Zuckerkandl tubercle: an important landmark in thyroid surgery

To find out the frequency of Zuckerkandl Tubercle [ZT] and the position of recurrent laryngeal nerve with reference to ZK. Cross-sectional observational study. Surgical Ward-3, Jinnah Postgraduate Medical Centre [JPMC], Karachi, from June 2010 to August 2011. Patients having goiter, aged between 12 - 60 years were admitted through OPD and operated after informed written consent. After admission, they underwent surgery. ZT and recurrent laryngeal nerve position i.e. whether medial, lateral or posterior to ZT was identified during surgery. Data was collected on pre-designed proforma and analysed on SPSS version 15 for descriptive statistics. Out of the 84 patients ZT was found in 52 [61.90%] patients. Nineteen patients had grade-I [less than 0.5 cm], 22 [42.3%] had grade-II [0.5 - 1 cm] and 11 [21.1%] had grade-III [more than 1 cm] ZT. During surgery, 33 [63.4%] patients had recurrent laryngeal nerve medial to ZT, 15 [28.8%] patients had lateral and in 4 [7.6%] patients recurrent laryngeal nerve was engraved posteriorly. Zuckerkandl tubercle was found in about 62% cases; recurrent laryngeal nerve was located pre-dominantly medial to ZT

Papillary thyroid carcinoma with tuberculous cervical lymphadenopathy mimicking metastasis

To determine the frequency of tuberculous cervical lymphadenopathy mimicking metastasis from papillary thyroid cancer. Case series. Surgical Unit-I, Ward-3 of Jinnah Postgraduate Medical Centre, Karachi, from March 2005 to March 2010. All patients above 12 years of age of either gender diagnosed on investigations as papillary thyroid cancer [PTC] were included in the study. Ultrasound and fine needle aspiration cytology [FNAC], neck of solitary thyroid nodules [STN] and cervical lymph nodes were done. Total thyroidectomy and excision biopsy of cervical lymph nodes was performed, histopathological results were recorded and patients were managed accordingly. A total of 55 patients had PTC and 25 had cervical lymphadenopathy. Eighteen patients of PTC with cervical lymphadenopathy were diagnosed after investigations as cases of tuberculous cervical lymphadenopathy [TCL] initially considered as metastasis from PTC; 5 patients had metastasis from PTC. Two patients proved to be of reactive hyperplasia which initially showed tuberculous cervical lymphadenopathy on FNAC. So 80% patients of cervical lymphadenopathy with PTC were due to benign disease and 20% had metastasis in lymph node due to PTC. PTC with cervical lymphadenopathy due to co-existent tuberculosis is common. Metastasis from PTC in lymph nodes were less common than tuberculous lymphodenitis in this study. Tuberculosis should be considered before deciding for neck dissection in cases of PTC

Splenic epithelial cyst

Cysts of spleen are rare entities. Congenital splenic cysts are even more uncommon comprising of only 10% of benign non-parasitic cysts. We report a case of 22 years old female who presented with history of 2 years abdominal pain and gradual distension. Ultrasound and computed tomography [CT] both were suggestive of splenic cyst. Laboratory tests show thrombocytopenia with platelets count of 97000 per cubic millimeter and anemia with hemoglobin 8.7 gram per deciliter. Serological tests were negative for parasitic infection. Splenectomy was done and the weight of the spleen was found to be 1.5 kilogram. Histopathological findings were consistent with splenic epithelial cyst. The aetiology, diagnostic modalities and treatment options are discussed in the case report

Single incision laparoscopic cholecystectomy [SILS]

Single incision laparoscopic surgery is a rapidly emerging technique worldwide. The primary goal of the surgery is invisible scar. The objective of this study was to share our initial experience with the rest of world. From October 2009 to April 2010, single port surgery was offered to 30 patients of symptomatic gallstones. The data collected prospectively included age, sex, operative time, complications, pain and reason for conversion. Thirty SILS cholecystectomies were attempted and 27 were completed successfully. The mean operative time was 80 minutes [ranges 50-180min].Three patients needed further ports to complete the operation. All patients were discharged on 2[nd] postoperative day except one who had severe abdominal pain. This patient was discharged on 6[th] postoperative day. Two patients had mild umbilical wound infection, one patient was readmitted for pain management. SILS Cholecystectomy is a safe, feasible and without visible scar surgery in the hands of trained laparoscopic surgeons but needs more studies before it is recommended

