Yield and safety profile of ultrasound guided fine needle aspiration cytology [FNAC] of lymph nodes

Objective: To determine the re-biopsy rate, positive yield and safety profile of ultrasound guided fine needle aspiration cytology [FNAC] in cervical lymph nodes in terms of its complications and repeat procedures

Study Design: An analytical study

Place and Duration of Study: Department of Vascular and Interventional Radiology, Dow University Hospital, Dow University of Health Sciences, Karachi, from June to December 2013

Methodology: Eighty neck swellings, which were found to be lymph nodes on ultrasound, underwent ultrasound guided FNAC, from outpatients. Lymph nodes which were included in the study were those that were not easily palpable, located near major blood vessels, where patient refused of direct palpation and wanted image guided FNAC, those directly sent by physician for image guided FNAC and where blind biopsy remained inconclusive. Patients who refused on explanation or did not give consent were excluded. Complications and repeat biopsy were noted

Results: This study consisted of 80 cases, of which 51 cases [63.75%] were female and 29 cases [36.25%] were male. Repeat biopsy was required in 1 case [1.6%]. There were no procedure-related complications. A total of 44 cases [55%] revealed evidence suggesting or confirming the existence of tuberculosis. Rest of the others showed other benign lesions, reactive lymphadenopathy and malignancy

Conclusion: Ultrasound guided FNAC is a safe procedure with low re-biopsy rate that aids diagnosis. The predominant cause of cervical lymphadenopathy in this study was tuberculous lymphadenitis

Age and site of colonic neoplastic lesions: implications of screening in south Asia

To evaluate the Age of patients and the site of Colonic Neoplastic Lesions [CNL] and to determine the appropriate screening strategy for Colorectal Carcinoma [CRC] [sigmoidoscopy versus colonoscopy] in our population. This is a cross sectional study. Data of all patients more than 16 years of age who underwent full colonoscopic examination at the Aga Khan University hospital between January 2011 till December 2013 and were diagnosed to have CRC or advanced adenomas [defined as polyp more than 1 cm and/or having villous morphology on histology] was recorded. Lesions found distal to the splenic flexure were characterized as distal lesions and while lesions found between the splenic flexure and the cecum were characterized as proximal lesions. During the study period colonic neoplastic lesions were found in 217 patients; 186 [85.7%] patients had CRC and 31 [14.3%] patients had advanced adenomatous polyps. Mean age was 55.8 +/- 14 years and amongst them 72 [33.2%] patients were less than 50 years of age while 145 [66.8%] were more than 50 years. In 144 [66.4%] patients lesions were located in the distal colon, 65 [30%] had lesions in the proximal colon while in 8 [3.7%] patients the neoplastic lesions were found both in the proximal and distal colon. The predominant symptoms were bleeding per rectum in 39.6% of patients followed by weight loss in 31.8% of patients. Only 3 patients had familial syndromes with multiple polyps. When patients younger than 50 years of age were compared with patients more than 50 years there was no statistically significant difference between the site of neoplastic lesion as well as the presenting symptoms. [p value 0.85]. Colonic Neoplastic Lesions presented at younger age in our study population and one third of the lesions were found in the right sided colon. Hence screening for CNLs should be implied at an earlier age preferably with colonoscopy. More population based data is required to further validate our results

Complications and technical errors of tube thoracostomy and its underwater seal system

To find out the complications and technical errors of tube thoracostomy and its underwater seal system in a tertiary care hospital. Descriptive case series. Department of Thoracic Surgery Jinnah Postgraduate Medical Centre Karachi, from March 2010 to January 2012. All patients above the age of 12 year who were admitted directly or those referred from other centres were included in this study. Indications of chest tube insertion included both traumatic and non traumatic conditions. Data collection included both technical errors as well as complications related to the procedure. There were total of 144 patients managed during study period. This include 102 [70.8%] males and 42 [29.9%] females. The mean age of the patients was 32.2 year. Of total patients, 123 [85.45%] were referred from other hospitals while 21 [14.5%] were admitted directly in the ward. The most common complication related to insertion of chest tube was lung injury, [n=19, 13.19%] which resulted from the use of trocar or due to inadequate separation of the lung from the chest wall. Diaphragm injury occurred in 4 [2.78%] patients. The technical error frequently encountered was kinking of chest tube [n=25, 17.36%], followed by use of small chest tube [n=15, 10.41%]. Tube thoracostomy resulted in number of complications of which lung injury was most common. This occurred mainly due to trocar used for insertion. Kinking of tube was the most common technical error in the series

Radiographic patterns in HIV associated pulmonary tuberculosis

To compare the radiologic patterns in HIV positive patients with pulmonary tuberculosis with non-HIV positive patients of pulmonary tuberculosis. Descriptive study. The study is a carried out in the Department of Medicine at Dow University Hospital from July, 2010 to July, 2011. The admission records of 54 HIV-positive patients were analyzed. A total of 30 patients out of 54 presented with pulmonary symptoms, which were further evaluated by sputum smear for acid-fast bacilli and chest radiographs. These 30 patients were compared with 30 non-HIV, smear positive for acid-fast bacilli patients. Out of 30 HIV seropositive patients, 29 were male and 1 was female with the mean age +/- SD 33.9 +/- 95 years. Sputum staining for acid-fast bacilli was positive in 10 patients [33.3 %]. Frequent radiographic patterns included normal 12[40%] and apical infiltrates 5[16.6%]. Cavitatory lesion was observed in 1 patient. Dominant symptoms were weight loss 29[93.3%] and fever 24[80%]. Out of the 30 non-HIV seropositive pulmonary tuberculosis patients, 20 were male and 10 were female of mean age +/- SD 33.9 +/- 95 years. Sputum staining for acid-fast bacilli was positive in 30 patients [100%]. Frequent radiographic patterns were apical cavitations 12[40%], apical infiltrates 5 [16.6%], bronchopneumonia 6[20%], interstitial infection3 [10%].Dominant symptoms were weight loss 29[93.3%] and fever 24[80%]. Majority of HIV seropositive patients with pulmonary tuberculosis were male. Common radiographic patterns were normal radiographs and apical infiltrates. Atypical radiographic presentation is particularly related in advance stages of immunosuppresion. Cavitatory lesions and pleural effusion were rare findings. Non HIV seropositive pulmonary tuberculosis patients were both male and female. Common radiographic patterns were apical cavitatory lesions, bronchopneumonia, interstitial infiltrations and pleural effusion. This radiographic presentation is particularly related to delayed hypersensitivity reaction