The Surgical Approach to Lymphadenopathies

A CAJM article on the Surgical approach to Lymphadenopathies.The diagnosis of the true nature of a lymph gland enlargement must finally rest upon histological evidence. With the increasing use of radiotherapy it often happens that patients are treated without a definite diagnosis being established, because of the major operation entailed in obtaining histological evidence. Yet the clinical and radiological findings on which the diagnosis must otherwise rest may be misleading and the treatment given may, as a consequence, be unsuitable. Moreover, unless the clinical diagnosis is supported in all cases by histological evidence, some doubt as to the correctness of the diagnosis cannot altogether be discounted when the value of- treatment comes to be assessed later, particularly five-year cures by radiotherapy

Hospital of Saint Raphael Annual Report, 1925

Eighteenth Yearhttps://elischolar.library.yale.edu/hospital_st_raphael_annual_reports/1014/thumbnail.jp

Hospital of Saint Raphael Annual Report, 1917

Tenth Yearhttps://elischolar.library.yale.edu/hospital_st_raphael_annual_reports/1006/thumbnail.jp

Detailed diagnoses and procedures, National Hospital Discharge Survey, 1993

Written by Edmund J. Graves."October 1995."Also available via the World Wide Web.Includes bibliographical references (p. 3)

The Problem of Tuberculous Empyema in Sanatorium Practice

Abstract Not Provided

Intrathoracic tumours: a review of the literature and a study of thirty five cases of primary intrathoracic cancer

In recent years the subject of intrathoracic tumours has received increasing attention. The apparent increase in the incidence of cancer of the lung, out of proportion to that of malignant disease of other organs, has been recognised by observers from all parts of the world. Intrathoracic lesions manifested by symptoms such as cough, expectoration, haemoptysis, have been so readily diagnosed as phthisis without much consideration of the possibility of the presence of new growth, that it was thought that it would be of interest to study more closely the cases which have been recorded and the literature surrounding neoplasms arising within the thorax.Personal contact with a few instances in which the symptoms, at first suggestive of pulmonary tuberculosis but proved by subsequent careful investigation to result from benign intrathoracic growths, has to a large degree stimulated this study. It seemed, from these examples, that many patients suffering from similar lesions may have been condemned to lives of invalidism in Sanatoria until a fatal termination was reached, in whom more complete investigation with a more accurate conception of the details and modes of securing a diagnosis might have lead to successful treatment.In the standard text book "Practice and Principles of Medicine" (Osier and Macrae) published in 1923 this subject is given scant attention, and only a few pages are allotted to its discussion. Within the last few decades the bibliography has grown to such an extent that it is now possible to review all aspects of a number of cases of intrathoracic tumour sufficiently large to allow deductions to be made with regard to their main features. It is thus intended to review the more important contributions to the literature in order to ascertain the present state of our knowledge, and, by this means, to indicate in some measure the lines on which further progress is likely to be made in dealing with intrathoracic neoplasms.The field under review will include benign and malignant new growths arising primarily within the chest. Those originating from the thoracic wall, from the oesophagus, the pericardium, and the heart will not be considered except with regard to differential diagnosis and other associated features. Enlargements of the thymus gland of non- neoplastic nature will be discussed in view of the confusion which may arise in the diagnosis and treatment of thymic new growths. With regard to the rarer forms of tumour, most of the examples recorded in the literature will be mentioned though it is not intended to form a complete collection of each series. The scope of the review will include the incidence, aetiology, pathology, symptomatology, diagnosis and treatment of the various types of benign' and malignant neoplasm arising within the chest.A report of thirty -five cases of intrathoracic tumours which were submitted to autopsy within the last five years at the Royal Infirmary, Edinburgh, is added. A discussion will be made of the clinical and pathological details and a summary will be given of the more striking features which these cases portray