Sensitivity and specificity of bi-rads scoring system in carcinoma of breast

To find out the sensitivity and specificity of mammogram according to BI-RADS scoring, in correlation with pathological findings so as to develop protocol for biopsy in patients presenting with clinically palpable breast lump or nipple discharge. Cross sectional study. Jinnah Postgraduate Medical Centre, Surgical unit 1 [Ward 3] Karachi, from July 2007 to June 2008. Female patients who presented with clinically palpable breast lumps or nipple discharge in general surgical OPD were examined and referred for mammography. Ultrasound examination was also done where considered necessary. The final diagnosis regarding the lump or nipple discharge as shown in the mammography was made and patients sent for biopsy [FNAC/ Trucut/ excision biopsy]. The mammographic diagnosis was compared with the histopathological report. Fifty patients were examined of whom 47 clinically suspected patients had confirmation of diagnosis on biopsy while 3 were found negative. Forty one suspected cases on BI-RADS mammogram were true positive that revealed 87.2% sensitivity of BI-RADS mammogram while 6 cases were false negative. All three cases of negative on biopsy were true negative that revealed hundred percent specificity. In this way positive predictive value was also hundred percent with negative predictive value of 33.3%. Overall diagnostic accuracy of mammogram was 88% when compared with histopathological diagnosis. Mammography can be used as an important diagnostic tool for the diagnosis of breast diseases and where there is doubt, diagnosis should be made by means of triple assessment i.e. clinical examination, mammography, and histopathology

Splenectomy in thalassaemia : a personal experience

To assess the efficacy and benefits of splenectomy in Thalassaemic patients with hypersplenism. Prospective study from June 2003 to April 2006. Setting: Patients registered and referred from the Thalassaemia Control Centre of Husaini Blood Bank, underwent splenectomy at Hashmani?s Hospital and Hamdard University Hospital, Karachi. 23 patients of thalassaemia with hypersplenism underwent splenectomy, but only 20 were included as three could not be followed-up. Patients of thalassaemia are registered and treated at the Thalassaemia Control Centre of the Hussaini Blood Bank.Complete data of the patients is kept at the centre. Those with hypersplenism are referred for splenectomy. These cases were followed-up regularly and development of any complications noted. Out of the 20 patients, 13 were males and seven were females, with a mean age of 13.9 years [range 9-19 years]. Nineteen suffered from thalassaemia major and one from thalassaemia intermedia. Two [10%] cases deve-loped haematomas at the incision site while one [5%] had to be re-explored for venous bleeding on the fourth day. None of the post-splenectomized patients developed any serious infection in the follow-up ranging from four months to three years. There is a significant reduction in the number of transfusions required post-operatively. One patient died in the first 24 hours due to non-surgical causes resulting in a mortality rate of 5%. Splenectomy can be carried out relatively safely in patients suffering from thalassaemia with proper pre-operative cardiac and anaesthetic assessment. After splenectomy there was a significant reduction in the number of transfusions required. Those thalassaemic patients who are suffering from hypersplenism can avail the benefits of splenectomy without undue risk

Transhiatal versus ivor-lewis procedure for the treatment of carcinoma oesophagus

To compare the results of Transhiatal and Ivor-Lewis operations for the treatment of Carcinoma Oesophagus. Comparative study conductedfrom 1[st] April 1999 to 30[th] March 2001. Ward 2, Jinnah Postgraduate Medical Centre, Karachi. Thirty patients with resectable carcinoma in the middle and the lower third o[the oesophaglls. The patients were randomly assigned to the two groups. Group-A patients [15] underwent Transhiata/oesophagectomy while Group-B patients [15] were operated by the Ivor-Lewis approach. The data of these patients was collected and analyzed. Student 't' test was applied for statistical significance. Among the thirty cases, 60% were male and 40% female. The average age of the patients was 55 +/- 11.29 years in Group-A and 50.53 +/- 13.83 years in Group-B. In 50% of the patients, the tumour was present in the lower 1/3 of the Oesophagus, in 46.66% in the middle 1/3 and in 3.33% patients both in the middle and the lower 1/3. Histopathology revealed that in 63.33% cases the tumour was squamous cell carcinoma, while in 36.66% it was adenocarcinoma. The mean operative time for Transhiatal Oesophagectomy was 3.75 hours, whereas it was 5.25 hours for the Ivor-Lewis procedure. There was no statistically significant difference in the result of both the procedures. We conclude that Transhiatal and Ivor-Lewis Oesophagectomies are comparable operations for resectable carcinomas of the Oesophagus

experience with primary closure in pilonidal sinus

Variety of procedures adopted for the management of pilonidal sinus attest to the fact that the choice depends on the surgeon. The advantages of successful outcome in primary closure are obvious. This procedure is carried out under general anaesthesia, the hospital stay is minimal and postoperative care restricted to the basics. The problem with procedures carried out as day cases under local anaesthesia is the long and tedious follow-up required postoperatively till the wound heals. Of the 52 cases dealt by primary suture only one [1.92 percent] had recurrence and 2 of the initial 7 in whom suction drain was not kept required change of dressing because of soakage, prior to removal of stitches