clinico-pathological study of oral cancers

In many Asian cultures where chewing betel, paan and areca is common, oral cancer represents up to 40% of all cancers. It may arise as a primary lesion originating in any of the oral tissues, by metastasis from a distant site of origin, or by extension from a neighboring anatomical structure. A tissue biopsy and microscopic examination of the lesion confirms the diagnosis and malignancy of oral cancer. To see the clinical and histopathological pattern of oral cancer. This was a retrospective case series studies carried out at Histopathology Department of PNS Shifa Hospital, Karachi. Detailed clinical histories of the patients were recorded and their histopathology was performed using haematoxylin and eosin [H and E] stain. Clinical data collected included the age, sex of patient and intra-oral site of cancer. Histopathological data included type of cancers and their degree of differentiation. The inference was drawn from this record. The data was analysed on SPSS version 17. A total of 268 oral mucosal biopsy reports were studied which constituted 6.6% of all malignant tumours reported during this period. Among the 268 cases studied, 256 [95.5%] cases were of squamous cell carcinoma [SCC], 4 [1.5%] were of basal cell carcinoma [BCC] and 2 [0.75%] each were of adenoid cystic carcinoma, mucoepidermoid carcinoma, adenocarcinoma and undifferentiated carcinoma. amongst the SCC group, 116 [43.28%] cases were well differentiated, 128 [47.76%] cases were moderately differentiated and 16 [5.97%] cases were poorly differentiated. Tongue was the commonest site involved in 116 [44%] cases followed by buccal mucosa 88 [33.3%] cases. Squamous cell carcinoma is the predominant type of oral cancer and tongue is the commonest site of origin for these cancers. In our patients oral cancer presented at a relatively early age group

Diagnostic sensitivity and specificity of serum ascites albumin gradient [SAAG] in patients with ascites

Objective: to determine the sensitivity and specificity of SAAG in predicting the presence of esophageal varices and to find out the association between level of SAAG and increase in portal vein diameter

Study design: prospective-observational study

Place and duration of study: medical Unit III, JPMC Karachi from August 1999 to March 2000

Patients and methods: patients with ascites were selected on the basis of selection criteria demonstrated by history, physical examination and ultrasonography. Ascetic fluid aspirated for DR and albumin, and simultaneously blood sample taken for total protein and albumin estimation at the time of paracentesis. After determining the level of SAAG upper GI endoscopy was performed. To determine the cause of ascites detailed history was taken and relevant investigations were carried out. At the end of our study sensitivity and specificity of serum ascites albumin gradient were determined in comparison of endoscopy findings

Results: among 50 subjects SAAG more than 1.1-g/dl was found in 30 [60%] patients and less than 1.1-g/dl in 20 patients [40%] of total 50 patients. Out of 30 patients with gradient more than 1.1-g/dl esophageal varices present in 27 patients and portal vein diameter more than 1.3-cm present in 24 patients. The commonest cause of ascites among subjects with SAAG more than 1.1-g/dl was chronic liver disease with portal hypertension and the commonest cause of ascites among SAAG less than 1.1-g/dl was abdominal tuberculosis. The sensitivity and specificity of SAAG were 100% and 87.8% respectively

Conclusion: serum ascites albumin gradient is a reliable marker to differentiate ascites into portal hypertensive and non-portal hypertensive etiology. Based upon our finding we conclude that the presence of esophageal varices is significantly associated with high SAAG levels