Salivary gland tumours: a tertiary care hospital experience

To study demographic, clinical and histopathological features of salivary gland tumours in a tertiary care hospital. Prospective cross sectional study. This study was carried out in the Department of ENT, Head and Neck surgery, Postgraduate Medical Institute, Lady Reading Hospital Peshawar from June 2010 to May 2014. This prospective cross sectional study of 4 years was carried out in the Department of ENT, Head and Neck surgery, Postgraduate Medical Institute, Lady Reading Hospital Peshawar. All the patients qualifying inclusion criteria were evaluated in terms of detailed history, thorough examination and relevant investigation. After performing required surgery specimen was examined for histopathology. In this study 123 patients were included with mean +/- SD age of 40 +/- 5.1 years [age range 7–76 years]. Males were 81 and females were 42 with male: female ratio of 1.9:1. Most of the patients presented in 4th decade [28.45%, 35]. Lump was the commonest clinical feature lasting for 1-5 years [66.66%, 82]. Among the tumours 77.23% were benign while 22.76% were malignant. Benign tumours were commonly noticed in parotid gland [53.65%]. Pleomorphic adenoma was the commonest benign tumour [65.04%, n-80], affecting parotid gland in 52.03%. Mucoepidermoid carcinoma is the commonest malignant tumour [12.19%] predominantly found in minor salivary gland of palate [6.50%]. Salivary gland tumours predominantly affecting middle aged male population. Benign tumours are the commonly occurring salivary gland tumours. Pleomorphic adenoma is commonly occurring benign tumour affecting predominantly parotid gland while mucoepidermoid carcinoma is the commonest malignant tumour of salivary glands

An audit of tracheostomy at a tertiary care hospital

To determine the indications and complications of tracheostomy in a tertiary care hospital. This descriptive study was conducted at the department of ENT, Head and Neck surgery, Lady Reading Hospital Peshawar from January to December 2010. This study included 160 patients fulfilling inclusion and exclusion criteria. All these patients were properly evaluated. After taking well informed consent tracheostomy was performed in all the patients as emergency or elective procedure depending upon the clinical condition of the patient. The data was collected on a prof or ma and it was analyzed using SPSS version 10. A total of 160 patients underwent tracheostomy who constituting 110 male and 50 female, with male: female ratio of 2.2:1. The age of the patients ranged from 01-75 years with mean age of 37.61 +/- S.D 19.99 years. Tracheostomy was performed in 148 cases [92.5%] as emergency and in 12 cases [7.5%] as elective procedure. The commonest indication for tracheostomy was trauma [65.62%] followed by infection [26.25%]. Elective tracheostomy was performed for inoperable tumours. The early complications were 37.5% while late complications were 7.5%. It is concluded that the common etiology of tracheostomy in our part of the world is airway obstruction due to trauma and complications of tracheostomy can be minimized by improving the postoperative care of tracheostomized patients

frequency of malignancy in nodular goiter - a single center study

To find out the frequency of malignancy in nodular goiters. A total of 204 cases were studied in the department of ENT and Head and Neck surgery, Hayatabad Medical Complex, Peshawar. The duration of this descriptive study was from June 1, 2008 to May 31, 2010. After taking informed consent, a detailed history was obtained. Clinical and laboratory investigations were carried out as an aid to diagnosis and determine the patients' fitness for surgery. Patients with nodular goiters were categorized into two categories i.e., Solitary thyroid nodule and multinodular goiter. Surgically resected thyroid specimens were examined histopathologically. The data was analyzed using SPSS 16.0 for windows to determine the frequency of malignancy in nodular goiter. Ages of the patients ranged from 17 to 84 years with a mean age of 37 +/- 12.48 years. The male to female ratio was 1:3:5. 18.14% cases presented as solitary thyroid nodules [STN] and 81.86% as multinodular goiters [MNG]. Out of the total 83.82% cases were benign and 16.18% cases were malignant. The prevalence of malignancy in multinodular goiter was 14.37% and in the solitary thyroid nodules as 24.32%. Papillary carcinoma was the commonest malignancy followed by follicular carcinoma. The prevalence of cancer is significant in nodular goiters and these malignant tumours are usually of the papillary type. Solitary thyroid nodules have more chances of being malignant than multinodular goiter

Yield of diagnostic rigid bronchoscopy in children

To highlight yield of rigid bronchoscopy in cases of suspected foreign body [FB] tracheobronchial tree [TBT] in children. This is a prospective analytical study of 78 cases, conducted in the E.N.T-Head and Neck Surgery department of Post Graduate Medical Institute [PGMI], Hayatabad Medical Complex Peshawar during six years i.e. from April 2000 to March 2006. All patient underwent rigid bronchoscopy for removal of suspected inhaled foreign body [FB] from tracheobronchial tree. Cases included were of paediatric age group [12 years and below] and of either sex. Out of total 78 cases 42 were male and 36 were female with male to female ratio of 1. 7:1. All patients were of paediatric age group [12 years and below]. The eldest patient was of 12 years and the youngest was two months of age. Most of the patients [47%] were referred from paediatric units of this hospital. Twelve cases [15%] were referred from other hospitals. Nineteen [24%] cases were referred through casualty while another 10 patients [13%] came directly through OPD. Twenty three patients [29%] were Afghani nationals. All 78[100%] cases underwent rigid bronchoscopy on the basis of suspicion of inhalation of FB. In [13%] cases history of inhalation of FB was obtained retrospectively after successful procedure. In the remaining 77% cases it was the failure to respond to medical treatment that lead to referral for the procedure. In 62% cases FB was recovered on bronchoscopy while in 38% cases no FB was found. Other pathologies were recorded in 18% cases while 20% cases bronchoscopy yielded no FR or other pathology: Right main bronchus was the most common site where FB was lodged [42% cases] followed by left main bronchus [28% cases], smaller bronchiole on right side [18% cases] and smaller bronchiole on left side [12% cases]. No FB was found in trachea or subglottic area. 75 patients [96%] had complete removal of FBs with first intervention. Only 3 [4%] cases a second attempt was required. One [1.3%] mortality occurred in the study. Over all complication rate recorded was 7%. It was included that index of suspicion should be kept very high in all cases presenting with respiratory symptoms not responding to medical treatment or those with recurrence of symptoms. All such patients should undergo rigid bronchoscopy

Complications of conventional tracheostomy

To study the various complications associated with conventional tracheostomy. Material and It is a descriptive study, conducted in the department of E.N.T and Head and Neck Surgery P.G.M.I Hayat Abad Medical Complex Peshawar from 1st June 2003 to 31 May 2004. Fifty patients of both genders and all age groups on whom tracheostomy was performed were included in the study. All patients were assessed pre-operatively. They were observed for complications during the procedure, in the recovery room and in the ward. They were followed for 3 months after the procedure. Complications arising during that period were recorded on the proforma. Fifty patients, comprising of thirty-eight male and twelve female patients, underwent tracheostomy, with male to female ratio of 3:1 and average age of 35 years. Out of 50 patients, 70% [n=35] underwent emergency tracheostomy and only 30% [n=15] had elective procedure. Immediate complications included primary haemorrhage [6%] and apnoea [2%]. Intermediate complications were surgical emphysema [4%], stomal infection [4%], tube obstruction [4%] and dislodgement of tube [2%]. Late complications seen at 3 months follow up included difficult decannulation, tracheal stenosis and hypertrophired scar [2% each]. Mortality due to procedure itself was nil. Tracheostomy is a commonly performed life saving operation. It is associated with certain complications that are more in cases of emergency procedures and in children. However mortality associated with the procedure is largely due to the primary disease and not due to the procedure itself