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

Frequency of congenital heart diseases in infants of diabetic mothers referred to pediatrics department

To determine the frequency of congenital heart disease in infants of diabetic mothers referred to Pediatrics department. A total of 101 full-term neonates, aged from 0 to 29 days, admitted in the Neonatology unit, Lady Reading Hospital Peshawar - Pakistan, diagnosed clinically and confirmed by echocardiography were included in the study. All the children included in the study were sent to Cardiology Department of the Institute for echocardiography. After Echocardiography report, frequency of normal and congenital heart diseases [CHD] like VSD, ASD, PDA, TGA and PFO among these children was determined. Out of 101 neonates, 67 [66.30%] were males and 34 [33.7%] were female. Majority [n=97, 96.0%] neonates' age ranged from 0-10 days. Maternal history showed that 55 [54.5%] mothers got diabetes during the pregnancy and 46 [45.5%] were having pre-gestational diabetes. The frequency of CHD was 52.5% in infants of diabetic mothers. Following CHDs were found in 53 neonates of diabetic mothers; Patent ductus arteriosus [PDA] in 17 [16.8%] cases, Ventricular septal defect [VSD] in 13 [12.9%], Atrial septal defect [ASD] in 09 [08.9%], Patent foramen ovale [PFO] in 08 [7.9%] and Transposition of the great arteries [TGA] in 6 [5.9%] cases respectively. Frequency of congenital heart disease in IDMs was 52.5%. Careful evaluation and early diagnosis of CHD in this high-risk group are highly indicated and echocardiography is recommended for all infants of diabetic mothers as soon as possible

Percutaneous retrogasserian glycerol rhizolysis in the management of trigeminal neuralgia

To evaluate the outcome and complications of Percutaneous Retrogasserian Glycerol Rhizolysis [PRGR] in intractable trigeminal neuralgia. The patients who were poor risk for anesthesia [e.g. old age] with side effect of medical treatment or with intractable pain despite medical treatment for at least six months underwent PRGR. Forty-one patients were included in the study. They were followed for relief of pain and any complications for at least six months. The mean age of the patients was 59 years with a male to female ratio of 1:1.6. The distribution of pain was most common in V2 territory. The duration of pain was more than one year in 80% of the patients. Prompt pain relief occurred in 34 [83%] patients. Recurrence of pain occurred in 8 [19%]. Six [14%] patients developed Dysesthesia of face. Corneal sensations were affected in five [11%] patients but none developed corneal ulcers. Mastication was affected in two patients and one developed bradycardia, which responded to conservative treatment. None of the patients developed herpes or anesthesia of face. PRGR is an effective procedure in relieving intractable trigeminal neuralgia with few complications, especially in elderly patients and those with intractable pain

is high incidence of skull fracture associated with extradural hematoma in patients with head injury

To determine the correlation of skull fracture with extradural hematoma in head injury patients presenting to a tertiary care hospital in Pakistan. This descriptive study was carried out at Shifa International Hospital, Islamabad from January 2002 to January 2007. All patients who were operated for extradural hematoma during the study period were included in the study. Standard skull X-rays were done and type and location of fractures were noted on X-rays, CT scan and per-operatively. The incidence of skull fracture associated with extradural hematoma in various age groups was noted. The results were analyzed using SPSS version 14.0. A total of 110 patients underwent surgery for extradural hematoma. A linear fracture was demonstrated in 60 patients and a depressed skull fracture in 15 patients. Another 8 patients who did not have radiologically visible fracture were found to have a fracture line per-operatively. Thus, a total of 83 [75%] patients had skull fracture. There was no statistically significant difference in the incidence of skull fracture in various age groups. There is a strong association of skull fracture to extradural hematoma, however, a normal X-ray does not exclude extradural hematoma

Thoracolumbar junction injuries and their management with pedicle screws

To evaluate the use of pedicle screw fixation in earthquake injured thoracolumbar spine. Nineteen patients with posttraumatic instability of lower thoracic or upper lumbar spine were included in the study. White and Panjabi criteria was used to assess spinal instability. All patients underwent open reduction and internal fixation by posterior approach. Pedicles were localized using detailed anatomical landmarks and intraoperative imaging. Local bone was used as bone graft. The neurological status of the patients and any other complications were noted up to one year. There were 19 patients with unstable thoracolumbar junction injuries who were managed with pedicle screws and rods. Females were more affected [F:M ratio was 8.5:1]. Wedge compression was the commonest. None of the patients deteriorated after surgery. There were 20 Frankel improvements in 18 patients [1.11 Frankel on average] with neurological deficit whereas 1 patient in Frankel E remained in the same grade on subsequent follow-ups. There was one patient with wound infection and one patient developed DVT. None of the patients developed bedsores. Pedicle screw fixation is a useful choice for thoracolumbar junction injuries for achieving reduction and stability in both anterior and posterior column injuries, without affecting extra motion segments