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Background: The salivary gland lesions constitute around 3–6% of all head-and-neck lesions and have always posed a diagnostic riddle for the cytopathologists around the world. Since the majority of these lesions need surgical excision, it is, therefore, important to diagnose these lesions with utmost precision to prevent over or under stage procedures. The recent adaption of Milan system of reporting aims to establish a uniform, accurate, and consensual reporting system which bridges the communication between the pathologists and the clinicians. Aims and Objectives: The current study aims to assess the diagnostic application of Milan system and aims to reclassify the lesions according to it. Materials and Methods: The current study was conducted at our institute during 1 year period. All salivary gland swellings presenting to the fine-needle aspiration cytology (FNAC) section during this period were included in the study. Along with this, records and slides of cases of salivary gland lesions were retrospectively assessed. All relevant data and radiologic findings were retrieved from the case records. FNAC was done using 23 G needle. The slides were stained with both Leishman and Papanicolaou stain wherever possible. Quantitative data were expressed as mean and standard deviation and percentages. All the 83 lesions were reclassified as per the Milan system. Histopathology was available in 42 cases. Inclusion criteria: All the samples of the patient having salivary gland lesion(s) whose FNAC were performed in the department of pathology. Statistical Analysis: Data were be entered into Microsoft Excel spreadsheets. For quantitative data, mean and standard deviation were calculated. For qualitative data, percentage and proportion were calculated. Sensitivity, specificity, and spearman correlation between FNAC and histopathology were calculated. P

A retrospective study was performed to evaluate the diagnostic yield of lung cancer on biopsy, bronchial washings and brushings taken at fibreoptic bronchoscopy. Records of 526 patients were analysed and eventually 107 patients with endobronchial lesions, who had had biopsy, washing and brushing were included in this study. 89 cases were found to be malignant. Squamous cell carcinoma was the most common malignancy. Brush was found to be better than wash in tumor typing, though overall tumor typing using cytology was poor. Sensitivities of bronchial wash, bronchial brush and biopsy were found to be 70.8%, 64% and 94.4% respectively. Biopsy gave the only positive result in 38.2%, only brush in 1.1% and only wash in 1.1% malignant cases. Diagnostic accuracy of bronchial biopsy, brush and wash was found to be 95.3%, 70% and 73.8% respectively. Addition of bronchial wash and brush increased the positive yield by only 2.2% which was insignificant. It was concluded that the wash and brush cytology do not significantly add to the overall yield of positive results obtained from biopsies in endobronchial lesions. Keywords: Lung cancer, Fibreoptic bronchoscopy, Bronchial wash cytology, Bronchial brush, Endobronchial biopsy, Diagnostic accuracy.

The present study entitled ”Study of p53 gene expression as a prognostic marker in squamous cell carcinoma of oral cavity” was conducted in the department of pathology SRMSIMS Bareilly, 66 cases diagnosed on histopathology as squamous cell carcinoma of oral cavity from Jan 2016 to Jan 2017 were included in the study. Various parameters analysed for each case included age, gender, site, history of tobacco chewing, smoking &, alcohol consumption, histopathological grade of tumor and p53 expression. The patients age ranged from 24 to 85 years with mean age; 52.09 years and median age; 53 years. Maximum no of patients were male 54(81.8%) and 12 (18.2%) were female. Male: female ratio was 9:2. The most common site of presentation was lateral border of tongue (34.8). In the present study 89.4% were tobacco chewers, 72.7% were alcoholics and 57.6% were smokers.34 cases (51.5%) were diagnosed as well differentiated, 26 cases(39.4%) as moderately differentiated and 6 cases (9.1)% as poorly differentiated squamous cell carcinoma. The p53 expression was observed in 41(62.1%) of cases. The expression of p53 increased with the grade of tumor. The positivity being 17(50%) in cases of well differentiated, 19(73%) in moderately differentiated and 5(83%) in poorly differentiated squamous cell carcinoma. In present study p53 expression is found to be significantly related with tobacco chewing (p value= 0.034), smoking (p value= 0.0046) and tumor grade (p value=0.030). However no association was found with alcohol consumption (p value=0.917) the increasing prevalence of p53 expression with increasing grade of tumor suggests that it can be used as a prognostic indicator in oral cavity cancers. Keywords: Squamous cell carcinoma, p53 expression, Prognostic indicator, Oral cancer.

