One-year audit of breast clinic at abbasi shaheed hospital, Karachi

The British Association of Surgical Oncology [BASO] has set standards for services provision and provides an audit program for the breast clinics. This study is an audit based on retrospective data to examine and report the one-year performance of Breast clinic at Abbasi Shaheed Hospital, Karachi. Between October 2009 and September 2010,615 new and 1158 follow up in a total of 1773 patients visited Breast clinic for their breast symptoms. A specially designed Performa for breast diseases was filled on the first visit of all patients, which included each patient's detailed history, physical examination, investigations and diagnosis. Each Performa was reviewed for audit. The total number of patients visited Breast clinic at Abbasi Shaheed hospital was 1773 including 615 new and 1158 were follow-up cases.Majority of them were between 16 to 50 years of age group. There were 348 [56.58%] patients with breast lump out of which 300 [48.78%] turned out to be benign on further investigation and 48 [07.80%] were malignant. Breast pain was the presenting complaint in 144 [23.41%] patients while 33 [05.36%] patients presented with nipple discharge, 54 [08.78%] with breast abscess, 15 [02.43%] had atrophy breast, 06 [0.97%] had hy-pertrophied breast, 09 [01.46%] were with asymmetry of breast and 06 [0.97%] with eczema of nipples. The audit showed that 03 out of 07 performances based standard, according to British Association of Surgical oncology [BASO] were not met satisfactorily. It is concluded that multidisciplinary breast clinic in public hospital provides better services to the symptomatic breast patients on their first visit

Evaluation of blunt abdominal trauma: the evolving role of ultrasound

To evaluate importance of ultrasonography in the operative management of patients after Blunt Abdominal Trauma. All the suspected cases of Blunt Abdominal Trauma attending the emergency Department of Civil Hospital Karachi from 1999 to 2001 are subjected to the ultrasonography of Abdomen along with other laboratory and radiological investigations apart from those who were hemodynamically unstable. Patients profile consists of a thorough history, physical examination, investigations and diagnosis were registered in the performa. One Hundred Patients of Blunt Abdominal Trauma were assessed by abdominal ultrasound to detect free fluid in abdomen as a result of solid organ injury, to take the decision of laparotomy as an emergency management. 95 patients underwent ultrasound examination. 5 patient left without ultrasound examination. Out of 95 patients, 90 patients did not show any positive findings related to intrabdominal injuries. 2 patients had splenic tear,1 suffered from liver tear and 2 patients had free fluid in the peritoneal cavity. 1 patient turned out to be false negative as he developed fever and peritonitis leading to laparotomy showing small bowel perforation. In our study the sensitivity and specificity of ultrasound examination for detecting intrabdominal injury in clinical stable patients of blunt trauma were 83.33% and 100% respectively. The following conclusions were derived after conducting this study: Majority of the patients suffered from abdominal trauma are seen between 25- 44 years. Unrecognized abdominal injury remains a frequent cause of preventable death following blunt trauma. It can be prevented by the use of ultrasonography as it is cheap, easily repeatable and can be used at bed side. The results are operator dependant so ultrasound training will be incorporated into general surgical residency program

Surgical audit of unit ii, department of surgery abbasi Shaheed Hospital, Karachi

To report the experience of one year audit of general surgical procedures and comparison of results with other audit data. This study was carried out from January 2005 to December 2005 in the Department of Surgery, unit II, of Abbasi Shaheed Hospital, Karachi. Total numbers of patients were 881, majority of them were between 16 to 50 years of age group [73.4%]. Elective surgeries were performed in 449 [50.9%] cases whereas 315 [35.7%] cases underwent emergency surgical procedures. Rest of the patients were managed conservatively i.e. 117 [13.2%] cases. The most frequent region was gastrointestinal tract [36.1%], in which appendiceal pathologies were commonly encountered. Average duration of stay was 12 days. There was an overall mortality of 1.2% and a complication rate 5.9%. We conclude that audit is essential for better health practice and should be perform yearly. Moreover, there should be proper audit program and committse for this purpose

Role of GTN in the treatment of anal fissure

Anal fissure is a common problem that causes significant morbidity in a young and otherwise healthy population. The topical application of glyceryl trinitrate [GTN] represents a new easily handled and effective alternative in the treatment of anal fissure [3]. This avoids permanent division of part of the sphincter and the consequente disturbance of continence mechanisms [4]. The purpose of conducting this study was to find out the effectiveness of topical application of glyceryl trinitrate ointment, and whether it can be used as first line treatment of anal fissure. We concluded that GTN can be effectively used as first line treatment of anal fissure with the avoidance of surgery more than 80 percent