Isolated bilateral zygomatic arch fracture; an unusal case

Zygomatic fractures are the most common facial fractures or second in frequency after the nasal fractures. The high incidence of zygomatic fractures probably relates to its prominent position in the facial skeleton hence it is frequently exposed to fractures. This case report presents an isolated bilateral zygomatic arch fracture that was been reduced by Gille's temporal approach and stabilized using foley's balloon catheter. This study highlights the importance of early diagnosis and timely treatment to reduce the morbities

Role of genetic counselling in prenatal diagnosis of p-thalassaemia in Pakistan

To compare the response towards prenatal diagnosis [PND] of [3-thalassaemia, in individuals who had not received genetic counselling and a genetically counselled population. Cross-sectional survey. Department of Haematology, Armed Forces Institute of Pathology [AFIP], Rawalpindi, from March 2009 to December 2010. Using non-probability consecutive sampling, a total of 176 individuals having thalassaemic children, were interviewed regarding PND of thalassaemia, by using a structured questionnaire. Forty two individuals were taken as controls as they had received genetic counselling for PND, whereas the remaining 134 were taken as cases. Responses towards PND were compared using chi-square test. Odds ratio was also calculated for subsequent PND utilization. Seventy [52.2%] cases and 42 [100%] controls were aware of the availability of PND in Pakistan. This difference in awareness was statistically significant [p < 0.001]. In the controls, 40 [95.3%] individuals were aware of the appropriate timing of the test, in contrast to 52 [39%] cases [p < 0.001]. PND was used in subsequent pregnancies by 50 [37.3%] cases and 32 [80%] controls [p < 0.001]. The calculated odds ratio for subsequent PND utilization was 5.37. The study reflects a very positive attitude of genetically counselled thalassaemia affected families towards PND. For better utilization of PND, genetic counselling services should be available at all health strata

Frequency of janus associated kinase 2 [V617F] mutation in patients of polycythemia vera

To determine the frequency of Janus associated kinase 2 [JAK2] mutation in patients of polycythemia vera [PV]. Descriptive cross-sectional. Haematology Department, Armed Forces Institute of Pathology [AFIP], Rawalpindi, from January 2008 to December 2009. Forty-six consecutive patients of PV diagnosed by the conventional haematological criteria were included in the study. Blood samples of all patients were screened for G-T point mutation [V617F] in the JAK2 gene on chromosome 9 by an allele specific polymerase chain reaction [PCR]. JAK2 V617F mutation was found in 43 out of 46 patients [93.5%] with PV. Among them, 30 were males [65.2%] and 16 were females [34.8%]. Mean TLC in patients with PV was 16.5 +/- 9.1 x 109/L, mean haemoglobin [Hb] was 17.8 +/- 2.0 g/dl, mean platelet count was 531 +/- 261 x 109/L, mean PCV was 57.9 +/- 6.3 l/l, mean MCV was 78.8 +/- 11.0 fl and mean MCH was 24.4 +/- 4.8 pg. Peripheral blood mutation screening for JAK2 V617F can be incorporated into the initial work up of patients suspected to have polycythemia as this mutation is present in majority of such patients

Lunate dislocation

Carpal dislocations are wrist injuries and Lunate dislocation is its severe form. Lunate and perilunate dislocations are uncommon. These injuries have significant clinical impact on the patient but are easily missed and lead to potentially devastating effect if mismanaged. This case report outlines the important clinical aspects and management of Lunate dislocation

Etiology and pattern of swellings in mandible and maxilla

To determine the etiology and pattern of swellings in the mandible and maxilla. A descriptive study. This study was conducted at Oral and Maxillofacial Surgery Dept, Armed Forces Institute of Dentistry Rawalpindi for two years from December 2004 to December 2006. Three hundred and fifty patients with swellings in the jaws reporting to AFID were included in this study. After history, clinical examination and radiographic evaluation, patients were registered. All patients whether admitted to hospital or treated as outdoor patients in oral surgery clinic were included. Swelling of the parotid region, nasal and para nasal sinuses and neck were not included. In majority 131 [37.42%] the patients were of age between 21 to 30 years [mean 25.5 years]. Males were affected more than females with ratio 1.3:1. The most common swellings found were inflammatory which accounted for 138 cases [39.42%] due to odontogenic reasons i.e. caries and non vital teeth. The most frequent site involved was mandible which accounted for 202 cases [57.71%]. In 111 cases [31.71%] the treatment modality used was incision and drainage followed by antibiotics. Caries and non-vital teeth were cause of the most common inflammatory swellings. The predominant site of swellings was the mandible. Every person must visit a dentist for oral examination six monthly so that early lesions in mandible and maxilla can be detected and treated more conservatively