Background: The relationship between oral health and systemic conditions has been increasingly debated over recent decades with one such discussion existing about oral hygiene and periodontitis with chronic obstructive pulmonary disease (COPD). Hence, a study was conducted to assess and compare the oral hygiene status and periodontal status of age and gender-matched participants with and without COPD and to correlate oral hygiene status and periodontal status with lung function status among them. Materials and Methods: This hospital-based study included a study population of 117 participants (39 patients of COPD and 78 participants without COPD) 35–75 years of age with at least 20 natural teeth. Participant's demographic details and history of smoking were recorded. Lung function was recorded using a spirometer. Periodontal health was assessed by measuring Probing Pocket Depth (PPD), Clinical Attachment Loss (CAL), and Oral Hygiene Index (OHI) by a trained and calibrated examiner. Results: Higher mean of PPD, CAL, and OHI is being reported in the present study with 4.07 versus 3.50, 0.58 versus 0.24, and 5.24 versus 3.60, respectively, among patients with and without COPD which was statistically significant. The risk of having COPD was 0.4 times more in participants having poor oral hygiene and 0.07 times more in patients smoking. Smoking and oral hygiene, as independent variables, have a significant influence on COPD which is a dependent variable. A weak correlation was found of poor oral hygiene and loss of attachment among participants with COPD. Conclusion: Periodontitis and respiratory disease share a common risk factor, i.e., smoking. Smoking has a definite relation with periodontitis and COPD. Oral hygiene is significantly associated with increased risk for COPD when age and gender effects have been matched and when adjusted for smoking. However, no association was found of PPD with COPD.

Chondroid syringoma is a rare, benign, appendegeal neoplasm. It was initially termed as mixed tumor as it comprises both epithelial cells and chondromyxoid stroma. It usually presents as a slow growing, solitary, painless, subcutaneous, or intracutaneous mass, frequently in the head and neck region. Cytological features usually include the presence of both components, similar to histology but aspiration of only one component or atypical features can pose challenges in diagnosis. According to literature, only a few single case reports describing the cytological features of chondroid syringoma has been published. We report three cases of chondroid syringoma and its differential diagnosis on cytology.

Introduction: Metaplastic Carcinoma of Breast (MCB) is a rare heterogeneous neoplasm characterised by a mixture of adenocarcinoma with dominant areas of spindle cells, squamous and other mesenchymal differentiation. The reported incidence is 0.2% of all breast cancers. Aim: To study the clinicopathological presentation, pathologic features and differential diagnosis of MB. Materials and Methods: This retrospective cross-sectional descriptive study included 10 cases of MCB who underwent mastectomy and biopsies at BPS GMC Khanpur Kalan, Sonipat, Haryana, India from March 2013 to February 2020. Data were analysed by Microsoft Office Excel Datasheet 2019. Results: Out of 10 cases, five cases were MCB Not Otherwise Specified (NOS) type, four cases were MCB with mesenchymal differentiation and one case showed rhabdomyosarcomatous differentiation. The right breast was involved in nine cases. The mean size of tumour was 8 cm with range of 3 to 16 cm. Five patients were treated by modified radical mastectomy and axillary dissection, four patients had lumpectomy and one patient underwent mastectomy. Half of the patients were below 40 years with the mean age being 36.8 years and range of 21-60 years. On Immunohistochemistry (IHC), 90% (9/10) cases were triple negative. Conclusion: The MCB, although rare has to be diagnosed and excised at the earliest as the prognosis is predicted to be worse similar to other triple negative breast carcinomas. Ductal Carcinoma in Situ (DCIS) at the tumour periphery and co-expression of vimentin and cytokeratin would help to clinch the diagnosis in difficult situations.

