ABSTRACT
This study is conducted to assess most successful surgical procedure in such patients. Prospective comparative study. Nishtar Medical College and Hospital, Multan from July 2010 to July 2012 [two years]. All patients of mid gut atresia [duodenal atresia, annular pancreas, jejunal atresia and ileal atresia] during this period were included in the study. Patients with associated congenital anomalies in other systems, in sepsis and patients operated out of Nishtar Hospital, Multan but referred due to complications. The study included 52 patients of duodenal, jejunal and ileal atresia. End to end anastomosis, Bishop Koop enterostomy and Santulli's enterostomy were constructed according to convenience. Transanastomotic tube was retained in half the patients. Thorough washing of distal unused intestine was done during surgery, postoperatively tube was used for early feeding and saline dilatation, micro enemas were repeatedly done to help dilatation of unused gut. ln two years 52 patients of mid gut atresia were operated. ln duodenal obstruction all three patients survived with TAT and RDP unlike two out of three without TAT and RDP. 10 patients of jejunal atresia out of 12 survived after TAT and RDP Santulli's enterostomy was most fruitful method [05 survived out of 05] in ileal atresia, initial response after double barrel enterostomy was also good [03 out of 03 survived]. Ln patients of Duodenal obstruction transanastomotic tube [passed through nasal route] with early dilatation plan gives good results after end to end anastomosis. ln Jejunoileal atresia same is good after passing TAT through abdominal wall and in patients of lleal atresia Santulli's chimney give good results.
ABSTRACT
To determine the efficacy of triple assessment in diagnosis of malignant breast lumps in female patients taking core biopsy as a gold standard. Breast Clinic, Unit-III, Department of Surgery, Nishtar Hospital, Multan. October 2007 to March 2008. A total 0f 100 patients of breast lump, above the age of 14 years, having palpable lump of any size in breast were selected according to inclusion criteria. Out of 100 patients included in the study most of the patients were in the age group 45-54 years i.e. 46 [46%] followed by 32 [32%] in the age group 35-44 years. According to occupation 67 [67%] were house wives, 13 [13%] were teachers and 5 [5%] were nurses. In 48 [48%] patients the lump size was 2 cm, 35 [35%] patients had lump size from, 2-4 cm while in 17 [17%] patients lump size was > 4 cm. Presenting symptoms like lump was present in 50 [50%] patients, pain alone 25[25%] patients, discharge in 20 [20%] patients and discharge with pain in 5 [5%]. Lymph node status like grade-0 was seen in 60 [60%] patients, grade-1 in 21 [21%] patients, grade-2 in 15 [15%] patients and grade-3 in 4 [4%] patients. Triple assessment is a valuable tool for an accurate non surgical diagnosis of breast lump, allows assessment of breast cancer patient for conservative and neo-adjuvant primary treatment before surgical treatment