Management and outcome of chronic subdural haematoma

To analyze overall outcome in chronic subdural haematoma and study the results of different surgical methods employed to treat this condition. This prospective, descriptive observational study was carried in the Department of Neurosurgery, Nishtar Medical College and Hospital, Multan from October 2007 to April 2008. A total of 60 patients were included in the study. Out of 60 patients, 44 [73%] were male and 16 [27%] were female. 60% patients presented with history of minor trauma to he head in road traffic accidents, falls and slips in bath rooms of different durations, usually more than 2 weeks. The chronic subdural haematoma is a surgical lesion. The burr-holes aspiration under local anesthesia is the perfect surgical method in most of the cases

Oral cancer - are the dentists doing enough for its prevention and early diagnosis? - a study

The aim of this study was to determine whether and to what extent the dental profession is helping in the prevention and early diagnosis of oral cancers. Data were collected by distributing self administered questionnaires among two hundred randomly selected dentists of Rawalpindi and Islamabad to know what role they play in the prevention and early diagnosis of this deadly disease. More than half [52%] of the dentists did not ask or asked rarely about the use of tobacco, alcohol and other risk factors and only about a third [34%] advised and helped their patients to quit these habits. Only 22% of the dentists regularly examined the entire oral mucosa of all their patients and even fewer [12%] considered the possibility and then searched for a coincidental oral cancer. Only about 06% took biopsies of suspicious lesions regularly. The findings of this study indicate that the dentists of this region need to do a lot more for the prevention and early diagnosis of oral cancer

clinicomorphological study of lymphadenopathy

A total 238 lymph nod specimen were studied at various Hospitals of Lahore. The ages of these patients ranged from 2 years to 80 years. Maximum number of patients with lymphadenopathy [90 out of 238] 37.8% cases were in 10-19 years age group. Females [51.7%] presenting with lymph node enlargement were more affected than males [48.3%]. The commonest presenting complaint was fever [56.3%]. Cervical lymph nodes [80.3%] were the commonest site of involvement. On histopathological examination, seven morphological groups were highlighted; tuberculous lymphadenitis [42.5%], chronic nonspecific lymhadenitis [36.6%], viral lymphadenitis [3.4%] acute bacterial lymphadenitis [0.8%]. Fungal lymphadenitis [0.8%], Metastatic carcinoma [11.3%] and lymphomas [4.6%]

Immunoreactivity of proliferating cell nuclear antigen in transitional cell carcinoma of urinary bladder

This is a descriptive study designed to evaluate Proliferating cell nuclear antigen [PCNA] in transitional cell carcinoma. A total of fifty per urethra resected bladder tumour samples [TUR BT] were collected from Mayo Hospital and Services Hospital, Lahore and processed for H and E and PCNA stain. The grading of tumours were made on H and E stain. While Proliferating cell nuclear antigen labeling index was recorded for each case. The mean PCNA labeling index was significantly higher in grade III when compared with tumours of grade II. [p < 0.001] carcinoma. Similarly mean PCNA labeling index was significantly higher [p < 0.05] in patients having duration of symptoms up to 3 month when compared with the patients having longer duration of symptoms. The mean PCNA labeling index had significantly higher value in high grade tumours as compared to low grade tumours [p < 0.001]. Although determination of PCNA labeling index is costly yet it has significant role in tumour grading

Identification of the risk factors of obestity among high school children

To identify the risk factors of obesity among children of high school and to formulate preventive strategies for its prevention. A cross sectional study. Government high school, Township, Lahore 2008. Total number of children in the study was 100. Their mean age was 13 +/- 1.5 years. Information about physical activity was obtained, weight and height were taken and BMI was calculated. Food records for 24 hours were also obtained. Significant association of the obesity was observed with prosperity, televisionization, BMI, positive family history. Increased consumption of junk foods was observed in prosperous families. Sixty two per cent were having poor knowledge about health. They consumed inadequate amounts of calories; diet was poor in fruits; vegetables but was having high fat content. As the risk factors were significantiy found in prosperous families, thus the changes in life style and behavior are need of the day in this high risk group to prevent future generations from developing the obesity

