Diagnostic accuracy of fine needle aspiration cytology in the diagnosis of malignant solitary thyroid nodule

Objective: Objective of this study was to evaluate diagnostic accuracy of fine needle aspiration cytology in diagnosing solitary thyroid nodule keeping histopathology as gold standard

Study Design: Cross sectional study

Place and Duration of Study: Combined Military Hospital, Multan from 27 Aug 2010 to 26 Feb 2011

Material and Methods: Three hundred and forty nine patients were included in the study through non-probability convenient sampling. In outdoor visit, after taking detailed history, general physical examination was done. Patients fulfilling the inclusion criteria were admitted in ward. The procedure of FNA was explained in detail to the patient and Informed consent was taken

Results: Out of 349 patients, all underwent FNAC whereas 321 underwent surgery. FNAC showed 113/321 [35.20%] patients to have malignancy, however after surgery 109 / 321 [32.08%] patients were found to have malignancy on histopathology. Eighteen patients were diagnosed as papillary CA on FNAC all confirmed on histopathology. Follicular carcinoma was diagnosed in 35 patients on FNAC. However, only 32 were actually found to have the disease on histopathology

Conclusion: Role of FNAC is quite conclusive for the diagnosing malignancy and proposing surgery in most of cases of cold nodules due to its potential for malignancy. FNAC can be relied upon due to good sensitivity [92.56%], specificity [95.81%], Accuracy [94.49%], Positive predictive value 93.83% and Negative predictive value of 94.93%

Surgical and visual outcomes of retinal detachment surgery in eyes with chorio-retinal coloboma

Objective: To evaluate the anatomical and visual outcome of surgical management of retinal detachment associated with chorio-retinal coloboma

Study Design: Prospective interventional case series

Place and Duration of Study: This study was conducted at Al-Shifa Trust Eye Hospital Rawalpindi from Jan 2012 to Dec 2013

Material and Methods: Twenty one eyes [21 patients] that underwent surgery for retinal detachment associated with chorio-retinal colobomas were selected. Evaluation was done on the basis of type of intervention, final visual acuity and anatomical outcome and complications. Out of 21, 19[90.47%] eyes underwent pars plana vitrectomy with silicone oil [SO] and 2[9.52%] underwent primary scleral buckling surgery. SO was removed in 9 [47.36%] eyes at final follow up. Encircling band was placed in 12 [63.15%] eyes based on peroperative judgment of surgeon. Intra-operative lensectomy was performed in 6 [28.57%] eyes. The main outcome measures were retinal re-attachment and visual recovery. Statistical analysis was performed using "IBM statistical package for social sciences [SPSS] Statistics" [version 17.0, Chicago, Illinois, USA]. Qualitative variables were described using percentage; quantitative data were defined using mean +/- standard deviation. The pre op and post op frequency of best corrected visual acuity [BCVA] was compared using Wilcoxan Signed Ranks Test. Confidence interval was 95% [level of significance p<0.05]

Results: The mean number of operations per eye were 1.57 +/- 0.74; mean follow-up was 13.1 months [range 12-18]. The retina remained attached in 18 eyes [85.71%] at final follow-up. The post op BCVA improved significantly as compared to pre op BCVA [p< 0.01]. Mean pre op BCVA was counting fingers [CF] and mean post op value of BCVA was 3/60

Conclusion: Pars plana vitrectomy along with silicon oil tamponade for retinal detachment related to choroiretinal coloboma improves the long-term anatomical outcome however no significant improvement in visual acuity was observed

Changes in macular thickness and visual acuity after intravitreal bevacizumab injfection in patients with retinal vein occlusion

To evaluate the effect of singel Intravitreal Bevacizumab [Avastin] injection on visual acuity [VA] and central retinal thickness [CRT] in patients with macular edema secondary to branch retinal vein occlusion [BRVO] or central retinal vein occlusion [CRVO]. Prospective, non-randomized, interventional case series. This study was conducted at Al-Shifa Trust Eye Hospital Rawalpindi from March 2012 to February 2013. Twenty three patients with macular edema attributable to vein occlusion received intravitreal injection of Bevacizumab 1.25 mg. Nine patients had central retinal vein occlusion [CRVO] and 14 patients had branch retinal vein occlusion [BRVO]. Complete ophthalmic examination including best corrected visual acuity [BCVA] and optical coherence tomography [OCT] was done at base line and follow up visits. At base line mean visual acuity was Log MAR 0.73 and showed improvement to mean Log MAR 0.39 at 12 weeks after intravitreal Bevacizumab [IVB] injection. Mean CRT was 527 micro m at baseline that decreased to 274 micro m after 12 weeks of IVB treatment. Intravitreal Bevacizumab appears to result in significant short term improvement of VA and macular edema secondary to vein occlusion

Outcome of laser photocoagulation in chronic and recurrent central serous chorioretinopathy

To evaluate the outcome of laser photocoagulation in recurrent and chronic non resolving Central Serous Chorioretinopathy [CSCR]. In this interventional case series 9 eyes of 9 patients with recurrent or chronic CSCR underwent focal laser photocoagulation. Best corrected visual acuity [BCVA], Fluorescein Angiography [FA], Optical Coherence Tomography [OCT] were performed prior to treatment as baseline workup while BCVA and OCT were reassessed at 1 week, 1 month and three months after treatment. One month after treatment, CSCR in 5 [55.55%] eyes was completely resolved, 3 [33.33%] eyes showed partial resolution of sub-retinal fluid [SRF] while in 1 [11.11%] eye SRF did not resolve at all. However after 3 months residual SRF in 2 [22.22%] eyes resolved completely while the status of other 2 [22.22%] eyes remained same. The treatment of chronic or recurrent CSCR with laser photocoagulation may result in prompt resolution of sub-retinal fluid which can be associated with rapidly improved vision. Although this case series is limited in follow up and number of patients, the encouraging results and lack of visually significant complications suggests need for further evaluation

