Removable subcuticular skin sutures in open appendicectomy; surgeons fear

To determine the frequency of wound infection with skin closure by removable subcuticular sutures in non complicated open appendectomy wound. Descriptive case series. Department of Surgery Railway Hospital Rawalpindi, Seven months and ten days, from 1[st] Nov, 2009 to 10[th] June, 2010. The study was carried out after taking approval from the hospital ethics committee. Seventy three adult patients of either sex admitted in department of surgery with diagnosis of acute appendicitis were included in the study by non probability consecutive sampling. All the patients were explained about the procedure and an informed written consent was obtained. Right grid iron abdominal incision centred over the Me Burney's point was used to open the abdomen. Appendicectomy was done. In all patients subcuticular stitches by using polypropylene 2/0 were applied to close the skin. All the patients were followed on 3[rd], 7th and 30[th] post operative day for examination of wound. Data was entered in the predesigned Proforma [annexed] for analysis. Out of 73 patients 6 [8.2%] suffered from wound infection. Successful open management of the infected wounds was done. Rest of the patients had uneventful recovery. Frequency of wound infection is negligible with removable subcuticular skin suture in non complicated open appendicectomy wound

Diagnostic accuracy of fine needle aspiration of thyroid nodule verses biopsy in thyroid lesions

FNA biopsy of thyroid is a rapid, minimally invasive, and cost effective first line procedure in the evaluation of thyroid nodule. This study was conducted to evaluate the cytological accuracy, sensitivity and specificity of fine needle aspiration [FNA] of solitary thyroid nodules in correlation with post-surgical histological findings. This retrospective study was carried out at Department of Pathology, Abbottabad International Medical College, Abbottabad from January 2009 to December 2010. A total of 81 patients with clinically palpable solitary thyroid nodule were included in the study. Thyroid function tests were initially performed followed by FNA of thyroid nodules later operated and histopathological examination was conducted on the excised nodules. FNA diagnoses were correlated with the histological findings. The accuracy, sensitivity and specificity of the procedure were determined. Out of 81 cases, 5 [6.2%] were unsatisfactory and 76 cases were satisfactory for cytological evaluation. Cytohistopathological correlation was carried out for these cases. The study showed a diagnostic accuracy of 93% with sensitivity and specificity rates of 75% and 96% respectively. Positive predictive value is 81% and negative predictive value is 95%. Fine needle aspiration [FNA] has evolved as an accurate and sensitive diagnostic tool for the initial screening of patients with thyroid nodules, and has reduced the need for unnecessary surgery

comparative analysis of coronary adventitial T-lymphocytes-an autopsy study

Recent clinical and histopathologic data suggests that inflammation plays a key role in coronary artery plaque instability and subsequent occlusive thrombosis. The intima has received much attention as a site of inflammation, while the adventitia has remained relatively unexplored. The aim of the present study was to investigate the frequency of inflammatory activity in the cap and shoulder region of unruptured, atherosclerotic lesions in coronary arteries and to correlate these findings with distribution of inflammatory cells in adventitia. The study was carried out in Histopathology Department, Army Medical College, Rawalpindi and National University of Sciences and Technology [NUST], from August 2008 to July 2009. Sixty-seven autopsy cases performed at Military Hospital Rawalpindi, Pakistan were selected. The cases were divided into study group and control group. Case group [n=35] included those where cause of death was ischemic heart disease. Those coronary arteries were taken as control [n=32] where atherosclerotic changes were found by chance [death without history of ischemic heart disease]. Plaques in each group were assessed by light microscopy and by immunohistochemistry. The ages of the deceased ranged from 38 to 49 years. Within study group, adventitial lymphocytes exhibited strong correlation with erosion, thrombus formation in culprit plaque [p=0.001]. No correlation was found between adventitial T-lymphocytes and erosion of plaque [p=0.700] in control group. In 72% of culprit plaques moderate staining for T-lymphocytes was observed in adventitia as well as intima. In control group, most of the cases contained scattered cells. Few cases of stable plaques revealed lymphocytes as clusters, both in adventitia and in intima. Adventitial inflammation may play a pivotal role for atherosclerotic lesion histology and atheroma instability. With the help of these autopsy findings, we hope to be able to reduce the incidence of culprit plaques related to inflammatory reaction in patients of ischemic heart disease