Background: The knowledge of the parents toward the oral hygiene care might get affected by the family structure. Objective: Trend of capsular families in Urban India has led to change in infant oral health practices. Hence, the study was carried out to evaluate the knowledge, attitude, and practice about infant oral care among professional working mothers in Pune city, India. Methods: A 28-item semi-closed, closed-ended questionnaire was administered to 111 professional working mothers in Pune city, India. The data for demographic details, knowledge, attitude, and practice regarding infant oral care were collected with the help of this predesigned self-administered questionnaire from working professional mothers attending outpatient department of Pediatric Hospitals in Pune city. Results: An average, there was limited knowledge among mothers regarding oral health. However, only 13.5% mothers were aware about commercially available tooth wipes, 18% knew when the infant's first dental visit should be scheduled. About 22.5% had practice of bottlefeeding before nap time and 16.2% mothers added sugars/additives in milk while bottlefeeding. Conclusion: All the mothers had overall limited knowledge, positive attitude, and practices were inadequate about infant oral care.

Patients see their primary care physicians (PCPs) for a variety of medical conditions, chronic pain being one of the most common. An increased use of prescription medications (especially opioids) has led to an increase in adverse drug reactions and has heightened our awareness of the variability in response to medications. Opioids and other pain adjuvants are widely used, and drug–drug interactions involving these analgesics can be problematic and potentially lethal. Pharmacogenetics has improved our understanding of drug efficacy and response, opened doors to individual tailoring of medical management, and created a series of ethical and economic considerations. Since it is a relatively new field, genetic testing has not been fully integrated into the primary care setting. The purpose of this paper is to review the metabolism of commonly prescribed opioids, discuss the economic and ethical issues, and provide PCPs with an understanding of how to incorporate genetic testing into routine use to improve clinical practice and patient management.

Background: Ovarian lesions constitute a complex group with varied clinical behaviour and pathology. The ovaries constitute the internal reproductive organs their lesions can present in childhood to postmenopausal age group Clinical, radiological and gross examination alone cannot distinguish benign from malignant lesions; hence, histopathological examination is needed for their diagnosis and management. Objectives: A Clinico -pathological analysis of non-neoplastic and neoplastic ovarian lesions. Materials and methods: This descriptive study of one year comprised of 80 ovarian lesions diagnosed in the Department of Pathology, Bhagat Phool Singh Government medical college Sonipat. After thorough gross examination, representative bits were routinely processed and stained with H & E. Tumours were classified as per WHO classification. Results: Out of 80 ovarian lesions received, non-neoplastic lesions constituted 39% (31/80). Benign lesions constituted 45% (36/80) whereas borderline and malignant lesions constituted 5% (4/80) and 11.25% (9/80) respectively. Among non-neoplastic lesions, follicular cysts (67.7%) constituted the majority followed by corpus luteal cysts and endometriotic cysts. Among neoplastic lesions majority of the tumours were of surface epithelial type (69.38%) followed by germ cell tumours (18.36%). Bilateral lesions were seen in 17 (26.98%) patients while unilateral lesions were seen in 46 (73.01%) patients. Patients age varied from 16 to 75 years. For non-neoplastic lesions, patient age varied from 16 to 61 years. For neoplastic lesions patient age ranged from 18-75 years with age range of 18-75 years for benign tumours and 26-66 years for malignant tumours. Abnormal uterine bleeding was the commonest clinical presentation of non-neoplastic lesions. Benign and malignant tumours were most commonly associated with pain abdomen. Conclusion: Ovarian lesions comprise of variety of non-neoplastic and neoplastic lesions. By knowing clinical data, gross features, we can narrow our differential diagnosis and reach to the final diagnosis. So, early diagnosis and treatment definitely reduce the mortality from ovarian tumours. Keywords: Non-neoplastic, Benign, Malignant, Ovary, Lesions, Cysts, Tumours.

Peritoneum is a site for both primary and secondary tumors. Clear cell carcinoma of the peritoneum is an extremely rare primarytumor. The diagnosis of primary peritoneal tumors is based on the gynecology oncology group criteria, originally described forprimary adenocarcinoma of the peritoneum. A 55-year-old female presented with non-specific pain in the lower abdomen of 1-monthduration. Contrast-enhanced computed tomography findings of the abdomen were suggestive of suspected neoplastic mass mostlikely arising from the left ovary. Pre-operative serum cancer antigen-125 levels were 252 U/ml. Upon exploratory laparotomy, ahard nodular mass appearing to arise from anterior abdominal wall (15 × 12 cm) was found in the left iliac fossa. Histopathologicaldiagnosis of primary peritoneal clear cell carcinoma was made and immunohistochemistry was performed for confirmation.

