Routine histopathological examination of the foreskin after circumcision for clinically suspected lichen sclerosus in children: Is it a waste of resources?

Introduction: Circumcision is one of the most widely performed procedures in the world. One of the indications for circumcision is lichen sclerosis (LS). The natural history of LS in children is not as well-documented as in adult patients. Surgeons use the appearance of the foreskin or meatus to predict the diagnosis of LS.1 Indeed, if the diagnosis of LS is made in childhood, does it change management in the long-term? Pathological analysis of the excised foreskin is routinely done if there is suspicion of LS. Our aim is to assess the concordance between the clinical and pathological diagnosis of suspected LS and to assess the need for sending the foreskin for pathological examination.Methods: We conducted a retrospective chart review of 64 of 420 boys who underwent circumcision in a tertiary children’s hospital from June 2005 to June 2014, and who had their foreskin sent for pathology due to the clinical suspicion of LS. Demographics, presenting symptoms, presumed clinical diagnosis, pathological findings, and followup data were collected and analyzed. Results: Over the review period, 64 patients underwent circumcision for presumed LS. The mean age of the children was 9.7 years (range 3‒16.5). All the children who had circumcision for presumed LS diagnosis were symptomatic. LS was confirmed in 47 of 64 foreskins (73.5%). Balanitis xerotica obliterans (BXO) was clinically suspected in 40 (85%) of the 47 patients. The mean followup was 10 months (range 1–15), with seven recurrences (15%) during that period. The recurrences required revision surgery in two patients and five were managed with steroids only. Conclusions: In our series, the clinical diagnosis correlated with the pathological diagnosis in most cases. A clinical suspicion of LS without routine foreskin pathological assessment will reduces the overall cost to the healthcare system. Appropriate counselling of the patient/parents and their primary caregiver is imperative, as recurrence is common.

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Study On Clinical Profile of Patients Undergoing Abdominal Hysterectomy and Their Clinico-Pathological Correlation

Journal of Chitwan Medical College ◽

10.3126/jcmc.v9i2.24558 ◽

2019 ◽

Vol 9 (2) ◽

pp. 65-71

Author(s):

Sabita Shrestha ◽

Rakshya Joshi ◽

Renuka Tamrakar ◽

Basant Sharma

Keyword(s):

Clinical Diagnosis ◽

Ovarian Tumor ◽

Histopathological Examination ◽

College Teaching ◽

Abdominal Hysterectomy ◽

Clinical Profile ◽

Histopathological Analysis ◽

Presenting Symptoms ◽

Wide Range ◽

The Mean

Background: Hysterectomy is an effective treatment for a wide range of gynaecological diseases, both benign and malignant. There must be a periodic audit for the appropriate indication of the surgery and its complication rate. Histopathological analysis is mandatory for definitive diagnosis and further management. This study aims to review the clinical profile, indications of hysterectomy and to assess the correlation between the clinical diagnosis and histopathological report. Methods: A retrospective study of all the patients undergoing abdominal hysterectomy was conducted in the Department of Obstetrics and Gynecology, Chitwan Medical College Teaching Hospital, Nepal from January to December 2018. Demographic and clinical informations were retrieved from the medical record section. Datas were entered in the pre-designed proforma. Statistical analysis was done in terms of percentages, standard deviation, correlation and mean. Results: During the study period, 111 patients underwent abdominal hysterectomy. The mean age of the patients was 46 years. The mean duration of hospital stay was 8.7 days. Abnormal menstrual flow and pain abdomen were the commonest presenting symptoms. The most common preoperative diagnosis was fibroid followed by ovarian tumor. Leiomyoma was the commonest lesion on histopathological examination. The correlation between clinical diagnosis and histopathology was 96.07% for fibroid, 80.95% for ovarian tumor, 66.67% for adenomyosis and 38.46% for DUB. Conclusions: Fibroid uterus and ovarian mass are the common indications for abdominal hysterectomy. Histopathology is mandatory for confirming the diagnosis, proper counseling and holistic management of the patient.

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Does routine histology alter management post circumcision?

