Cervical lymphadenopathy: an audit of 116 cases

Objective: To find out the frequency of different pathologies causing enlarged cervical lymph nodes

Study Design: A Prospective observational study

Place and Duration: Study carried out from 1[st] Jan 2006 to 31[st] Dec 2006 at ENT Department of Khayber Teaching Hospital, Peshawar, Department of Pathology Kabeer Medical College, Peshawar and Department of Histopathology, Combined Military Hospital Peshawar Cantonment

Methodology: The patients presenting with cervical lymph node enlargement for more than one month duration were subjected to Fine Needle Aspiration. A Core Needle or open biopsy was performed when FNAC yielded a non diagnostic aspirate or when a histological confirmation of a malignant tumour was required

Results: A total of 116 patients, aged between 8-72 years with a mean age of 34.64 and male to female ratio of 1.23:1 were studied. Tuberculosis was the commonest cause of lymphadenopathy 36.2% [n=42], followed by metastatic disease 29.3% [n=34], reactive hyperplasia was the third commonest cause with 19.3% [n=22], followed by Lymphoma [both Non Hodgkin's and Hodgkin's] accounting for 13.8% of cases. A single case 0.86% of Kikuchi's or Necrotizing lymphadenitis was also found

Conclusion: Tuberculosis was the underlying cause in younger patients while metastatic disease was more commonly found in elderly patients

Relationship of alloantibody detection with number of blood transfusions

To study the presence of the alloantibodies and their relationship with the number of transfusions. Two hundred subjects undergoing regular blood transfusions with at least 5 pints of blood within last six months were included in the study. Out of 200 patients, 140 [70%] were transfusion depended thalassaemics, 20 [10%] were haemophilics receiving multiple transfusions, 20 [10%] patients were of aplastic anaemia and 20 [10%] patients were with chronic renal failure undergoing haemodialysis. Antibodies were detected in 9/200 [4.5%] subjects. Ninety four patients received 5-50 transfusions, 2.13% developed alloantibodies. Sixty five patients received >50-100 blood transfusions, 6.15% developed alloantibodies. Forty one patients received >100 blood transfusions, 7.31% developed alloantobodies. Frequency of red cell alloantobodies in our transfusion dependent patient population is 4.5%. The risk of developing alloantobodies increased with increasing number of blood transfusion irrespective of underlying disorder.

Deoxypyridinoline [DPD], a marker of bone resorption which predicts osteoporosis

With the improvements in medical facilities, the life expectancy of ladies has crossed fifty years in Pakistan. Because of this, problems related to menopause and senility is increasing. A cross-sectional study was conducted to determine the incidence of osteoporosis in Pakistani postmenopausal women residing at Rawalpindi. This was done by estimation of deoxypyridinoline [DPD], a marker of bone resorption, for its potential for early diagnosis; so that the patients are benefited by early treatment before the disease is severe and crippling. Seventy postmenopausal women having intact ovaries were selected randomly from the general public in the locality. Control group consisted of thirty healthy premenopausal women. The mean urinary DPD level in premenopausal ladies i.e. Controls was [5.8 nmol/mmol of creatinine], while in postmenopausal women the mean DPD level was significantly higher [27.4 nmol / mmol of creatinine]. The very high loser ladies [Urinary DPD level > 30 nmol / mmol of creatinine] were regarded to have osteoporosis. X-ray of the wrist remained a poor diagnostic marker as it was positive in only 15% of postmenopausal subjects. The frequency of osteoporosis was 13.5% in ladies between 50-59 years, while in ladies between 60 - 69 years the frequency was 78% and 100% in ladies over 70 years. These figures are quite alarming

Frequency of growth hormone deficiency in short statured children

To determine the frequency of growth hormone deficiency among short stature children referred for growth hormone evaluation. A cross-sectional survey. The study was conducted in the Department of Chemical Pathology and Endocrinology, Armed Forces Institute of Pathology, Rawalpindi, from June 1999 to July 2000. A total of 293 children were referred for growth hormone evaluation. All the patients underwent thorough clinical evaluation including recording of height, weight, presence of chronic diseases and malnutrition. Twenty children were excluded for various reasons. Screening for GH deficiency was carried out by exercise stimulation test and /or L-dopa stimulation test. The children with GH level < 10 mlU/L on screening tests were provisionally considered to have GH deficiency. These children underwent insulin tolerance test [ITT]. Out of 273 children, 189 were subjected to both exercise and L-dopa stimulation test, while 60 patients underwent only exercise stimulation test. The remaining 24 patients were subjected to L-dopa administration alone because of their physical weakness or inability to perform exercise. Sixty-six patients exhibited GH levels < 10 mlU/L on screening tests. The frequency of GH deficiency was found to be 24.17% on screening. Out of these 66 patients, 54 underwent an ITT, while 12 patients did not report back for the test. Thirty-eight children showed lack of response on ITT, therefore, after ITT, the frequency of GH deficiency was revealed to be 13.9%. GH deficiency is responsible for about 14% cases of short stature in a hospital setting. Screening tests showed a positive predictive value of 70.4% and a false positivity of 6.8%