Pattern of anterolateral cervical lymph nodes involvement in papillary thyroid carcinoma

To determine the pattern of metastatic involvement of anterolateral cervical lymph nodes in papillary thyroid carcinoma. Retrospective, descriptive study. Department of Surgery, Khyber Teaching Hospital, Peshawar, from July 1998 to July 2005. The clinical and pathological record of 38 patients who underwent neck surgery for cervical metastasis from papillary thyroid carcinoma was reviewed. Neck dissections were done and 85 lymph nodes were taken. Forty lymph nodes were histologically positive and were classified in 3 groups based on dissection procedure. The neck level [levels I-V] of the positive nodes of all the 3 groups was identified. The mean age of patients was 32+2.5 years. The positive nodes in neck level III were the most involved followed by level II, IV, V and then I. Modified neck dissection should be adopted for papillary thyroid carcinoma. Papillary thyroid carcinoma usually involves the neck level II, III and IV with the level III being the most frequently involved

Gall-stone ileus with multiple tuberculous strictures

Gall-stone ileus associated with tuberculous strictures is an uncommon cause of bowel obstruction related to a cholecystoenteric fistula. The stone usually obstructs the narrowest part of the intestine. The patient whose intestine is strictured due to tuberculosis or other disease, the stone can impact that part of the strictured area. We report such a case of gall-stone ileus in a patient of 80 years with multiple tuberculous strictures. After surgery, she responded to antituberculous drugs and did well

Results of primary closure in the management of gangrenous and viable sigmoid volvulus

To compare the outcome of primary repair, both in viable and gangrenous cases of Sigmoid Volvulus. Retrospective study conducted from August 2001 to April 2006. District Headquarter Hospital, Bannu, North West Frontier Province. All patients admitted with large gut obstruction due to Sigmoid Volvulus. After initial investigations and resuscitation, the patients were shifted to the operation theatre where the vascular status of the sigmoid colon was noted, and resection and primary anastomosis was done in all the cases. Patients were allowed orally after 3-5 days, when their bowel sounds returned and they were able to pass flatus and/ or faeces. All patients were discharged home after recovery, and were followed up for a minimum of four months. The outcome of both the gangrenous and the viable gut patients was compared in terms of anastomotic leakage, wound infection, hospital stay and long term complications. The findings were entered onto a proforma and the results compiled and analyzed. Amongst the total 83 patients, there were 72 [86.7%] males and 11[13.3%] females, with an age range of 35-80 years [mean 55 years]. All patients presented with the typical symptoms of intestinal obstruction. Local and systemic signs of toxicity were more common in the gangrenous group. Postoperatively 17 [53.12%] patients in the gangrenous group and 9 [17.64%] cases in the viable group developed paralytic ileus; 2 [6.25%] patients in the gangrenous group developed anastomotic leakage leading to peritonitis; 2 [6.25%] patients in the gangrenous group and one [1.96%] in the viable group developed intra abdominal abscess; eight patients in the gangrenous group and five in the viable group developed wound infection, two of these patients late on developed incisional hernia. The mean hospital stay in the gangrenous group was 10 days as compared to eight days in the viable group. The difference in the outcome of primary anastomosis in both the viable and non viable groups was insignificant. Primary anastomosis can be safely done for acute sigmoid volvulus in both gangrenous and viable gut