Diagnostic accuracy of fine needle aspiration cytology in the diagnosis of malignant solitary thyroid nodule

Objective: Objective of this study was to evaluate diagnostic accuracy of fine needle aspiration cytology in diagnosing solitary thyroid nodule keeping histopathology as gold standard

Study Design: Cross sectional study

Place and Duration of Study: Combined Military Hospital, Multan from 27 Aug 2010 to 26 Feb 2011

Material and Methods: Three hundred and forty nine patients were included in the study through non-probability convenient sampling. In outdoor visit, after taking detailed history, general physical examination was done. Patients fulfilling the inclusion criteria were admitted in ward. The procedure of FNA was explained in detail to the patient and Informed consent was taken

Results: Out of 349 patients, all underwent FNAC whereas 321 underwent surgery. FNAC showed 113/321 [35.20%] patients to have malignancy, however after surgery 109 / 321 [32.08%] patients were found to have malignancy on histopathology. Eighteen patients were diagnosed as papillary CA on FNAC all confirmed on histopathology. Follicular carcinoma was diagnosed in 35 patients on FNAC. However, only 32 were actually found to have the disease on histopathology

Conclusion: Role of FNAC is quite conclusive for the diagnosing malignancy and proposing surgery in most of cases of cold nodules due to its potential for malignancy. FNAC can be relied upon due to good sensitivity [92.56%], specificity [95.81%], Accuracy [94.49%], Positive predictive value 93.83% and Negative predictive value of 94.93%

Comparison of efficacy of polypropylene with chromic catgut suture in stitching paediatric facial lacerations

Objective: The objective of this study was to compare 5/0 polypropylene suture with 5/0 chromic catgut in small clean pediatric facial laceration repair in terms of cosmetic outcome

Study Design: Randomized controlled trial

Place and Duration of Study: Combined Military Hospital, Rawalpindi from 26[th] May 2012 to 25[th] Nov 2012

Patients and Methods: A total of 300 patients of both gender under 12 years of age, with small clean facial lacerations were selected and divided in two equal groups using random number tables. All the patients underwent suturing in minor operating theater of trauma centre CMH Rawalpindi as day care cases, under local anesthesia and aseptic measures. In group 1, polypropylene 5/0 suture was used where as in group 2 chromic catgut 5/0 was used for suturing

Aseptic dressing was applied. All patients were reviewed on 5[th] day [for stitch removal in polypropylene group] and 3 months post-operatively to establish cosmetic outcome which was determined by scar visual analog score both by parents of the child and consultant surgeon

Results: The mean VAS [visual analog score] as observed by Consultant surgeon was 79.14 and 78.63 for polypropylene and chromic catgut groups respectively

The mean VAS observed by the parents of the child for respective groups was 76.67 and 76.03. The significance value was 0.961 for parental VAS and 0.988 for surgeons VAS depicting insignificant difference in both suture groups

Conclusion: There is no long-term difference in cosmetic outcomes of both the sutures in the repair of facial lacerations in the pediatric population. No difference in complication rate of wound was observed. In addition, the parents of the children in absorbable suture group expressed satisfaction over prevention of psychological trauma of stitch removal

Normal anatomical variations of renal artery pedicle: a review of 100 renal angiograms of healthy proposed renal donors

Objectives: To present variations in renal arterial anatomy. To document renal artery number, source, course and patterns

Study Design: Observational / descriptive study

Place and Duration of Study: This study was conducted at the Angiography suite, Radiology Department, Sindh Institute of Urology and Transplantation from May 2011 to Oct 2011

Materials and Methods: A total of 100 healthy adultswho underwent renal angiography for renal donor assessment in living related transplant programwere included. Both male and female with age group between 20-50 years having normal clotting profile, renal function and normal morphology on IVP were fully evaluated by predesigned performa including number, source, course and pattern of renal artery