Complementary and alternative medicine in western medicine has had a more prominent role over the past few years, especially in multidisciplinary pain management. Of the physical modalities helpful in the concurrent management of pain, yoga and mindfulness meditation have emerged as effective options, and literature has identified acupuncture as efficacious and safe. Nutraceuticals have a role in the management of pain, but mechanisms of action need to be elucidated and regulatory bodies need to ensure quality control and dosage safety.

Healthcare delivery costs in the perioperative setting have increased due to varying factors. Regional anesthesia (RA) minimizes costs and would lead to cost benefits on evaluation. RA allows for airway avoidance and minimizes/eliminates general anesthesia requirements for perioperative patient care. Additionally, patients receiving RA have fewer effects from perioperative anesthetic agents than their general anesthesia cohorts.

Although long an integral part of the health systems of societies all around the globe, the role of complementary and alternative medicine (CAM) in Western medicine has become better defined over the past few years, especially in multidisciplinary pain management. Many patients have expressed dissatisfaction at conventional treatments of therapy, medications, and procedures. Often they have sought adjunctive treatments to make up for deficits in efficacy and to minimize unwanted side effects. CAM has been a source to fill the void. Additionally, physical modalities that promote the mind-body connection in pain states have emerged in common practice. Of the physical modalities helpful in the concurrent management of pain, yoga has emerged as one of the most effective options. The medical literature has identified acupuncture as efficacious and safe and determined that it may have benefit as a sole therapy or in conjunction with traditional interventions. Although nutraceuticals and marijuana have received lay press exposure and interest, as pain therapeutics, the mechanism of action of these agents needs to be more precisely elucidated and regulatory bodies need to ensure quality control and dosage safety in society. This review contains 4 figures, 1 table and 118 references Key Words: acupuncture, lower back pain (LBP), medical marijuana, nutraceuticals, transcutaneous electrical nerve stimulation (TENS)

Nearly 20 years ago it was shown that patients are exposed to unnecessary preoperative testing that is both costly and has associated morbidity. To determine whether such unnecessary testing persists, we performed internal and external surveys to quantify the incidence of unnecessary preoperative testing and to identify strategies for reduction.The medical records of 1000 consecutive patients scheduled for surgery at our institution were examined for testing outside of our approved guidelines. Subsequently, 4 scenarios were constructed to solicit physician views of appropriate testing: a 45-year-old woman for a laparoscopic ovarian cystectomy, a 23-year-old woman for right inguinal herniorrhaphy, a 50-year-old man for a hemithyroidectomy, and a 50-year-old man for a total hip replacement. One or more of these scenarios were sent to directors of preoperative clinics (all), United States anesthesiologists (all), gynecologists (cystectomy), general surgeons (herniorrhaphy), otolaryngologists (thyroidectomy), and orthopedists (hip replacement). Potential predictors of ordering and demographic information were collected.More than half of our patients had at least 1 unnecessary test based on our testing guidelines (95% lower confidence limit = 52%). The 17 responding preoperative directors were unanimous for 36 of the 72 combinations of test or consult (henceforth "test") and scenario as being unnecessary. Among the 175 anesthesiologists responding to the survey, 46% ordered 1 or more of the tests unanimously considered unnecessary by the preoperative directors for the given scenario. Among 17 potential predictors of anesthesiologists' unnecessary ordering, only training completed before 1980 significantly increased the risk of ordering at least 1 unnecessary test (by 48%, 95% confidence limits29%). Anesthesiologists were 53% less likely to order at least 1 unnecessary test relative to gynecologists for the cystectomy scenario, 64% less likely than general surgeons for the herniorrhaphy scenario, 66% less likely than otolaryngologists for the thyroidectomy scenario, and 67% less likely than orthopedists for the hip replacement scenario. The 95% lower confidence limits were all40%.The percentage of patients with at least 1 unnecessary test is a suitable end point for monitoring providers' ordering. The incidence can be high despite efforts at improvement, but may be reduced if anesthesiologists rather than surgeons order presurgical tests and consults. However, anesthesia groups should be cognizant of potential heterogeneity among them based on time since training.

