Manifestations of tuberculosis in breast

The aim of this study was to highlight the importance of tuberculosis as a cause of breast diseases. Retrospective study from 2000 to 2005. This study was conducted at Sarfaraz Rafiquee Shaheed Hospital and Civil Hospital, Karachi. All patients who were diagnosed as cases of tuberculous mastitis were included in the study. In all patients the biodata and a detailed history was taken and a thorough examination performed. Relevant investigations that were done included CP and ESR, X-ray Chest, Mammography, Mantoux Test, Sputum for acid fast bacilli, Discharge from sinuses for detection of acid fast bacilli and culture, Biopsy and histopathological examination. All patients underwent surgery with removal of the infected breast tissues, combined with anti-tuberculous chemotherapy. A total of seven cases were detected during the study period with tuberculosis of the breast. All were females with an age range from 17 to 50 years, but the majority were under 30 years of age. The duration a/their symptoms ranged from six months to two years. The main symptoms and signs were multiple discharging sinuses over the breast [n=3], painless lump [n=2], painful lump [n=1], ulcer [n=1], ipsilateral axillary lymphadenitis [n=3] and pulmonary tuberculosis [n=2]. The diagnosis was made on histopathology in all the cases; six cases belonged to the nodular tuberculous group, while one had disseminated tuberculous mastitis. Acid fast bacilli were detected in only two specimen, while positive culture was obtained in only one patient. Successful outcome was seen following treatment comprising of anti-tuberculosis drug therapy with removal of the infected breast tissue in six and mastectomy in one patient. This study establishes the importance of including and remembering tuberculosis in the list of the causes of breast diseases, specially in cases of recurrent abscesses, sinuses and lumps

Dilemma of mastalgia

To determine whether instances of mastalgia labelled as refractory were truly refractory to treatment or whether they were merely instances of inadequate treatment, by observing their response to non-pharmacological treatment. A prospective observational study carried out from 2003 to 2005. The study was undertaken in an Out-patient Breast Clinic setting at Sarfaraz Rafiquee Shaheed Hospital and Tahir Medical Centre, Karachi. Fifty-eight patients with "refractory mastalgia" were evaluated. The patients were treated by reassurance, low-fat, methyl xanthine restricted diet and dietary supplementation with 500 mg/day of evening primrose oil. The response was assessed at three and six months after begining the treatment. There was a 94.3% overall response to non-pharmacological treatment, which indicated that they were all instances of inadequately treated mastalgia and not refractory mastalgia. Cases of mastalgia labelled as refractory are usually due to inadequacy of treatment

Significance Of C-Reactive Protein Levels in reducing negative explorations for acute appendicitis

To study the significance of C-Reactive Protein in improving the diagnosis of acute appendicitis and to assess its role in preventing negative appendicectomies.Prospective, double blind study.Sarfaraz Rafiquee Shaheed Hospital and Faiz-e-Aam Hospital, Karachi.100 consequtive patients with acute appendicitis who underwent surgery. Blood sample from 100 patients were collected pre-operatively for Total Leucocyte Cont [TLC] and C-Reactive Protein [CRP]. All specimen removed were sent for histopathology. The TLC, CRP and histopathology findings were correlated, and patients grouped into positive [acute appendicitis] and negative [normal appendix] cases. In patients with histopathologically proven acute appendicitis, both the TLC and CRP were significantly raised, p-0.025 and p<0.0001 respectively. However, in 16 out of 19 negative explorations [normal appendix on histopathology], serum CRP level was found to be normal. The specificity and sensitivity of serum CRP was 84.21% and 93.8% respectively.A normal pre-operative serum CRP measurement in patients with suspected acute appendicitis is most likely associated with a normal appendix. Deferring surgery in this group of patients and/or further investigation into other possible causes might reduce the rate of unnecessary appendicectomies

Is it essential to keep a drain after Thyroid Surgery ?

To evaluate the necessasity of keeping a drain after thyroid surgery. A randomized, prospective, control study conducted over a period of three years. Department of Surgery, Fatima Jinnah Dental College, Karachi.94 patients undergoing 102 thyroid surgeries.Patients included in the study were randomly allocated to drain and non-drain group. The surgeon was informed of the group just before the closure of the wound. Ultrasonography [USG] of the neck was done on first and seventh post-operative day by the same ultrasonologist each time, to assess the amount of collection in the thyroid bed. Any swelling, change in voice, tetany and tingling sensation were also recorded. The data was analyzed using two-sample test for calculating unequal variance.Both groups were evenly balanced according to age, sex, size of tumors, type of procedure performed and histopathological diagnosis. There was no significant difference in the fluid collection at the thyroid bed as assessed by USG on Day-1 and Day-7 in the two groups [p=0.313], but the hospital stay was significantly reduced in the non-drain group [p=0.007]. One patient in the drain group required needle aspiration for collection in the thyroid bed. No patients in either group required re-operation for bleeding or haematoma.Routine drainage of thyroid bed following thyroid surgery may not be neccessary. Not draining the wound results in lesser morbidity and decreased hospital stay