Journal of Clinical Urology ◽

10.1177/2051415819895399 ◽

2020 ◽

Vol 13 (4) ◽

pp. 279-282

Author(s):

Lynne Kerr ◽

Jane Hendry ◽

Aaron Crookshanks ◽

Joby Taylor

Keyword(s):

Clinical Diagnosis ◽

Patient Management ◽

Lichen Sclerosus ◽

District General Hospital ◽

Clinical Suspicion ◽

Histological Diagnosis ◽

Alter Patient ◽

Number Of Patients ◽

Clinical Records

Objective: Circumcision is a commonly performed urological procedure, histology is often requested with unexpected malignancy cited as the reason. This paper aims to determine if routine histology following circumcision alters the clinical management of patients. Patients and methods: The clinical records of 508 consecutive adult patients circumcised at a district general hospital between 1/1/12 and 31/12/16 were retrospectively reviewed. Two groups were available for comparison, those with histological diagnosis (359 patients) and those with a clinical diagnosis only (149 patients). The following data were collected: indication for circumcision; preoperative clinical and histological diagnosis; patient follow-up (mean 40 months). Results: A total of 508 patients were reviewed. Histology was requested for 359 specimens (70.7%). Six cases of squamous cell carcinoma were correctly identified clinically and there were no cases of unexpected malignancy. The clinical diagnosis of lichen sclerosus was correct in 92% of cases; 39 patients were re-referred following discharge, only one required further management of a urethral stricture. Conclusion: The results of our study show there is no difference in the outcomes or re-referral rates of patients who have routine histology requested following circumcision compared with those who do not. Clinical diagnosis is consistently accurate. There is a minimal number of patients referred back to the service, even with lichen sclerosus, and histology does not affect the rate of this. We conclude that routine histology does not alter patient management following circumcision and is not required unless a clinical suspicion of malignancy exists. This study represents the largest cohort of circumcision patients and includes the longest period of follow-up to add to the current body of literature. Levels of evidence: 2b retrospective consecutive cohort study with follow up.

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CLINICO PATHOLOGICAL CORRELATION OF EYELID TUMORS AND THEIR SURGICAL OUTCOME

Journal of medical pharmaceutical and allied sciences ◽

10.22270/jmpas.v10i3.1126 ◽

2021 ◽

pp. 2890-2895

Author(s):

Sumit Thakur

Keyword(s):

Clinical Diagnosis ◽

Malignant Tumors ◽

Histopathological Examination ◽

Detailed Examination ◽

Lymph Node Excision ◽

Excision Biopsy ◽

Histopathological Diagnosis ◽

Presenting Symptoms ◽

Eyelid Tumors ◽

Lid Reconstruction

Eyelid tumors are the most common neoplasm in daily ophthalmology practice and encompass a wide variety of benign and malignant tumors. The most common presenting symptoms for skin cancer on the eyelids include a mass or tumor, ulceration, or soreness. It is an institution-based study and the patients were recruited from the OPD and Indoor-wards of Aravind Eye Hospital. Each patient was examined by the slit lamp bio-microscope. The size of the tumor is measured with a detailed examination of the tumor-like margin, the involvement of the other adnexal structure, and the lymph node. Excision biopsies were done and send for histopathological examination. Wound closure with lid reconstruction done according to the size and site of the tumor. Out of 66 patients, the clinical diagnosis of 56(85%) patients was correlated with the histopathological diagnosis but in the remaining 10(15%) patients no correlation was found between histopathological and clinical diagnosis. Proper knowledge of the tumor, anatomy of the lid, and history will help in the appropriate diagnosis of eyelid tumor which can be confirmed by histopathological examination. In the present study, tumors were managed with excision biopsy and lid reconstruction was done depending upon the location and extent of the tumor.

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Histopathological Examination in the Categorization of fungal Rhinosinusitis - a Retrospective Study

Nepalese Medical Journal ◽

10.3126/nmj.v4i2.41377 ◽

2021 ◽

Vol 4 (2) ◽

pp. 478-481

Author(s):

Sangeetha Kandasamy ◽

Megala Chandrasekar ◽

Thamilselvi Ramachadran

Keyword(s):

