Role of Postoperative Intact Parathyroid Hormone Levels in Predicting Hypocalcaemia after Thyroidectomy.

OBJECTIVE: To determine the sensitivity and specificity of intact parathyroid hormone (iPTH) levels in predicting hypocalcaemia after thyroidectomy. STUDY DESIGN: A descriptive cross-sectional study. Place and Duration of the Study: Department of General Surgery, Shifa International Hospital and Shifa Foundation, Islamabad, from May 2021 to 2022. METHODOLOGY: The sample size was calculated to be 205 with consecutive non-probability sampling. Serum iPTH levels and serum calcium levels were measured postoperatively at 6 hours and 24 hours and recorded in a proforma for analysis. After collection, the data were entered and analysed using SPSS version 24.0. RESULTS: Among 205 patients, 157 (76.6%) were females and 48 (23.4%) were males. At 6 hours postoperatively, 121 (59%) patients had normal iPTH levels and 123 (60%) patients had normal serum calcium levels (p = 0.15). At 24-hour, 130 (63.4%) patients had normal iPTH levels and 92 (44.9%) patients had normal serum calcium levels (p = 0.001). Overall, 8 (3.9%) patients developed symptomatic hypocalcaemia (p = <0.001). The sensitivity and specificity of iPTH levels at ≤15 pg/ml were 100% and 70%, respectively, but at 24 pg/ml cut-off level, the specificity increased to 90% with sensitivity of 100%. CONCLUSION: Low serum iPTH levels at 6 hours after surgery can predict hypocalcaemia in patients undergoing thyroidectomy, even if serum calcium levels appear normal at that time. KEY WORDS: Parathyroid hormone, Serum calcium, Hypocalcaemia, Total thyroidectomy, Calcium homeostasis.

Endoscopic pilonidal sinus treatment (EPSiT) for sacrococcygeal pilonidal sinus disease: A prospective long-term study.

Objectives: To assess short-term and long-term outcomes of endoscopic pilonidal sinus treatment for pilonidal sinus disease. METHODS: The prospective study was conducted at Shifa International Hospital, Islamabad, Pakistan, from July 2015 to July 2021, and comprised all pilonidal sinus cases undergoing minimal invasive endoscopic pilonidal sinus treatment who were treated by a single surgical team. The primary outcomes were duration of healing, post-operative morbidities, persistence of discharge and recurrence at 1-7 years. The secondary outcomes were operative time, return to work, cosmetic results and patient satisfaction. The patients were observed for wound healing and discharge on follow-up in the out-patient department at 1, 3, 6 and 24 weeks. They were further followed up every year through telephonic survey for persistence or recurrence of symptoms. Patient satisfaction was assessed using the 36-item Short Form Survey questionnaire filled at admission and then at 6 weeks post-surgery. Data was analysed using SPSS 23. RESULTS: Of the 67 patients, 55(82%) were males and 12(18%) were females. The overall mean age was 25.69±8.305 years. There were 13(19.4%) patients with a history of recurrent disease and previous procedures for pilonidal sinus, while 54(80.6%) had no previous surgery. The median operative time was 35 minutes (interquartile range: 20-45 minutes). Complete wound healing was achieved in 60(89.6%) patients, while recurrence was seen in 7(10.4%). The median time off work was 2.5 days (interquartile range: 1-3 days). Patient satisfaction with the procedure was significantly high (p<0.05). CONCLUSIONS: Endoscopic pilonidal sinus treatment appeared to be a good minimally invasive surgical technique for the treatment of pilonidal sinus disease in terms of both short-term and long-term outcomes.

Cross-sectional study of mammographic breast density of Pakistani women and its association with breast cancer.

OBJECTIVE: To explore if a positive association existed between breast cancer and increased breast density. METHODS: The retrospective cross-sectional study was conducted at Shifa International Hospital, Islamabad and comprised data from July 10, 2018, to July 10, 2020, of all patients who underwent mammography for screening or diagnostic purposes. Data was collected by reviewing patients' charts, and was divided into diagnostic group A and screening group B according to mammography target. Breast Imaging Reporting and Data System category was also noted. Data was analysed using SPSS 21. RESULTS: Of the 1,035 women with mean age 46.8±2.5 years (range: 35-82 years), 928(89.7%) were in group A and 107(10.3%) were in group B Prevalent breast densities overall were category A 67(6.3%), B 349(33.7%), C 530(51.2%) and D 89(8.5%). In group A, a lump was detected in 542(58.4%) patients. Of them, 367(67.7%) lesions were malignant and 175(32.3%) were benign. Breast density and malignant tumours had significant association (p<0.05). CONCLUSIONS: Mammographic breast density wsa found to have a significant association with breast cancer.