Assessment of atherosclerotic plaque vulnerability of coronary arteries in cases of sudden cardiac death

To study the plaque vulnerability in coronary arteries taken from autopsy specimens, of individuals dying of ischemic heart disease in our setup and to compare it with atheroma of those who died of non-cardiac causes. Case control study. Study was carried out in the department of Pathology [Histopathology], Army Medical College, Rawalpindi and National University of Sciences and Technology [NUST], from June 2008 to June 2009. Sixty coronary arteries having atherosclerosis, from autopsies of patients who died of sudden cardiac death were divided into case and control groups. Case group included thirty coronary arteries having atherosclerosis from autopsies of patients of whose death was attributable to Ischemic Heart Disease [IHD]. Control group included thirty coronary arteries where atherosclerotic changes were found by chance [death not attributable to ischemic heart disease]. Plaques were assessed for fibrous cap thickness, foam cells; mean percentage of inflammatory cells on Haemotoxylin and Eosin [H and E] stained slides whereas immunohistochemical [IHC] markers for T-Cells were done by IHC stain method. In present study, foam cells are significantly more in study group than in control group [P=0.007]. Fibrous cap thickness fulfilling the criteria of vulnerable plaque was more in study group as compared to control group [P<0.001]. The present study demonstrated that there was insignificant difference [P=0.152], in the mean percentage of inflammatory cells in case group and control group. An overall significant association was found between vulnerable plaque and death due to ischemic heart disease [P<0.001]. Patients dying of ischemic heart disease have more vulnerable plaque in their coronary arteries as compared to those dying from non ischemic cause. Although this is an autopsy study but the significance of in this study can be very important to guide cardiologists to identify patients at high risk of acute coronary syndrome and use new diagnostic modalities like intravascular ultrasonography and therapeutic strategies like genomic and proteomic techniques. This will help the early detection and treatment of such cases and may ultimately reduce the incidence of sudden cardiac death

Spectrum of atherosclerotic changes in deceased dying of non-cardiac cause

To study the pattern of coronary atherosclerosis in deceased of sudden death, dying of non cardiac cause. This descriptive study was carried out in the department of Histopathology, Army Medical College, Rawalpindi, from January 2009 to January 2010. Fifty autopsy specimens from 20 to 50 years old who died of non cardiac causes and had no history of cardiac disease. Coronary arteries were removed and examined for atherosclerotic plaques. Fifty autopsy specimens of coronary atherosclerosis who had died of non cardiac cause were included in the study. All were males with a median age of 38 years, with range between 20- 55 years. Analysis in different age groups revealed that advanced atherosclerotic plaques, progressed with age reaching a maximum of 62% by the age of 31-40 years, and in the same age group number of severe atherosclerosis seen was also high [16%]. This study showed that the frequency of atherosclerotic plaque was more after third decade. The study showed that in patients with sudden cardiac death due to non ischemic causes there is high frequency of atherosclerosis in coronary arteries in people of age group of 31-40 years. Although this is an autopsy study but the significance finding found in this study can be very important to guide the clinicians in reducing the traditional risk factors of coronary atherosclerosis. This will help the early detection and treatment of such cases and may ultimately reduce the incidence of sudden cardiac death

Immunohistochemical localization of keratin in 100 cases of squamous cell carcinoma

The keratinizing tumors are less radiosensitive and non-keratinizing are more radio responsive. This study was carried out to detect the presence of keratin in apparently non- keratinizing poorly differentiated squamous cell carcinomas by immunoperoxidase staining. It is a cross sectional and descriptive study conducted at King Edward Medical College, Post Graduate Medical Institute, Lahore. A total of 100 patients suffering from squamous cell carcinomas were included in the study. Both H and E and immunoperoxidase staining were performed. The results of both types of staining were compared for each case. Four groups were identified. Forty nine cases showed obvious keratinization on both H and E and immunoperoxidase staining. Twenty cases had doubtful keratinization on H and E but showed more obvious keratinizaton on immunoperoxidase staining. Ten cases were non-keratinizing on H and E as well as on immunoperoxidase analysis. Cytokeratin can be used as a tumour marker for squamous cell carcinoma. The immunohistochemical technique can help us in revising and modifying our H and E impression of a squamous cell carcinoma