Hashimoto's thyroiditis: not uncommon in simple benign goiter. A review of 1102 thyroidectomies for simple benign goiter

Objective: To see the frequency of Hashimotos Thyroiditis [HT] in patients operated with the diagnosis of simple goiter

Study Design: A retrospective multicenter study

Place and duration: From 1[st] January 1999 to 31[st] March 2011 at three tertiary care hospitals

Methodology: All patients with simple benign goiter irrespective of age and sex are included in the study. Patients already diagnosed for hashimotos thyroiditis, recurrent goiter, abnormal thyroid hormone profile, diagnosed congenital thyroid pathology or non availability of postoperative histopathology were excluded from the study. Histopathology of all patients reviewed to see the frequency of hashimotos thyroiditis in patients operated for benign simple goiter

Results: Among a total of 1102 patients, 91.28% [n=1006] were female and the majority were in 5[th] decade [35.48%, n=391] of life. Histopathology review of all patients operated for benign simple goiter showed that 2.81% [n=31] were having Hashimoto's thyroiditis and majority [87.09%, n=27] were female. Hashimoto's thyroiditis were common in patients who was in the 3[rd] decade of life followed by 4[th] decade, i.e. 35.48% [n=11] and 32.26% [n=10] respectively

Conclusion: Hashimotos thyroiditis is not uncommon and due to its varied clinical presentation it should be ruled out in simple benign goiter before surgery

Laparoscopic cholecystectomy in acute gall bladder

To look for the feasibility and results of laparoscopic cholecystectomy in acutely inflamed gall bladder, gangrenous cholecystitis and empyema gall bladder. It was a prospective observational case series. As an institutional policy early laparoscopic cholecystectomy was performed in all the patients with diagnosis of acute cholecystitis. The incidence of gangrenous cholecystitis and empyema gall bladder was noted and laparoscopic intervention was preferred in all these patients. The demographic profile, clinical records, operative details, complications and follow up details were prospectively gathered on a performa. Early laparoscopic cholecystectomy was performed in 142 patients. 103 patients had simple acute cholecystitis, 13 patients had empyema gall bladder and 26 patients had gangrenous cholecystitis. The incidence of comorbids such as diabetes mellitus, hypertension and ischemia heart diseases was 28.1%, 61.5 and 80.75 in patients with simple acute cholecystitis, empyema gall bladder and gangrenous cholecystitis respectively. Male gender was predominating in patients with complicated cholecystitis. The open conversion rate was 3.88% in simple acute cholecystitis, 15.38% in empyema gall bladder and gangrenous cholecystitis combined. There were 2 major complications in patients with simple acute cholecystitis and 2 major complications in patients with gangrenous cholecystitis. There was one mortality in a patient with simple acute cholecystitis. Laparoscopic cholecystectomy is a safe and effective option in acute gall bladder. Based on our experience we recommend an early laparoscopic gall bladder removal, provided expertise and gadgets are available

experience with retrosternal Goiter: analysis of 89 cases

To determine the frequency of retrosternal goiter, clinical presentation and post operative complications among the patients presenting with goiter. It is a prospective, crossectional study conducted at Department of Surgery, Fauji Foundation Hospital, Rawalpindi from January 1997 to December 2008. All patients with goiter were evaluated for retrosternal extension of thyroid, clinical presentation, and post operative complications. Among 978 patients, 89 [9.10%] patients had retrosternal extension of thyroid. Majority of the patients were female [94.51%] and euthyroid [91.02%]. Among all the patients, [39.33%] were in the 5th decade. Retrosternal extension of both lobes was found in 83.15% and one lobe in 16.15% patients. Dysponea was the commonest complaint by all patients, followed by headache [30.33%] and dysphagia [25.84%]. Recurrent laryngeal nerve palsy was seen in 4.49% patients and 3.37% patients developed hypocalcaemia and wound infection after surgery. Retrosternal extension of thyroid is not uncommon. Surgery can be easily done through cervical approach

