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2017 | July-September | Volume 3 | Issue 3

ORIGINAL ARTICLE

Histopathological Spectrum of Non-neoplastic and Neoplastic Lesions of Thyroid: A 5-year Prospective Study in a Tertiary Care Hospital

[Year:2017] [Month:July-September] [Volume:3] [Number:3] [Pages:6] [Pages No:63 - 68]

PDF  |  DOI: 10.5005/jp-journals-10045-0059  |  Open Access |  How to cite  | 

Abstract

Introduction: Thyroid gland is unique among the endocrine glands in that it can be affected by a wide spectrum of diseases ranging from functional and immunologically mediated enlargements to neoplastic lesions. Thyroid neoplasms represent the most common malignancies of the endocrine system. Aims and objectives: To study the frequency of various thyroid lesions in thyroidectomy specimens and categorize neoplasms based on current World Health Organization (WHO) classification. Materials and methods: All thyroidectomy specimens received in the Department of Pathology, Raja Rajeswari Medical College, Bengaluru, India, for histopathological examination over a period of 5 years, from July 2010 to June 2015, were included in the study. Results: A total of 211 thyroidectomies were examined in the study. The highest incidence of thyroid lesions was seen in the fourth decade (n = 68, 36%) and showed a female predominance (90%). Non-neoplastic lesions accounted for 148 cases (70.1%) and neoplasms accounted for 63 cases (29.9%). The common non-neoplastic lesions were multinodular goiter (37.2%) followed by Hashimoto thyroiditis (35.8%), colloid goiter (16.9%), and adenomatous hyperplasia (5.3%). Benign neoplasms (22.2%) were lower with all cases being follicular adenoma, and malignancies were higher (77.8%) with papillary carcinoma (58.7%) as the most common malignancy in our study. Colloid goiter and multinodular goiter were the common features in peritumoral thyroid tissue, followed by Hashimoto thyroiditis. Conclusion: Thyroid disorders are commonly encountered endocrine diseases. Histopathological examination is the mainstay for definitive diagnosis and management of thyroid neoplasms. Appropriate categorization of neoplasms according to international guidelines is to be followed for diagnostic accuracy.

ORIGINAL ARTICLE

Jithumol T Thomas, Sathyanarayana P Sankaranarayana, Muninarasimhiah Manjuladevi

Comparison of the Hemodynamic Responses with Laryngeal Mask Airway vs Endotracheal Intubation in Adults undergoing General Anesthesia for Elective Surgeries

[Year:2017] [Month:July-September] [Volume:3] [Number:3] [Pages:7] [Pages No:69 - 75]

PDF  |  DOI: 10.5005/jp-journals-10045-0060  |  Open Access |  How to cite  | 

Abstract

Aim: The aim of this study was to compare the hemodynamic response between laryngoscopy with endotracheal intubation and laryngeal mask insertion. The study also compared immediate postoperative complications between laryngeal mask airway (LMA) and endotracheal intubation. Materials and methods: Fifty-five American Society of Anesthesiologists (ASA) physical status I and II adult patients who underwent elective surgeries under general anesthesia were included in either group I—LMA or group II—endotracheal tube (ETT). Patients were induced with intravenous (IV) propofol, fentanyl, and atracurium. After intubation/insertion, patients were mechanically ventilated and isoflurane was used to maintain adequate level of anesthesia with N2O/oxygen mixture. Hemodynamic parameters were measured before induction and after insertion of the airway device every minute for the first 10 minutes and every 5 minutes after that for the first half hour following insertion of the airway device. Results: A significant and longer increase in heart rate (HR) was noted after ETT intubation as compared with LMA group. However, a decrease in systolic, diastolic, and mean arterial pressures (SBP, DBP, and MAP) was noted after both LMA insertion and ETT intubation. The decrease was significantly more in LMA group (p < 0.001). Complications of postoperative sore throat and hoarseness of voice were also significantly more in ETT group. Conclusion: Pressor responses might be of no clinical importance in the healthy, normotensive patients, but might be harmful in patients with hypertension, aortic or cerebral aneurysm, raised intracranial pressure, or other cardiovascular diseases. In such cases, the attenuated response of the LMA might be desirable. Therefore, where appropriate, the use of the LMA would be recommended in such patients to avoid the marked response produced by the ETT.

CASE REPORT

Veeresh Hosur, Vani Thanthri

Acute Pulmonary Edema in a Patient undergoing Appendectomy under Spinal Anesthesia

[Year:2017] [Month:July-September] [Volume:3] [Number:3] [Pages:3] [Pages No:76 - 78]

PDF  |  DOI: 10.5005/jp-journals-10045-0061  |  Open Access |  How to cite  | 

Abstract

Acute pulmonary edema, accumulation of large amount of fluid in the interstitial and alveolar space, in patients undergoing surgeries poses a great challenge to the Anesthetist. If not treated well, it could be associated with high mortality rate up to 40%. We report a case of a patient aged 21 years undergoing emergency appendectomy under spinal anesthesia who developed acute Negative Pressure Pulmonary Edema and was successfully managed. His preoperative blood investigations were normal and had no other comorbidities.

