Role of vitamin E in mastalgia in young women

Background: Vitamin E is a fat soluble vitamin and plays key role in many body systems. It has been in clinical practice for mastalgia for decades, however there is still limited literature defining its precise role

Methods: This case series was retrospectively collected from a prospectively established database of a dedicated breast clinic for a period of 16 months. A total of 100 patients came with a complaint of breast pain; 20 patients excluded as 17 were having palpable lump while 3 were post menopausal. Eventually 80 patients were included in this study. They were given Vitamin E 400 mg a day for six months. They were followed up at six weeks then at three months and finally after six months. Patients were given a pain chart to mark severity of pain on daily basis

Results: Follow up initially at six weeks, three and six months suggested significant improvement in the symptoms of cyclical mastalgia [p<0.001]

Conclusion: Vitamin E is relatively safe supplement with a better compliance, therefore can be safely considered as first line management of mastalgia in premenopausal young patients

Analysis of 200 cases of tube thoracostomies performed by general surgeons

OBJECTIVE OF STUDY: To observe various indications and complications of tube Thoracostomy

DESIGN: Prospective, descriptive study

PLACE and DURATION OF STUDY: Public and private sector hospitals of Nawabshah and Hyderabad from 1[st] Jan 2005 to Dec 2008

METHODOLOGY: All patients of either sex above the age of 13 years having pathology related to chest cavity and underwent chest intubation were included in the study. Patients below the age of 13 years, having serious co morbid illness like Ischemic heart disease [ASA-3], severe chronic obstructive airway disease requiring ventilator support, and complicated chronic liver disease and patients who lost to follow-up were excluded. Data was collected for age, sex, indications of chest intubations, cause of the disease, procedural and post procedural complications and hospital stay. Descriptive analysis was performed using SPSS version 10 for continuous and frequency variables

RESULTS: Total 200 patients of different pathologies related to chest cavity underwent chest intubations. Mean age was 43.57 years SD+/- 12.68 with 60.5% male and 39.5% female. Indications were: pleural effusion 86[43%] patients, pneumothorax 36[18%] patients, empyema thoracis 33[16.5%] patients, hydropneumothorax 24[12%] patients and haemothorax 18[9%] patients

Etiology for intubations includes 118[59%] patients of complicated pulmonary tuberculosis, 27[13.5%] patients of blunt trauma chest and 21[10.5%] patients of post pneumonic empyema

Procedural complications were found in 24[12%] patients and postoperative complications in 25 [12.5%] patients. Mean hospital stay was 5.5 days

CONCLUSION: We found chest tube insertion as the first line of treatment for variety of life threatening chest diseases. It is safe and effective procedure associated with procedural [12%] and post procedural complications [12.5%] which are comparable to international literature

Closure of elective abdominal incisions with monofilament, non-absorbable suture material versus polyfilament absorbable suture material

Background: Closure of abdominal incisions with different suture materials has been a matter of great controversy. Polypropylene and Polylactide with Polyglycolide are among the commonest suture materials used for closure of abdominal incisions. Objectives of this study were to assess optimal suture material used for closure of elective abdominal incisions and to see complications associated with these suture materials. Methods: This prospective, comparative, randomised study was conducted at public and private sector hospitals of Nawabshah and Hyderabad from 1st Jan 2005 to 31st October 2009. All patients who underwent abdominal surgery under the investigators' supervision were included in the study. Patients were divided into 2 groups on even or odd numbers. In group-A patients' incision was closed with monofilament, non-absorbable Polypropylene [Prolene] No. 1 suture material and in groupB incision was closed with Polyfilament, absorbable, co-polymer of Polylactide with Polyglycolide [Vicryle] No. 1. Results: A total 274 patients were finally analysed for closure of elective abdominal incisions, with 138 [50.4%] patients in Group-A and 136 [49.6%] patients in Group-B. Vicryle was found superior in knot security and suture handling. Superficial wound infection was found in 5.79% patients of Group-A and 6.61% of Group-B. Discharging sinus was found in 3.62% of Group-A vs 0.73% of Group-B. Burst abdomen was seen in 2.17% patients in Group-A and 1.47% in Group-B. Incisional hernia was present in 4.34% of Group-A and 0.73% patients of Group-B. No patient in Group-B developed persistent pain at incisional site while it was found in 8.69% patients of Group-A. Conclusion: Polylactide is an optimal suture material in closure of elective abdominal incisions. Keywords: elective, incisions, monofilament, polyfilament, suture, postoperative, complications

