Adherence to post colorectal cancer surveillance colonoscopy guidelines at a tertiary care center / Adesão às diretrizes de colonoscopia para rastreamento após câncer colorretal em um centro de atendimento terciário

Abstract Background: Surveillance colonoscopy 1 year after resection of colorectal cancer is recommended by all major societies, including National Comprehensive Cancer Network and United States Multi Society Task Force. Study objectives: Our study assesses adherence to post colorectal cancer resection surveillance colonoscopy guidelines at a large tertiary care center and aims to identify reasons for non-adherence. Methods: A retrospective study was conducted for patients who underwent curative resection for colorectal cancer between January 2016 and June 2017. Adherence to surveillance colonoscopy for non-obstructed or partially obstructed colon and rectal cancers was defined as performance of colonoscopy 11-14 months and 11-15 months after surgery, respectively. Results: A total of 80 patients were identified. Mean age was 66 ± 13 years and 58% (n = 46) were males. 60% (n = 48) had colon cancer and 40% (n = 32) had rectal cancer. 69% (n = 24) of patients with colon cancer and 42% (n = 8) of patients with rectal cancer adhered to surveillance colonoscopy guidelines and the mean time to colonoscopy was 315 ± 44 days and 369 ± 103 days, respectively. The most commonly identified reasons for non-adherence to surveillance colonoscopy included metastases (10.9%) and patients' refusal to undergo surveillance (6.5%). Conclusion: Overall, post colorectal cancer resection to follow up surveillance is inadequate. There is a need to identify barriers to surveillance post colorectal cancer resection and address them.

Resumo Introdução: A colonoscopia de rastreamento um ano após a ressecção do câncer colorretal é recomendada por todas as principais sociedades, incluindo a National Comprehensive Cancer Network e a Multi Society Task Force dos Estados Unidos. Objetivos do estudo: Avaliar a adesão às diretrizes de colonoscopia de rastreamento após ressecção de câncer colorretal em um grande centro de atendimento terciário e identificar razões para a não adesão. Métodos: Um estudo retrospectivo foi realizado em pacientes submetidos a ressecção curativa de câncer colorretal entre janeiro de 2016 a junho de 2017. Adesão à colonoscopia de rastreamento em cânceres de cólon e reto não obstruídos ou parcialmente obstruídos foi definida como a realização do procedimento entre 11 a 14 meses e 11 a 15 meses após a cirurgia, respectivamente. Resultados: Um total de 80 pacientes foram identificados. A média de idade foi de 66 ± 13 anos; 58% (n = 46) eram do sexo masculino, 60% (n = 48) tinham câncer de cólon e 40% (n = 32) tinham câncer de reto. Aderência às diretrizes de colonoscopia de rastreamento foi observada em 69% (n = 24) dos pacientes com câncer de cólon e 42% (n = 8) dos pacientes com câncer retal; o tempo médio até a realização da colonoscopia foi de 315 ± 44 dias e 369 ± 103 dias, respectivamente. Os motivos mais frequentemente identificados para a não adesão à colonoscopia de rastreamento incluíram metástases (10,9%) e recusa dos pacientes (6,5%). Conclusão: De forma geral, o rastreamento após a resecção de câncer colorretal é inadequado. É necessário identificar barreiras ao rastreamento após a ressecção do câncer colorretal e abordá-las.

Salivary duct carcinoma of the parotid gland: report of two cases in females

Salivary duct carcinoma is a rare tumor, commonly involving parotid gland. It typically affects middle aged to elderly males. The tumor has an aggressive behaviour and is notorious for early metastasis, high rate of local recurrence, and high mortality. Treatment is mainly surgical but other modalities are also used. We are reporting 2 cases in females who had different presentation, course of disease, treatment, and prognosis

Diagnostic accuracy of leukocytosis in prediction of acute appendicitis

An analytical study was conducted to find out the diagnostic accuracy of leukocytosis in predicting acute appendicitis in patients undergoing emergency appendicectomy. The degree of inflammation of the resected specimens was grossly assessed and graded into acute inflammation, acute inflammation with complications [such as gangrene, perforation, abscess] and un-inflamed appendix. The operative findings were correlated with leukocyte counts using 2 x 2 table. Out of 233 appendicectomies, with exclusion of the negative appendicectomies [17.59%, n = 41], there were 67.38% patients [n = 157] with elevated leukocyte count. The overall sensitivity, specificity, positive predictive value and negative predictive value of elevated leukocyte counts for inflamed appendix were 91.81%, 43.55%, 81.77% and 65.85% respectively

Validity of early parathyroid hormone assay as a diagnostic tool for sub-total thyroidectomy related hypocalcaemia

