Retrosternal goitre, presentation and treatment outcome

To assess the clinical presentation, surgical out come and complications of retrosternal goitre [RSG]. A descriptive retrospective study. Departments of Ear Nose Throat and Head and Neck Surgery, Fatima Hospital Baqai Medical University and Civil Hospital Dow University of Health Sciences Karachi, between January 2002 to March 2008. Twenty seven patients of both gender and different ages of retrosternal goitre who under went for thyroidectomy between January 2002 to March 2008 were studied regarding their clinical presentation, and surgical outcome. Only two [7.4%] of our patients were presented with acute air way obstruction. Six [22.2%] patients were complained of dsypnoea only in supine posture, dysphagia and hoarseness were noticed in 3[11.1%] and 1 [3.7%] patients respectively while fifteen [51.5%] were asymptomatic apart from the obvious neck swelling. Total thyroidectomy was performed in twenty two [81.4%] cases and lobectomy with isthemectomy was done in five [18.1%] patients. CT scan was done in seven [25.9%] cases. Majority of our cases i.e. twenty five [92.6%] were benign while malignancy was noted in only two [7.4%] cases. Complications noted was haematoma formation in one [3.7%], recurrent laryngeal nerve injury in four [14.8%], hypoparathyroidism [transient] was recorded in three [11.1%] patients, and wound infection was observed in two [7.4%] patients. There was no mortality pre and post-operatively and no case of permanent hypoparathyroidism was noted where as only one patient had permanent unilateral recurrent laryngeal nerve injury. Retrosternal goitre is often asymptomatic and thyroidectomy is the treatment of choice with very low mortality and morbidity

Causes of unilateral proptosis and its management

To evaluate the common ENT diseases causing proptosis. A retrospective analysis. Department of ENT and Head and Neck Surgery Civil Hospital and Jinnah Postgraduate Medical Centre Karachi [JPMC] during September 1995 to September 1998. This study is based on 25 patients admitted in the ENT dept. of Civil Hospital and JPMC Karachi during the period of three years. RESULTS: Out of25 cases 15 were female and 10 were males of 13 to 62 years of ages carrying different pat hologies e.g 8 cases of fungal sinusitis, 6 of nasal polyps, 2 of inverted papilloma, 2 cases of carcinoma maxilla, 3 of carcinoma ethmoid sinus, 2 of angio fibroma, one case of mucocele forontal sinus and one patient of T.B granuloma of maxillary sinus. All 25 patients treated surgically via different approaches like lateral rhinotomy, Jansen Horgan ethmoidectomy and Weber Furgusson approach. Malignant cases also received radio, and chemotherapy, while patients of fungal sinusitis kept on antifungal treatment orally in post operative period. Proptosis caused by sinonasal pathologies once diagnosed must be treated promptly to get the best results. Radiations should be avoided if possible to prevent the loss of vision

Unilateral nasal obstruction caused by sino-nasal neoplastic lesions

To report pattern of unilateral nasal obstruction caused by sino-nasal neoplasms seen in two teaching hospitals in Sindh, Pakistan. A case series. Ear, Nose and Throat [ENT] departments of Jinnah Postgraduate Medical Centre, Karachi and People's Medical College, Nawabshah between June 1995 to June 1998. This study included 51 patients who presented with unilateral nasal obstruction persistantly for more than eight weeks. A proforma was designed to note the complaints, pinpoint the cause and look at the outcome of the treatment and prognosis. Thus, a detailed history of patients was undertaken through clinical examination, laboratory investigations e.g. blood profile, urine analysis, radiological [common and special] imaging, biopsy and histopathology. Neoplastic lesions of the nose and paranasal sinuses were found in 51 patients. This included 16 [31.37%] females and 35 [68.62%] males with an average age of 37 years. Benign lesions were 19 [37.25%] and 32 [62.75%] were malignant including single case of schwanoma, two cases of squamous papilloma and three patients with fibrous dysplasia while inverted papilloma was seen in six and nasopharyngeal angiofibroma in seven patients. Commonest malignant lesion was squamous cell carcinoma seen in 30 [58.82%] patients. Maxillary sinus was involved in 30 cases and 2 of them were arising from the ethmoid sinus and nasal cavity, and were found to be adenocarcinoma. For benign lesions, wide surgical approach was adopted and except one case of inverted papilloma which reccurred, rest were cured completely. Radical and oncologically sound surgical resection combined with radiation therapy remained the treatment of choice for all the malignant lesions. Local recurrence was seen in two cases. Only one patient died after 8 months due to distant metastasis. Two patients were lost to follow up after 25 months. Neoplastic lesions especially the benign tumors, promptly treated via wide surgical approach, mostly cure the lesion with negligible complication or no recurrence. Malignant lesions of the nose and sinuses are very often diagnosed in advanced T-stages [intracranial or intraorbital extentions] due to non-specific symptoms and have a poor overall prognosis even in the advances in surgical techniques, radiation therapy and new chemotherapeutic agents

Surgical management of juvenile nasopharyngeal angiofibroma, with and without pre-operative embolization. A comparative analysis

To compare the outcome of surgical excision of juvenile nasopharyngeal fibroma [JNF] with and without pre-operative embolization. A descriptive study. Conducted at departments of Otolaryngology of Peoples Medical College, Nawabshah and Jinnah Post Graduate Medical Centre Karachi between Jan: 1997 to Dec:1999. 23 cases with high clinical and radiological [C.T scan] indices of suspicion of nasopharyngeal angiofibroma were included in this study. Patients were divided into two groups [A and B]. Group A comprising of 10 patients who underwent pre-operative embolization. Group B comprising of 13 patients underwent surgery without preoperative embolization. 1. To compare pros and cons between surgical procedures with and without pre-operative embolizaion. 2. To compare the chances of recurrence after excision of JNF with and without embolization. Group A indicated 1- Significant reduced blood loss [average 200cc]. 2-Recurrence - 3 cases. 3- facial numbness - 1 case. 4- Total cost incurred Rs: 15000. Group B 1- Average blood loss of 2000cc. 2- Recurrence-nil. Surgical excision of INF with pre-operative embolization has an advantage of much reduced blood loss during surgery but the rate of recurrence is almost nil in patients who underwent excision of JNF without pre-operative embolisation