Results: Out of 100 cases of healthy renal donors, 66 were male and 34 were female. Fifty four percent were in 20 - 30 years of age group while 30% between 31 - 40 years and 16% in between 41 - 50 years. In 56% right renal artery found to be higher than left, where as 40% had both the arteries at same level. Right renal artery longer in 52% and left in 46%. Only 2% had same length of both renal arteries. Regarding the number, 66% had bilateral single, 24% unilateral double, 6% bilateral double and only 4 % unilateral triple. Out of 100 renal donors with 200 renal pedicles [each donor having 2kidneys], single hilar artery seen in 75% in single hilum with inferior polar aortic branch in 14% and single hilar with suspicious polar aortic branch seen in only 4%. Double hilar arteries seen in 1% and hilar with extrahilar branch in 4%. Triple vessels found in 4% cases

Conclusion: The study shows that normal variation of vascular anatomy of renal pedicle is clinically very important to perform urological interventional procedures and transplantation. This study providesinformation concerning renal artery anatomy not only for interventional radiologists but also to urologic surgeon

Reach the leech: an unusual cause of hematuria

Leeches are found in fresh water as well as moist marshy tropical areas. Orifical Hirudiniasis is the presence of leech in natural human orifices. Leech have been reported in nose, oropharynx, vagina, rectum and bladder but leech per urethra is very rare. We report a case of leech in urethra causing hematuria and bleeding disorder in the form of epistaxis and impaired clotting profile after use of stream water for ablution. The case was diagnosed after a prolonged diagnostic dilemma. A single alive leech was recovered from the urethra after ten days with the help of forceps. The hematuria and epistaxis gradually improved over next 48 hours and the patient became asymptomatic. Natives of leech infested areas should be advised to avoid swimming in fresh water and desist from drinking and using stream water without inspection for leeches

Mortality and mortality in hospitalized preterm neonates

Objective: to determine pattern of morbidity and mortality in hospitalized preterm neonates

Material and Methods: all preterm babies presenting to the Neonatology Ward of Services Hospital except those with major congenital malformations were selected for the study. A predesigned proforma was used to record clinical data on presentation. This included physical characteristics like gestational age, weight, gender, presenting complaints. The proforma was updated on daily basis to make note of any clinical problems or complications arising during the course of hospital stay till outcome [discharge, leave against medical advice or death]. Note was made of respiratory complications, infections, metabolic, neurological and hematological problems and complications related to feeding and weight gain. The data was subsequently computed and analyzed using SPSS [Statistical Package for the Social Sciences] version 14 by the authors

Results: three hundred and one preterm babies ranging in gestational age from 22 to 36 weeks [mean 31.2 SD+/- 2.9] were included in the study. The overall mortality was 53.8%. Survival was significantly better in more mature, larger babies and those who could be started successfully on enteral feed. Most deaths were encountered within the first 7 days of admission. The chances of survival increased significantly with longer duration of admission. There was no significant difference in mortality between males and females. Respiratory distress was the commonest admitting complaint seen in 46.5% cases. During hospital stay respiratory problems [requiring varying degree of ventilator support] were seen most frequently, followed by metabolic complications and infection related morbidity

Conclusion: prematurity is associated with significant mortality and morbidity seen in hospitalized neonates

Hepatic artery pseudoaneurysm mimicking Mirizzi syndrome

Acute cholecystitis leading to development of a pseudoaneurysm of the hepatic artery is a very rare complication; however, a pseudoaneurysm resulting in gallbladder neck compression with dilatation of intrahepatic duct giving a Mirizzi syndrome like presentation is virtually unreported to the best of our knowledge. We report a case of a 60 years male patient who presented in emergency department with right hypochondrial pain and mild jaundice. Initial diagnosis of hepatic artery pseudoaneurysm causing compression of neck of gallbladder and common bile duct was made on ultrasound examination. This was resulting in gross distention of gallbladder and mild dilatation of intrahepatic ducts. Findings were confirmed on CT scan. Later successful selective transcatheter arterial embolization of the aneurysm and percutaneous cholecystostomy were performed