To determine the validity of early [one hour postoperatively] parathyroid hormone [PTH] assay [[2] 10 pg/ml], keeping gold standard as the serum ionic calcium level, for predicting sub-total thyroidectomy-related hypocalcaemia and to calculate the sensitivity and specificity of latent signs of tetany. Cross-sectional validation study. Department of General Surgery, Pakistan Institute of Medical Sciences, Islamabad from August 2008 to August 2010. Patients undergoing sub-total thyroidectomy were included by convenience sampling. PTH assay was performed 1 hour post sub-total thyroidectomy. Serum calcium levels were performed at 24 and 48 hours, 5th day and 2 weeks after surgery. Cases that developed hypocalcaemia were followed-up for a period of 6 months with monthly calcium level estimation to identify cases of permanent hypocalcaemia. Symptoms and signs of hypocalcaemia manifesting in our patients were recorded. Data was analyzed through SPSS version 10. 2 x 2 tables were used to calculate sensitivity and specificity of PTH in detecting post-thyroidectomy hypocalcaemia. Out of a total of 110 patients included in the study, 16.36% [n=18] developed hypocalcaemia including 1.81% [n=2] cases of permanent hypoparathyroidism. The sensitivity of one hour postoperative PTH assay as a predictive tool for post-thyroidectomy related hypocalcaemia was 94.4% while its specificity was 83.6% with 53% positive predictive value and 98.7% negative predictive value. One hour post sub-total thyroidectomy PTH assay can be helpful in predicting post sub-total thyroidectomy hypocalcaemia. Moreover, it can be useful in safe discharge of day-care thyroidectomy patients

Surgical presentation and outcome of parotid gland tumours

To assess the clinical presentation and outcome of surgical management of various parotid gland disorders requiring parotidectomy. Case series. Department of General Surgery, Pakistan Institute of Medical Sciences [PIMS], Islamabad, from January 2003 to December 2010. Patients presenting in surgical OPD with parotid gland disorders requiring parotidectomy were included. Data were obtained through the Hospital Management Information System [HMIS] and patient charts. The sociodemographic profile of the patient, presenting features among patients, benign versus malignant nature of the disease, FNAC reports, type of surgical procedure instituted, complications encountered and histology reports of the surgical specimens were all recorded on a proforma. The data were subjected to statistical analysis with SPSS version 15. Out of 126 patients, 62 [49%] were males and 64 [51%] females with mean age of 41 +/- 12.6 years. All had presented with a lump usually painless. One hundred and fourteen [90.47%] patients had benign pathology while 9.52% [n = 12] had malignanciy. Superficial parotidectomy was carried out in 79.36% [n = 100] patients, total parotidectomy in 19% [n = 24] and extended total parotidectomy was performed in 2 cases [with mucoepidermoid carcinoma]. The most common post-operative complication was greater auricular nerve paresis [n = 19; 15%] followed by facial nerve transient paresis [n = 10; 8%]. There was no in-hospital mortality. Parotid gland lumps commonly affect relatively young individuals of either gender. Most of the patients have benign pathology. Superficial parotidectomy is the most commonly offered surgical procedure. Parotid surgeries are safely performed in general surgery units with low morbidity and no mortality

Alvarado scoring system in prediction of acute appendicitis

To evaluate the diagnostic accuracy of Alvarado score for the prediction of acute appendicitis. Analytical study. This study was carried out in the Department of Surgery, Pakistan Institute of Medical Sciences [PIMS], Islamabad, during the period from January 15, 2009 to July 15, 2010. The study included all adult patients of either gender who presented with clinical findings suggestive of acute appendicitis, who were assigned Alvarado score of < 4 pre-operatively and subsequently underwent emergency appendicectomy with histological examination of the resected specimens. Based on the Alvarado score, the patients were stratified into two groups. i.e. Group I [with a score of > 7] and Group II [with a score of 5-7]. Alvarado score was compared with the histopathology. The data was subjected to statistical analysis to measure the objective. The overall sensitivity, specificity, positive predictive value and negative predictive value of Alvarado score for acute appendicitis were 66%, 81%, 96%, 29% respectively. The sensitivity was higher though not significant, for males with a score over 7 than females with similar scores [97% vs. 92%]. However, for scores less than 7, sensitivity among males was significantly higher than females with similar scores [79% vs. 61%; p < 0.05]. The presence of a high Alvarado score in adult males is highly predictive of acute appendicitis, however, in women of child bearing age other causes of similar clinical presentation lead to a low diagnostic accuracy of the score

Mesenteric lipoma leading to small gut strangulation and short gut syndrome

A rare case of mesenteric lipoma was presented to us as acute abdomen. His abdominal x-ray showed dilated small gut. Ultrasonography of abdomen revealed dilated small gut loops and minimal amount of free fluid in the peritoneal cavity. On exploration, most of the small gut was gangrenous and tightly twisted twice around its mesentery that contained a lump which was confirmed as lipoma on histopathology