CASE REPORT

Somanna Prabhakara, V Sreedhar Reddy, Kolandaswamy Anbazhagan, J Vineetha Mercy, Basanth K Reddy

Sex Ambiguity in a 1-year-old Child having Penoscrotal Hypospadias with Bilateral Undescended Testes (Cryptorchidism)

[Year:2017] [Month:July-September] [Volume:3] [Number:3] [Pages:3] [Pages No:79 - 81]

PDF  |  DOI: 10.5005/jp-journals-10045-0062  |  Open Access |  How to cite  | 

Abstract

Hypospadias with cryptorchidism is not a very common anomaly in infants and preadolescents. However, it is a perplexing situation to ascertain the exact sex of the child and to assign a proper chromosomal and gonadal sex of the child. The testis can be ectopic, incompletely descended, retractile, absent, or atrophic. In hypospadias, the urethral opening is located on the under surface of the penis, anywhere from the glans to the perineum, depending on the severity of the case. It is associated with chordee, patulous glans, and hooded prepuce. The present case is a 1-year-old child having penoscrotal hypospadias and bilateral undescended testes (cryptorchidism) with genital ambiguity. Our aim of the study was to identify the chromosomal sex and to rule out any microdeletion in the Y chromosome of the child by using conventional cytogenetic and polymerase chain reaction (PCR) techniques. We found that the chromosomal sex was male and there was no microdeletion in the Y chromosome.

CASE REPORT

PS Sharmila, BM Rupakala, TS Anisha, Ajay K Sahu, Jyothi A Raj, M Gautham

A Rare Case of Transitional Cell Carcinoma of Ovary: Case Report and Review of Literature

[Year:2017] [Month:July-September] [Volume:3] [Number:3] [Pages:4] [Pages No:82 - 85]

PDF  |  DOI: 10.5005/jp-journals-10045-0063  |  Open Access |  How to cite  | 

Abstract

Introduction: Transitional cell carcinoma (TCC) of the ovary is a rare and recently recognized variant of epithelial ovarian cancer. It has been described as primary ovarian carcinoma with definite urothelial features, without benign, metaplastic, and/or proliferating Brenner tumor (BT) identified. Case report: A 60-year-old lady presented with low back pain, growing abdominal mass, and loss of weight since 15 days. Magnetic resonance imaging (MRI) of abdomen showed a large ill-defined heterogeneous lesion with solid and cystic components. Beta human chorionic gonadotropin (β-hCG) and carcinoembryonic antigen (CEA) levels were raised. Surgery was performed and primary TCC of ovary was reported on histopathology. Conclusion: Recognition of such tumors is important because of their rarity, favorable response to chemotherapy, and improved patient survival.

CASE REPORT

KN Mohan Rao, Gundappa Vivek, SV Siva P Reddy

An Unusual Case of Multiple Primary Malignancies with Fungal Infection

[Year:2017] [Month:July-September] [Volume:3] [Number:3] [Pages:3] [Pages No:86 - 88]

PDF  |  DOI: 10.5005/jp-journals-10045-0064  |  Open Access |  How to cite  | 

Abstract

A 50-year-old male presented with complaints of cough with expectoration since 2 months with pain during defecation and loose stools since 1 month, and one episode of hemoptysis. Chest X-ray showed bilateral multiple nodular opacities with multiple cavities with air fluid levels. Sputum acid-fast bacilli (AFB) fungal culture showed growth of Aspergillus terreus. Computed tomography (CT) scan of chest and abdomen showed bilateral multiple cavities and nodules with left pleural effusion and adrenal metastasis with rectal mass and narrowing of lumen. Rectal biopsy showed moderately differentiated adenocarcinoma. Computed tomography-guided lung biopsy was also done, which surprisingly came as poorly differentiated large cell carcinoma. We report a case of synchronous multiple primary malignancy (MPM), rectum and lung, primary lung metastasizing to adrenal glands and lung with secondary fungal infection (A. terreus).

BRIEF COMMUNICATION

Gabriel M Khan

Sitosterol Blood Levels are Elevated in Diabetics and may be the Cause of Coronary Artery Disease and Stroke

[Year:2017] [Month:July-September] [Volume:3] [Number:3] [Pages:6] [Pages No:89 - 94]

PDF  |  DOI: 10.5005/jp-journals-10045-0065  |  Open Access |  How to cite  | 

Abstract

Introduction: Worldwide, diabetes is on the rise. Tight glucose control in randomized control trials has not shown significant improvement in cardiovascular outcomes. It is true that hyperglycemia causes a metabolic syndrome and low-density lipoprotein-cholesterol increases, but atheromatous coronary artery disease (CAD) and cerebrovascular disease are not completely curbed by marked reduction of hyperglycemia. It is necessary, therefore, to search for other culprits that cause atheroma. High blood sitosterol causes atheromatous CAD and fatal myocardial infarction in young adults with sitosterolemia, in which mutations in either ABCG5 or G8 proteins cause intestinal hyperabsorption of sitosterol and elevated levels. A milder intestinal genetic defect [ABCG5/G8] is present in diabetics. This fact is unknown to endocrinologists, doctors in the field, researchers, and the public. Diabetics consume much vegetable foods that contain sitosterol. The aim of this study is simply to determine if fasting blood sitosterol is elevated in diabetics, particularly in those with CAD. Materials and methods: Estimation for sitosterol was performed at the Mayo Medical Laboratories for 40 patients with type II diabetes and 17 control subjects. Results: Sitosterol was elevated in 45% of diabetics, and normal in 100% control subjects; 78.26% of diabetic subjects with CAD showed elevated fasting blood sitosterol levels, 5.1 to 9.5 mg/L (normal range 0—4.9 mg/L). Conclusion: This novel but preliminary study shows that 12 to 14 hours fasting blood sitosterol levels are elevated in patients with diabetes particularly in diabetics with CAD. The objective was achieved. Most diabetics have elevated blood sitosterol and require treatment as is done for familial homozygous sitosterolemia.

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