Late Presentation of Acute Limb Ischemia: Causes and Outcomes.

OBJECTIVE: To determine the causes of interventions in patients with acute limb ischemia (ALI), the time lapse of presentation, and the outcome. STUDY DESIGN: An observational study. METHODOLOGY: All delayed acute limb ischemia cases (presenting later than 6 hours after the onset of symptoms) were included in the study. Cases of ALI secondary to accidental trauma were excluded except those of iatrogenic trauma like patients with intravenous drug abuse and intra-arterial accidental drug infiltration. Patients' demographic data, clinical history, aetiology, examination findings, and treatment data; including type of surgery, level of amputation, adjunctive treatment were recorded. RESULTS: Total number of delayed ALI cases was 147. Mean age was 59.52 ±17.77 years. Seventy-five (51%) were females while 72(49%) were males. The right lower limb was involved in 56(38%) cases. A hundred (68%) thromboembolectomies were successful and limbs were saved, while 19(12.9%) had failure after the procedure. Three (2%) patients expired within 24 hours of thromboembolectomy. Twenty-five (17%) had frank gangrene at presentation and ended up in amputations while 122 (82.9%) had questionable viability and underwent limb salvage procedures. CONCLUSION: Delayed presentation of ALI is very common; timely management with effective thromboembolectomies can save limbs in most of the patients. KEY WORDS: Acute limb ischemia (ALI), Treatment, Amputation, Thromboembolectomy, embolism.

Port site tuberculosis a rare post operation entity: A case report.

Laparoscopic cholecystectomy is one of the most common procedures done worldwide. Post-surgical site infections are common, yet there are occurrences of uncommon complications, including port site tuberculosis (TB). We report a case of a 62-year-old man who was the victim of post-surgical site infection of port sites caused probably by improper sterilization. The patient lacked any common symptoms of tuberculosis and his initial lab investigations were not affirmative. A biopsy depicting the growth of multiple epithelioid granulomas finally led to the diagnosis of port site tuberculosis. The patient was treated by incision and drainage followed by anti-tubercular therapy. This treatment regime showed complete resolution of disease on follow-ups. Such cases require multidisciplinary team (Surgery, Pathology and Infectious disease department in our case) inputs for prompt diagnosis and treatment.

Mucocoele of the appendix: A case report.

Mucinous cystadenoma is a rare tumour of the appendix. It accounts for only 0.4% of the gastrointestinal tract malignancies and is reported rarely in the literature. Therefore, surgical management is not yet established. Here we report the case of a 65-year-old female who presented with a dragging sensation and a feeling of a mass in the right iliac fossa. Her computed tomography (CT) suggested formation of an abscess in the parietal peritoneum. She was scheduled for laparotomy and upon exploration, a mass was found arising from the tip of the retroperitoneal appendix. The whole of the appendix was studded with mucoid material. Right hemicolectomy was performed and histopathology of the appendix showed mucinous cystadenoma with no evidence of malignant changes. The recovery was uneventful and the patient was discharged on the fourth post-operative day. The unusual presentation of retroperitoneal pseudomyxoma without any intraperitoneal pathology prompted us to report this case.

A retrospective study of complications of total thyroidectomy; is it a safe approach for benign thyroid conditions.

OBJECTIVE: To assess frequency of complications of total thyroidectomy for benign thyroid diseases. METHODS: The retrospective descriptive study was conducted at Shifa College of Medicine, Islamabad, Pakistan, and comprised patient data from March 2016 to March 2018 of all patients who had undergone total thyroidectomy at the centre. Operative findings and post-op complications were documented in a self-generated proforma. Followup visits documented in the charts were also reviewed. Patients who did not keep the follow-up appointment were interviewed over the phone. Data was analysed using SPSS 20. RESULTS: Of the 96 patients, 78(81.2%) were female and 18(18.7%) were male. The overall mean age was 32.9 } 9.84 years. Hypocalcaemia was the most common complication in 4(4.1%) cases, transient in 3(3.1%) and permanent in only 1(1.04%) case. Haemorrhage occurred in 1(1.04) patient, and recurrent laryngeal nerve injury in 2(2.08%). . CONCLUSIONS: Simple multi-nodular goitre was effectively treated with total thyroidectomy with minor complications.