Facial nerve morbidity following surgery for benign parotid tumours

To determine the frequency and severity of facial nerve dysfunction following surgery for benign parotid gland tumours. A case series. ENT Department, Karachi Medical and Dental College and Abbasi Shaheed Hospital and Ziauddin University Hospital, from 1990 to 2010. Data was collected of all patients who were surgically managed for benign parotid tumours from 1990 to 2010. Data was reviewed for presentation of tumour, age and gender of the patient, site of tumour, nature and morphology of the tumour, primary or recurrent, surgical procedure adopted and the complications of the surgery especially the facial nerve dysfunction, its severity, complete or partial paresis and transient or permanent and time of recovery. Results were described as frequency percentages. Out of 235 patients, 159 [67.65%] were female and 76 [32.35%] were male. Age ranged from 18 to 70 years. Pleomorphic adenoma was the most common tumour [n=194, 82.6%], followed by Warthin's tumour. Superficial parotidectomy was done in 188 cases and extended parotidectomy in 47 cases. In the immediate postoperative period facial nerve function was normal in 169 [72%] patients and nerve dysfunction was observed in 66 [28%] patients. Complete paresis involving all the branches of facial nerve was seen in 25 [10.6%] patients and 41 [17.4%] patients were having incomplete dysfunction. Of these, 62 [26.3%] recovered and 04 [1.7%] had permanent facial nerve dysfunction. Marginal mandibular branch of facial nerve was involved in 57 [86.3%] cases. The frequency of temporary and permanent facial nerve dysfunction was 26.3% and 1.7% respectively in 235 consecutive parotidectomies for benign parotid gland tumours. Higher frequency of facial nerve dysfunction was found in recurrent and deep lobe tumours

Frequency of congenital anomolies in polyhydramnios

Polyhydramnios is a relatively uncommon but distressing complication associated with pregnancy. To find frequency of congenital anomalies with increasing severity of polyhydramnios. Prospective study. This study was conducted in Lady Willingdon Hospital, Lahore from July 2009 to June 2011. Total 70 diagnosed cases of polyhydramnios from 20-41 weeks of gestation were included in the study. Polyhydramnios was diagnosed in 170 pregnancies. Mild polyhydramnios [AFI 24.0-29.9cm] was found in 112 [65.88%] pregnancies, moderate [AFI 30.0-34.9 cm] in 38 [22.35%] pregnancies and severe [AFI 35.0 cm or more] in 20 [11.76%] pregnancies. Antenatal detection of anomalies was 71 [41.76%] fetuses. The prevalence of anomalies was higher in pregnancies with more amniotic fluid. A total of 83 anomalies were detected in 71 fetuses. Pregnancies complicated with severe polyhydramnios had maximum number of fetuses with multiple anomalies. 37 pregnant women out of 170 [21.76%] with polyhydramnios had maternal diabetes. Of these 37 pregnancies 11 [29.72%] had pregestational diabetes, 13 [35.13%] had gestational insulin treated diabetes, 13 [35.13%] had gestational diet controlled diabetes. Anomalous fetuses were present in 5 [13.51% of diabetic pregnancies with polyhydramnios. There were 7 [4.11%] fetal deaths in pregnancies complicated with polyhydramnios. This study proves that pregnancies with severe polyhydramnios have a greater frequency of fetal anomalies. Diagnosis of second trimester polyhydramnios should initiate a search for possible associated fetal anomalies and causative factors

