Hashimoto's thyroiditis: not uncommon in simple benign goiter. A review of 1102 thyroidectomies for simple benign goiter

Objective: To see the frequency of Hashimotos Thyroiditis [HT] in patients operated with the diagnosis of simple goiter

Study Design: A retrospective multicenter study

Place and duration: From 1[st] January 1999 to 31[st] March 2011 at three tertiary care hospitals

Methodology: All patients with simple benign goiter irrespective of age and sex are included in the study. Patients already diagnosed for hashimotos thyroiditis, recurrent goiter, abnormal thyroid hormone profile, diagnosed congenital thyroid pathology or non availability of postoperative histopathology were excluded from the study. Histopathology of all patients reviewed to see the frequency of hashimotos thyroiditis in patients operated for benign simple goiter

Results: Among a total of 1102 patients, 91.28% [n=1006] were female and the majority were in 5[th] decade [35.48%, n=391] of life. Histopathology review of all patients operated for benign simple goiter showed that 2.81% [n=31] were having Hashimoto's thyroiditis and majority [87.09%, n=27] were female. Hashimoto's thyroiditis were common in patients who was in the 3[rd] decade of life followed by 4[th] decade, i.e. 35.48% [n=11] and 32.26% [n=10] respectively

Conclusion: Hashimotos thyroiditis is not uncommon and due to its varied clinical presentation it should be ruled out in simple benign goiter before surgery

Strangulated paraesophageal hiatus hernia: a case report

Strangulation of hiatus hernia is a rare event and difficult to diagnose in emergency. We are reporting a case of 14 year old girl who was diagnosed sliding hiatus hernia since childhood but due to delayed treatment presented in emergency with perforation of stomach and generalized peritonitis. She was treated successfully

Massive retroperitoneal mass - giant schawanoma

Schwannoma are usually solitary, slow growing, and non-aggressive neoplasms usually found in head and neck region. Retroperitoneal Schawanoma especially large sized are rare and difficult to diagnose clinically. We are discussing a 43 years old lady, who presented with huge reteroperitoneal mass of left side, treated successfully

Assessment methods in medical education: a review

Good assessment is a major challenge in medical education. One of the major obstacle to a comprehensive assessment is the lack of familiarity on the part of medical educators about proper selection and effective use of different assessment methods. This primer [review] gives an overview of the basic ideas and vocabulary that one should understand in order to evaluate the quality of any assessment tool designed for the purpose of evaluating the undergraduates, postgraduates or other medical professionals. Applicability and effectiveness of different assessment tools are described along with their limitations and advantages. In addition, assessment methods currently in use are reviewed with attention to their psychometric strength and weaknesses. The data was collected from cross sectional studies, review articles, books on medical education and from guidelines for assessment between 1956 to 2013. Websites and other online resources of medline, NCBI and medscape were used to extract the data

12 year study of medico-legal aspect of burns in females

Objective: To assess medico-legal aspects, risk groups, types and severity of burns in female patients coming to the tertiary care hospital

Study design: A descriptive study

Place and Duration of Study: Burns Unit Fauji Foundation Hospital Rawalpindi, from April 1997 to March 2009

Methodology: All female patients above 15 year of age reported with burn injuries were evaluated regarding their demographic details, nature and severity of burns. Circumstances leading to burn injuries and other important factors leading to homicidal or suicidal burns were also evaluated

Results: Rate of homicidal burns and suicidal burns was 16.54% and 4.32% respectively among 139 patients studied. Among these homicidal and suicidal burns, majority of females [51.08%]were less than 25 year of age, 86.21% from rural areas and 86.66% belonged to lower socio-economic group. Majority [51.72%] of them were married and 65.52% living with their in-laws at the time of incident. Flame burns [89.66%] were commonest and kerosene oil stove burst was the main cause of injuries in 89.66% cases. Most women [51.72%] were having disputes with in-laws. Among these, 48.27% female sustained 81- 90% of the total body surface area burn. Assault was done by in-laws in 34.49% patients and by husband in 20.49% patients respectively. Majority of these females [75.86%] were brought to the hospital by other relatives and 72% were brought to the hospital after 48 hours of the incident