Molecular epidemiological studies have provided evidence that individual susceptibility to cancer is mediated by both genetic and environmental factors. Several allelic variants of polymorphic glutathione s-transferases (GSTs) show impaired enzyme activity and are suspected to increase the host’s susceptibility to various cancers. To determine the association of GST variants with the risk of oral submucous fibrosis (OSF), the distribution of polymorphisms in GSTM1 and GSTT1 was studied in 90 OSF patients and 130 healthy controls. Genotypic analysis was performed by multiplex PCR. The relationship between the null genotypes and the risk of OSF was assessed by means of odds ratios (OR) with 95% confidence intervals (CI) calculated by logistic regression. The frequency of both the GSTM1 and GSTT1 null genotypes was higher in the OSF cases than in the controls. The prevalence of the GSTM1 null genotype in the OSF cases was 46.6% as compared to 29.2% in the controls (OR 2.12, 95% CI 1.2–3.9) and GSTT1 null was 24.4% in the OSF cases versus 10.7% in the controls (OR 2.68, 95% CI 1.22–5.96). There was evidence of an increased risk with the absence of both genotypes (7.5-fold; OR 7.5, 95% CI 2.3–24). Our findings suggest that the GSTM1 and GSTT1 null genotypes, separately or in combination, increase the risk of developing OSF in the North Indian population.

A 42-year-old woman developed right arm and right leg weakness when turning her head to the left. A carotid angiogram, in the neutral position, demonstrated anterior deviation of the left internal carotid artery and complete occlusion of the left internal carotid artery when the head was rotated to the left. During surgery, our patient had redundant left internal carotid artery and was treated by resection and reanastomosis of the internal carotid artery. The patient's Doppler 4 months postoperatively showed widely patent arteries, and she has subsequently been asymptomatic.

Background: Thyroid disease is most common endocrine disorder and is different from other endocrine diseases because of its visible swelling and ease of diagnosis. If left untreated, thyroid disease makes a person more prone for heart disease, infertility and osteoporosis. In India, significant burden of thyroid diseases exist with an estimation of around 42 million cases. The thyroid status and autoimmune status of adult Indian population in the post iodinization phase is largely unknown. Aim: The main objective of this study was to generate valuable epidemiological data regarding the prevalence of thyroid disorders in rural population of Khanpur Kalan, Sonepat in the post-iodinisation era in India. To assess whether thyroid autoimmunity or goitrogens along with environmental factors play role in the development of thyroid.This paper is being presented in view that no such study has been carried out in the rural population of this region in Haryana. Materials and Methods: The present study was conducted in Department of Pathology, Bhagat Phool Singh Medical College for Women, Khanpur Kalan, Sonepat between August 2011 to July 2013. It included retrospective analysis of cytomorphology of fine needle aspiration cytology material of 206 patients presenting with thyroid nodule in the Department of Pathology. Results: The commonest age group affected was 31-40 yrs. The female patients (93.4%) outnumbered the male patients (6.6%).The cytomorphological analysis of 206 patients revealed 190 cases (92.2%) of neoplastic lesions, 10 cases (4.8%) were neoplastic and 6 cases (2.9%) had indeterminate cytomorphology. Maximum number (65.5%) of patients was suffering with goiter followed by lymphocytic thyroiditis (26.2%). Amongst the malignant cases three cases were of papillary carcinoma and one case of medullary carcinoma. Two out of the six cases of follicular neoplasm proved to be follicular adenoma on histopathology. Four patients with high T3 levels were under treatment with neomercazole. They showed change in cytomorphology from hyperplasia to colloid goiter. Only one case of acute suppurative thyroiditis was reported which shows rarity of its type. Conclusion: The increased prevalence of goiter in this post iodinisation era can be attributed to goitrogens, autoimmune thyroid disease and micronutrient deficiency of iron and selenium. Higher prevalence of autoimmune thyroiditis in females is linked with both genetic and environmental factors such as infection, stress.