Abdominal pain: a common presentation of dengue fever

Dengue fever [DF] is a mosquito born viral disease caused by dengue virus and is endemic in large areas of southeast of Asia. Pakistan is an endemic country for dengue virus infection. Abdominal pain is a commonly reported symptom in dengue fever [DF]. The most common causes of abdominal pain are acalculus cholecystitis, ascites, acute pancreatitis, acute hepatitis, pleural effusion and peptic ulcer disease. A case series study. This study was conducted at Mayo and Lady Willingdon Hospitals, Lahore from September and October 2011. 105 patients with fever and abdominal pain admitted to Mayo and Lady Willingdon Hospitals, Lahore during months of September and October 2011 were included in the study. A provisional: headache, retro orbital pain, myalgia, arthralgia, skin rash, hemorrhagic manifestations and leucopenia. The diagnosis was confirmed by enzyme immunoassay based serology. The cause of pain was determined by blood tests [Serum amylase, serum lipase, liver function tests [LFTs]] and radiology [ultrasound contrast enhanced CT [CECT] and chest xray [CXR] except for pregnant patients. 67 patient had dengue fever and 38 patients had other causes of fever and abdominal pain. In patient with dengue fever causes of abdominal pain were acalculus cholecystitis, ascites, acute pancreatitis, acute hepatitis, pleural effusion and peptic ulcer disease. Among 67 patients 2 were pregnant, one at 28 weeks and other at 32 weeks of gestation. Results of this study show that among 105 patients having fever and abdominal pain, 67 patients had serologically proven dengue fever. Table I shows that among patients with serologically proven dengue fever 29 had acalculus cholecystitis, 14 had ascites, 9 had acute pancreatitis, 11 had gastrointestinal disorder and 4 had bilateral pleural effusion. Among 3 patients with menorrhagia 2 had acalculus cholecystitis and 1 had gastrointestinal disorder. 2 patients were pregnant and 28 and 32 weeks of gestation. Both of them had peptic ulcer disease. Among 67 ranging from 101 [degree sign] F to 104 [degree sign] F while mean duration of fever was 5 days. In patient with dengue fever etiology of abdominal pain should be aggressively looked into for proper and better management. If carefully looked into, the etiology of abdominal pain in dengue fever can be found and appropriately managed

Fine needle aspiration cytology: sensitivity and specificity in thyroid lesions

Thyroid enlargement is one of the common problems in patients presenting at outpatients department of ENT particularly in females. Thyroid nodules are common, thyroid cancer is uncommon and the most common way for it to present is as a solitary thyroid nodule. This study was conducted to evaluate the sensitivity and specificity of Fine Needle Aspiration Cytology [FNAC] in thyroid diseases. This prospective analytic study was conducted at ENT Department of Karachi Medical and Dental College/Abbasi Shaheed Hospital during year 2004-8. One hundred and five cases were enrolled who underwent thyroid surgery after complete evaluation by history, clinical examination, Thyroid profile, Thyroid Scintigraphy, Ultrasound neck and FNAC. In cases which were revealed malignant by FNAC, CT scan were done to see the extent of disease and neck node status. Surgery was done in all cases and specimens sent for histopathology. Male to female ratio of the patients was 1:8.5. Most common lesion was benign nodule [96]. Malignant lesions were 9 in FNAC. In histopathology, the benign nodules were 92, and malignant cases were 13. Sensitivity of FNAC was 61.53% and specificity was 98.9%. FNAC in Thyroid has high sensitivity and specificity

Morphological pattern of parotid gland tumors

To determine the morphological pattern of parotid tumours. Case series. ENT Department of Karachi Medical and Dental College and Abbasi Shaheed Hospital, Karachi, from 1990 to 2004. During this study, 204 patients with parotid tumours were registered. The patients of all ages and both gender were included in this study. All patients were evaluated by history, clinical examination, F.N.A.C. and ultrasound, C.T/MRI was done in selected cases. All patients were surgically managed and their tumour specimen was sent for histopathology. Classification of individual tumour was based on 1991 World Health Organization Classification. Discrete data was presented in percentage and proportions. Out of 204 cases, 152 [74.5%] were benign and 52 [25.5%] were malignant. Of these, 117 [57.35%] patients were females and 87 [42.65%] males. Benign tumours were more common in females whereas malignant tumours were common in males. The mean age of patients was 34 years and 42 years for benign and malignant tumours respectively. Pleomorphic adenoma was most common benign tumor [83.5%], followed by Warthins tumour. The most common malignant tumour was mucoepidermoid carcinoma [60%], followed by adenoid cystic carcinoma. Superficial lobe of parotid gland was the commonest site, 120 benign and all 52 malignant tumours arising from it while 32 benign tumours originated from deep lobe. Parotid swelling for years was main feature of benign tumours, whereas malignant tumours presented with pain, fixation to skin or underlying structure, cervical lymphadenopathy and facial palsy. Pleomorphic adenoma was the most common benign tumour and mucoepidermoid carcinoma was most common malignant tumour. The morphological patterns and distribution followed the known pattern