Papillary carcinoma thyroid – A cytomorphological study

Background: Fine Needle Aspiration Cytology is a widely accepted diagnostic tool for thyroid lesions. It is well known that nuclear features form the mainstay of diagnosis for papillary carcinoma thyroid. Focal nuclear features can be missed unless carefully looked for and pose diagnostic dif culty. The aim was to study the cytomorphological features of papillary carcinoma thyroid and to calculate the percentage of nuclear grooving. Materials and Methods: This retrospective study was carried out by reviewing the data and cytology smears of 21 histopathologically con rmed cases of papillary carcinoma thyroid. The percentage of nuclear grooves was calculated in oil immersion by counting 200 to 500 cells depending on the cellularity. The study was approved by the institution ethical and research committee. Results: Out of the total 21 cases, 03(14.2%) were males and 18(83.8%) were females. Mean age was 38.9years. Predominant papillary arrangement was seen in 17(80.9%) of the cases. Nuclear crowding and overlapping, pale chromatin, nuclear grooves, nuclear enlargement and prominent nucleoli were seen in all (100%) the cases. Intranuclear cytoplasmic pseudoinclusions were seen in only 5(23.8%) of the cases. The percentage of nuclear grooving ranged from 15% to 85%. Greater than 20% nuclear grooves were observed in 19(90.4%) of the cases. Histiocytes, metaplastic cells and multinucleated giant cells were seen in 12(57.1%), 10(47.6%) and 6(28.5%) of the cases. Conclusion: The cytologic diagnosis of papillary carcinoma is easy when majority of the classical features are present. But it becomes really challenging when the features are either present focally or classical features are absent. 

Comparison of variables affecting the surgical outcomes of tubularized incised plate urethroplasty in adult and pediatric hypospadias

INTRODUCTION

The American Academy of Pediatrics recommends operating on hypospadias between the ages of 6-12 months. Since most births in developed countries are conducted in a hospital, parents are likely to be well informed and counseled about the hypospadias. However, significant numbers of births in developing countries are still conducted at home, with illiteracy, poverty and ignorance often leading to late presentation at the hospital. Reported hypospadias-repair complication rates are higher in adults compared with those having surgery in childhood. The present study's objective was to evaluate the factors affecting surgical outcome in hypospadias patients undergoing tubularized and tubularized incised plate urethroplasty (TIPU) in adulthood compared with childhood.

MATERIALS AND METHODS

A prospective study of 60 adult patients >16 years, and 60 pediatric patients <5 years who underwent TIPU for primary hypospadias between May 2008 and May 2012. Patients were operated on by a single surgeon, under similar circumstances, and were pre-operatively examined to assess meatal location, chordee, and torsion; they were also examined intra-operatively for quality of spongiosum and urethral plate width. The outcomes were assessed by patient/parents for satisfaction regarding cosmesis, urinary stream and complications.

RESULTS

The age of the patients varied from 16 to 27 years, with a mean of 20.8 years in adults, and 6 months to 5 years, with a mean of 2.1 years, in children. The type of hypospadias, degree of curvature, quality of spongiosum and urethral plate width were comparable in both groups, but complication rates were higher in adults (16.7%) than in the pediatric (6.7%) group (Figure 1A-D). Meatal stenosis responded well to dilatation, but fistulae required revision surgery and had a cure rate of 100%. The median follow-up was 37 months in adults, and 39 months in children.

DISCUSSION

The higher complication rates in adults may be due to more frequent erections; increased susceptibility to infection along with relatively reduced vascularity lead to poor wound healing and increased complication rates. The limitation of the study was the small number of patients with mid and proximal hypospadias having lesser incidences in comparison with distal hypospadias. Adequate number of patients in these subgroups could have further strengthened the statistical correlation. Secondly, there was no objective criterion like uroflowmetry to assess urinary stream.

CONCLUSIONS

Complication rates were higher in adults undergoing TIPU compared with pediatric patients, which was also statistically significant in distal hypospadias. The important factors in surgical outcome were: severity of hypospadias, degree of curvature, quality of spongiosum, and urethral plate width.

