra-psoas abscess', and 'omental patches' in Medline and on PubMed. Discussion: We attribute the abscess' recurrence to possible epithelialization of the abscess cavity. Intra-psoas abscesses, albeit rare, are a known manifestation of CD. Percutaneous drainage is the initial standard of care, although diagnosis can be difficult given its association with several diseases, which can delay definitive treatment. We summarize a recently proposed and agreed upon treatment scheme for the management of the Crohn's patient with an abdominal abscess. We also propose the novel technique of omental packing in abscess management. Conclusion: Clinician awareness must be heightened for perforating CD in the setting of abscess refractory to either multiple drainage procedures, although care should be taken to individualize treatment to each CD patient who presents with an abdominal abscess.
Language	English
Publishing date	2019-11-19
Publishing country	Netherlands
Document type	Journal Article
ISSN	2210-2612
ISSN	2210-2612
DOI	10.1016/j.ijscr.2019.11.021
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Article ; Online: Robotic and Laparoscopic Approaches for Adrenal Surgery in Obese Patients.

Shalaby, Hosam / Abdelgawad, Mohamed / Omar Md, Mahmoud / Zora Md, Ghassan / Alawwad, Saad / Alameer, Ehab / Youssef, Mohanad / Attia, Abdallah S / Buell, Joseph / Grace, Lee / Kandil, Emad

The American surgeon

2020 Volume 87, Issue 4, Page(s) 588–594

Abstract: Objective: Minimally invasive adrenalectomy is a challenging procedure in obese patients. Few recent studies have advocated against robot-assisted adrenalectomy, particularly in obese patients. This study aims to compare operative outcomes between the ... ...

Abstract	Objective: Minimally invasive adrenalectomy is a challenging procedure in obese patients. Few recent studies have advocated against robot-assisted adrenalectomy, particularly in obese patients. This study aims to compare operative outcomes between the robotic and laparoscopic adrenalectomy, particularly in obese patients. Materials and methods: A retrospective analysis was performed on all consecutive patients undergoing adrenalectomy for benign disease by a single surgeon using either a laparoscopic or robotic approach. Adrenal surgeries for adrenal cancer were excluded. Demographics, operative time, length of hospital stays, estimated blood loss (EBL), and intraoperative and postoperative complications were evaluated. Patients were divided into 2 groups; obese and nonobese. A sub-analysis was performed comparing robotic and laparoscopic approaches in obese and nonobese patients. Results: Out of 120, 55 (45.83%) were obese (body mass index ≥ 30 kg/m Conclusion: Robot-assisted adrenal surgery is safe in obese patients and appears to be longer; however, it provides improvements in postoperative outcomes, including EBL and shorter hospital stay.
MeSH term(s)	Adrenal Gland Diseases/complications ; Adrenal Gland Diseases/surgery ; Adrenalectomy/methods ; Adult ; Aged ; Female ; Humans ; Laparoscopy ; Male ; Middle Aged ; Obesity/complications ; Retrospective Studies ; Robotic Surgical Procedures ; Treatment Outcome
Language	English
Publishing date	2020-11-01
Publishing country	United States
Document type	Comparative Study ; Journal Article
ZDB-ID	202465-2
ISSN	1555-9823 ; 0003-1348
ISSN (online)	1555-9823
ISSN	0003-1348
DOI	10.1177/0003134820951498
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