Quality of life assessment in patients with locally advanced head and neck malignancy after ablative surgery and reconstruction with microvascular free flaps

To assess the improvement in Quality Of Life [QOL] after ablative surgery in locally advanced head and neck malignancies by microvascular free flaps reconstruction. Quasi-experimental. Department of Plastic Surgery, Combined Military Hospital, Rawalpindi, from September 2005 to February 2007 A total of 44 patients with locally advanced stage III and IV malignancy of head and neck were included in the study. All patients were treated with ablative surgery and reconstruction with microvascular free flaps. QOL was assessed by using a scoring questionnaire [including 5 parameters for extra oral cancers including physical and role function, body image, weight loss score and pain donor site morbidity; and an additional 5 parameters for intraoral tumours that included swallowing, speech, drooling of saliva and mouth opening]. A high score indicated a poor QOL. Patients were assessed pre-operatively and then at 2, 4 and 6 months postoperatively. Mean accumulative score and mean individual parameter scores for both extra- and intraoral tumours were significantly improved [p < 0.05]. Microvascular free flap reconstruction after ablative surgery in locally advanced head and neck malignancy had a profound impact on the improvement of QOL. There was an initial deterioration of physical scores postoperatively and postradiotherapy, followed by gradual improvement. By the end of 6 months, it surpassed the pre-operative QOL scores

Clinico-pathological profile and outcome of inhalational burns

To determine clinico-pathological profile and outcome of inhalational burns in a specialized burns treatment unit. Case-series. The Department of Plastic Surgery and Burns Centre Unit, Combined Military Hospital, Kharian Cantonment in March 2005. Patients of inhalational burns were included and evacuated within 30 hours of accident to the specialized burns centre after immediate resuscitation. Total Body Surface Area [TBSA] involved in burns was calculated. Complete blood count and renal profile along with serum albumin and total proteins was obtained. Portable chest radiographs and bronchoscopic examination was conducted. Escarotomies were carried and wounds were covered with split thickess skin grafts. Ventilatory support was used as needed. Comparison of the clinico-pathological profile of surviving and fatal cases was done for significance using t-test. There were 19 patients of inhalational burns, 8 [42%] of whom expired. The mean percentage of TBSA in 11 surviving patients was 50 +/- 10.87 and 70 +/- 15.46 in fatal cases. The mean haemoglobin [Hb] on admission was 15.8 +/- 1.6 g/dL and after fluid resuscitation it became 11.4 +/- 1.5 g/dL. The mean Total Leucocyte Count [TLC] in surviving patients was 9.6 +/- 6.1x10[9]/L and 1.5 +/- 2.3x10[9]/L in fatal cases [p=0.001]. The mean platelet count of surviving patients was 205 +/- 63x10[12]/L while in fatal cases was 58 +/- 48x10[12]/L [p=0.05]. The serum urea levels in surviving patients was 4.3 +/- 2 mmol/L while in fatal cases was 8.6 +/- 0.9 mmol/L [p=0.05]. The serum creatinine levels were 98.2 +/- 16.5 micro mol/L in the survivor group and 249.5 +/- 76 micro mol/L in the mortality group [p=0.05]. The serum total protein in surviving patients was 63 +/- 8 g/dL while in mortality cases it was 57 +/- 7 g/L. Serum albumin in the survivor group was 36.7 +/- 5 g/L and 35 +/- 4 g/L in fatal cases. Significant in Hb, protein and albumin levels. All the expired patients had acute respiratory distress syndrome while acute renal failure with multi-organ failure co-existed in 6 patients. Inhalational burns injury cases multi-system injury with high mortality. Body area involvement, total leucocyte count, platelet count, serum area and serum creatinine are important indicators of survival

Male Pseudohermaphroditism

An unusual case of a 40-year-old infertile male is presented. On examination he had cryptorchidism with other normal secondary sexual characters. Ultrasonography and computerized tomography raised the suspicion of tumour in the right abdominal testis. On exploration, a uterus with cervix, fallopian tubes and abdominal testes were detected. This was confirmed histopathologically. Chromosomal analysis revealed 46XY

Massive splenic hydatid cyst

Hydatid disease can involve any organ of the body and a high suspicion of this disease is justified in endemic regions. A case of massive splenic hydatid cyst with hepatic hydatidosis presented with 5 years history of abdominal distension with discomfort is reported. Clinically she had massive splenomegaly with hepatomegaly. Laboratory and radiological findings were diagnostic of hydatid disease of the liver and spleen. Peroperatively huge [35 x 20 cm] splenic hydatid cyst with two liver cysts was seen. Splenectomy was performed and hepatic lesions were subjected to endocystectomy with capsulorrhaphy

Follicular carcinoma thyroid in pendred syndrome

Pendred syndrome is a rare inherited disorder of bilateral sensorineural deafness with goitre. Presence of follicular carcinoma thyroid makes it even rarer. A case of a young girl is described with the features of Pendred syndrome and euthyroid state. Follicular carcinoma of thyroid was detected on histopathology requiring re-tailoring of the management

Ideal treatment for chronic pilonidal sinus

A hospital-based study was carried out from January 2001 to August 2002 to compare the results of Open excision operation and Karydakis technique for the treatment of pilonidal sinus. In Group A, 23 patients underwent Open excision operation, while in Group B, 22 patients were treated by Karydakis operation. In Group A, the mean hospital stay was 6.74 days, mean healing time and mean period off work were 7.9 weeks and 6.98 weeks respectively. The most common complications after this procedure were sepsis [17.39%] and scar pain [17.39%]. Recurrence occurred in 04 cases [17.39%]. The overall complication rate in this group was 21.74%. On the other hand, in Group B, the mean hospital stay was 3.23 days while, mean period of recovery and mean period off work were 2.95 weeks and 2.68 weeks respectively. Most common postoperative complications were sepsis [13.63%] and wound dehiscence [13.63%], the overall complication rate being 13.64%. Early recurrence occurred in 01 case only [4.5%]. From our study, it is concluded Karydakis technique is superior to Open excision operation in terms of shorter hospital stay and early recovery. Moreover, it is cost-effective procedure with low postoperative morbidity and recurrence rate