Importance of fine needle aspiration in evaluation of single nodular goiter

Improvements in the sensitivity and specificity of biochemical thyroid tests, as well as the development of fine needle aspiration biopsy [FNA] and improved cytological techniques, have dramatically impacted clinical strategies for detecting and treating thyroid disorders. Fine needle aspiration is a safe and relatively painless procedure where a hypodermic needle passed into the lump and samples of tissue taken out. This procedure will provide us with more information about the nature of the lump, and especially differentiate between a benign and malignant mass. The current prospective study designed to evaluate the sensitivity, specificity and accuracy of FNA. The study was performed in the regional major hospital, Khartoum, Sudan. A thousand and three hundred thirty one patients who underwent thyroid surgery between January 2004 to June 2007 were enrolled. 247 [18.3%] had single nodular goiter. The incidence of benign and malignant lesions in single nodular goiter were 204 [87.6%] and 29 [12.4%] respectively. The overall sensitivity, specificity and accuracy of FNA were 95.5%, 99.5% and 99.4% respectively. Also there is correlation between the nodule size and the result of FNA, as the nodular size increase there is increase of the probability of malignant changes. So, solitary or dominant nodules 1cm in diameter might be evaluated by FNA

sensitivity and specificity of the conventional symptoms and signs in making a diagnosis of acute appendicitis

Simple appendicitis can progress to perforation, which is associated with a much higher morbidity and mortality. So, surgeons have therefore been inclined to operate when the diagnosis is probable rather than wait until it is certain. This study is designed to evaluate the sensitivity and specificity of clinical examination in the diagnosis of acute appendicitis. The study included 866 patients of acute appendicitis who had undergone appendicectomy with preoperative diagnosis of acute appendicitis. They were analyzed retrospectively. The parameters evaluated were age/gender, clinical presentation [signs and symptoms] and total white blood cell counts. The operative findings were recorded and the inflammation of the appendix was graded into normal, acutely inflamed and gangrenous. Clinical diagnosis was made correctly in 807 [93.2%] of the patients. White blood cells count ranged from 3.70 to 45.30 /mm[3] [mean 17.5353 /mm[3]]. It was <10.000/mm[3] in 133 [15.4%] patients. Clinical assessment is the best criterion to reach a confident diagnosis. Investigations may supplement the diagnosis but are never a substitute for it

Comparison between usages of a single preoperative metronidazole dose with other antibiotic regimens in nonperforated acute appendicitis

In this study, the safety and efficacy of a single dose of metronidazole in preoperative prophylaxis in nonperforated appendicitis were evaluated. Records of 866 patients underwent appendectomy were evaluated and 11.43% [99] of these patients received 500 mg of metronidazole only before undergoing operation on induction for anaesthesia. Factors known to affect the incidence of wound infection, such as abdominal or wound drains, and the inclusion of patients with perforated or ruptured appendicitis, were eliminated. The patients were divided into three groups: patients with a normal appendix, patients with an acutely inflamed appendix, and patients with a gangrenous appendix. The study showed for each group a significant reduction of the incidence of wound infection in patients receiving prophylaxis. Routine preoperative prophylaxis is recommended before appendectomy. The findings demonstrated that more than ninety-four percent of the wound infections were detected after discharge from the hospital strongly indicate the need for follow-up

Outcomes and complications of thyroid surgery among the Sudanese patients

To reveal the outcomes and complications of post-thyroidectomy, a study was carried out on 1351 patients aged between 18 and and 76 years [mean, 43.9 years] of whom 945 were female [69.95%] and 406 [30.05%] were male patients [female to male ratio was 2.3:1]. The most common Indications for total thyroidectomy were diffuse goiter and multlnodular goiter [45.7% and 36.04%of cases respectively]. Incidence of malignancy was 41 cases [2.7%]. Of those patients with malignancy, thirty cases [73.2%] underwent an associated nodal dissection along with total thyroidectomy. The Incidence of postoperative wound haematoma was 0.6% [8 cases], wound infection was 0.4% [5 cases], and mortality rate was 0.0%. The Incidence of postoperative hypocalcaemia was 8.4% [113 cases]. Younger age was statistically associated with an Increased Incidence of hypocalcaemia [P<0.002], whereas sex [P=0.31], Indication for surgery [P=0.16], and associated neck dissection [P=0.13] were not. The Incidence of hyperthyroidism was 0.148% [2 cases]. The mean duration of hospital stay was 4.2 days and was unaffected by occurrence of postoperative hypocalcaemia. The Incidence of unilateral and bilateral vocal cord paralyses was 1.1% [23 cases] and 0.22% [3 cases], respectively. The study showed that there is an Increase of the Incidence of complications when the operation performed for carcinoma. This Increase may be due to the extent of disease found at operation or the less experienced surgeons. Postoperative hypocalcaemia is the most common immediate surgical complication of total thyroidectomy. Other complications, including recurrent laryngeal nerve paralysis, hypothyroidism, hyperthyroidism, and haematoma formation