Thyroid malignancy in Multinodular goiter; incidence, a retrospective study in southern Punjab

To assess the incidence of malignancy in patients with Multinodular goiter in southern Punjab. A retrospective study. Department of General Surgery, Sheikh Zayed Medical College and Hospital Rahim Yar Khan, from April 2010 to May 2012. All patients were presented in OPD with history of Multinodular goiter on clinical examination or USG neck. FNAC of any dominant nodule or suspicious nodule on USG neck was performed. All patients were operated and total thyroidectomies were done in all patients irrespective of the age. We sent all specimens for histopathological examination and reports were collected from department. The whole information collected was entered in a pre designed proforma. During 2 years period, total 141 patients of thyroid disease were seen in OPD out of which 98 patients have Multinodular goiter. Histopathology of these patients showed 10 malignancies and 88 benign. Most of the patients that turned out to be malignant belong to 41-50 years age group. 7 patients were female and 3 were male. Among the malignancies 50% were papillary, 30% were follicular, and 10% were anaplastic carcinoma and lymphomas each. Multinodular goiter [MNG] is the commonest indication of thyroidectomy in iodine deficient areas of Pakistan. This study concludes that don't consider MNG as a benign disease anymore until proved otherwise

Altered alvarado score; role of caecal gurgling as a new sign in diagnosis of acute appendicitis

Background: Diagnosis of acute appendicitis is mainly clinical and many scoring systems are being used

Objectives: To assess the reliability of caecal gurgling as clinical sign in the diagnosis of acute appendicitis in equivocal cases with Alvarado score of 5-6

Patients and Methods: This descriptive study was conducted in the department of General Surgery, Sheikh Zayed Medical College and Hospital, Rahim Yar Khan, from 1st September 2009 to 31st September 2012. All the patients were presented in OPD and emergency department with history of pain in right lower abdomen of short duration and have no co morbid condition. We divided the patients into three groups on the basis of Alvarado score. Group I with score 1-4, Group II with score 5-6, Group III with score 7 or above. Group II was further subdivided into Ila having no caecal gurgling and IIb having caecal gurgling on clinical examination. We calculated the rate of negative appendicectomies on histopathology in different groups. Data was entered and analyzed in SPSS version 15

Results: A total of the 840 patients were included in the study with age ranges from 12-60 years, out of which 67% were male. 185 patients fall in group I, 180 of which were managed conservatively successfully on oral medicine without admission. In group I only 5 patients needed to be operated and found appendicitis on histopathology. Group II included 286 patients, which was further subdivided into Group Ila [172 patients] having no caecal gurgling on examination and Group Ilb [114 patients] having caecal gurgling on clinical examination. Out of 172 patients of group Ila, 135 were operated and 24 negative appendicectomies were found on histopathology. While all 114 patients of group lib were operated and only 3 appendices were found normal on histopathology. In group III, 369 patients were recruited, all were operated and only 12 appendices were proved normal on histopathology report. So with the addition of caecal gurgling, in group II with equivocal cases having alvarado score 5- 6, there is decrease in rate of negative appedecectomies from nearly 17% reported in literature to 10.8% reported in this study

Conclusion: Appendicitis is the common surgical emergency and diagnosis is mainly clinical. Delay in diagnosis and proper treatment increases morbidity. Altered Alvarado scoring, with addition of caecal gurgling as a clinical sign, is slightly more reliable as compared to the conventional Alvarado scoring system especially in equivocal cases with score of 5-6

Factor responsible for higher complication rate in patient operated for perforated peptic ulcer

Background: Perforation of peptic ulcer is a life-threatening emergency and associated with marked post surgical morbidity

Objective: To enlist the predictors of the postoperative morbidity in surgically treated patients of perforated peptic ulcer

Methods: A cross sectional study was conducted at Surgical Departments of Allied and DHQ Hospital Faisalabad. Clinically and radiologically suggestive but surgically proven, 60 cases of the perforated peptic ulcer were included in the study. Possible predictors were recorded on admission as well as during surgery. Postoperatively, patients were taken care of and followed up for the development of complication till the time of discharge. Depending upon the presence/ absence of the post operative complications, patients were divided into two groups. Data was entered and analyzed by using SPSS version 11

Results: In our study, age ranged from 24-80 years. 26.7 percent of the cases had clinical features of shock at presentation. Smoking was noted in 47 percent of the cases. In 97% of the cases, the size of perforation was less than 1 cm while more than half of the cases had amount of peritoneal spillage more than 1 Litre. The most common complication was wound infection. Most of the patients were discharged home between the 7[th] and 10[th] postoperative days. Age more than 40 and male sex [p-value < 0.147] were not found to be associated with increased risk of development of the post operative complication. Complication rate was found to be quite high for the patients presenting after 72 hours of the development of the pain [p=0.006, OR=9.3]. Other factors which showed significant difference between the two groups for the development of complication included shock at presentation [p-value= 0.032], history of smoking [p-value= 0.002] and the presence of associated medical illness [p-value= 0.01]

Conclusions: Late presentation, history of smoking, presence of shock at the time of presentation and presence of the associated medical illness significantly influence the rate of development of post operative complications