Background: In India, tobacco consumption is responsible for one of the highest rates of oral cancer in the world, the annual oral cancer incidence is steadily increasing among young tobacco users. Studies have documented efforts taken by physicians, doctors and even dentists, in the form of individual or group counseling to curb tobacco use in smoke or smokeless form. However, which one is more effective, still remains an unanswered question. The aim of the study was to compare the effectiveness of individual and group counseling for cessation of the tobacco habit amongst industrial workers in Pune and to compare quit rates. Materials and methods: An interventional study design was selected for 150 industrial workers which were stratified randomly into three groups (control, individual and group counseling groups) and interventions were provided to individual and group counseling groups over a period of six months, which were then compared with the control group that received brief intervention at the start of the study. Results: There was significant difference in the quit rates of the participants in the individual counseling group (ICG) and group counseling group (GCG) when compared at 6 months with the control counseling group (CCG). In the individual counseling group was 6% while in group counseling group it was 7.5% after six months of counseling. Conclusions: No conclusion could be drawn whether individual or group counseling were better interms of quit rates. Individual and group counseling groups were definitely better than the control group when compared at 3 and 6 months, respectively.

Trichoepithelioma is an uncommon, benign hamartomatous tumor of the pilosebaceous follicle. Presenting as multiple papules and nodules on face and neck, they pose a significant cosmetic problem in affected individuals. Familial involvement of this dermatosis occurs in an autosomal dominant pattern, the locus being located on chromosome 9p21, which causes multiple facial lesions in family members and their kins. Here, we report a case of multiple familial trichoepithelioma causing considerable disfigurement of the face.

Introduction: Programs oriented toward prevention have proven to be highly rewarding in reducing the dental disease burden in western populations. Some developing countries have also reported studies of school health programs with varying effectiveness. However, reports regarding improved effectiveness due to mobile dental unit are scarce. Thus, the present study aims at assessment of effectiveness of prevention-oriented school health program in a private school in Pimpri, Pune. Materials and Methods: A longitudinal study was conducted from May 2015 to June 2016 in Dr. D.Y. Patil school among 449 students aged 5 and 10 years using census sampling. Ethical clearance was obtained from Institutional Ethics Committee of Dr. D. Y. Patil Dental College and Hospital and permission was obtained from the school principal. The study was conducted in 3 phases. SPSS version 18 was used for analyzing the data. Results: There was significant reduction in decayed component and a significant increase in filled component in primary and permanent dentition. There was a significant reduction in treatment needs, i.e., one surface, two surface fillings, and pulp care and restoration. Conclusion: It can be concluded that this prevention-oriented 1-year program was helpful in improving the oral health of the children.

Hydatid disease, an endemic in the cattle grazing areas, particularly in the Asian region, is a parasitic infection which is caused by the cestode tapeworm, Echinoccocus granulosus. There is involvement of the intra–abdominal organs apart from the liver, in 10-15% of the cases. We are reporting a case, wherein the appendix was involved with this parasitosis and we have discussed the review of the literature regarding the diagnostic, surgical and the newer percutaneous approaches for the management of this disease.

Objective: To study hematological profile in patients with clinically palpable spleen and to find out the role of hematological investigations as a diagnostic tool in elucidating etiopathogenesis of splenomegaly. Materials and methods: This cross-sectional study was conducted on 50 patients at a teaching hospital from Aug 2011 to 2013. Detailed clinical history including name, age, sex, chief complaints, clinical findings, X-ray and USG (if done) were noted. Grading of splenomegaly was done by Hackett's classification. Laboratory tests including peripheral blood smear, complete blood count and bone marrow examination (if required) were performed. Results: In the present study, maximum numbers of patients were males in the age group of 0-15 years. The commonest cause of splenomegaly found was acute leukemia followed by malaria, hemolytic anemia, chronic myeloid leukemia, liver cirrhosis and infections. Hematological causes were the most common etiology of splenomegaly in this study. The commonest grade of splenomegaly was I and II (mild). There was also a case of congenital dyserythropoietic anemia type I (CDA), a rare autosomal recessive disorder. We also came across one case of plasmodium falciparum malaria with no evidence of parasite on peripheral blood smear which called for bone marrow study. Conclusion: Splenomegaly is a subject of considerable clinical concern as spleen is not palpable under normal circumstances. When palpable, it may be associated with serious disorders from which no age is exempted. Thus, hematological evaluation becomes necessary to understand the etiopathogenesis of splenomegaly.