Clinical Diagnosis ◽

Gold Standard ◽

Nasal Polyps ◽

Histopathological Examination ◽

Clinical Suspicion ◽

Fungal Sinusitis ◽

Medical College ◽

Fungal Rhinosinusitis ◽

Hematoxylin And Eosin ◽

Made In

Introduction: Fungal Rhinosinusitis is broadly defined as any sinonasal pathology related to the presence of fungi and is increasingly recognized worldwide. This study aimed to assess and ascertain the need for histopathological examination in the management of fungal Rhinosinusitis. Materials and Methods: This study was performed over two years, from April 2019 to April 2021, in the Department of Pathology, Vinayaka Missions KirupanandaVariyar Medical College and Hospital, Salem. A total of 383 cases of rhinosinusitis/nasal polyps were studied. Histopathological examination and categorization were done and compared with clinical diagnosis. Results: Only 4/18 cases of acute fungal Rhinosinusitis were correctly diagnosed(22.22%). Nineteen cases of the fungal ball were diagnosed, but none was correctly categorized. Clinical suspicion of fungal sinusitis was present in 10 cases of Rhinosinusitis, which turned out to be chronic Rhinosinusitis in histopathology. In AFRS, fungal elements were overlooked in Hematoxylin and Eosin stained slides and identified only by Grocottmethenamine silver in one-fourth of the cases. Conclusions: Though clinical diagnosis was made in 86% of fungal rhinosinusitis cases, correct categorization was done only in one-third of cases. CT scan could diagnose 60% of cases, but none was categorized. As treatment depends on the type of fungal Rhinosinusitis, histopathological examination is the gold standard for diagnosing and treating fungal Rhinosinusitis.

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Brief Overview and Experience of Visual Evoked Potential of First 67 cases at Referral Neuroscience Hospital in Bangladesh

Journal of National Institute of Neurosciences Bangladesh ◽

10.3329/jninb.v6i2.50744 ◽

2020 ◽

Vol 6 (2) ◽

pp. 74-77

Author(s):

Mohammad Enayet Hussain ◽

Bithi Debnath ◽

AFM Al Masum Khan ◽

Md Ferdous Mian ◽

Md Nahidul Islam ◽

...

Keyword(s):

Multiple Sclerosis ◽

Optic Neuritis ◽

Clinical Diagnosis ◽

Optic Neuropathy ◽

Cross Sectional Study ◽

P Value ◽

Pattern Reversal ◽

Cross Sectional ◽

The Mean ◽

Visual Evoked

Background: The visual evoked potentials (VEP) is a valuable tool to document occult lesions of the central visual channels especially within the optic nerve. Objectives: The purpose of the present study was to observe the findings of first few cases of VEP done in the neurophysiology department of the National Institute of Neurosciences (NINS), Dhaka, Bangladesh. Methodology: This cross-sectional study was conducted in the Department of Neurophysiology at the National Institute of Neurosciences and Hospital, Dhaka, Bangladesh from September 2017 to March 2020. All patients referred to the Neurophysiology Department of NINS for VEP were included. Pattern reversal VEPs were done using standard protocol set by International Federation of Clinical Neurophysiology (IFCN). Results: The mean age of the study population was 30.70 (±12.11) years (6-68 years) with 31 (46.3%) male and 36 (53.7%) female patients. The mean duration of illness was 8.71 (±1.78) months (3 days- 120 months). Most common presenting symptom was blurring of vision (37.3%) and dimness of vision (32.8%). Patterned VEP revealed mixed type (both demyelinating and axonal) of abnormality in most cases [29(43.35)]. The most common clinical diagnosis was multiple sclerosis (29.85%) and optic neuropathy (26.87%). In the clinically suspected cases of multiple sclerosis, optic neuropathy and optic neuritis most of the cases of VEP were abnormal and the p value is 0.04 in optic neuropathy and optic neuritis. Conclusion: The commonest presentation of the patients in this series were blurring of vision and dimness of vision. The most common clinical diagnosis for which VEP was asked for, was optic neuritis and multiple sclerosis. Most abnormalities were of mixed pattern (demyelinating and axonal). Journal of National Institute of Neurosciences Bangladesh, 2020;6(2): 74-77

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Higher Caloric Refeeding Is Safe in Hospitalised Adolescent Patients with Restrictive Eating Disorders

Journal of Nutrition and Metabolism ◽

10.1155/2016/5168978 ◽

2016 ◽

Vol 2016 ◽

pp. 1-9 ◽

Cited By ~ 12

Author(s):

Elizabeth K. Parker ◽

Sahrish S. Faruquie ◽

Gail Anderson ◽

Linette Gomes ◽

Andrew Kennedy ◽

...

