Frequency of thyroid carcinoma in solitary thyroid nodule

Objective: To determine the frequency of Thyroid Cancer in solitary nodules of thyroid

Study design: A Retrospective descriptive study

Place and duration: The study was conducted from 1[st] January, 2000 to 31[st] May, 2010 at SOMH [Fauji Foundation Hospital] Karachi and from 1[st] July, 2010 to 31[st] December, 2013 at Al-Tibri Medical College and Hospital, Isra University, Karachi Campus

Methodology: One hundred and ninety consecutive cases of solitary thyroid nodule presented and operated were included in the study. Patients with multi-nodular goiters were not included in the study. Hemi thyroidectomy was done and if histopathology examination revealed carcinoma, then total thyroidectomy was followed. Results for frequency and percentages were calculated and analysed

Results: Out of Total 190 Cases, 61.58% were females and 38.42% were males. Important presenting symptoms were dysphagia [15.26%], palpitations [14.21%], rapid increase in size [13.68%], apart from the nodule [100%] in thyroid gland. Most of the cases were in 4[th] decade [35.26%], followed by 3[rd] decade [22.63%] of life. Most of the nodules were benign [91.57%] which included adenoma colloid goiter [42.94%] follicular adenoma [36.81%], simple cysts [18.40%]. Malignant nodules were 8.42%, which included papillary carcinoma [75%], follicular carcinoma [18.75%] and medullary carcinoma [6.25%]. No case of anaplastic carcinoma was found

Conclusion: Solitary thyroid nodules are mostly benign and malignant nodules are mostly well differentiated Carcinomas

Complication of open transvesical prostatectomy vs. TURP: a comparative study

To assess the outcome, complications and frequency of re-operation of BPH in Transversical Prostatectomy and TURP, a ten years single centre study. A retrospective comparative study. This study was conducted at the Department of Surgery and Allied, SOM Fauji foundation Hospital, Karachi, Pakistan from January 2001 to May 2010. All cases which underwent Open Transversical Prostatectomy or TURP from January 2001 to May 2010 were reviewed. Total of 360 cases were included, out of which 250 were done by open method and 110 by TURP. Outcome, complications and frequency of re-operation of both the techniques were noted. Data entered into SPSS v.15 and analyzed statistically. Age ranged from 48 to 77 years with a mean age of 57 +/- 6 years. Hospital stay and catheter removal times were longer in open surgery. Symptom score improvement of 6 points noted in TURP group while 10 points in open surgery group. Four point five percent cases of TURP while 2.8% cases of open surgery needed transfusion. TUR Syndrome was seen in 1.8% of TURP, while no case of open surgery. Stricture urethra developed in 3.6% cases of TURP, while in 0.4% case of open surgery. Urinary Incontinence was seen in 2.7% cases of TURP while nil in open surgery. Re-operation to relieve obstruction needed in 11.8% cases of TUR, while only 1.2% cases of open surgery needed re-operation. There is no statistically significant difference in complications between TURP and open surgery methods, whereas outcome of operation in terms of symptom score improvement was better in open surgery group and no need of re-operation. Disadvantages of open surgery included longer hospital stay and catheter removal time and a scar

Endoscopic Findings of Patients Reporting With Upper Gastrointestinal Symptoms - A Study of 1493 Cases

OBJECTIVE: Endoscopic findings of patients reporting with upper gastrointestinal symptoms

STUDY DESIGN: A retrospective observational study

PLACE AND DURATION: Shaukat Omar Memorial Fauji Foundation Hospital, Karachi and Khan Diagnostic Laboratories, Malir Karachi from January 2001 to May 2010

METHODS: All the consecutive cases that underwent upper gastrointestinal endoscopic examination during January 2001 to May 2010 were included in the study. The computerised data of these cases was retrieved from hospital record. The cases were thoroughly reviewed regarding their history, examination, investigations and findings of the endoscopy. Patients with known gall bladder and pancreatic diseases and advanced malignancies were excluded. Results were compiled and statistically analysed using SPSS v.16

RESULTS: A total of 1493 patient were included. Male to female ratio was 1.4:1. Mean age was 44.38+13.52 years. The common indications were dyspepsia, dysphagia and haemtemesis. Four hundred and thirteen [27.7%] endoscopies were normal. The common pathological findings were Oesophagitis 25%, duodenal ulcer 12.9%, Gastritis 11.7%, gastric ulcer 8.4%, esophageal malignancies 4.5%, gastric malignancies 4.3% others i.e. less common findings [oesophageal web, oesophageal stricture, oesophageal varices, oesphageal candidiasis, achalasia etc] were 5.5%

CONCLUSION: Upper GI endoscopy is an important diagnostic tool for patients of upper GI symptoms to differentiate pathological from non-ulcer dyspepsia. Upper GI endoscopy is recommended in all cases of dyspepsia to evaluate the actual pathology

impact of renal lower pole radiographic anatomy on the clearance of stone fragments after extracorporeal shock wave lithotripsy

