Delayed presentation of forgotten thyroid goiter - 25 years after thyroidectomy

Forgotten goiter is a rare occurrence [2 - 16% of retrosternal thyroid cases] that depicts recurrence of retrosternal thyroid mass due to growth of remnant thyroid tissue overlooked during an initial thyroidectomy. The patient is a 59-year female who presented with dyspnea and stridor 25 years after total thyroidectomy. She was diagnosed as having a mediastinal mass on radiographic imaging. There were only localized pressure symptoms due to mass effect. The mass was excised employing an extra-cervical approach and using a partial sternotomy. The profuse extension of thyroid tissue, adherent to vital structures in the thorax and the extra-cervical thyroidectomy was a novel experience. The mass was completely excised and the patients symptoms alleviated after the surgery. The patient recovered without any complications and there was no recurrence at 1 year of follow-up

Maternal morbidity in emergency versus elective caesarean section at tertiary care hospital

In the past 30 years the rate of caesarean section [C/S] has steadily increased from 5% to more than 20% for many avoidable and unavoidable indications. The objective of this study was to compare maternal morbidity and determine its cause in elective and emergency caesarean section. It was a cross-sectional comparative study conducted in Civil Hospital Karachi at Obs/Gyn Unit III. All mothers admitted through OPD or emergency during the study period, of any age or parity undergoing C/S were recruited in the study. Patients having previous myomectomy, hysterotomy or classical C/S were excluded from the study. Patients undergoing emergency C/S were placed in group A, and those delivered by elective C/S were included in group B. Study variables were general and obstetric parameters and complications observed intra-operatively. Any postoperative complications were recorded from recovery room till patient was discharged from the ward. There were 50 patients in each group. In group A, 11 [22%] were booked and 33 [66%] were referred cases. In group B, 48 [96%] were booked. The mean age in both groups was 28 years. In both groups, multigravida compared to primigravida were 78% vs 22% in group A, and 92% vs 8% in group B. Indication for C/S was previous C/S in 10 [20%] patients in group A, and 39 [78%] patients in group B, placenta previa, chorioamionitis, obstructed labour [6, 12% each]; pregnancy induced hypertension and eclampsia in 5 [10%] cases in group A only. Intra-operative complications in group A were 48 [96%] vs 15 [30%] in group B [p=0.000]. Postoperative morbidity in group A was 50 [100%] and 26 [52%] in group B [p=0.000]. Intra-operative complication was haemorrhage in 46 [92%] cases in group A and 11 [22%] in group B. Anaesthetic complications were 40 [80%]; prolonged intubation 25 [50%], aspiration of gastric contents 8 [16%], and difficult intubation 7 [14%] in group A. Ten [20%] cases had anaesthetic complications in group B. Commonest postoperative complication in both groups was anaemia in 41 [82%] and 11 [22%] cases respectively. Maternal morbidity is significantly higher in emergency C/S. Haemorrhage is a frequent complication in C/S, emergency or elective.