role of CT guided fine needle aspiration biopsy in the management of intra-abdominal masses

The evaluation of deep non-palpable abdominal masses or focal lesion is often difficult. Distinction between malignant and non-malignant lesions and particularly inflammatory lesions is vital for patient management, and is often suspected from imaging techniques; the diagnosis requires confirmation by biopsy. Fine needle aspiration cytology [FNAC] is a well established diagnostic technique. This study aimed at evaluation of CT guided FNAB in diagnosis of intra-abdominal masses and its impact on treatment planning. The study was conducted on thirty patients with intra-abdominal masses [clinically or radiologically diagnosed] admitted to the Department of Surgery, Faculty of Medicine, the Main University Hospital. FNAs were performed at the Radiology unit in the Main University Hospital with the pathologists assistance. Patients were subjected to surgical exploration according to the findings, aiming at resection of the mass. The impacts of CT and FNAB on the surgical decision were recorded The pathological findings of FNAB were compared with the final histo-pathological findings of the specimen. The study was carried but on 30 patients who had abdominal mass or masses. Each patient was subjected to CT guided FNAC. The age of the patients ranged between 18-70 years, with a mean of 48.57 +/- 13.69 years. with a male to female ratio 1:1. The Sensitivity for CT was 76% and for FNAB was 89%. Specificity for CT was 100% and for ENAB was 100%. Positive predictive value for CT was 90% while it was 95% for FNAB. Negative predictive value was 18% for CT and 40% for FNAB. CT guided FNAB is a relatively painless procedure. It is a safe method for obtaining a pathologic diagnosis. The overall accuracy of the CT guided FNA in intra-abdominal masses was 73.3%. CT guided FNAB helped in avoiding surgery in patients with metastatic or irresectable tumors. The accuracy was 100% in hepatic, pancreatic and pelvic masses. while it was less accurate in retroperitoneal and gastrointestinal masses. This accuracy increased with adenocarcinomas and benign tumors, but decreased with lymphomas, smooth muscle tumors, inflammatory and fibrotic lesions

Primary hyperparathyroidism: clinical presentation and management

Nineteen patients with primary hyperparathyroidism were operated upon in the period from January 1994 till December 1998. Thirteen patients were females and six were males. The maximum age incidence occurred in the fourth decade. Bony lesions were the frequent presentation. They were in the form of localized pain and bone swelling [38.8%], pathological fracture [26.3%] and generalized bone ache [10.5%]. The diagnosis of primary hyperparathyroidism was established on basis of elevated levels of ionized calcium, 24-hours urinary caclium and PTH together with decreased levelof serum phosphorus. Preoperative ultrasonography correctly localized the parathyroid pathology in 73.7%. Bilateral exporation of the neck revealed a sizable solitary parathyroid adenoma in 18 patients. In a single case the adenoma was intra thyroid in location. A concomitant partial throidectomy was performed in 7 patients. The postoperative complications were trivial; 11 patients suffered from transient hypercalcaemia. The determined postoperative serum calcium and PTH were normalized although both attained a different pattern to do this after operation. Among the 15 patients presenting with bone cysts, only two were treated surgically. The majority responded to conservative treatment adopting rest and immobilization after parathyroid adenectomy. Moreover, the pathological fractures healed well conservatively after the adenectomy. Internal fixation was resorted to in only 2 cases having pathological fractures of the femur