Comparative study of ultrasound guided fine needle aspiration cytology with open/laparoscopic biopsy for diagnosis of carcinoma gallbladder

To determine the accuracy of fine Needle Aspiration Cytology [FNAC] in cases of gallbladder mass. Comparative Study. Surgical Units of Mayo Hospital, Lahore and Lahore General Hospital, Lahore in collaboration with the Department of Radiology, Sir Ganga Ram Hospital, Lahore and Department of Pathology of PGMI, Lahore, from September 2006 to September 2007. Ultrasound guided fine needle aspiration cytology was done in all cases and histopathological findings were confirmed with open/laparoscopic biopsies. The results of these two modalities were compared. Fifty cases with mean age 60.71 +/- 11.073 years presented with mass gallbladder underwent FNAC. Smears showed adenocarcinoma 23, undifferentiated carcinoma in 7, dysplasia and suspicion of malignancy in 5, hemorrhagic background without malignant cells in 12 and inflammatory cells with no malignancy in 3 cases. Results compared with open/laparoscopic biopsy showed a sensitivity, specificity and Positive Predictive Value [PPV] of 72.91%, 100% and 100% respectively. Ultrasound guided FNAC is a safe and less invasive diagnostic modality for diagnosing carcinoma gall bladder preventing the patient to undergo major surgery and helps in better quality of life

Transhiatal esophageal surgery for malignancy - A 7-year experience at a tertiary care hospital

The aim of this study was to determine the outcomes of transhiatal esophagectomy for dysphagia for esophageal malignancy in terms of short and long-term morbidity and mortality and to determine the survival series. Case series study. South and West Surgical Ward, Mayo Hospital, Lahore, from January 2001 to December 2007. All patients referred electively or admitted through OPD presenting with features of progressive dysphagia due to malignancy were included in the study. The patients were investigated for site of stricture and extent of growth into the surrounding structures. All underwent transhiatal esophagectomy and gastric tube or colon was used as the conduit to restore continuity. Patients with squamous cell variety were referred to oncology department for chemoradiotherapy postoperatively. Morbidity and in-hospital mortality were recorded. A total of 42 patients were operated electively for malignant stricture esophagus through transhiatal approach. Site of lesion were 5 [11.9%] upper, 13 [31%] middle and 24 [58%] at lower end of esophagus. The TNM staging were stage I, IIa, IIb, III and IV in zero [0], 5 [11%], 10 [22%], 24 [57.8%] and 3 [7.1%] respectively. Mean operating time was 154 minutes and average blood loss of 371 ml. Postoperative complications included pneumothorax 16.7%, pulmonary complication [16.7%], anastomotic leakage [9.5%], wound infection [3.4%], recurrent laryngeal nerve injury [4.8%] and stricture formation [4.8%]. Only 3 [7.1%] 30-day in-hospital mortality was recorded. Transhiatal esophagectomy is the surgical treatment of choice for resection of carcinoma esophagus specifically at the lower and mid-esophageal levels. The frequency of complications is lower as compared to transthoracic approach and the early stage of presentation can lead to high 5-year survival ratios