Analysis of 105 uninodular goitres.

Data on 105 solitary thyroid nodules, confirmed at surgery to be solitary, is presented. Six (5.7%) were malignant, 4 papillary and 2 follicular. The sensitivity and the specificity of 131I radionuclide thyroid scan (n = 90) were 100% and 24% respectively. Similarly, the sensitivity and specificity of fine needle aspiration cytology (n = 65) was 75% and 100% respectively. In both instances, the "gold standard" was the histopathology of the surgically removed nodule. In order to avoid unnecessary surgery, without missing malignancy, we would recommend the combination of radionuclide thyroid scan and FNAC for investigation of solitary thyroid nodules.

Solitary retroperitoneal angiofollicular lymph node hyperplasia.

The fine needle aspiration cytology (FNAC) and ultrasound radiologic features of a solitary retroperitoneal angiofollicular lymph node hyperplasia (AFLNH), hyaline vascular type are described. Based on a combination of the two, this diagnosis can be suggested in the differential diagnosis of a retroperitoneal mass.

Use of esophagostomy in the management of corrosive esophageal strictures.

Thirty six cases of corrosive esophageal strictures seen over a period of ten years are presented. The primary treatment modalities followed include antegrade dilatation per oral (11 cases), retrograde followed by antegrade dilatation with endless string per oral (12), retrograde followed by antegrade dilatation with endless string through esophagostomy (12), and surgery (1). Per oral dilatation with endless string was not well tolerated by 15 patients due to friction of the string against the posterior 1/3rd of the tongue, and hence compliance was poor. Dilatation through esophagostomy was easy, and patient compliance was good. Furthermore, patients could be trained to do self bougienage easily through the esophagostomy. Esophagostomy closed within 4-6 weeks after successful distal dilatation was achieved.

Comparative study between modified Freyer's prostatectomy, classical Freyer's prostatectomy and Millin's prostatectomy.

Classical Freyer's method was modified in which, prostatic fossa was packed after the enucleation of the gland for hemostatic purpose; and the pack and suprapubic drain were brought out laterally. The pack was removed after 48-72 hours postoperatively and catheter was introduced per urethrum for early closure of suprapubic ostomy. Fifty such cases of Modified Freyer's prostatectomy were compared with cases of classical Freyer's prostatectomy (n = 25) and Millin's prostatectomy (n = 25). The duration of surgery and requirements for perioperative blood transfusion were found to be less with our method.

Spontaneous perforation of the left hepatic duct with acalculous cholecystitis.

Spontaneous rupture of the biliary tree leading to bile peritonitis is rare. We report a boy who developed spontaneous perforation of the left hepatic duct and had acalculous cholecystitis.

Ischemic bowel disease.

Twenty-five cases with ischemic bowel disease seen over a period of 4 years are presented. Of these, 20 cases presented with acute symptoms and five with chronic symptoms. In the majority of patients, the diagnosis was established at operation and on histopathology. Occlusive disease of the superior mesenteric artery was the commonest cause of acute ischemia. Non-occlusive ischemia was not observed in any case. All the patients were treated by resection and anastomosis of the involved bowel. Vascular procedures were not carried out in any. No planned second-look procedures were carried out. Of the 20 acute cases, eight patients died and three developed complications. One chronic case died and there were no other complications in this group. We suggest that ischemic bowel disease should be considered while dealing with cases presenting as acute abdomen or with chronic abdominal pain.