Conclusions: Most of the women were less than 25 year of age. Majority were from the rural area and were from lower socioeconomic group. Flame burns due to kerosene oil was the commonest type

Prevalence of study related anxiety among female medical students

Objective: To see the prevalence of study related anxiety, its severity and frequency of different symptoms related to anxiety among female medical students

Study Design: Across-sectional analytic study

Place And Duration: At Women Medical College, Abbottabad in August 2012

Methodology: A self-administered anonymous questionnaire was given to MBBS female students from all classes. Informed consent was taken from the students who were present at the time of handing over of the questionnaire. Data was collected and analysed at the end of study

Results: A total of 93 students participated in the study and all were female. Study related anxiety was found in 72.26% of students. Anxiety was more common amongst final year students [83.10%], followed by 1[st] /2[rd] year students [75%]

Majority of the students were having mild to moderate severity of anxiety i.e. 41.07% and 37.51 % respectively. Prevalence of anxiety was less among 4[th] year students which was 63.23%

Conclusion: Our study suggests the current educational process may have a negative effect on students' mental health, with a high frequency of anxiety among medical students

Giant goiter: not uncommon in endemic areas of Pakistan. a 10 years experience

Objectives: To determine the prevalence of giant goiter and morbidity after surgery and to compare the data with the national and international literature

Study Design: A prospective, observational study

Place And Duration: Department of Surgery, Fauji Foundation Hospital, Rawalpindi from May 1999 to April 2008

Methodology: All patients with giant multinodular goiter [Grade IV] were operated and prevalence of compilations was recorded meticulously, and data compared with national and international literature

Results: A total of 744 patients operated and majority were female 94.89% [n=706] from 5[th] decade of life i.e. 35.75% [n=266]. Giant multinodular goiter [Grade IV] found in 26.08% [n=194]. Among them, 96.90% [n=188] were euthyroid. Near total thyroidectomy was done in 59.79% [n=116] patients, total thyroidectomy in 28.86% [n=56] and subtotal thyroidectomy in 11.35% [n=22] patients. Transient hypocalcaemia was the commonest complication observed, in 8.24% [n=16] patients followed by seroma formation- 7.21%, [n=14]. Permanent hopoparathyroidism-2.66%, [n=4], Permanent recurrent laryngeal nerve injury-1.03%, [n=2], transient recurrent laryngeal nerve palsy-4.63%, [n=9], postoperative bleeding-1.03%, [n=2] and wound infection noticed in 2.57% [n=5] patients

Conclusion: Giant goiter is not uncommon in our setup, with expected high postoperative complications so surgery should be done by experienced hands in the centers where all facilities are available. Public awareness should be created by health authorities and organizations regarding prevention and early treatment

Mucocele appendix - case report and literature review

Mucocele appendix is a rare pathology involving appendix. We are reporting a 36 years old female operated with the provisional diagnosis of acute appendicitis but per operative findings shows mucocele appendix. Literature review is also presented along with this case report

Analysis of risk factors and demographic pattern of carcinoma breast in Pakistani women and literature review

OBJECTIVE: To analyze the risk factors and demographic pattern of carcinoma breast with literature review among patients reporting in surgical department

STUDY DESIGN: A prospective descriptive study

PLACE AND DURATION: This study was conducted in the Department of surgery PESSI Hospital Islamabad from February 2009 to March 2011

SUBJECTS AND METHODS: Sixty two female patients of all ages presenting with the clinical features of carcinoma breast were included. A questionnaire was filled with information gained in OPD and in wards

