Clinical and pathological correlation in benign breast diseases in women

Background: Benign breast diseases are a common problem presenting in a day to day surgical practice. A combination of three tests i.e. clinical examination, radiological imaging and pathological examination is commonly used to accurately diagnose breast diseases. This study was aimed to know the clinico-pathological correlation in diagnosing benign breast diseases in women.Methods: A study of 30 female patients of benign breast disease was conducted by clinical examination and comparing its accuracy with the pathological findings.Results: The highest incidence of benign breast diseases was in the age group of 30-39 years (33.3%). The most common presenting symptom was lump (53.3%) in the breast. The most common quadrant involved was the upper outer quadrant (60%). Fibroadenoma (53.3%) was the most common lesion in this study. The clinical examination in cases of fibroadenoma had sensitivity and specificity of 87.5 % and 92.8% respectively. In cases of fibrocystic disease, clinical examination had sensitivity and specificity of 85.7 % and 91.3% respectively.Conclusions: Overall clinical breast examination had a sensitivity of 90% and specificity of 98% in this study. Hence, combination of all three diagnostic modalities i.e. clinical, radiological and pathological examination should be used. But in rural areas where radiological and pathological facilities are not available, clinical examination can also give us a fair amount of idea in diagnosing benign breast diseases

Cytomorphological variables of hepatic malignancies in fine needle aspiration smears with special reference to grading of hepatocellular carcinoma

Background: The evaluation and management of discrete hepatic masses is a clinical problem. Ultrasound guided fine needle aspiration cytology (FNAC) is a rapid, accurate and safe diagnostic procedure that can be used in various neoplastic and non-neoplastic diseases of the liver. Aim: To evaluate the cytomorphological features of hepatocellular carcinoma. Materials and Methods: Ultrasound-guided fine needle aspiration was performed on 52 patients clinically suspected of having hepatic lesion. Results: Malignancy was detected in 50 cases. The primary malignancies consisted of 15 cases of hepatocellular carcinoma (HCC), 4 cases of cholangiocarcinoma and 2 of hepatoblastoma. There were 29 metastatic lesions, which included 26 cases of adenocarcinoma, 2 cases of squamous cell carcinoma and 1 of lymphoma. The key diagnostic features for HCC were trabecular arrangement, polygonal cells with eosinophilic and granular cytoplasm, hyperchromatic nuclei with macronucleoli. Atypical naked hepatocytic nuclei and malignant cells separated by sinusoidal capillaries were also commonly seen. The sensitivity and specificity of FNA for malignancies was found to be 96% and 100% respectively, yielding a positive predictive value of 100% and negative predictive value of 50%. Conclusions: There was a very good correlation of cytological criteria and histopathological diagnosis in hepatocellular carcinoma of various grades as well as in differentiating primary from metastatic tumors. It is recommended that image directed FNAC should be the primary diagnostic modality for assessing potential malignancy in any patient with a localized hepatic mass

Insertion of i-gel™ by the reversed technique improves the success rate and reduces the time taken for its placement: A prospective, randomized, controlled, interventional trial

Background and Aims: We hypothesized that the i-gel™ supra-glottic airway can be inserted with relative ease in a reversed manner just like a Guedel's airway. Material and Methods: A prospective, randomized, controlled interventional trial was conducted on 100 patients to compare reversed insertion of the i-gel™ (Group R) with the conventional insertion (Group C). In Group C, i-gel™ was introduced in a conventional manner, whereas in the Group R, i-gel™ was introduced into the oral cavity with the concavity facing the hard palate. On reaching the oropharynx, the device was rotated 180° and advanced further until it fitted over the larynx. The time of insertion, ease, and placement appropriateness were compared. Results: All patients completed the study. Better success rate of the first attempt insertion was achieved using the reversed technique (96% vs. 86%), but it was not statistically significant. Mean time required for i-gel™ insertion in Group R was 17.5 ± 6.9 s as compared to 20.8 ± 5.9 s in Group C, which was statistically significant. In Group R, it could be inserted within 20 s in 84% of cases, but only in 62% in Group C. The seal of the i-gel™ was similar in both the groups with the leak volumes (inspired – expired tidal volumes) being similar. Conclusion: Reversed insertion technique for the placement of i-gel™ resulted in appropriate placement with easier insertion and lower placement time than that with the conventional technique