ABSTRACT
Salivary duct carcinoma is a rare tumor, commonly involving parotid gland. It typically affects middle aged to elderly males. The tumor has an aggressive behaviour and is notorious for early metastasis, high rate of local recurrence, and high mortality. Treatment is mainly surgical but other modalities are also used. We are reporting 2 cases in females who had different presentation, course of disease, treatment, and prognosis
ABSTRACT
An analytical study was conducted to find out the diagnostic accuracy of leukocytosis in predicting acute appendicitis in patients undergoing emergency appendicectomy. The degree of inflammation of the resected specimens was grossly assessed and graded into acute inflammation, acute inflammation with complications [such as gangrene, perforation, abscess] and un-inflamed appendix. The operative findings were correlated with leukocyte counts using 2 x 2 table. Out of 233 appendicectomies, with exclusion of the negative appendicectomies [17.59%, n = 41], there were 67.38% patients [n = 157] with elevated leukocyte count. The overall sensitivity, specificity, positive predictive value and negative predictive value of elevated leukocyte counts for inflamed appendix were 91.81%, 43.55%, 81.77% and 65.85% respectively
ABSTRACT
To determine the validity of early [one hour postoperatively] parathyroid hormone [PTH] assay [[2] 10 pg/ml], keeping gold standard as the serum ionic calcium level, for predicting sub-total thyroidectomy-related hypocalcaemia and to calculate the sensitivity and specificity of latent signs of tetany. Cross-sectional validation study. Department of General Surgery, Pakistan Institute of Medical Sciences, Islamabad from August 2008 to August 2010. Patients undergoing sub-total thyroidectomy were included by convenience sampling. PTH assay was performed 1 hour post sub-total thyroidectomy. Serum calcium levels were performed at 24 and 48 hours, 5th day and 2 weeks after surgery. Cases that developed hypocalcaemia were followed-up for a period of 6 months with monthly calcium level estimation to identify cases of permanent hypocalcaemia. Symptoms and signs of hypocalcaemia manifesting in our patients were recorded. Data was analyzed through SPSS version 10. 2 x 2 tables were used to calculate sensitivity and specificity of PTH in detecting post-thyroidectomy hypocalcaemia. Out of a total of 110 patients included in the study, 16.36% [n=18] developed hypocalcaemia including 1.81% [n=2] cases of permanent hypoparathyroidism. The sensitivity of one hour postoperative PTH assay as a predictive tool for post-thyroidectomy related hypocalcaemia was 94.4% while its specificity was 83.6% with 53% positive predictive value and 98.7% negative predictive value. One hour post sub-total thyroidectomy PTH assay can be helpful in predicting post sub-total thyroidectomy hypocalcaemia. Moreover, it can be useful in safe discharge of day-care thyroidectomy patients
ABSTRACT
To assess the clinical presentation and outcome of surgical management of various parotid gland disorders requiring parotidectomy. Case series. Department of General Surgery, Pakistan Institute of Medical Sciences [PIMS], Islamabad, from January 2003 to December 2010. Patients presenting in surgical OPD with parotid gland disorders requiring parotidectomy were included. Data were obtained through the Hospital Management Information System [HMIS] and patient charts. The sociodemographic profile of the patient, presenting features among patients, benign versus malignant nature of the disease, FNAC reports, type of surgical procedure instituted, complications encountered and histology reports of the surgical specimens were all recorded on a proforma. The data were subjected to statistical analysis with SPSS version 15. Out of 126 patients, 62 [49%] were males and 64 [51%] females with mean age of 41 +/- 12.6 years. All had presented with a lump usually painless. One hundred and fourteen [90.47%] patients had benign pathology while 9.52% [n = 12] had malignanciy. Superficial parotidectomy was carried out in 79.36% [n = 100] patients, total parotidectomy in 19% [n = 24] and extended total parotidectomy was performed in 2 cases [with mucoepidermoid carcinoma]. The most common post-operative complication was greater auricular nerve paresis [n = 19; 15%] followed by facial nerve transient paresis [n = 10; 8%]. There was no in-hospital mortality. Parotid gland lumps commonly affect relatively young individuals of either gender. Most of the patients have benign pathology. Superficial parotidectomy is the most commonly offered surgical procedure. Parotid surgeries are safely performed in general surgery units with low morbidity and no mortality
ABSTRACT
To evaluate the diagnostic accuracy of Alvarado score for the prediction of acute appendicitis. Analytical study. This study was carried out in the Department of Surgery, Pakistan Institute of Medical Sciences [PIMS], Islamabad, during the period from January 15, 2009 to July 15, 2010. The study included all adult patients of either gender who presented with clinical findings suggestive of acute appendicitis, who were assigned Alvarado score of < 4 pre-operatively and subsequently underwent emergency appendicectomy with histological examination of the resected specimens. Based on the Alvarado score, the patients were stratified into two groups. i.e. Group I [with a score of > 7] and Group II [with a score of 5-7]. Alvarado score was compared with the histopathology. The data was subjected to statistical analysis to measure the objective. The overall sensitivity, specificity, positive predictive value and negative predictive value of Alvarado score for acute appendicitis were 66%, 81%, 96%, 29% respectively. The sensitivity was higher though not significant, for males with a score over 7 than females with similar scores [97% vs. 92%]. However, for scores less than 7, sensitivity among males was significantly higher than females with similar scores [79% vs. 61%; p < 0.05]. The presence of a high Alvarado score in adult males is highly predictive of acute appendicitis, however, in women of child bearing age other causes of similar clinical presentation lead to a low diagnostic accuracy of the score
Subject(s)
Humans , Male , Female , Appendectomy , Sensitivity and Specificity , Predictive Value of Tests , Acute DiseaseABSTRACT
A rare case of mesenteric lipoma was presented to us as acute abdomen. His abdominal x-ray showed dilated small gut. Ultrasonography of abdomen revealed dilated small gut loops and minimal amount of free fluid in the peritoneal cavity. On exploration, most of the small gut was gangrenous and tightly twisted twice around its mesentery that contained a lump which was confirmed as lipoma on histopathology