ABSTRACT
Oral Submucous Fibrosis [OSF] is a pre-cancerous condition that has ability to get malignant transformation. The main causative factors of OSF are smoking, betel nut, pan masala, gutka, naswar, chalia etc. The chemicals used in all these cause dysplastic changes into the oral mucosa epithelium and eventually leads to malignant transformation into Oral Squamous Cell Carcinoma [OSCC]. The aim of the present study was to observe the dysplastic changes in buccal mucosa associated with smoking in OSF patients. Forty patients of all age groups and both genders were evaluated as per inclusion and exclusion criteria and written informed consent was taken. The study was done at the Department of Pathology [Histopathology Section], Postgraduate Medical Institute, Lahore. Biopsy specimens from study participants were obtained from Punjab Dental Hospital, Lahore. Punch biopsy was performed under local anesthesia, and the sample size measuring 5mm was taken from the buccal mucosa. Staining with Hematoxylin and eosin [H and E] was done after tissue specimens were fixed and processed. The prepared slides were seen under light microscope to record the dysplastic changes in epithelium. Statistical significance was evaluated by c2 analysis and showed significant association of Age with history of smoking and duration of smoking with the value p=0.001 and p=0.002 respectively. Also the significant association was found between Dysplastic changes in OSF patients with age, history of smoking and duration of smoking [p= 0.05, p=0.00, p=0.03 respectively]. This suggests that patients who are 31-45 years of age with more than 10 years of smoking history showed moderate dysplastic changes than patients age range18-30 with 5 years or less than 10 years of smoking history showed mild dysplastic changes. In local population no such related study has been done so study must be conducted to rule out the dysplastic changes exhibiting in buccal mucosa of OSF patients with smoking history
ABSTRACT
<p><b>BACKGROUND</b>The value of gamma probes in the surgical treatment of secondary hyperparathyroidism (sHPT) was determined. The aim of this study was to enhance the rate of successful total parathyroidectomy in patients with sHPT using intraoperative gamma probe investigations.</p><p><b>METHODS</b>We retrospectively analyzed the clinical data of 48 sHPT patients between May 2007 and September 2011. Preoperative (99)Tc(m)- methoxyisobutyl isonitrile (MIBI) scintigraphy and high-frequency ultrasonography were used for parathyroid localization. Thirty-five patients (group I) underwent conventional neck exploration and open parathyroidectomy. Thirteen patients (group II) underwent gamma probe-guided total parathyroidectomy and parathyroid transplantation. The two groups were compared in terms of the number of parathyroid resections, operative time, and postoperative changes in the blood levels of parathyroid hormone (PTH), calcium, and phosphate.</p><p><b>RESULTS</b>The clinical manifestations, PTH and calcium levels, age distribution, and clinical characteristics did not differ between the two groups. The accuracy of preoperative (99)Tc(m)-MIBI scintigraphy (89.74%) for the diagnosis of hyperparathyroidism did not differ from that of ultrasonography (81.25%). However, the accuracy of (99)Tc(m)-MIBI scintigraphy (66.67%) for localizing hyperfunctioning parathyroids was significantly lower than that of ultrasonography (76.86%). The operation time was significantly longer in group I ((120 ± 25) minutes) than in group II ((90 ± 30) minutes). The accuracy of parathyroid identification was significantly higher in group II (92.59%) than in group I (80.39%). On average, significantly fewer parathyroid specimens were obtained in group I (2.5 ± 0.5) than in group II (3.5 ± 0.5). Compared with group I, group II showed a significant increase (15.4%) in the number of parathyroid resections. The PTH, calcium, and phosphate levels significantly decreased postoperatively in all patients.</p><p><b>CONCLUSIONS</b>Intraoperative gamma probe examination confirmed that the excised specimen was parathyroid tissue and improved the accuracy of parathyroid resection. The parathyroidectomy rate was increased by 15.4% due to the use of these probes. However, the probes did not detect all ectopic parathyroids, and further research is required to clarify the underlying reasons.</p>