Keyword(s):

Eating Disorders ◽

Weight Gain ◽

Statistical Significance ◽

Caloric Intake ◽

Tube Feeding ◽

Retrospective Chart Review ◽

Refeeding Syndrome ◽

Restrictive Eating ◽

Weight Restoration ◽

The Mean

Introduction. This study examines weight gain and assesses complications associated with refeeding hospitalised adolescents with restrictive eating disorders (EDs) prescribed initial calories above current recommendations.Methods. Patients admitted to an adolescent ED structured “rapid refeeding” program for >48 hours and receiving ≥2400 kcal/day were included in a 3-year retrospective chart review.Results. The mean (SD) age of the 162 adolescents was 16.7 years (0.9), admission % median BMI was 80.1% (10.2), and discharge % median BMI was 93.1% (7.0). The mean (SD) starting caloric intake was 2611.7 kcal/day (261.5) equating to 58.4 kcal/kg (10.2). Most patients (92.6%) were treated with nasogastric tube feeding. The mean (SD) length of stay was 3.6 weeks (1.9), and average weekly weight gain was 2.1 kg (0.8). No patients developed cardiac signs of RFS or delirium; complications included 4% peripheral oedema, 1% hypophosphatemia (<0.75 mmol/L), 7% hypomagnesaemia (<0.70 mmol/L), and 2% hypokalaemia (<3.2 mmol/L). Caloric prescription on admission was associated with developing oedema (95% CI 1.001 to 1.047;p=0.039). No statistical significance was found between electrolytes and calories provided during refeeding.Conclusion. A rapid refeeding protocol with the inclusion of phosphate supplementation can safely achieve rapid weight restoration without increased complications associated with refeeding syndrome.

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Can an amino acid mixture alleviate gastrointestinal symptoms in neuroendocrine tumor patients?

BMC Cancer ◽

10.1186/s12885-021-08315-4 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Aman Chauhan ◽

Satya Das ◽

Rachel Miller ◽

Laura Luque ◽

Samuel N. Cheuvront ◽

...

Keyword(s):

Amino Acid ◽

Neuroendocrine Tumor ◽

Gastrointestinal Symptoms ◽

Retrospective Chart Review ◽

Final Analysis ◽

Acid Mixture ◽

Tumor Patients ◽

Short Gut Syndrome ◽

Oral Rehydration ◽

The Mean

Abstract Background Neuroendocrine tumors, although relatively rare in incidence, are now the second most prevalent gastrointestinal neoplasm owing to indolent disease biology. A small but significant sub-group of neuroendocrine tumor patients suffer from diarrhea. This is usually secondary to carcinoid syndrome but can also be a result of short gut syndrome, bile acid excess or iatrogenic etiologies. Recently, an amino acid based oral rehydration solution (enterade® Advanced Oncology Formula) was found to have anti-diarrheal properties in preclinical models. Methods A retrospective chart review of all NET patients treated with enterade® AO was performed after IRB approval. Results Ninety-eight NET patients who had received enterade® AO at our clinic from May 2017 through June 2019 were included. Patients (N = 49 of 98) with follow up data on bowel movements (BMs) were included for final analysis. Eighty-four percent of patients (41/49) had fewer BMs after taking enterade® AO and 66% (27/41) reported more than 50% reduction in BM frequency. The mean number of daily BMs was 6.6 (range, 3–20) at baseline before initiation of therapy, while the mean number of BMs at 1 week time point post enterade® AO was 2.9 (range, 0–11). Conclusions Our retrospective observations are encouraging and support prospective validation with appropriate controls in NET patients. This is first published report of the potential anti-diarrheal activity of enterade® AO in NET patients.

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Correlation between fundus autofluorescence and visual function in patients with cone-rod dystrophy

Scientific Reports ◽

10.1038/s41598-021-81597-7 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Satoru Kanda ◽

Takumi Hara ◽

Ryosuke Fujino ◽

Keiko Azuma ◽

Hirotsugu Soga ◽

...

Keyword(s):

Visual Field ◽

Significant Relationship ◽

Fundus Autofluorescence ◽

Univariate Analysis ◽

Retrospective Chart Review ◽

Mean Deviation ◽

Wide Field ◽

The Mean ◽

The Relationship ◽

Field Imaging

AbstractThis study aimed to investigate the relationship between autofluorescence (AF) signal measured with ultra-wide field imaging and visual functions in patients with cone-rod dystrophy (CORD). A retrospective chart review was performed for CORD patients. We performed the visual field test and fundus autofluorescence (FAF) measurement and visualized retinal structures with optical coherence tomography (OCT) on the same day. Using binarised FAF images, we identified a low FAF area ratio (LFAR: low FAF/30°). Relationships between age and logMAR visual acuity (VA), central retinal thickness (CRT), central choroidal thickness (CCT), mean deviation (MD) value, and LFAR were investigated. Thirty-seven eyes of 21 CORD patients (8 men and 13 women) were enrolled. The mean patient age was 49.8 years. LogMAR VA and MD were 0.52 ± 0.47 and − 17.91 ± 10.59 dB, respectively. There was a significant relationship between logMAR VA and MD (p = 0.001). LogMAR VA significantly correlated with CRT (p = 0.006) but not with other parameters. Conversely, univariate analysis suggested a significant relationship between MD and LFAR (p = 0.001). In the multivariate analysis, LFAR was significantly associated with MD (p = 0.002). In conclusion, it is useful to measure the low FAF area in patients with CORD. The AF measurement reflects the visual field deterioration but not VA in CORD.