RESULTS: Majority of patients [n=26, 41.94%] were from 5 decade. Age varies from 35 years to 80 with mean age of 53.22 +10.23. Age of menarche was 12 to 18 years. Most of women [61.30%, n=38] were postmenopausal with mean postmenopausal period 9.61+7.77 years. Mean age at first pregnancy was 21.24+3.32 years and majority of patients were married [n=61, 98.39%], multiparous [n=60, 96.77%], lactated [n=59, 95.16%], had no family history [n=60, 96.77%] or use of oral contraceptives [n=58, 93.54%]

Duration of symptoms ranged from two months to three years [Mean duration 07.67 + 02.91 months]

Painless lump [n=48, 77.41%], lump with ulceration [n=16, 25.80%], nipple discharge [n=12, 19.35%] and weight loss [n=8, 12.90%] are the commonest presentations among patients

CONCLUSION: Low risk factors are commonly observed in contrast to high risk factors which are rarely observed among our patients in this study and after national literature review. It is concluded that different demographic factors responsible for low or high risk in breast cancer mentioned in literature should be re evaluated in our country

Recurrent lumbar hernia

Lumber hernias are not very common and needs meticulous assessment and treatment plan to avoid recurrence. Recurrence is commonly seen in treated lumber hernia because of lack of experience and inadequate preoperative assessment of treating surgeon. A case of recurrent lumber previously treated improperly, was successfully treated at second attempt with mesh repair and iliac crest fixation

Malignant mesothelioma: a dilemma

Malignant peritoneal mesothelioma is a rare tumour of peritoneal cavity, difficult to diagnose pre-operatively

Radical resection is the preferred treatment whereas the cytoreductive surgery along with hyperthermic intraoperative or early postoperative intraperitoneal chemotherapy reported good results. The role of radiotherapy or chemotherapy alone or in combination is limited to the palliative treatment. We are presenting a case of peritoneal mesothelioma treated with cytoreductive surgery along with hyperthermic intraoperative intraperitoneal chemotherapy with a better outcome

Is there any change in the pattern of clinical staging of ca breast at time of reporting in OPD during last two decade

OBJECTIVE: To evaluate the pattern of clinical staging of carcinoma breast among patients at the time of reporting in surgical department and to analyze any change in pattern of presentation in last two decades

STUDY DESIGN: It was a prospective analytic study conducted in the Department of Surgery, Punjab Employees Social Security Hospital, Islamabad from March 2009 to February 2011

SUBJECTS AND METHODS: Sixty two female patients of all ages presenting with the diagnosis of carcinoma breast were included. Clinical staging was assessed through clinical examination and investigations followed by operative findings and histopathology

RESULTS: Majority of patients were from 5 [n=26, 41.94%] and 6 [n=20, 32.26%] decade of life. Duration of symptoms ranged from 2 months to 4 years. Lump was fixed to skin in 46.78% [n=29] and to underlying structures in 29.03% [n=18]. Left breast was involved in 82.25% [n=51]. Regarding tumor size, 46.78% [n=29] were T4, 29.03% [n=18] were T3, lymp nodes were palpable in 66.13% [N1 40.32, N2 22.58%] and distant metastasis was found in 14.52% [n=9] patients. TNM clinical stage was IIB in 38.71% [n=24], IIIB in 33.87% [n=21] and IV in 14.52 % of patients. 33.88% [n=21] patients reported 7-9 months after initial symptoms and 27.42% [n=17] reported after more then one year of symptoms

CONCLUSION: Majority of patient still report to hospital in advanced stage of carcinoma breast and there is no change in this trend during last two decades. Government institutions, electronic and print media and NGOs should take active part in creating awareness against carcinoma breast among females

Phytobezoar: not an uncommon cause of intestinal obstruction

We are presenting a case report of an 18 year old boy brought in emergency with acute intestinal obstruction. An exploratory Laparotomy revealed Guava pulp and seeds making a large phytobezoars as a cause of the acute small intestinal obstruction at mid ileum. Enterotomy was done to remove the bezoars and patient had smooth recovery