Mono therapy versus double therapy versus triple therapy in the treatment of diabetic macular edema

To compare the efficacy of macular laser photocoagulation [MPC] alone or MPC with intravitreal Bevacizumab or MPC with both intravitreal bevacizumab and intravitreal triamcinolone as primary treatment of Diabetic macular edema [DME]. A randomized clinical trial. Fifty eyes of 30 patients with clinically significant DME and no previous treatment were enrolled. The eyes were randomly assigned to one of three treatments groups. In Group-1, 20 eyes underwent focal or modified grid laser, In group-2, 15 eyes received 1.25 mg / 0.05ml of intravitreal bevacizumab [IVB] followed by MPC while in group-3, 15 eyes received 1.25 mg / 0.05ml of IVB and 2 mg / 0.05ml of intravitreal triamcinolone [IVT] followed by MPC. At 12 weeks after treatment, average improvement of visual acuity in group-1 was 1.0 line, in group-2 was 1.5 lines and in group-3 was 2.0 lines. Average central macular thickness reduction was significantly more [p=0.001] in group-3 [354 +/- 110 [micro]m] than in group- 1 [1 67 +/- 57 [micro]m] and group- 2 [278 +/- 76 [micro]m]. Up to 12 weeks triple therapy group showed better visual outcome than the other two groups where as the average reduction in central macular thickness was also more in triple therapy group. Further clinical trials with longer follow-up are required to evaluate the long-term visual outcomes and complication profiles after this treatment

Comparison of latanoprost with timolol in lowering intraocular pressure in patients with primary open angle glaucoma

To evaluate efficacy of latanoprost as compared to timolol in lowering intraocular pressure [IOP] in patients with primary open angle glaucoma [POAG]. Comparative study. A total number of 40 patients included in this study at the department of ophthalmology Nishtar Hospital Multan, out of which 20 patients received latanoprost eye drops once daily and 20 patients received timolol eye drops twice daily. There were two groups each comprising of 20 eyes. Effect of intraocular pressure was studied by using Timolol in group I and Latanoprost in group II. Timolol was prescribed twice daily as one drop in the morning and one drop in the evening, while Latanoprost was prescribed once daily as one drop in the evening. At the end of study with six months follow-up, the mean reduction in IOP from base line was 5.63 mm Hg [22.56%] in patients receiving Timolol and 7.88 mm Hg [30.13%] in patients receiving Latanoprost Latanoprost 0.005% is an effective ocular hypotensive agent than Timolol 0.5% in lowering IOP in primary open angle glaucoma

Outcome of different treatment options for periampullary carcinoma

To study the outcome of different treatment options for periampullary carcinoma. This study included 30 patients with periampullary carcinoma. A standard protocol was prepared for every patient comprising thorough history and full physical examination and relevant investigations. All this was recorded in data collection form. Later on outcome of different treatment options for periampullary carcinoma was discussed. All the patients were between 45-70 years. Most patients were male and belong to low socioeconomic class. The diagnosis was based on history, clinical examination and relevant investigations. The treatment options were divided into two groups. Curative resection [pancreaticoduodenectomy] was done in 18 [60%] patients. 12 [40%] patients had unresectable disease. These patients were treated by palliative procedures. Endoscopic stenting was done in 8 [66.7%] cases and 4 [33.3%] underwent surgical bypass. The morbidity noted in curative resection was [wound infection 20%, anastomotic leakage 15%, respiratory infection 10%, cholangitis 7.5% and renal failure 6.7%]. Six months survival after curative procedure was 90%. Morbidity of endocsopic stenting being blockage 20% and cholangitis in 75% of cases. Six months survival after stenting was 78%. Morbidity noted in surgical bypass included 15%[wound infection], chest infections 15% and six months survival being 75%. It was concluded that periampullary carcinoma is common in male predominantly with low socioeconomic class. Most patients were having resectable disease with relatively high morbidity

Comparison of FNAC and open Biopsy in palpable breast lumps

To compare the results of FNAC and open biopsy in patients presented with palpable breast lump. Comparative study. Nishtar Hospital, Multan, during the period of October 2001 to October 2003. All female patients, irrespective of their age, who presented with breast lump were included in the study. The patients were divided into two groups, group I and II of clinically benign and clinically malignant respectively. Both groups underwent FNAC. The patients with suspicious FNAC were subjected to excision biopsy in group I patients. Group II patients were advised surgery and final report was made on histopathology. Sensitivity and specificity of the FNAC was determined. A total of 89 cases were included in whom both FNAC and histopathology results were available for comparison. Clinically, 54 were benign and 35 were malignant. The cytological diagnosis was unequivocally malignant in 29 patients, suspicious in 3 cases, unequivocally benign in 44 patients and probably benign in 7 patients while specimen was inadequate in 6 patients. Histological diagnosis of these 89 patients showed 55 patients with benign disease and 34 patients having malignant disease. In malignant disease, sensitivity of the FNAC was 85.29% with 100% specificity, 14.7% false negative rate, 100% positive predictive value and 98.79% negative predictive value. FNAC has good sensitivity [85.29%] and very high specificity [100%]. It can replace the open biopsy in majority cases of clinically malignant disease. Although FNAC is slightly less sensitive [80%] in benign diseases, it is highly specific [100%], so it can help to reassure and relieve the anxiety of the patients