Efficacy of urinalysis in screening patients undergoing CT KUB for suspected urolithiasis

Objective: To determine the role of urinalysis in patients undergoing CT KUB [kidney, ureter, bladder] for acute renal pain

Study Design: Descriptive cross sectional validation study

Place and Duration of Study: Study was conducted at PAF hospital Islamabad, from Aug 2014 to Sep 2015

Material and Methods: A total of 93 patients coming to the radiology department of Pakistan Air Force [PAF] hospital for assessment of acute flank pain underwent CT KUB [Kidneys, ureter and bladder] and urine routine examination [RE]. Urinalysis was considered abnormal if it contained pus cells greater than five per high field or red blood cells, or both. Result of CT KUB was compared with urinalysis to find out if the latter could be used to predict presence or absence of urolithiasis. Frequency of abnormal urinalysis was calculated for site and size of calculus detected on CT KUB for selection for CT while those with normal urinalysis could be evaluated by ultrasound only

Results: Urinalysis was identified as an invalid indicator for renal tract calculi in patients with acute flank pain. Abnormal Urine RE was mostly associated with lower tract urinary calculi and with smaller calculi than larger ones

Conclusion: Urinalysis was identified as an invalid indicator for urolithiaisis in patients having acute renal pain. In patient with urolithiasis, abnormal urinalysis was more frequently seen when the calculus was smaller and moreover was impacted in the lower urinary tract

Adult intussusception. An overlooked diagnosis in the emergency department

To study the appropriate method of diagnosis and management in adult intussusception [AI] focusing on the clinical manifestations, diagnostic tools, and management of this rare disease. This retrospective study reviewed and analyzed the demographic data, clinical features, diagnosis, management, and pathology reports of all adult patients [18 years of age and older] with a diagnosis of intussusception admitted to Sohag University Hospital, Sohag, Egypt, and Najran Armed Forces Hospital, Najran, Kingdom of Saudi Arabia [KSA] from January 2004 to August 2012. From 2004-2012, 14 patients with AI were diagnosed and treated. Ages ranged from 22-63 years. Ten patients [71.4%] were males. Thirteen patients [92.9%] presented with abdominal pain. All patients were diagnosed after a CT scan, and confirmed at laparotomy. The lead point was found in all, except for 2 patients. Ileo-ileal and jejuno-jejunal intussusceptions represented most of our cases [64.3%], followed by ileocolic [28.5%], and colocolic [7.1%]. The most common causes were Peutz-Jeghers polyps [5 cases], submucosal lipoma [2], and malignancy [2]. Surgery was the treatment option in all except one patient. Postoperative complications occurred in 3 cases [21.4%]. One patient died 28 days postoperatively due to septic shock and multiorgan failure. Owing to its rarity, AI needs a high index of suspicion especially in patients attending ERs with recurrent abdominal pain. A CT scan is of prime importance in the diagnosis, and surgical treatment is the preferred method of management

Choroidal metastasis from renal cell carcinoma presenting with cataract

We report a case of rare involvement of the eye with choroidal metastasis from renal cell carcinoma presenting 08 years after the primary tumor was removed. The patient initially presented with cataract most probably induced by the tumor. After cataract extraction, tumor was detected when it induced vitreous involvement and retinal detachment. Enucleation was performed and an extraocular mass was also excised. Histopathology confirmed the diagnosis of metastasis from renal cell carcinoma in the ocular tumor, extraocular mass and the vitreous

Cytohistopathological correlation of C3 and C4 breast lesions

To conduct an audit of smears in cytological categories C3 and C4 of fine-needle aspirates from breast lesions in comparison with histopathological diagnoses. Comparative, cross-sectional study. Department of Histopathology, Armed Forces Institute of Pathology [AFIP], Rawalpindi from January to December 2002. Out of all patients referred to AFIP, Rawalpindi for aspiration of breast masses, those adjudged C3 and C4 were chosen for this study. History, clinical details and mammographic findings were noted. Aspirated smears were stained with haematoxylin and eosin as well as a Romanovsky dye. On excision or incision biopsy of these lesions, the cytological findings were compared with those on paraffin-embedded histological sections. The total number of patients in these two categories was 54. Surgical specimens of 3 cases were found inadequate for assessment. Of the remaining 51 cases, 13 were categorised C3 and 38 C4. Sensitivity of 92%, specificity of 83% and accuracy of 90% were attained. Positive and negative predictive values were 95% and 77% respectively. Categories C3 and C4 are areas where the cytopathologist is in doubt as to the benign or malignant nature of a breast mass. High sensitivity, positive predictive value and accuracy, being the hallmarks of a good screening procedure, underscore the validity of the technique

Typing and grading of cytological category C5 breast lesions

To determine the tumour type, cytological grade and nuclear grade on fine-needle aspiration smears in cytological category C5 breast lesions and compare them with histopathological findings. Cross-sectional, cohort. Department of Histopathology, Armed Forces Institute of Pathology [AFIP], Rawalpindi from January to December 2002. Out of all patients referred to AFIP, Rawalpindi for fine-needle aspiration of breast masses, those adjudged C5 [malignant] were chosen for this study. History, clinical details and mammographic findings were noted. Aspirated smears were examined and an attempt was made to ascertain tumour type, cytological grade and nuclear grade. On excision of these lesions, the cytological findings were compared with those on paraffin-embedded histological sections. A total of 71 patients were included in this study. Of these, 64 [90.14%] were cytologically diagnosed as ductal carcinoma, 4 [5.63%] lobular carcinoma, 2 [2.82%] mucinous carcinoma and 1 [1.41%] as medullary carcinoma. Seventy [98.60%] tumours were correctly typed on aspiration smears. Sixty-eight [95.77%] cases were cytologically graded with accuracy. Nuclear grading was even better on cytology and, excluding one malignant lymphoma, all 70 [100%] smears were assessed correctly. Overall efficiency of the tumour typing, cytological grading and nuclear grading on aspirated material turned out to be quite accurate. In expert hands, cytological examination can be of great help in pre-operative planning and in cases where tumour morphology in paraffin-embedded material has been distorted by neo-adjuvant therapy prior to excision