High resolution ultrasonography of thyroid nodules: can ultrasonographic assessment obviate the need for invasive aspiration cytology in ultrasonographically benign lesions?

The use of high-resolution ultrasound (HRUS) thyroid imaging has resulted in a significant revolution in the treatment of thyroid nodules. The enigma of thyroid nodules has been a blind spot for radiologists for a long period. Reporting a thyroid nodule as benign or malignant is quite difficult and many times not accurate. The American Collage of Radiology-Thyroid Imaging Reporting and Data System (ACR-TIRADS) 2017 classification has solved this problem to a large extent. However, the classification needed pathological confirmation for it to be highly accurate. We compared our HRUS-based TIRADS labeling of thyroid nodules with thyroid cytopathology using revised Bethesda classification system. Patients detected with thyroid nodules by HRUS were categorized using ACR-TIRADS and further were taken for fine needle aspiration cytology (FNAC) in our department. The pathological results were compared with the initial TIRADS category of the nodule and the effectiveness of the TIRADS classification in categorizing nodules into benign and malignant was assessed using various statistical variables. The initial USG and the FNAC were performed by a single radiologist with over 10 years of experience. A total of 201 patients underwent HRUS followed by FNAC after obtaining written consent in our department. The thyroid nodules labeled as true benign on ACR-TIRADS (TIRADS 2) were all true benign on Bethesda cytopathology (less than Bethesda III), confirming the high accuracy of HRUS. The diagnostic accuracy of HRUS in cases of ACR-TIRADS 3 nodules was approximately 90.6% with an error rate of 9.4%. Nodules labeled as ACR-TIRADS 4 and 5 had error rates of 47% and 10% in labeling nodules as malignant. The ultrasound-based ACR-TIRADS system can accurately predict the likelihood of specific nodules being benign. There is a strong concordance between Bethesda cytology and ACR-TIRADS classification, particularly for benign nodules. In resource-constrained system like ours, patients with TIRADS 2 and 3 nodules can be safely followed obviating the need for an invasive procedure like FNAC

Etiology and chemical composition of gall stone disease: a prospective observational study from the developing world

Background: Aim of the study was to assess the etiology and determine the chemical composition of gallstones in our population.Methods: This was a prospective observational study conducted at GMC Srinagar from 2018 to 2020. One hundred patients having gall stone disease were enrolled into the study and after cholecystectomy was performed the stones chemical composition was analyzed by fourier-transform infrared (FTIR) spectroscopy. The data was collated and analysed.Results: 54 patients had mixed stones with chemical composition of cholesterol, calcium carbonate and calcium bilirubinate; 39 had cholesterol stones and 7 patients had pigmented stone with chemical composition of cholesterol, calcium carbonate and calcium bilirubinate.Conclusions: Our results suggest that cholesterol, either singularly or in combination with calcium carbonate or bilirubin is a common component of gall stones in our population

Primary Pelvic Hydatid Cyst: A Case Report

This is a case report of a young man who presented to us as a case of hypogastric pain and frequency of micturation. General physical examination and radiological evaluation confirmed a multiloculated pelvic swelling. Patient was subjected to laparotomy which confirmed the diagnosis of a primary pelvic hydatid disease. Patient was put on chemotherapy after surgery and is doing well on follow up

Carcinoma lung: Clinical presentation, diagnosis, and its surgical management

The aim of this article is to review the surgical management of lung carcinoma. Lung cancer is the most common cancer in the world, and a leading cause of death in men and women. By any conventional measure, the enormity of this global problem is immense. In some countries incidence and mortality rates have peaked and are beginning to decline. In many developing nations, the burden of disease is rising and will continue to rise because of aggressive tobacco industry marketing which is leading to a growing prevalence of cigarette smoking. This is also one of the major causes of cancer deaths in our Kashmir valley. The method of literature search was from articles published in PubMed and Google Scholar

Evaluating conservative treatment for acute appendicitis with lump formation

Background: Interval appendectomy after acute appendicitis with lump formation (phlegmon) remains controversial. We conducted this study to determine the risk of recurrent appendicitis following initial non-operative treatment for appendicitis, and evaluate factors associated with recurrence. Secondarily, we evaluate the efficacy of interval appendectomy versus no appendectomy. Materials and Methods: Patients who received conservative treatment for appendicitis with lump formation were prospectively studied from June 2006 to June 2008. These patients were followed for recurrence of appendicitis. Results: Of 763 patients with acute appendicitis some 220 patients had lump formation (28.8%). Median age was 28 years. Conservative treatment was successful in 213 (96.8%) patients. The rate of recurrence was 13.1%, all occurring within six months after the index admission. Mean follow-up was 26±18 months. Conclusion: Conservative treatment of appendicitis with lump formation is efficient and the recurrence rate is low. Routine interval appendectomy after initial conservative treatment for lump formation is not a cost-effective intervention and not recommended

Clinico-Pathological Profile and Management of Acute Mechanical Small Bowel Obstruction: A Prospective Study

Aim: To identify and analyze the clinical presentation, etiopathology, management and outcome of patients with acute mechanical small bowel obstruction. Materials and methods: This is a prospective study of patients admitted with acute mechanical small bowel obstruction between 2001 and 2006. Results: Of the 300 patients included in the study, 296 (98.66%) patients presented with abdominal pain, while distention of the abdomen was the most common physical finding on clinical examination, which was present in 236 (78.66%) patients. Ascaris lumbricoides (44.60%) and adhesions (34.0%) were the most frequent causes of obstruction. 86 patients (28.66%) were managed conservatively and 214 (71.33%) patients were operated on. Simple obstruction was present in 190 (63.33%) patients, while strangulation was present in 110 (36%) patients. Intussusception was the most common etiology associated with non-viable strangulation, which was present in 12/14 patients (85.71%). Enterotomy and adhesiolysis were the most commonly performed operative procedures (28.97% and 14.95% respectively). Superficial surgical site infection was the most frequently noted complication and ndash; 84/300 (28.0%). Septicemia was the commonest cause of mortality in our series and ndash; 4/300 (1.33%). Conclusion: Abdominal pain and distention of the abdomen are the most common symptoms and physical findings in patients presenting with acute mechanical small bowel obstruction (SBO). Worm (ascaridial) obstruction is the most common cause of obstruction followed by postoperative adhesions. Although all patients were managed conservatively to start with, the operative rate in our series remained very high because it is very difficult to distinguish simple from strangulation obstruction on clinical, biochemical and/or radiological grounds with certainty. [Arch Clin Exp Surg 2013; 2(3.000): 154-160

Recurrent Hemorrhoids—Efficacy, Utility and Initial Experience with the Use of Stapled Hemorrhoidopexy in Recurrent Hemorrhoids

Overview Hemorrhoidal disease (HD) is a common surgical disorder. The treatment modalities can be surgical or nonsurgical. Every surgical option has its own indications and limitations. Postsurgical symptomatic recurrence rates are low and vary between different techniques. The ideal way to deal with recurrent HD is not clear. Material and Methods The present prospective case series enrolled a total of 87 patients (54 male/33 female). Thirteen out of 87 patients (15%) had history of previous intervention for HD. A modification of the standard technique was adopted for patients with recurrent HD. A mean follow-up of 22 months was achieved. Results Stapled hemorrhoidectomy (SD) was performed in 13 patients who had history of previous surgical intervention for HD. There were no adverse events related to the technique. Patients with recurrent HD had severe pain scores with SH as compared to patients who underwent SH at the first time. There were no wound related complications. Conclusion Stapled hemorrhoidectomy can be performed easily and offers good results in patients with recurrent HD