Treatment and outcomes of soft tissue sarcoma of groin, hip and thigh: a retrospective review from a tertiary care hospital.

OBJECTIVE: To study the frequency of the thigh, hip and groin soft tissue sarcomas and retrospectively analyse the management, treatment results, and outcomes of these uncommon malignant tumours, in a tertiary care hospital of the city of Karachi. METHODOLOGY: Data of soft tissue tumours registered from 2017-2018 was retrieved during January 2019 to March 2019 from Aga Khan University Hospital, Karachi bone and soft tissue tumour registry. A retrospective review was performed and all soft tissue tumour cases treated with surgical intervention (with adjuvant /neoadjuvant therapy) or palliative intention were included. RESULTS: Total 119 cases of soft tissue tumours (STS) were identified out of which 85 were malignant cases (sarcomas) while 30 were benign. On presentation 84 (70.6%) were primary cases. On topographical distribution, there were 25 patients who had hip, groin and thigh sarcoma. Of these, 15 were males and 10 were females. As treatment, neo-adjuvant radiation was done in 4 (16%) patients and adjuvant chemo/radio therapy was given to 13 (52%) patients. Wide margin excision was performed in 19 (76%) patients and 4 (16%) had amputation. Reconstruction was offered to 3 (12%) patients. In post-surgical complications, 1 (4%) patient had wound infection. On final surgical histopathology, majority of the sarcomas were liposarcomas, myxofibrosarcoma, synovial sarcoma and Leiomyosarcoma. Post-surgery recurrence occurred in 7 (28%) patients. Overall survival was 76%. CONCLUSIONS: In treatment of soft tissue sarcoma, limb salvage is an achievable option and survival results are also good.

Hypoglossal Nerve Paraganglioma Depicting as Glomus Tumor of Neck.

INTRODUCTION: Paraganglioma are infrequent neuroendocrine tumors that are most commonly found in the carotid body, ganglia of the vagus, jugular and tympanic nerve. Very rarely they can involve other cranial nerves outside the cranial cavity, we present one such case of hypoglossal nerve paraganglioma in neck. CASE REPORT: A 48 years old male presented with 1-month history of right sided stroke and aphasia. Ultrasonography of neck revealed a highly vascular mass on the right side of the neck. CT angiogram confirmed a highly vascular mass arising above the carotid bifurcation. With the working diagnosis of Glomus tumor, he underwent right sided neck exploration, however, intra-operatively tumor was found to be arising from the hypoglossal nerve instead. Surgery was abandoned on basis of the available literature, with only 6 reported cases in the past 54 years. Patient had no immediate post op complications and was sent for cyber knife treatment. After completion of 5 cycles of cyber knife there was a total of 45% reduction in the size of the paraganglioma with the resolution of the patient's symptoms after a follow up of 6 months. CONCLUSION: Hypoglossal nerve paraganglioma is an uncommon tumor of the neck and can be misdiagnosed with the other tumors in this region especially chemodectoma and glomus tumor. The diagnostic criteria and appropriate treatment modalities have not been established due to the rare presentation hence hypoglossal paraganliomas should be kept in mind when Highly vascular neck mass is encountered.

Awareness regarding obesity amongst general physicians of Karachi.

BACKGROUND: Obesity is considered a disease and one of the fastest growing global threats. In Pakistan General Physicians (GPs) are approached first in case of any disease thus their knowledge and practices regarding obesity are very important to assess. Our objective was to assess the knowledge and practices of GPs regarding obesity and management. METHODS: This was a cross-sectional study conducted among GPs of Karachi. 140 GPs from 17 towns of Karachi were selected by convenience sampling. Data was analyzed using SPSS-16. RESULTS: Total 140 GPs with mean age of 46.1 +/- 11.1 years were included in the study. Among them 90 (64.3%) were males and 40 (28.3%) were females. Awareness was assessed regarding factors related to obesity and knowledge was compared on basis of qualification and knowledge update. Significant difference was found for insufficient physical activity (p = 0.001) and social problems (p = 0.02). On the basis of knowledge update, stress and anxiety (p = 0.013) were found to be significant. Significant difference was found in readings for BMI (p = 0.038) and waist circumference (p = 0.000) to label patient obese. Among several lifestyle modifications advised, significant difference was found for increase fibre in diet (p = 0.006), low fat intake (p = 0.003), low carbohydrate intake (p = 0.02). CONCLUSION: Overall awareness regarding obesity was fair among GPs, while certain gaps were found in criteria for labelling patient obese. Significant difference in knowledge of GPs was found among those GPs who update their knowledge and who did not.