Urological complications of intrauterine contraceptive device

To elucidate the urological complications of Intrauterine contraceptive device [IUCD]. This study was conducted in Fauji Foundation Hospital Rawalpindi to elucidate. The urological complications of IUCD presenting to Urology department from January 2002 to December 2006. During this period 12 ladies having IUCDs presented with lower urinary tract symptoms [LUTS]. After thorough work up, 6 patients were managed surgically and the remaining 6 were managed conservatively. In all cases the IUCDs were inserted by paramedics. Out of six cases managed surgically, 3 patients had developed complete intravesical migration of device with stone formation. While in two other patients there was partial migration of the IUCD and stone formation over the migrated component of the device. One patient had simultaneously two IUCDs, one in uterus and another in bladder. We successfully performed cystolitholapaxy and retrieved four IUCDs in these patients endoscopically. A large vesical stone and the entombed IUCD in one of our patients were also removed endoscopically. The patient who presented with two IUCDs also got the vesical IUCD removed endoscopically. In remaining six cases, the IUCDs were in proper location and the cause of LUTS in these patients was urinary tract infection. These patients were successfully managed conservatively. Insertion of IUCD necessitates regular follow-up to confirm its correct position. Migration of an IUCD warrants prompt removal, even in asymptomatic patients. Cases presenting with UTI with undisplaced IUCD should be managed with appropriate antimicrobial therapy

Flexible cystoscope: a useful aid to difficult male catheterization

To assess usefulness of flexible cystoscope in difficult male urethral catheterization. Fauji Foundation Hospital and Maryam Memorial Hospital, Rawalpindi during a period of four years. In a consecutive series of thirty patients with acute urinary retention and initial difficulty in urethral catheterization, a flexible cystoscope and a guide wire was used to insert the Foley's catheter. Ten patients [33.3%] presented with acute urinary retention due to benign enlargement of prostate. Five patients [16.6%] required re-catheterization following unsuccessful trial after transurethral resection of prostate. Four patients [13.3%] had carcinoma of prostate. This technique was used five times [16%] to catheterize prior to intravesical instillation of cytotoxic drugs. Two patients [6.6%] had bladder neck distortion due to transitional cell carcinoma of bladder, one [3.3%] had an extravesical haematoma and another one [3.3%] had massive post traumatic clot retention. The procedure was successful in 86.7% of the cases. Difficulty to negotiate the urethra was faced in cases of urethral strictures [6.6%]. Flexible cystoscope is a safe, quick and effective method for difficult urethral catheterization in male patients

Electrocoagulation versus suture-ligation of lymphatics in kidney transplant recipient surgery

To compare electrocoagulation versus suture-ligation of the lymphatics in kidney transplant operation of the recipient in terms of operating time, cost effectiveness, drainage from renal bed and incidence of lymphocele. This prospective comparative study was conducted at the department of Urology and Kidney Transplantation, Hearts International Hospital Rawalpindi during a period of two and a half years [January 2003 to July 2005] by a single surgical team. All patients who underwent kidney transplant during this period and did not fall into exclusion criteria were included in the study. Ninety Cases of End-stage Renal Disease undergoing kidney transplant were randomly divided into two equal groups. Patients in the group A had their lymphatics electrocoagulated and divided in the preparation of external iliac vessels for allograft anastomoses, while the patients in group-B underwent suture-ligation and division of the lymphatics covering the external iliac vessels. The average operating time was reduced in group-A. Also, no suture material was used for this step. Over all anesthesia time was also less. There was no significant difference in the quantities of postoperative drainage from the wound. There was no incidence of lymphocele development in group-A [0%]. While one patient [2.2%] in group-B had a moderate lymphocele which was aspirated and there was no recurrence. Cut off point of the study was six months from the day of surgery. Electro-coagulation and division of lymphatics coursing over the external iliac vessels is an attractive procedure. It saves time, is cost-effective, the postoperative wound drainage is not a problem and the procedure is not associated with increased incidence of lymphocele

Rupture splenic artery aneurysm

We present a case of ruptured splenic artery aneurysm in 18 years old unmarried girl who presented with severe upper abdominal pain and sudden collapse. Ultrasound abdomen showed free fluid and ultrasound guided needle aspiration confirmed haemoperitoneum. On laparotomy, a 3cm saccular aneurysm of the middle of the splenic artery was noted. With prompt and urgent management the patient survived