Aural hygiene practices among underprivileged children of Delhi

BACKGROUND

Though ear hygiene is important for proper hearing, it is usually neglected. Improper ear care practices may have serious consequences such as loss of hearing. In childhood, loss of hearing may affect learning and development. There is scarcity of information on ear care practices in the community in India. We aimed to ascertain the magnitude of problems related to aural hygiene and assess ear care practices among children of schoolgoing age in a resettlement colony of Delhi.

METHODS

A cross-sectional community-based survey was done among 1398 children 5-14 years of age. The houses were selected by systematic random sampling and all eligible children in the selected house were interviewed and examined. The data were analysed using SPSS version 12 and chi-square test was used to ascertain significance between two variables.

RESULTS

Almost two-thirds (60%; 834) of the children gave a history of themselves or an elder cleaning the ear using unhealthy methods. Earbuds were used by 21.7% (304) of children. Match and broomsticks were used for cleaning by 18.3% (256) and 3% (43) of children, respectively. One hundred and fifty-nine children (11.3%) were applying oil to clean the ear canal. Ear cleaning with unhealthy means was significantly higher (56% v. 44%, p<0.03) among children belonging to low socioeconomic strata. There was a significant association between unhealthy ear cleaning practices and middle ear infection (p<0.001).

CONCLUSION

A majority of children practised unhealthy/ not recommended methods for cleaning their ear. There is a need to raise awareness about healthy ear cleaning practices in the community.

Correction of penile torsion and chordee by mobilization of urethra with spongiosum in chordee without hypospadias

OBJECTIVE

To investigate the feasibility of correcting coexistent penile torsion and chordee without hypospadias by mobilization of the urethra and spongiosum.

MATERIALS AND METHODS

A retrospective study of nine patients with simultaneous penile torsion and chordee without hypospadias was undertaken between January 2006 and December 2012. During this period, a total of 364 cases of hypospadias and 38 of chordee without hypospadias were operated on, making a total of 402 patients with hypospadias-related complexes. The same steps were used for correction of both torque and chordee. After a circumcoronal incision, the penis was fully degloved and the spongiosum with urethra was lifted up off the cavernosa. Next, mobilization of the hypoplastic urethra with spongiosum was extended into the glans. If chordee or torque persisted, urethral mobilization was performed proximally up to the bulbar urethra, as required. Spongioplasty and glansplasty were done and a per-urethral stent was kept in for three to five days.

RESULTS

The age of the patients ranged from 5 to 16 years (median 6 years). Penile torsion ranged from 30° to 120°, with a median of 75°. Ventral chordee ranged from 45° to 100°, with a median of 50°. A ratio of 1:9.6 was found for chordee without hypospadias compared to the total hypospadias cases, with an incidence of 9.5%. The ratio of chordee without hypospadias with torsion compared to the total hypospadias cases was 1:29. There was an incidence of chordee without hypospadias with penile torsion of 3.5% in all patients with hypospadias. The ratio of chordee without hypospadias with torsion to only chordee without hypospadias was 1:1.71, with an incidence of 37.0%. Every step contributed to the correction of curvature and torsion. Chordee was corrected in two patients by penile degloving and lifting of the spongiosa off the urethral plate; three patients required additional mobilization of the urethra into the glans. Another two patients needed proximal urethral mobilization and one required a dorsal plication. In five patients, torque was corrected by penile degloving, lifting of the spongiosa and mobilization of the urethra into the glans; four patients required further proximal urethral mobilization. All patients had excellent functional and cosmetic results. No residual chordee or torque was observed in any patient on follow-up at 12-24 months.

CONCLUSION

The technique of distally mobilizing a hypoplastic urethra with spongiosum from the corpora into the glans, and proximally up to the bulbar region corrects moderate to severe chordee and torsion with excellent cosmetic results. The incidence of torsion with chordee without hypospadias was 3.5% of all cases of hypospadias.