Diffusion weighted MR imaging of ring enhancing brain lesions

To evaluate the role of diffusion weighted imaging in differentiating the cause of ring enhancing brain lesions. Analytical, descriptive study. Department of Radiology, The Aga Khan University Hospital, Karachi, from March 2007 to July 2011. Diffusion weighted imaging [DWI] was performed on 37 patients having ring enhancing lesions on their post-contrast brain MRI scans. These lesions were characterized into neoplastic and abscess cavity on the basis of diffusion restriction. Correlation of all these findings was done with histopathology obtained in all these patients. Sensitivity, specificity, positive and negative predictive values and diagnostic accuracy of DWI were calculated. Comparisons of mean ADC values of abscess and neoplastic lesions were also done using t-test. DWI had a sensitivity of 94.73%, specificity of 94.44%, positive predictive value of 94.73%, and negative predictive value of 94.44% and diagnostic accuracy of 94.5% in differentiating brain abscess from neoplastic brain lesions. Mean ADC value in central cavity and wall of neoplastic lesions and brain abscesses were calculated with significant p-value of 0.001 and 0.025 respectively. Diffusion weighted imaging is non-invasive method with high sensitivity and specificity which can help in differentiation of ring enhancing neoplastic lesions and brain abscesses. This modality should be read in conjunction with conventional imaging

Mortality in meconium aspiration syndrome in hospitalized babies

To determine the outcome of the babies in terms of mortality with the diagnosis of Meconium Aspiration Syndrome [MAS]. An observational study. The Neonatal Unit of Services Institute of Medical Sciences and Services Hospital, Lahore, Pakistan, from February 2008 to January 2009. All the babies admitted to the neonatal unit during the period of study with the diagnosis of MAS were included. At admission, demographic, maternal, antenatal and natal data were recorded on a specific form. The progress of the baby, including need for ventilation, medications, complications and outcome were also followed and documented. One hundred and nine babies admitted with MAS, 32% died. Most of the babies [n=73] were admitted from our obstetrical unit and the rest through the emergency department. Majority [60 of 109] were admitted within the 1st hour of life. Most [14 of 15] of the newborns requiring intubation within 1st hour of life, died. Forty four babies were ventilated and 35 of these babies succumbed. Of ventilated babies, 11 developed pneumothoraces. Seventy two percent [13 out of 18] of expired babies stayed for less than 24 hours. Mortality rate for MAS was higher in the study group as compared to international figures. It was especially high in babies requiring mechanical ventilation in 1st hour of life or with co-existing severe hypoxic ischemic encephalopathy

Gastro esophageal reflux: an over investigated entity in neonates and infants

To determine the outcome of clinically suspected gastro esophageal reflux in neonates and Infants. To find a protocol for evaluation of these patients in order to reduce unnecessary radiation to neonates and infants. Fifty three neonates and infants of up to 1 year of age with clinical suspicion of gastro esophageal reflux [GER] were referred for Upper gastro intestinal barium studies. This retrospective descriptive case study was carried out over a period of one year starting from October, 2006 to September, 2007. Positive cases were followed for another one year to see the final outcome. The neonate and infants of upto one year of age, referred from Neonatal intensive care unit [NICU], Paediatric ward and Out Patient Department [OPD] were included in this study. Out of 53 cases 32 were positive for G.E.R and no reflux could be identified in rest of the patients. Out of these positive cases only 4 had massive or severe G.E.R. These patients were prescribed conservative and medical treatment and were advised to follow up in the O.P.D where on subsequent follow ups the medical treatment was stopped as there were no further complaints These patients showed normal weight gain on subsequent O.P.D visits. Other positive cases only had mild to moderate G.E.R and they were managed conservatively. These patients showed normal weight gain on subsequent O.P.D visits with complete resolution of symptoms. Regurgitation or gastro esophageal reflux is a common finding in the first 3 months of life [especially in preterm infants] and usually resolves by 6-12 months of age and should not be over investigated