Frequency of malignancy in goiter in Pakistan: a review of 359 thyroidectomics

To determine the frequency of malignancy in patients presenting with goiter undergoing for surgery. An observational study. Surgical Department of Social Security Hospital Islamabad January 2002 to February 2011. All patients more than 10 years of age underwent thyroidectomy were included in the study. Postoperatively histopathologies of specimens were evaluated in all patients. A total of 359 patients were operated and post operative histopathology specimens were reviewed. Eleven patients [3.06%] were having carcinoma. among all the thyroid carcinomas, papillary carcinoma was the commonest i.e. [45.45%, 5/11] followed by follicular carcinoma [27.27%, 3/11]. Anaplastic carcinoma was seen in [18.18%, 2/11] and medullary carcinoma seen only in [9.09%, 1/11]. Thyroid carcinoma is not an uncommon condition. Frequency of papillary carcinoma is very high in females among all the thyroid carcinoma

Comparison of smoking behaviour among medical and other college students in Rawalpindi

To assess the frequency of smoking among students in medical and non-medical colleges of Rawalpindi and to explore the differences in smoking behaviour of the two college students. A cross- sectional comparative study. Random sampling of students from a medical college and non-medical college of Rawalpindi was carried out in October 2006. An anonymous, self-administered questionnaire was used for the study which inquire about gender, number of daily smoked cigarettes, feeling addicted, attempt and success or failure at quitting, most important factor that helped in quitting smoking and reasons of smoking were compared between the medical college and non-medical college students. The total medical college students in the study were 444 and among them 32.7% were smokers. The total non-medical college students were 405 and among them 41% were smokers [p=0.012]. Nine point seven percent medical students and only 6% non-medical students were successful in quitting their habit of smoking [p=0.231]. There was significant difference in smoking behaviour among the group. Being medical students it had effect on the decision to smoke, which may have modified their consumption level

Burns: frequency and mortality related to various age groups

To find out frequency of burns injury and mortality related to it in different age groups and their association with various types and degree of burns. Descriptive study. From July 1999 to April 2008, at Fauji Foundation Hospital, Rawalpindi. Patients of all ages and both sexes received in emergency room with burns injuries whether admitted or managed on outpatient basis were included in the study. A total 248 patients were received during the study period. Majority [n-109 - 43.96%] had sustained flame burns followed by scalds [n-89 - 35.89%]. Most of the patients were in the 1st and 2nd decade of life [n-70 - 28.23% and n-68 - 27.42% respectively]. The percentage of total body surface area involved was up to 10 percent in 77- 31.04% and between 11-20 percent in 55 -22.17%. Eleven [4.43%] patients had more than 90% total body surface area burns. Fifty two patients [20.96%] died with 100% mortality in more than 70% and none in less than 30% of total body surface area burns. Mortality was high in flame burns [n-41 - 16.53%]. Sepsis was the common cause of death [75%] followed by irreversible shock [13.46%]. Mortality was high in flame burns and hot liquid burns

Emergency thyroidectomy in infected thyroid cyst due to spontaneous gas forming organisms

We are reporting a case of a young female, who presented to emergency room with sudden increase in thyroid swelling, high fever and acute respiratory distress. Clinical diagnosis of spontaneous infection of thyroid cyst was made. Operative finding was infection of thyroid cyst with gas formation. Systemic antibiotics and operative intervention by subtotal thyroidectomy led to recovery of the patient

Recurrent laryngeal nerve injury: an experience with 310 thyroidectomies

Thyroid surgery has been associated with complications ranging from nerve injury to death. Improvements in techniques have reduced the mortality rate to minimum. Morbidity, however, remains a significant concern. This study was designed to determine the prevalence of recurrent laryngeal nerve [RLN] injury and duration of recovery following transient recurrent laryngeal nerve injury, during thyroid surgery. This prospective, observational study was carried out in the Surgical Department of Fauji Foundation Hospital, Rawalpindi, from January 2000 to December 2005. All patients undergoing Thyroid surgery were included. 310 patients, predominantly female [97.09%], were operated. Majority were euthyroid [90.33%]. 3.22% patients had recurrent laryngeal nerve injury. Amongst them, 87.5% had transient and 12.5% had permanent nerve lesion. Majority of the patients [87.5%] showed signs of recovery within 12 weeks after surgery. Injury was observed more in huge goiters [3.57% transient and 1.42% permanent], total thyroidectomy [7.69% transient and 3.84% permanent] and during lobectomy and total thyroidectomy [6.25% respectively for transient and permanent nerve injury. Thyroid surgery should be done by experienced surgeon and care should be taken especially in huge goiters and patients undergoing total thyroidectomy

Recurrent goiter: is it preventable?