1. To determine the frequency of clearance of stone fragments after extracorporeal shock wave lithotripsy [ESWL] for isolated lower pole renal calculi. 2. To compare the average Lower Infundibular diameter and lower infundibulo-pelvic angle [L-IPA] between patients with residual stone fragments and those who become stone free after extracorporeal lithotripsy [ESWL] for isolated lower pole renal calculi. Descriptive Study. This study was conducted at Department of Urology, Liaquat National Postgraduate Medical Centre, Karachi from June 2006 to June 2010. One Hundred patients of either sex, aged > 14 years with isolated lower pole calculi [LPC] of <20mm undergoing ESWL were included in the study, while patients with lower pole calculi > 20mm, multiple renal calculi, congenitally distorted pelvi-calyceal anatomy, with concomitant Ureteric calculi, with decreased urine output due to renal insufficiency, with Hydronephrosis, with previous pyelo-uretral surgery, who required ancillary procedures e.g. Ureteroscopy, DJ Stent insertion were excluded from the study. The confirmation of stone in lower pole and LPC anatomy [width of the infundibulum and lower infundibulo-pelvic angle] were viewed on the IVU. The Infundibular width was measured as the narrowest point of the infundibulum. The L-IPA was determined in two axes, the ureteropelvic axis and the infundibulo-pelvic axis. Frequency of clearance of stone fragments after ESWL for lower pole renal calculi was 82%. Average L-IPA was significantly higher in those who become stone free after ESWL than patients with residual stone fragments [79.34 +/- 8.33 vs. 64.56 +/- 5.53, p<0.001]. Average Lower Infundibular diameter was slightly higher in stone free patients after ESWL but not statistically significant [5.02 +/- 0.76 vs. 4.89 +/- 0.78, p=0.631]. Successful ESWL is sensitive to lower pole anatomical variables especially lower Infundibulo-pelvic angle and preferably first line treatment in patient with a lower pole stone has L-IPA >80 degrees and lower infundibular diameter of >5mm

Veress needle versus direct trocar insertion techniques for inducing pneumoperitoneum in laparoscopic procedures

To compare the safety and complications of veress needle [VN] versus direct trocar insertion [DTI] techniques in laparoscopic procedures. Comparative study. The study was conducted at three different hospitals in Karachi from October 2005 to May 2011. A total of 1050 consecutive laparoscopic surgeries were done during the study period. Female to male ratio was 2.5:1. In 73% of the cases direct trocar placement was done while in 27% pneumoperitoneum was achieved with Veress needle. Variables noted included technique, complications, and duration of surgery. Data was analyzed statistically using SPSS version 16. Female to male ratio was 2.5:1.Complications were more in direct trocar insertion method. Overall total complications were 3.4%. One percent in group I [VN technique] and 4% in group II [DTI technique] had complications [p=0.017]. No visceral injuries were noted in either group, but pre-peritoneal insufflations found in 2 patients [0.25%] in group II. Late complications were more in group II. This include wound infection [1.5%], late wound bleeding [0.9%], port site hernia formation [0.9%] and chronic sinus formation [0.38%].All these were statistically insignificant except wound infection [p 0.036]. Veress needle method is as safe as direct trocar insertion method in expert hands

Frequency of anxiety in patients reporting for pre-anaesthesia assessment

To study the frequency of anxiety in patients who reported for pre-anaesthesia assessment pre-operatively in Combined Military Hospital [CMH] Malir Cantt and to establish any association of anxiety with demographic characteristics. A cross-sectional study. The study was performed in the Deptts of Psychiatry and Anaesthesiology, CMH, Malir Cantt, from October 2007 to March 2008. One hundred consecutive patients who reported for pre-anaesthesia prior to planned surgeries were included in the study. Inclusion and exclusion criteria were setup. A questionnaire in Urdu language based on Beck Anxiety Inventory was filled up by each patient. Results were summed and statistically analyzed using SPSS 11.0. A total of 100 patients took part in the study ranging from 18 years to 60 years of age. Twenty nine [29%] were males and 71 [71%] were females. Fifty five [55%] were up to 30 years of age and forty five [45%] above 30 years of age. Forty two percent had no anxiety while 58% had varying grades of anxiety; 35% had mild, 17% moderate and 6% had severe anxiety. The frequency of anxiety in males was 48% as compared to 62% in females [P>0.118]. Moreover 40% of patients up to 30 years of age had anxiety as compared to 80% in patients above 30 years of age [P<0.001]. Anxiety was a common problem in patients who were assessed pre-operatively. during pre-anaesthesia. Association of anxiety with gender was insignificant while there was a significant association of anxiety with different age groups