Role of Cytological Evaluation in Cervical Lymphadenopathy

INTRODUCTION: A neck mass in an adult, when present for longer than a week is pathological until proven otherwise. Enlarged lymph nodes are by far the most common neck masses encountered. In our country, tubercular lymphadenitis is not uncommon but even so, a large percentage of all persistent adult neck masses in adults turn out to be malignant. Lymphadenopathy is one of the first sign of malignancy in a patient. FNAC not only confirms the presence of metastatic disease, but also gives clues regarding the nature and origin of the primary tumour. The number of lymph nodes involved, the size of the lymph nodes or the lymph node metastasis, or the regional lymph node basin involved also has been shown to have prognostic value. In patients with enlarged lymph nodes and previously documented malignancy, FNAC can obviate further surgery performed merely to confirm the presence of metastasis. However, regional lymphadenopathy is not always due to metastatic tumour, and not every nodule represents a lymph node. Cysts (congenital or acquired), abscesses, subcutaneous benign and malignant tumours may also raise the question of lymph node metastasis, especially in patients with a known tumour. A positive evidence of tuberculosis can obviate the need for further evaluation and leads to early instillation of definite therapy at the secondary or primary care centre itself. Early treatment leads to better prognosis, as organism load and virulence are minimal; with a good host response. The disease spread and community burden are significantly reduced. Avoiding false-positive diagnosis is of obvious importance since therapeutic and surgical decisions are taken on cytology results. Moreover; the procedure is very simple, cost effective, and free from complications, well tolerated by the patient, can be done on an out-patient basis and repeatable when necessary. India is imminently suited to use this procedure. This study will address the neck nodes occurring in the adult population. They are usually metastatic nodes, lymphomas or tuberculosis. The metastatic are generally from the upper aero digestive tract, thyroid and salivary glands or may present as occult primaries. Occasionally a neck metastasis from a distant site springs from the gastrointestinal tract, kidney or the lung. Other primary sites below the clavicle, which may appear in the neck, are the cervix, ovary, testis and sometimes even the bladder. AIMS AND OBJECTIVES: • To study the pattern of cervical lymph node enlargement. • To evaluate the diagnostic accuracy of FNAC in cervical lymphadenopathy with an emphasis on discordant cases between the cytology and the histopathology. MATERIALS AND METHODS: The study was conducted on 100 selected patients with cervical lymphadenopathy who presented to the General Surgical Department with cervical lymphadenopathy. Patients’ informed written consent was taken. The patients were examined clinically after taking a detailed history. Nodes enlarged were classified according to Memorial Sloan-Kettering Cancer Centre leveling system of cervical lymph nodes. The number of nodes, their size, consistency and presence of periadenitis was noted at each level. Histories of any form of previous treatment to the nodes like radiotherapy, chemotherapy were excluded from the study. Terminally ill patients were also excluded. Blood investigations and radiological investigations were made. Ultrasonography of the neck and CT scan were made wherever necessary. A pre FNAC clinical diagnosis was arrived. Patients requiring surgical biopsy either in the form of node biopsy or neck dissection were included in study. A Fine Needle Aspiration Cytology was done. The equipments used for FNAC; 1. Spirit soaked cotton swab, 2. 10 ml disposable syringe, 3. 22 G disposable needle, 4. 5 Glass slides, 5. Jar with ether-alcohol fixative. RESULTS : A total of 100 patients were examined, subjected to FNAC of cervical lymph nodes and histopathological study. Patients with acute presentation of lymphadenopathy and diagnosed as non-specific lymphadenitis with or without FNAC correlation were excluded from study. They were treated with antibiotics and followed up in the outpatient department. The size of the nodes, which were, sampled range from 1 – 6 cm. No complication due to cytology occurred in the series. All inadequate and inconclusive aspirations were repeated. CONCLUSION: Cervical lymphadenopathy can be due to varying causes. The diagnosis of which involves clinical examination, imaging and pathological correlation. The fact that secondaries from head and neck primary, follows definitive patterns of nodal spread proves very valuable. Cytology forms one of the most important investigations in the initial evaluation of cervical lymphadenopathy. Early confirmation of the disease facilitates institution of immediate treatment. In case of discordance between clinical and cytological findings, FNAC is always repeatable. Further a positive cytology is always significant. A negative result does not rule out the disease and may require further evaluation. A good cytological study requires a good communication between an experienced cytologist and treating surgeon. This study demonstrates that fine needle aspiration is a safe, accurate and valuable tool in the evaluation of cervical lymphadenopathy. It helps in planning surgery for malignant cases, where definitive operative intervention can be performed in one session. It permits early institution of anti-tubercular drugs in patients with tuberculous lymphadenitis. In case of undetected primary tumour, FNAC directs further investigations towards the possible primary. The two fundamental requirements on which the success of cytology depends are representativeness of the sample and high quality of the preparation. The main advantage of FNAC lies in its simplicity. Being an uncomplicated outpatient procedure that offers a rapid and specific diagnosis with little trauma, it is very cost-effective. It is ideal for developing countries and smaller hospitals with limited resources

A Study of Twenty Interesting Cases

CASE 1 : A case of klain waardenburg syndrome. CASE 2 : A rare case of papillary carcinoma in thyro glossal cyst. CASE 3 : A case of rare tumour of the ear. CASE 4 : A case of esthesioneuroblastoma. CASE 5 : A case of osteoma-temporal bone. CASE 6 : A case of Gradenigo's syndrome. CASE 7 : A case of successful decannulation in a case of laryngotracheal stenosis. CASE 8 : An interesting case of ary-epiglottic fold papilloma with left vocal cord paralysis and laryngeal web. CASE 9 : A rare case of amianthoid myofibroblastoma of nose. CASE 10 : Functional total parotidectomy in a case of pleomorphic adenoma. CASE 11 : A case of excision of branchial cyst by contract delineation technique. CASE 12 : A interesting case of invasive mucormycosis responsive to treatment. CASE 13 : A case of soft tissue sarcoma of palate. CASE 14 : A case of schwannoma of tongue base. CASE 15 : An interesting case of neck swelling. CASE 16 : A case of recurrent brain abscess. CASE 17 : A case of post-fess epistaxis. CASE 18 : A case of difficult tracheo-oesophageal puncture. CASE 19 : A case of peritonsillitis with tubercular adenitis. CASE 20 : A case of oesophageal carcinoma in a child