To determine the different factors responsible for the recurrence of goiter after surgery. Department of Surgery, Fauji Foundation Hospital, Rawalpindi from January 1998 to December 2005. All patients with recurrent goiter irrespective of place of first surgery were included. The patients with recurrent goiters due to thyroid malignancies were excluded. Sixty-four patients were included during study period from January 1998 to December 2005. 34.38% were in 4[th] and 25% of patients reported in 3[rd] and 5[th] decade each. Among them 96.9% were females and 3.1% males. 46.88% patients noticed recurrence after 4-6 years and 28.13% after 6-7 years of surgery. 75% of patients had not used thyroxin at all and 25% used for some duration after surgery. None of the patients gave the history of continuous use of suppressive dose of thyroxin postoperatively. During surgery it was observed that the site of recurrence was 25% whole one lobe, 18.75% from both lobes or at multiple places, 12.5% from pyramidal lobe and 9.37% from superior pole. Adequate thyroxin prophylaxis, correct indications for primary surgery, adequate surgery and removal of all palpable nodules reduce the risk of recurrent goiter

comparison of open vesicolithotomy and cystolitholapaxy

To compare Vesicolithotomy with Transurethral optical cystolitholapaxy. Comparative Observational study. Study was conducted at Department of Surgery, Fauji Foundation Hospital Rawalpindi, from October 2002 to April 2005. Study comprises of 40 patients, which were divided into two equal groups of twenty each. All patients having stones less than 30 mm in size were included. Group-I patients were treated with open vesicolithotomy and Group-II patients with transurethral optical cystolitholapaxy. All 40 patients were between age of 16 -76 years [mean age 52 years and 54.5 years in Group-I and II respectively] and female to male ratio were 1:2.3. Average hospital stay was long [7.33 days] in Group-I. 2.5% patients had UTI postoperatively in both groups and transient haematuria [5%], urethral trauma [5%] and recurrent stone formation [5%] was noted in Group-II patients. Transurethral optical cystolitholapaxy is a better way of managing Vesical stones because it is minimally invasive with short hospital stay. Complications noticed with this procedure are minor and can be reduced by experienced surgeon

Seroprevalence of Hepatitis B and C among the healthy blood donors at Fauji Foundation Hospital, Rawalpindi

To find out the seroprevalence of Hepatitis B and C virus among the healthy blood donors at Fauji Foundation Hospital, Rawalpindi. A prospective observational study. From April 2005 to September 2005 at Fauji Foundation Hospital, Rawalpindi. All healthy blood donors reporting to blood bank were screened for Hepatitis B and C. Total number of 1428 donors were screened, among them 97.05% were males. Prevalence of Hepatitis B was 2.45% with a male predominance of 2.38%. Seroprevalence of Hepatitis C was 2.52% with male predominance of 2.52%. Prevalence of Hepatitis B and C is not uncommon in our country. Transfusion of contaminated blood is one of the important cause of its spread. To control its further spread public awareness and health education programs and selection of healthy blood donors should be done

Schawanoma disguising as a solitary thyroid nodule

Schawannoma is a benign tumor arising from schawann"s cells. Schawannoma is arising from nerve tissue in central and peripheral nervous system is not uncommon, but is rarely found in body organs like pancreas, parotid gland or clinically simulate some other organ pathology. A case of Schawannoma clinically presenting as a solitary thyroid nodule is presented in this case report

To ligate or not the inferior thyroid artery to avoid hypocalcaemia after thyroid surgery

Hypocalcaemia is a well recognized complication of thyroid surgery. We have compared the prevalence of hypocalcaemia in our patients following ligation and non-ligation of the inferior thyroid artery [ITA] during thyroid surgery. A prospective observational study was done from January 2000 to December 2004, at Fauji Foundation Hospital, Rawalpindi. All patients undergoing subtotal or total thyroidectomy were placed in two groups at random. Group I had ITA ligated whereas in Group II, ITA was not ligated. 310 patients were operated, majority of them being female [97.10%]. Transient hypocalcaemia was observed in 4.29% patients in Group I and 3.4% patients in Group II. Permanent hypocalcaemia was observed in 1.84% and 1.36% patients in Group I and Group II, respectively. Results were statistically insignificant [p value > 0.5%]. There is no significant difference in post-operative hypocalcaemia whether or not the ITA is ligated

