Fine needle aspiration cytology: sensitivity and specificity in thyroid lesions

Thyroid enlargement is one of the common problems in patients presenting at outpatients department of ENT particularly in females. Thyroid nodules are common, thyroid cancer is uncommon and the most common way for it to present is as a solitary thyroid nodule. This study was conducted to evaluate the sensitivity and specificity of Fine Needle Aspiration Cytology [FNAC] in thyroid diseases. This prospective analytic study was conducted at ENT Department of Karachi Medical and Dental College/Abbasi Shaheed Hospital during year 2004-8. One hundred and five cases were enrolled who underwent thyroid surgery after complete evaluation by history, clinical examination, Thyroid profile, Thyroid Scintigraphy, Ultrasound neck and FNAC. In cases which were revealed malignant by FNAC, CT scan were done to see the extent of disease and neck node status. Surgery was done in all cases and specimens sent for histopathology. Male to female ratio of the patients was 1:8.5. Most common lesion was benign nodule [96]. Malignant lesions were 9 in FNAC. In histopathology, the benign nodules were 92, and malignant cases were 13. Sensitivity of FNAC was 61.53% and specificity was 98.9%. FNAC in Thyroid has high sensitivity and specificity

Role of tracheostomy [early VS late] in intubated cases of neurosurgical patients in surgical intensive care unit [SICU] setting

To study the role of early vs. late tracheostomy, in neurosurgical intubated cases admitted in surgical intensive care unit, on recovery from pneumonia during ventilation, length of intensive care unit stay and duration of ventilatory support and weaning. The Study was conducted in the Department of Anaesthesia and Surgical Intensive Care Unit with collaboration of ENT Department, Abbasi Shaheed Hospital, Karachi from Jan 2007-Dec 2008. A retrospective analysis of the case file records of the intubated neurosurgical patients admitted in surgical intensive care unit for whom elective tracheostomy was performed, for prolonged ventilation, was made from 2007-2008 of 50 cases. Early tracheostomy was consider, when it was performed within 3 - 7 days of intubation and late was after that or 8- 14 days. Data collected include the information regarding the patient's name, age, sex, etiology and Glasgow coma score [GCS] on admission, time duration of patients' stay in surgical intensive care unit, time period of weaning from mechanical support and recovery from pneumonia during ventilation, along with chest x-ray's, culture and sensitivity reports. Depending on the time of tracheostomy performed two groups were made: Group- I in which tracheostomy was performed early within 3-7 days of intubation and Group- II in which tracheostomy were performed after an interval of more than 7 days or 8-14 days [late tracheostomy]. For group I the early tracheostomy was done at the median of 4th day vs. that of 10th day for the group II. The number of cases that developed pneumonia in group- I was 45.45% versus Group- II 54.54%, [odd ratio 0.27]. Duration of mechanical ventilation was significant with early tracheostomy [mean, standard deviation] 11.95 days +/- 3.14 versus late tracheostomy 21.79 days +/- 6.06. Intensive care unit stay was shorter in group- I [mean, standard deviation] 15.09 days +/- 3.49 versus in group- II 26.71days +/- 7.00. Recovery from pneumonia was shorter in group- I [mean, standard deviation] 9.0 days +/- 1.63 versus in group- II 14.23 days +/- 1.81. Our study shows that early tracheostomy has a positive role in reducing the risk of pneumonia, because of easier access to lower airway for clearance but not statistically significant, decreased the overall time period of surgical intensive unit stay and patients were weaned off earlier from mechanical support, in comparison to those in which tracheostomy was performed late. Therefore early tracheostomy in selected patients may help in reducing unnecessary resource utilization

Synovial cell sarcoma: rare presentation in head and neck area

We report a case of a 17 years young male who presented to us with a huge neck swelling on the left side of the neck that has been present for about 2 years. He presented to us with the complains of mild pain and disfiguring swelling

Morphological pattern of parotid gland tumors

To determine the morphological pattern of parotid tumours. Case series. ENT Department of Karachi Medical and Dental College and Abbasi Shaheed Hospital, Karachi, from 1990 to 2004. During this study, 204 patients with parotid tumours were registered. The patients of all ages and both gender were included in this study. All patients were evaluated by history, clinical examination, F.N.A.C. and ultrasound, C.T/MRI was done in selected cases. All patients were surgically managed and their tumour specimen was sent for histopathology. Classification of individual tumour was based on 1991 World Health Organization Classification. Discrete data was presented in percentage and proportions. Out of 204 cases, 152 [74.5%] were benign and 52 [25.5%] were malignant. Of these, 117 [57.35%] patients were females and 87 [42.65%] males. Benign tumours were more common in females whereas malignant tumours were common in males. The mean age of patients was 34 years and 42 years for benign and malignant tumours respectively. Pleomorphic adenoma was most common benign tumor [83.5%], followed by Warthins tumour. The most common malignant tumour was mucoepidermoid carcinoma [60%], followed by adenoid cystic carcinoma. Superficial lobe of parotid gland was the commonest site, 120 benign and all 52 malignant tumours arising from it while 32 benign tumours originated from deep lobe. Parotid swelling for years was main feature of benign tumours, whereas malignant tumours presented with pain, fixation to skin or underlying structure, cervical lymphadenopathy and facial palsy. Pleomorphic adenoma was the most common benign tumour and mucoepidermoid carcinoma was most common malignant tumour. The morphological patterns and distribution followed the known pattern

Role of azithromycin in acute sinusitis and acute otitis media

To investigate the efficacy of Azithromycin 250 mg in acute sinusitis and acute otitis media. It is an observational study carried out on sixty patients, 30 each from acute sinusitis and acute otitis media were selected from E.NT OPD department of Karachi Meddical and Dental College and Abasi Shaheed Hospital. These all patients were treated with azithromycin 250 mg b.i.d for 3-7 day according to the severity of disease and response of the patients. Out of 30 patients with acute otitis media, 08 were having ear discharge at the time of presentation. All patients were followed for a period of 02 months to evaluate the efficacy, failure and complication of treatment. Out of 60 patients pain and fever subsided within 03 days in 40 patients[67%] and within 05 days in further 12 patients[20%]. The remaining 08 patients i.e. 13% [2 with acute sinusitis and 06 with acute otitis media] did not responded to the treatment at the end of 07 days, requiring surgical intervention. Nasal discharge and obstruction was improved on 4th day in 28 patients with acute sinusitis. Ear discharge disappeared in all 08 patients with discharging ears and hearing improved on 10th day in 24 patients. No serious complication was observed in any patient regarding the disease or antibiotic therapy. Azithromycin 250 mg b.i.d for 3-7 days was found highly effective in patients with acute sinusitis and acute otitis media. It has excellent antimicrobial activity against H.Influenza, Strep.Pneumonia and M.Catarrhalis. The overall clinical success rate was 87% within 05 days with failure rate of 13%