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Abstract Introduction Selective neck dissection inclinically node-negative neckisconsidered the standard of care for oral squamous cell carcinomas (SCCs). Controversy still prevailsinnode-positive disease regarding the extent of neck dissection. In our part of the world, comprehensive neck dissection is mostly considered to be the minimal optimal treatment for palpable neck disease. Objective To compare regional control and disease-specific survival between clinically node-positive and node-negative patients undergoing selective neck dissection for oral SCC. Methods This was a retrospective cohort study conducted in the department of ENT, Head and Neck surgery at a tertiary care hospital. All patients with biopsy-proven oral and lip SCC, with or without nodal disease, who underwent selective neck dissection between April 2006 and July 2015 were included in the study. Results During the study period, 111 patients with oral SCC underwent selective neck dissection, of whom 71 (62%) were clinically node-negative and 40 (38%) patients had clinically positive nodes in the neck. The mean follow-up was 16.62 months (standard deviation [SD]: 17.03). The overall regional control rates were 95 versus 96% for clinical negative versus positive nodes, respectively (p = 0.589). The disease-specific survival was 84.5% in the node negative group versus 82.5% in the node-positive group (p = 0.703). Conclusion Selective neck dissection in node-positive neck oral SCC has similar regional control rates when compared with node-negative neck SCC. The difference in disease-specific survival between the two groups is also not significant.
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Objective: To assess bone turnover status in osteopenic and osteoporotic postmenopausal females
Study Design: Cross-sectional analytical study
Place and Duration of Study: The Aga Khan University Hospital, Karachi, from January to December 2013
Methodology: A cross-sectional study was conducted on 203 postmenopausal females undergoing bone mineral density testing [BMD] by DXA scan. Patients with clinical history of any disorder or medications affecting bone turnover were excluded. Bone turnover was assessed with osteocalcin and beta-CTx. Data was analyzed by SPSS version 19
Results: Mean age of the participants was 54 +/- 4.66 years with a mean BMI of 28.7 +/- 5.5 kg/m2. Mean beta-CTx [0.28 +/- 0.24 ng/ml] and osteocalcin [21.5 +/- 10.6 ng/ml] levels were within the normal reference range. Subjects were grouped into normal [26.6%], osteopenic [44.8%], and osteoporotic [28.6%] based on the t-scores. Serum levels of osteocalcin and beta-CTx between normal, osteopenic, and osteoporotic groups were not significantly different. beta-CTx was negatively and significantly associated with only lumber spine BMD [r = -0.13, p=0.04]. Positive association [< 0.0001] was noted between both markers in normal, osteopenic, and osteoporotic females. However, association of these markers with BMD in the 3 groups were not found. Multivariate linear regression showed a positive and significant effect of BMI on BMD [beta = 0.332, p= < 0.0001]. beta-CTx had negative but significant effect on BMD [beta = -0.155, p= 0.018] of postmenopausal women
Conclusion: Association between baseline levels of BTM and rate of bone loss is variable and site dependent. beta-CTx correlates better with BMD. However, role of osteocalcin in postmenopausal osteoporosis is uncertain and needs further investigation
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Background: Xanthogranulomatous cholecystitis is a benign, uncommon, localized or diffuse inflammatory pathological condition of the gallbladder and a catastrophic distinct transformation of chronic cholecystitis. Macroscopically distinguished by multiple yellowish with lipid packed tumor like foamy masses [nodules or streaks] in the wall of the gallbladder. Microscopically, it is distinguished by a number of bubbly histiocytes with acute or chronic inflammatory cells, while in upcoming phase manifest with tremendous fibrosis. The present study was undertaken to analysis of the histopathology reports to see the frequency of incidental xanthogranulomatous cholecystitis after elective cholecystectomy
Methods: 1522 cholecystectomies performed from January 2011 to December 2015, at tertiary care single centre Ziauddin University and Hospitals Karachi Pakistan. On Histopathology of ten gallbladder specimens after elective cholecystectomy revealed xanthogranulomatous cholecystitis. These histologically confirmed cases are identified from the retrospective analysis of patient's record
