Clinicopathological profile of papillary carcinoma of thyroid: A 10-year experience in a tertiary care institute in North Karnataka, India.

CONTEXT: Papillary thyroid carcinoma (PTC) is the most common thyroid malignancy accounting for 80% of the thyroid cancers. Many histopathologic variants of PTC have been recognized, and few of these are of prognostic significance. The studies on clinicopathological features of PTC and its variants are so far seldom reported in India. AIM: The aim of the study was to study the percentage distribution of PTC among total thyroid specimens, the age and sex distribution of PTC, its histopathological features including frequency of nuclear findings, and various histological subtypes are also studied in detail. Methods: All cases of PTC diagnosed in our department from April 2003 to March 2013 formed the material for the study. The tissues were routinely processed and stained. On microscopic examination, tumors were classified according to 2004 WHO classification. RESULTS: PTC formed the predominant type of malignancy accounting to 71% of the total cases. Of these, about 75% of patients were in the second to fifth decade. Male to female ratio was 1:5.4. Other than the usual classic variant and follicular variant, we also found rare types such as clear cell variant, tall cell type, oncocytic type, and macrofollicular variant. Microscopically, nuclear overcrowding and ground glass nuclei were seen in more than 90% of cases. Nodular goiter, Hashimoto's thyroiditis, and follicular adenoma were associated lesions in some cases. CONCLUSION: PTC is the most common thyroid malignancy, and it can affect any age group though it presents mostly in the third to fourth decade of life. Recognition of histological subtype is crucial in patient prognosis.

Cardiac pacing in patients with a cervical spinal cord injury.

STUDY DESIGN: Retrospective medical record review. OBJECTIVES: To compare patients, admitted to an intensive care unit (ICU) with an acute cervical spinal cord injury (SCI) and documented motor deficit, who did, with those who did not, require a cardiac pacemaker. SETTING: South Australian Tertiary Referral Intensive Care and Spinal Injury Unit. METHODS: Retrospective medical record review and data set linkage. RESULTS: From 1995 to 2007, 465 patients sustained a cervical SCI. Of these, 30 (6.5%) were admitted to ICU with a clinically assessable motor deficit and 3 (0.6% of all patients, or 10% of those admitted to ICU) required a cardiac pacemaker. All three patients had a cervical SCI, C5 (American Spinal Injury Association A) tetraplegia, and required invasive mechanical respiratory and inotropic support and a tracheostomy for weaning. Two patients (66%) were discharged alive to rehabilitation. Patients requiring a pacemaker had bradycardic episodes over a longer period (11 vs 4 days, P=0.01), a trend towards a later onset of bradycardia (8 vs 1.5 days, P=0.05) and a longer ICU length of stay (37 vs 10 days, P=0.02). CONCLUSION: Patients with a cervical SCI requiring a cardiac pacemaker are characterized by a higher level of SCI injury and motor loss, require mechanical respiratory and inotropic support, a tracheostomy to wean, and bradycardic episodes of a later onset and over a longer period of time. These findings suggest that such patients should be managed at hospitals with specialized acute spinal injury, intensive care and cardiac pacemaker services.

History of analgesia and regional anaesthesia through philately.

Medical philately is the study of postage stamps commemorating events and pioneers in the field of medicine. In 1929, Dr Fielding H. Garrison, doyen of medical history, remarked that stamps were a great resource for the medical fraternity, something he hoped that physicians would soon recognise. His prediction has hardly come to fruition in the years since then, with medical philatelic articles rarely seen in the medical press. The history of pain medicine is unique, diverse and extremely interesting, with many chemists, physicists, philosophers, contributing in their own way over centuries to pave the path to present day pain medicine.