Public awareness about hypertension: finding of a kidney day

To determine the frequency of hypertension, its associated life style factors and to explore the level of awareness about hypertension among adult populace attending the kidney day and to formulate the strategies to improve the awareness. A cross sectional study. One day health camp at Sharif Medical City Hospital Lahore 2008 on 13.03.2008. A total of one hundred participants were interviewed. The structured questionnaire was filled at the spot to obtain sociodemographic information after taking verbal informed consent. Height, weight, pulse, blood pressure were recorded. A total of one hundred participants were interviewed. Overall frequency of hypertension in the study population was twenty five percent [25%]. The prevalence of hypertension increased with increasing age and body mass index. Only thirty five percent [35%] could define hypertension and this awareness was significantly associated with educational level. Lack of physical activity, card playing and televisionization was observed in sixty percent of participants while thirty three percent were overweight. Fifty nine percent were using additional salt while seventy percent were having meals and snacks outside. High frequency of hypertension, obesity, lack of physical activity, unhealthy nutrition, and faulty dietary habits was observed in the study population. Emphasis on health education and use of electronic and print media is recommended to improve the public awareness about the risk factors and consequences of hypertension like stroke, heart attack, kidney failure etc

Medulloblastoma: a life threatening cancer of infancy and childhood

Medulloblastoma is a rare and aggressive tumor of the brain that usually occurs in children or young adults with a tendency to metastasize. The incidence in infant is rare. We came across one such child who presented with slight disorientation, vomiting, irritable personality and somewhat large size head. The clinical, radiological preoperative diagnosis was space occupying lesion in the posterior fossa. On histological examination it turned out to be Medulloblastoma of infratentorial region in posterior fossa

Role of anti microbial agents in delaying changes of autolysis

Background: Formalin is the most widely used tissue fixative. However, it renders tissue unfit for immunohistochemistry by masking most of the commonly useful antigens. Other organ preservation solutions should be tried. To assess the ability of tissue preservation in Ringer lactate, Euro Collins solution [EC solution] and University of Wisconsin solution [UW solution], with and without antimicrobial agents. Experimental study on rabbit renal tissue. Main. outcome measures: Histological examination of the sections to assess preservation by a semi quantitative method. UW solution was found to be the best preservation solution.. EC solution was second, followed by Ringer lactate. The addition of anti microbial agents improved the preservation in the latter two solutions markedly. Ringer lactate with addition of anti microbial agents was found to be a cost effective alternative. Immunohistochemistry should be tried on tissues submitted in Ringer lactate with anti microbial agents

AgNOR stain in normal, cirrhotic and carcinomatous liver

In this era of tumor marker AgNOR stain has still retained the diagnostic yield in tumor pathology. This study was conducted to evaluate the role of AgNOR number and morphological features in cirrhotic and carcinomatous liver. A total of one hundred liver biopsy specimens were included, twenty cases were of hepatocellular carcinoma, sixty were those of cirrh0sis of the liver and twenty cases with normal histology as control. The mean AgNOR count, size and distribution were significantly of higher grade in hepatocellular carcinoma as compared to cirrhosis of liver

Patterns of argyrophilic nucleolar organiser regions in pleural and peritoneal effusions

To evaluate AgNOR size and dispersion as alternate methods to AgNOR counts in order to differentiate malignant from non-malignant effusions. Comparative study. Department of Pathology, Postgraduate Medical Institute, Lahore, from January 2003 to June 2004. A total of 240 samples of pleural and peritoneal effusions were centrifuged, deposits smeared on slides and stained with H and E and AgNOR stain. The diagnosis of malignancy or otherwise was made on H and E staining. AgNOR counts, variation in size and dispersion of AgNOR dots in smears were graded and compared in malignant and non-malignant effusions. Mean AgNOR counts of 11.47 +/- 3.60 and 11.04 +/- 3.89 in malignant pleural and peritoneal effusions, respectively, were significantly [p<0.0001] greater as compared with counts of 3.36 +/- 0.69 and 3.35 +/- 0.66 in non-malignant effusions. AgNOR size and dispersion were of higher grade in significantly greater proportion of malignant as compared with non-malignant effusions [p<0.0001]. Typing of AgNOR size and dispersion was found to be an easy and reproducible alternative to traditional AgNOR counts for differentiating malignant from non-malignant effusions. These parameters should be correlated with already established but expensive techniques of AgNOR area and size imaging by electron microscopy and flow cytometry, as an economical alternative

Correlation of glial fibrillary acidic protein [GFAP] with grading of the neuroglial tumors

