audit of laparotomies; carried out in combined military hospital Panno Aqil over three years period

To make an audit of laparotomies carried out at Combined Military Hospital Pano Aqil over a three year period. Cross sectional, retrospective study. Study was carried out at surgical department of combined military hospital Panno Aqil over a period of three years from Jan 2009 to Dec 2011. Patients with significant intra-abdominal pathology presenting as acute abdomen and who underwent laparotomy were included in study. Patients were either electively admitted via outpatient department or through Accident and Emergency [A and E] department. Patient charts and records were used to collect data. All 174 patients underwent laparotomy. In [27.6%] cases, intestinal perforation was the underlying cause; gynaecological pathology was found in [21.2%] patients. In 19.5% cases blunt and penetrating abdominal trauma was the cause of acute abdomen. Acute intestinal obstruction was found in [21.3%], tumors were found in [7.9%] and miscellaneous causes were identified in [2.3%] cases. Laparotomies carried out at Combined Military Hospital Pano Aqil fulfilled the evidence based medicine criteria

Diagnostic accuracy of fine needle aspiration cytology in hepatic tumours

To determine the diagnostic accuracy of fine-needle aspiration cytology [FNAC] in liver masses to isolate malignant from benign tumours and hepatocellular carcinoma [HCC] from metastatic tumours. Cross-sectional, observational. Department of Histopathology, Combined Military Hospital, Peshawar, from June 2004 to June 2005. All the patients with liver masses confirmed by ultrasonography, irrespective of age and gender, were included. Patients with inflammatory lesions were excluded from the study. Selected patients underwent fine-needle aspiration under ultrasound guidance followed by needle biopsy. The cytological slides were stained by haematoxylin and eosin [H and E] stain, while Papanicolaous stain was employed in selective cases. Needle biopsy fragments were fixed in formalin followed by paraffin embedding and staining with H and E stain. Sensitivity and specificity of FNAC in the diagnosis of liver masses was determined using histological diagnosis on liver biopsy as gold standard. There were one hundred subjects. The mean age at presentation was 55 +/- 12 years with male to female ratio of 1.7:1. Cytological diagnosis in 19 cases was benign/non-neoplastic and 81 was malignant. Out of the latter, 49 [60.49%] were HCC and 32 [39.51%] were metastatic tumours on cytology. The overall sensitivity, specificity and accuracy of FNAC in the diagnosis of malignant lesions was 95.2%, 100% and 96% respectively using histological diagnosis on liver biopsy as gold standard. Sensitivity of FNAC to differentiate HCC from metastatic tumours in liver was 96% while specificity was 100% having a diagnostic accuracy of 97.5%. The discrepancy in cyto-histological comparison was mainly seen in well-differentiated and poorly-differentiated HCCs. FNAC of the liver masses is a simple, safe, accurate, economical screening test without significant morbidity that can be used to identify the vast majority of hepatic neoplasms of primary or metastatic nature with high sensitivity, specificity and diagnostic accuracy

Microbial keratitis

To find out the incidence of microbial keratitis in patients with red eyes. randomized prospective study. 07 months ranging from 1st Jun 2001 to 31st Dec 2001. Eye Department, Military Hospital, Rawalpindi. Out of 857 patients with red eye 32 cases were found to have Microbial Keratitis [3%]. Preventive aspects of ocular infection should be taught to the people, like, proper washing of eyes, wearing of protective glasses. Patients coming with ophthalmic problems, i.e., red eye, photophobia, irritation and watering to the general practitioner should be referred as soon as possible to the ophthalmology department

Fine needle aspiration biopsy of soft tissue tumours

To determine the usefulness, limitations and diagnostic accuracy of fine needle aspiration biopsy [FNAB] in soft tissue tumours. Design: Cross-sectional analytical [comparative] study. Place and Duration of Study: Department of Histopathology, Armed Forces Institute of Pathology, Rawalpindi. Materials and A total of 78 soft tissue tumours were subjected to FNAB from May 2000 to April 2002. Adequate aspirate was obtained in 69 patients. The smears were stained with Haematoxylin and Eosin [H and E] and May-Grunwald-Giemsa [MGG] stains. FNAB smears were put into three categories i.e. benign, borderline or malignant. A definite diagnosis was also given where possible. Tissue biopsies were received in 38 of these patients. Routine H and E staining was done in each case alongwith special stains and immunohistochemistry where required. Out of 69 tumours, 30 were categorised as benign, 9 as intermediate and 30 as malignant. Lipomas were the most common benign tumour while small round blue cell tumours constituting 7 cases [23%] were the commonest malignancy. FNAB-histological correlation showed all tumours reported as benign on FNAB to be confirmed as such. There was only one false positive diagnosis on FNAB. All cases placed in intermediate category were found to be malignant on histopathology. Considering intermediate cases alternatively as benign and malignant revealed sensitivity of 80.6% and 100%, specificity of 85.7% and 85.7% and accuracy of 81.6% and 97.4% respectively. Majority of soft tissue tumours can be categorized on FNAB with high degree of accuracy. The tumours placed in intermediate category should be subjected to biopsy or excision as it is more likely that they turn out to be malignant