Results: During the study period 1522 patients underwent cholecystectomy. Histopathologically confirmed xanthogranulomatous cholecystitis in ten patients [0.65% of all cholecystectomies]. The mean age and standard deviation of patients with xanthogranulomatous cholecystitis was 54 +/- 17.19 years [range 29-85], with male to female ratio is 1:1. The most common clinical features were abdominal pain and tenderness in the right hypochondrium. Biliary colic and acute cholecystitis were the most common preoperative diagnostic features. Ultrasonogram was performed in all patients
Conclusion: Xanthogranulomatous cholecystitis is a scarce variant of cholecystitis with marked topographical discrepancy and preoperative clinical uncertainty and a per-operative diagnosis is a challenging task. Many times diagnosis is a histopathological revelation
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Background: Appendicitis is one of the common cause of abdominal pain and surgical emergency. The diagnosis is mainly clinical, augmented by the imaging modality in which ultrasound still is a first paradigm. This study aims to assess the accuracy of ultrasound strategy in the diagnosis of acute appendicitis
Methods: This retrospective cross-sectional validation study was conducted in General Surgery Department, Ziauddin University and Hospitals, Karachi Pakistan from 2012 to 2015 on patients who underwent Appendectomy. It concerned 200 cases of appendectomy following, prior ultrasound examination of lower right abdomen. In 126 cases ultrasonography clearly showed the acutely inflamed appendix. In 59 cases the appendix was not visualized. In15 cases ultrasound showed periappendicular fluid collection. Among 200 patients later shown in surgery to have appendicitis, ultrasonography was unequivocally positive in 114 patients [Sensitivity 95%] and 24 patients in whom appendicitis was definitely excluded according to ultrasound examination [specificity 70%]
Results: The gold standard for the diagnosis of appendicitis still requires histopathological confirmation after appendicectomy. Pooled sensitivity is 95% and specificity is 70%, ultrasound still remains the first line and extremely accurate measurement in the diagnosis of acute appendicitis
Conclusion: We conclude that ultrasonography is our first line useful aid in patients referred with clinically suspected acute appendicitis. Ultrasonography has high accuracy in diagnosing acute appendicitis and reduces negative appendectomies. A non-compressible tubular structure of 7-9 mm in diameter of the appendix is the most accurate ultrasound finding
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Objective: To determine the frequencies of histopathological findings in endometrial and endocervical biopsy samples with clinical history of Postmenopausal Bleeding [PMB]
Study Design: Descriptive cross-sectional study
Place and Duration of Study: Section of Histopathology, Department of Pathology and Laboratory Medicine, The Aga Khan University Hospital, Karachi, from February 2012 to January 2013
Methodology: A total of 157 consecutive endometrial and endocervical biopsy specimens with history of postmenopausal bleeding were included. After microscopic examination, frequencies of histological findings in different age groups were generated. Chi-square and independent sample t-tests were applied to see whether the difference was significant which was set at p < 0.05
Results: One hundred and twenty-one [77.1%] specimens showed benign pathologies while 36 [22.9%] were malignant. Endometrial polyp was seen in 67 [42.7%] cases followed by endometrial carcinomas in 25 [15.9%], endometrial hyperplasia in 21 [13.4%], cervical carcinoma in 12 [7.6%] and cervical polyps in 9 [5.7%] cases. A highly significant increase in the percentage of malignant and pre-malignant lesions was seen with increasing age group [p < 0.001]. Mean age of patients with type-2 endometrial carcinoma was higher than type-1 endometrial carcinoma but statistical significance was not observed [70.2 +/- 6.5 vs. 61.8 +/- 9.1 years respectively, p=0.069]
Conclusion: Although benign pathologies were more common in postmenopausal bleeding but the collective proportion of endometrial and cervical malignancies and pre-malignant conditions was quite high. Therefore, PMB should be urgently evaluated for cause and early commencement of treatment