To determine the distribution of glial fibrillary acidic protein [GFAP] in human neuroglial tumours and its correlation with histologic grading. Analytical. Postgraduate Medical Institute, Lahore, on the cases from 1999 to 2001. Materials and Methods: Fifty formalin fixed paraffin-embedded tissue blocks were obtained. Two sections from each block were taken. One was stained with heamatoxylin-eosin stain while second for GFAP that is the unlabelled antibody immunoperoxidase [peroxidase ' antiperoxidase PAP] method was used. The non-neoplastic brain tissue was used as positive control, while cases reported medulloblastoma tumour was used as negative control. We applied a scoring scale 0 to 3+, to evaluate its correlation with the grade of tumour. In positive control only the cell process and perikaryons of fibrous astrocytes was stained. The 35 cases of various grade astrocytoma showed a varying intensity of GFAP staining. Similarly, 3 cases of glioblastoma multiforme, 2 cases of sub-ependymal giant cell astrocytoma, 2 cases of pleomorphic xanthoastrocytoma, 2 out of 4 cases of ependymoma and the case of oligoastrocytoma showed a positive reaction. The stain was more intense over processes than in perikaryons, with the exception of gemistocytic astrocytomas and the giant cells in glioblastoma multiforme, which showed an equally intense stain over perikaryons and processes. Comparison of the histological grade with GFAP score was significantly higher in high grade tumour when compared with tumour of grade I [p<0.001]. In astrocytic neoplasms the number of GFAP positive cells and the intensity of the stain were directly proportional to the degree of malignancy. All the 3 cases of oligodendroglioma showed a negative reaction to GFAP. Only astrocytic component was positive which are poorly visualize by H and E stain. The GFAP score shows significant relation with the present WHO grading system of glial tumours. GFA protein is specific for glial cells and it is useful to diagnose those glial tumours which are difficult to be identified by heamatoxylin-eosin stain or due to rare or unusual site

Morphological variations in appendicectomy specimens

To study and describe the various gross and microscopic presentations of appendicectomy specimens. Prospective analysis of surgical specimens. Pathology Department, PGMI, Lahore. Single center. Morphological examination of the specimens. 250 appendicectomy specimens were studied. The gender more frequently affected was male [1.6:1 cases]. The mean age was 16 years. The clinical diagnosis was acute appendicitis in 246 cases. This was confirmed in 209 cases. 28 cases revealed normal morphology. Worm infestation was seen in 4 cases. All of these belonged to the paediatric age group. One case revealed a carcinoid tumour. All resected specimens including appendices should be subjected to a thorough histopathological examination

AgNOR staining in malignant and benign effusions

To evaluate the correlation of argyrophilic nucleolar regions[AgNORs] and malignancy in benign and malignant effusions. Design: The study group consisted of pleural and peritoneal effusion samples obtained from patients suffering from various benign or malignant diseases. The cytological smears were studied by conventional haematoxylin and eosin [H and E] and silver staining for AgNORs. Setting: The samples were obtained from patients admitted in Mayo Hospital, Services Hospital, Gulab Devi Chest Hospital and Institute of Nuclear Medicine and Oncology [INMOL]. Subjects: One hundred cases having either pleural or peritoneal effusions were selected. Fifty of these cases were positive for malignant cells and fifty had reactive mesothelial cells in them. Main Outcome Measures: Assessment of AgNOR count as a diagnostic marker of malignancy. AgNOR count was helpful in differentiating benign from malignant cells. AgNOR count in malignant cells was 10.62 t 3.36 and 3.04 t 0.64 in reactive mesothelial cells. AgNOR count is a rapid, easily reproducible method of differentiating reactive mesothelial cells and malignant cells

Morphological evaluation of rabbit renal tissues preserved in ringer lactate, Euro collins and university of Wisconsin solutions

Formalin though an excellent preservative of tissue morphology for routine use, compromises tissue antigenicity. This interferes with immunohistochemistry. An attempt was made to preserve rabbit renal tissues in three most commonly used organ preservation solutions. These are Ringer lactate, Euro Collins solution and University of Wisconsin solution. The tissue slices were kept in these solutions at room temperature for various fixed time intervals. This was followed by routine processing. The degree of preservation was assessed in qualitative as well as quantitative terms. The quantitative assessment was made by a newly devised method. This semi quantitative method is based on established microscopic features of autolysis. The method was found to be reliable and reproducible. Amongst the solutions tried, UW solution revealed clear superiority over other solutions