Accuracy of high resolution ultrasound examination for prediction of malignancy thyroid nodules: FNAC or HP as reference standards

Background: Thyroid nodules comprise a diagnostic challenge mainly because of the need to exclude thyroid malignancy. Approximately, 4% is an estimated prevalence of thyroid nodule on palpation with 15% lifetime risk of developing a thyroid nodule

Objective: To provide importance of sonographic and doppler criteria for differentiation between benign and malignant solid thyroid nodules and their correlation with Fine-needle aspiration cytology [FNAC] or histopathology [HP]

Methods: A prospective study of 103 patients [January 2012 to June 2013] selected from radiology department of Dr.Ziauddin Hospital Karachi who came for ultrasound [US] of thyroid with clinical diagnosis of thyroid nodule followed by FNAC. Presence of malignant features were taken as positive finding for malignancy. The results of US were compared with FNAC/HP and diagnostic accuracy was calculated

Results: Out of 103 cases, 80 were labeled as true positive because US and FNAC results were positive for malignancy while the 2 were false positive as US shows malignant features but FNAC results were negative. 8 patients were labeled as true negative because US and FNAC were negative for malignancy and 13 patients were false negative because US results were negative for malignancy but FNA results were positive. The overall sensitivity and specificity of US was 86.0% and 80.0% respectively. Similarly the positive predictive value [PPV] was 97.5%, negative predictive [NPV] was 38.0% and diagnostic accuracy was 85.43% when compared with FNAC/HP results

Conclusion: Although US is an important tool for prediction of thyroid nodule malignancy, it cannot substitute FNAC/HP for accurate detection for malignancy. However, it can reliably anticipate the suspicion lesions which need intervention on priority basis

Diagnosis of pfeiffer syndrome with umbilical hernia

Pfeiffer syndrome [PS] is a form of acrocephalosyndactyly, a group of rare genetic syndromes, and is characterized by variable degrees of bicoronal craniosynostosis, variable hand and foot malformations and various other associated manifestations. Type I Pfeiffer syndrome is compatible with life. It is characterized by normal intelligence and a classic phenotype of craniosynostosis, broad thumbs, and syndactyly. Types II and III are sporadic in occurrence, with more severe involvement of the central nervous system [CNS] than in type I. Type II is associated with the classic cloverleaf-shaped skull. Neurologic compromise is common in both types II and III

Unilateral mandibular condylar hyperplasia- a rare entity

True unilateral condylar hyperplasia [CH] of mandible including its variants is an uncommon maxillofacial deformity. It represents unilateral abnormal growth of the mandible including its body and ramus. Discrepancy in the growth of the mandible causing vertical facial asymmetry, creating aesthetic problem resulting in malocclusion as well as psychological issues requiring bi-maxillary surgical correction. In this report we discuss the use of imaging in the diagnosis of these pathologies and investigate its variants

Ectopic supernumerary kidney: a rare anatomic variant

Urogenital anomalies are common, correspond to 33% of all congenital anomalies and supernumerary kidney is one of the rarest entity; less than hundred cases have been reported in the past. The Supernumerary kidney is considered a third kidney in addition to the two already present independent kidneys and considered an infrequent developmental anomaly of the urinary tract. The accessory kidney most commonly located on left side caudal to the normal kidney. Because of uncommon occurrence and prevalence, it frequently causes diagnostic challenges in clinical practice. The supernumerary kidney must be differentiated from the more common congenital anomaly, duplex kidney, having two pelvicalcyceal systems that are connected with single or double ureters. The supernumerary kidney, in distinction, is thought to be an accessory organ with a separate arterio-venous supply, collecting system and a different capsule. The case of a 33 years old male patient is depicted who presented a history of hypertension and was diagnosed as having left sided unilateral supernumerary kidney located cranial to normal renal parenchyma

Analysis of retinal signs in patients with primary hypertension

OBJECTIVE OF STUDY: To detect retinal signs in patients with primary hypertension

DESIGN OF STUDY: Hospital based prospective study

PLACE OF STUDY: Department of Medicine Unit II, Chandka Medical College Hospital Larkana

DURATION OF STUDY: One year from January 2010 to December 2010

MATERIAL AND METHODS: Our study included evaluation of 495 patients of age greater than 20 years with primary systemic hypertension [BP>139/89mmHg] for presence of retinopathy

The hypertension was detected by physician with sphygmomanometer and the retinopathy was detected by ophthalmologist with fundoscopy. The type and severity of hypertensive retinopathy was graded on the basis of KEITH-WAGENER CLASSIFICATION. The investigations advised were complete blood cell count, complete urine examination; sugar fasting, lipid profile, blood urea, serum creatinine, electrocardiogram, echocardiography and X-Ray chest PA-view. Only known patients of primary hypertension were included in this study and patients of primary hypertension with other retinal vessel diseases and secondary hypertension were excluded

RESULTS: We evaluated 495 patients, 317[64.04%] males and 178 [35.95%] females aged 20 years and above. [P value=<0.001, X[2] Value=34.29, df=4]. The hypertensive retinopathy was present in 223[45.1%] patients and absent in 272[54.9%] patients [P value= <0.045, X[2] value=6.19, df=2]. The severity and grading of retinopathy seen was, grade-I hypertensive retinopathy in 108 [48.4%,n=223] patients, grade-II in 71[31.8%, n=223], grade-III retinopathy in 36[16.1%, n=223] patients and grade-IV in 8 [3.6%, n=223] patients. [P value=<0.0001, X[2] Value=52.76, df=6]

CONCLUSION: With early detection of retinal signs in primary hypertensive patients, the eyes and other systemic complications of primary hypertension can be prevented

Otogenic intracranial complication

Two patients one male of 25 years the other a girl of 10 years old presented to us with purulent ear discharge, severe hcadache and nausea/vomiting and amastoid abscess in one of them of few days duration. Otoscopy revealed purulent foul smell discharge filling the ipsilateral ears with X-ray mastoid showing a cavity due to bone erosion. Incision and drainage of mastoid abscess followed by radical mastoidectomy in one and radical mastoidectomy straight away in the other were performed with complete eradication of disease and chlesteatoma was achieved clinically. But within 16 hour in the young girl and after 12 days in the 25 years old male again both cases presented in emergency with sever headache, nausea/vomiting and disorientation. CT scan of both the cases revealed right temporal lobe abscess. The girl was already in ICU and the male was re- admitted for the drainage of abscesses under care of neurosurgeon and follow up was done in both the departments for four months