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Objective: The aim of this study was to determine the duration of hospital stay in different types of infantile burn
Methods: This retrospective study was conducted at the plastic surgery, burn unit of Patel hospital during the period of 7 years from January 2007 to December 2013. Children ageing one year or less at the time of admission with any type of burn were included in the study and those above one year were excluded. The patients medical records were obtained from medical record department. SPSS 21 version was used for statistical analysis. Data description is given by percentage. Standard deviation and central tendency [medians and means] were taken as measures of variability. For comparison Chi square test was used. P value less than 0.05 was taken as statistically significant
Results: Total 789 paediatric burn patients were admitted in Patel Hospital during January 2007 to December 2013, in which 106 were infants. Infants having scald burn were 83 [78.3%], fire burn 21 [19.8%] and chemical burn 2 [1.9%]. Male to female ratio was 1.5:1. Out of these 106 infants, 74 [70%] were hospitalized for 1 - 10 days, 18 [16.9%] were hospitalized for 11 - 20 days, 6 [5.6%] and 8 [7.5%] infants were hospitalized for 21 - 30 days and more than 30 days respectively. Most of the infants with different types of burn injuries remained under treatment between 1 - 10 days. Infants with scald, fire and chemical burn were 59 [71.1%], 14 [66.7%], and 1 [50%] respectively and remained under treatment at hospital between 1 - 10 days. It was observed that duration of stay was prolonged for infants with fire burn as compared to those with scald burn, if total body surface area [TBSA] was more than 10%. Infants with both second and third degree of fire burn [66.6%] had length of stay more than 20 days as compared to [27.3%] of scald burn. The length of stay was affected mostly in those infants who had secondary wound infections. Out of 106 infants, 28 [26.4%] had growth of organisms in wound cultures. In 106 infants, 95 [89.6%] were discharged, 2 [1.9%] left against medical advice [LAMA] and 9[8.5%] expired. Among these 6 [66.6%] of them expired due to scald burn and 3 [33.3%] expired due to fire burn. Most of the infants 5 [55.5%] expired within 5 days due to more than 40% of their TBSA involved and having third degree burn
Conclusion: We have seen through this study that infants with less than 10% of their TBSA involved were hospitalized for less than 10 days due to scald, fire or chemical burn. However in fire burn the duration of stay was prolonged as compared to scald burn if TBSA was more than 10% or having both second and third degree burn. The length of stay is also affected for those infants who developed secondary bacterial wound infections. Infants who had more than 40% of their TBSA involved and had third degree burn, survived for less than 5 days
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To determine the percentage agreement between serology and histology for detection of Helicobacter [H.]pylori infection. Cross-sectional analytical study. Department of Pathology and Microbiology, The Aga Khan University and Hospital, Karachi, from January to December 2009. Fifty subjects were selected by non-probability purposive sampling from laboratory data who had serological testing of H. pylori IgG antibody, prior to histological evaluation of endoscopic gastric or/and duodenal biopsies. Serological Quantification of H. pylori IgG was carried out with HpG screen ELISA kit [Genesis Diagnostics, UK], using an enzyme linked immunosorbent assay for detection of IgG antibodies against H. pylori. Manufacturer's recommended cutoff value was used and results were considered positive when greater than 7 U/ml. For histological diagnosis, an expert histopathologist characterized the presence of spiral bacteria in the mucosal layer or the surface of epithelial cells on microscopic examination, as a positive test. An agreement of 0.72 was found by Kappa statistics between serology and histopathology results and a good diagnostic accuracy [86%] of serological testing was observed for the diagnosis of H. pylori infection. A substantial agreement was found between serology and histopathology results to detect the H. pylori infection. Laboratory-based serologic testing using ELISA technology to detect IgG antibodies is inexpensive, noninvasive and convenient method to detect the H. pylori infection in primary care setting.