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Visual outcome of endogenous endophthalmitis in Thailand

Scientific Reports ◽

10.1038/s41598-021-93730-7 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Preeyachan Lourthai ◽

Pitipol Choopong ◽

Dhanach Dhirachaikulpanich ◽

Kunravitch Soraprajum ◽

Warinyupa Pinitpuwadol ◽

...

Keyword(s):

Retrospective Chart Review ◽

Visual Outcome ◽

Post Treatment ◽

Endogenous Endophthalmitis ◽

Infectious Episode ◽

Hand Motion ◽

Phthisis Bulbi ◽

Causative Agents ◽

Corneal Decompensation ◽

The Mean

AbstractTo evaluate a 10-year visual outcome of endogenous endophthalmitis (EE) patients. A 10-year retrospective chart review of EE patients. Thirty-eight patients (40 eyes) were diagnosed with EE at the mean age of 42. Among the identifiable pathogens (71.1% culture positive), the causative agents were predominantly gram-negative bacteria (48.1%). The most common specie was Klebsiella pneumoniae (25.9%). About a quarter of the patients required surgical eye removal, and the remaining 45.7% had visual acuity (VA) worse than hand motion at one month after the infectious episode. The most common complication was ocular hypertension (52.5%). Poor initial VA was significantly associated with a worse visual outcome in the early post-treatment period (p 0.12, adjusted OR 10.20, 95% CI 1.65–62.96). Five patients continued to visit the clinic for at least ten years. One patient had gained his vision from hand motion to 6/7.5. Two patients had visual deterioration, one from corneal decompensation, and the other from chronic retinal re-detachment. Two patients developed phthisis bulbi, with either some VA perception of light or no light perception. Poor initial VA is the only prognostic factor of a poor early post-treatment visual outcome of EE.

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Are the First and Second Hip in Staged Bilateral Total Hip Arthroplasty Equal? A Hospital Adverse Event and Perioperative Risk Comparison

The Journal of Hip Surgery ◽

10.1055/s-0041-1729868 ◽

2021 ◽

Author(s):

Jesus M. Villa ◽

Tejbir S. Pannu ◽

Carlos A. Higuera ◽

Juan C. Suarez ◽

Preetesh D. Patel ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Adverse Events ◽

Hip Arthroplasty ◽

Retrospective Chart Review ◽

Consecutive Series ◽

Level Of Evidence ◽

Exact Test ◽

Total Hip ◽

Discharge Disposition ◽

The Mean

AbstractHospital adverse events remain a significant issue; even “minor events” may lead to increased costs. However, to the best of our knowledge, no previous investigation has compared perioperative events between the first and second hip in staged bilateral total hip arthroplasty (THA). In the current study, we perform such a comparison. A retrospective chart review was performed on a consecutive series of 172 patients (344 hips) who underwent staged bilateral THAs performed by two surgeons at a single institution (2010–2016). Based on chronological order of the staged arthroplasties, two groups were set apart: first-staged THA and second-staged THA. Baseline-demographics, length of stay (LOS), discharge disposition, hospital adverse events, and hospital transfusions were compared between groups. Statistical analyses were performed using independent t-tests, Fisher's exact test, and/or Pearson's chi-squared test. The mean time between staged surgeries was 465 days. There were no significant differences in baseline demographics between first-staged THA and second-staged THA groups (patients were their own controls). The mean LOS was significantly longer in the first-staged THA group than in the second (2.2 vs. 1.8 days; p < 0.001). Discharge (proportion) to a facility other than home was noticeably higher in the first-staged THA group, although not statistically significant (11.0 vs. 7.6%; p = 0.354). The rate of hospital adverse events in the first-staged THA group was almost twice that of the second (37.2 vs. 20.3%; p = 0.001). There were no significant differences in transfusion rates. However, these were consistently better in the second-staged THA group. When compared with the first THA, our findings suggest overall shorter LOS and fewer hospital adverse events following the second. Level of Evidence Level III.

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