Complications of thyroid surgery: a five year experience at fauji foundation hosp., Rawalpindi

To determine the prevalence of complications after thyroid surgery and to compare our results with those in the international literature. This prospective observational study was conducted from April 2000 to March 2005. Department of Surgery, Fauji Foundation Hospital, Rawalpindi. 310 patients who underwent thyroid surgery were included. The data of all these patients was collected and analysed. Majority of the patients were females [97.09%] and only 8.06% were hyperthyroid pre-operatively, the rest being euthyroid. Subtotal thyroidectomy was done in 63.23%, while 10.96% patients underwent near total thyroidectomy. Complications were noted in 16.45% patients. Amongst them 5.48% developed hypocalecmia, 3.22% recurrent laryngeal nerve palsy, 2.90% seroma formation and 0.96% post-operative bleeding. Successful outcome of thyroid surgery depends on improving surgical training and skills

Cholecystogastric fistula: an unusual presentation

We are presenting a rare case of cholecystogastric fistula, which presented as chronic cholecystitis and obstructive jaundice

Pattern of benign breast diseases

This observational study was done on 234 patients at surgical unit-1 of Fauji Foundation Hospital, Rawalpindi to see the pattern of benign breast diseases in females. All patients presenting with breast lumps were evaluated clinically and subjected to FNAC or core needle biopsy. Fibrocystic disease was the commonest [26.92%] followed by fibroadenoma [23.50%]. fibrocystic disease was common in 5th decade [41.26%] and fibro adenoma in 2nd decade [42.27%] of life. Incidence of mastalgia [8.54%] was quite low with chronic granulomatous mastitis [5.98%] quite high in our study as compared to international literature

Incidence of malignancy in females presenting with breast lumps in OPD: a study of 277 cases

To find the incidence of malignancy in females presenting with breast lumps in surgical out patient and to find out the age related incidence of benign and malignant diseases in these patients. Study: A prospective study. Place and duration of study: The study was conducted from January 1999 to December 2000 at Fauji Foundation Hospital, Rawalpindi. Patients and All cases reporting to surgical outdoor with breast lumps were included and underwent investigation for the breast lumps to determine the histopathological diagnosis. A total of 277 cases were studied. 24.2% breast lumps were malignant and 75.8% were benign. The incidence of malignancy increases from 0% in 2nd decade to 38.9% in 5th and 100% in 9th decade of life. The probability of diagnosing a breast lump as a malignant is one in three in 4th decade, two in five in 5th decade and more then one in two there after. Fibrocystic disease [33.8%] and Fibro adenoma [27.1%] was the commonest finding among the benign lumps. Among malignant lumps infiltrating duct carcinoma [68.7%] is the commonest finding. There is a significantly high incidence of malignant breast lumps after the 3rd decade of life and it increases subsequently. It is recommended that the surgeon managing a case of breast lump in a patient above 30 years should be highly suspicious and cautious so that early detection and management of malignant lumps be carried out

Pattern of malignancies at Fauji Foundation Hospital Rawalpindi

This retrospective observational study was carried out from July 2000 to June 2001 to find out the pattern of malignancy at Fauji Foundation Hospital Rawalpindi. 733 cases of malignancies were recorded with mate to female ratio of 1:1.46. Majority of them were in the 5th [23.19%] and 6th [26.96%] decades of life. The commonest malignancy observed among males was Urinary Bladder Tumour [19.12%] and in females Breast Cancer [37.47%]. The ten commonest malignancies among both the sexes were compared with the patterns recorded at different centers in Pakistan. Analysis of the data shows the high prevalence of breast, lung, ovarian, cervical colorectal malignancies and lymphoma in our country. The type of data presented is of limited significance. It is important that these findings are elaborated and confirmed by more detailed studies. In this contest the importance of establishment of a tumor based registry can not be overemphasized

Varicocelectomy: Paloma's procedure versus Ivanissevich's procedure

This prospective study was carried out to see the age incidence of varicocele in our population and to compare the results of two commonly practiced surgical procedures i.e., Ivanissevich's procedure and Paloma's procedure. Seventy-two patients with the mean age of 24.7 years, having left-sided varicocele, were studied over two years. Among them 58.33% had Grade-II varicocele. Operative time and hospital stay was almost same in both the groups. However, postoperative complications rate with Ivanissevich's procedure was comparatively more. Postoperative improvement in semen quality was found in 60% patients having history of infertility or sub-fertility