Laparoscopic versus inguinal [Ivanissevich] varicocelectomy

To compare the postsurgical outcome of laparoscopic and open inguinal varicocelectomy. Quasi-experimental study. Department of Surgery, Liaquat University of Medical and Health Sciences, Jamshoro, from July 2003 to June 2007. One hundred seven patients underwent either open inguinal or laparoscopic varicocelectomy. Diagnosis was made by clinical examination and color Doppler scan in doubtful cases. Pre-operative semen analysis was done in all patients. Operative time, postoperative analgesic requirement in number of tablets, hospital stay in days, improvement in semen parameters in subfertile subjects, pain on visual analog score, and postoperative complications were recorded and compared between the two groups. There were 50 patients in each group, with age ranging from 12-50 years [26.9 +/- 7.67 in open inguinal and 26.2 +/- 7.08 in laparoscopic group]. Average operative time was 34.8 +/- 7.89 minutes for open inguinal and 43.8 +/- 8.95 minutes for laparoscopic group. The analgesic requirement was 16.3 +/- 1.58 tablets in the open inguinal and 11.3 +/- 2.23 in the laparoscopic group. Postoperative pain was significantly less in the laparoscopic group. There was statistically significant [p < 0.001] improvement in sperm count as well as motility in both groups irrespective of procedure. The open inguinal [Ivanissevich] procedure and laparoscopic varicocelectomy had almost equivalent postoperative outcomes regarding improvement in semen parameters and postoperative complications. Open inguinal procedure had a shorter operating time while laparoscopic varicocelectomy had the advantage of less analgesic requirement and short hospital stay. On the whole, open inguinal [loupe magnified] varicocelectomy is an effective procedure where availability and costs of laparoscopic instruments are barriers

Emergency laparoscopic cholecystectomy in acute cholecystitis

To study the presentation and outcome of cases operated for Gynecomazia. A retrospective study spread over four years i.e. June 2002 to May 2006. Different hospitals of Karachi including Civil Hospital. 46 males who were admitted for surgery of Gynecomazia. All patients included in this study were evaluated in detail clinically and by appropriate investigations. They were counselled about the condition, and operated via a peri-areolar or sub-mammary incision, and the outcome noted in terms of healing and complications. Out of the 46 cases, majority [71.74%] presented in the age group 11-20 years with peak incidence around 16 years of age. The main symptom was breast enlargement, though pain or discomfort was also seen in 12 [26.1%] patients. The size of the breasts varied between 4-8 cms, and 34 [73.9%] cases were bilateral. Surgery was done for macromastia in 7, long standing gynecomazia in 11 and cosmetic reasons in 28 cases. Wound infection and hypertrophic scar formation constituted the few complications noted. Gynecomazia is the commonest condition affecting male breasts. In majority of the cases counselling and observation is all that is required for management, as they subside spontaneously or on medication. Surgery is indicated in those cases that do not subside or on patient demand

Comparative study of non steroidal anti inflammatory durgs in postoperative pain

To compare the efficacy of ketoprofen and diclofenac sodium in the management of postoperative pain. Patients and The study was conducted in Surgical Unit-I with the collaboration of Pharmacology Department Liaquat University of Medical and Health Sciences Jamshoro from May 2002 to February 2003 [10 months]. This study was carried out on 100 patients, 50 for each group [group-A ketoprofen and group-B diclofenac sodium]. Assessment of analgesic action of two drugs was carried out on a prepared proforma designed for the study. Grading of severity of pain was based on clinical grounds and visual analogue scale. Postoperative requirement of these analgesic drugs regarding dosage, duration and efficacy were compared. Hundred postoperative patient-, were selected in this study, which included 50 patients in each group. Majority of patients belonged to 20 - 40 years of age with mean age in group-A of 35.58 years, and in group--9, 29.96 years. Male to female ratio in group-A was 1:19. and group-B=1:13. All underwent major surgical procedures under general anaesthesia and were assessed for postoperative pain relief. Severe pain was experienced by most of the patients in group-A [45-90%] and group-B [44-88%]. Onset of analgesia of each drug varied from 15 - 30 minutes, but it revealed early response i.e 15-20 minutes in group-A [46-92%] as compared to group-B [42-84%]. Average duration of analgesia was 8 - 12 hours, but maximum effect i.e 12 hours was seen in group-A [45-90%] as compared to group-B [39-78%]. Opioids were given to 30% of patients in group-A and 36% of patients in group-B. Side effects were seen more in cases of group-B as compared to group A. NSAIDs are as effective as opioids in postoperative pain relief. They also decrease the use of opioids post-operatively. Ketoprofen is more potent analgesic as compared to diclofenac sodium because of its dual mode of action i.e. peripheral as well as central. It has minimum side effects