Preventive analgesia using non-opioid analgesic strategies is recognized as a pathway to improve postoperative pain control while minimizing opioid-related side effects. Ketorolac is a nonsteroidal antiinflammatory drug frequently used to treat postoperative pain. However, the optimal dose and route of administration for systemic single dose ketorolac to prevent postoperative pain is not well defined. We performed a quantitative systematic review to evaluate the efficacy of a single dose of perioperative ketorolac on postoperative analgesia.We followed the PRISMA statement guidelines. A wide search was performed to identify randomized controlled trials that evaluated the effects of a single dose of systemic ketorolac on postoperative pain and opioid consumption. Meta-analysis was performed using a random-effects model. Effects of ketorolac dose were evaluated by pooling studies into 30- and 60-mg dosage groups. Asymmetry of funnel plots was examined using Egger regression. The presence of heterogeneity was assessed by subgroup analysis according to the route of systemic administration (IV versus IM) and the time of drug administration (preincision versus postincision).Thirteen randomized clinical trials with 782 subjects were included. The weighted mean difference (95% confidence interval [CI]) of combined effects showed a difference for ketorolac over placebo for early pain at rest of -0.64 (-1.11 to -0.18) but not at late pain at rest, -0.29 (-0.88 to 0.29) summary point (0-10 scale). Opioid consumption was decreased by the 60-mg dose, with a mean (95% CI) IV morphine equivalent consumption of -1.64 mg (-2.90 to -0.37 mg). The opioid-sparing effects of ketorolac compared with placebo were greater when the drug was administered IM compared with when the drug was administered IV, with a mean difference (95% CI) IV morphine equivalent consumption of -2.13 mg (-4.1 to -0.21 mg). Postoperative nausea and vomiting were reduced by the 60-mg dose, with an odds ratio (95% CI) of 0.49 (0.29-0.81).Single dose systemic ketorolac is an effective adjunct in multimodal regimens to reduce postoperative pain. Improved postoperative analgesia achieved with ketorolac was also accompanied by a reduction in postoperative nausea and vomiting. The 60-mg dose offers significant benefits but there is a lack of current evidence that the 30-mg dose offers significant benefits on postoperative pain outcomes.

Deepti Agarwal1, Suprabha Sharma2, Shyamoli Dutta1, Rani Bansal2, Seema Awasthi1, Anjali Khare2, Maryem Ansari11Department of Pathology, Teerthanker Mahaveer Medical College, Moradabad, India; 2Department of Pathology, Subharti Medical College, Meerut, IndiaBackground: Fine needle aspiration (FNA) biopsy is a well accepted diagnostic procedure and considered to be a valuable test for initial assessment of head and neck swellings in adults. The technique has gained popularity in the pediatric population over the last decade, with varying degrees of acceptance rates, accuracy, and results among pathologists.Objective: This study was performed to evaluate the utility of aspiration cytology as a first-line diagnostic tool in palpable head and neck masses in children, taking into account the diversity of lesions observed in this subset of the population. Cytologic analysis was correlated with histologic results for evaluating diagnostic accuracy wherever possible. The applicability of FNA biopsy in diagnosing pediatric malignant lesions was also evaluated.Methods: This retrospective study conducted from January 2008 to December 2009 screened all pediatric cases referred to the departments of pathology at two tertiary care hospitals in India. Data from a total of 662 children aged 0–15 years presenting with head and neck masses who underwent FNA biopsy were collected. Cytologic results were interpreted and analyzed according to anatomic site. The lesions were then categorized into inflammatory, infective, and neoplastic.Results: Of the 662 lesions, 23 cases were excluded due to inadequate material, thus the data for 639 cases were finally evaluated. Lymph node lesions predominated, accounting for 570 cases (89.2%), of which 412 (72%) cases were diagnosed as reactive and 91 (16%) cases as tubercular lymphadenitis. Other lesions aspirated were thyroid (18 cases, 2.8%), salivary gland (12 cases, 1.8%), and miscellaneous surface lumps (39 cases, 6.1%). Of all the cases, 628 (98.27%) were reported as benign and 11 (1.67%) as malignant. The positive predictive value of cytologic analysis in diagnosing malignancy was 100%, although exact typing of lesions was possible only on histopathologic examination.Conclusion: FNA biopsy is a sensitive and minimally invasive first-line investigation in the diagnosis of head and neck masses in children. It is highly accurate in isolating and determining potentially neoplastic lesions, thus guiding the way for cases which truly require excision biopsy or other second-line investigations.Keywords: fine needle aspiration, biopsy, tubercular, lymphadenopathy, thyroid