Breast diseases; pattern in a general hospital

Objective: To determine pattern of breast diseases presenting in the surgical OPD of a General hospital

Design: A prospective observational study

Place and duration of study: The study was conducted at Railway hospital, Rawalpindi from September 2008 to Feburary 2010

Patients and Methods: Female patients presenting with complaints regarding breast were recruited in the study. All of them underwent clinical breast examination followed by necessary radiological and / or histopathological investigations to diagnose the disease. Data regarding personal information, clinical examination findings and results of investigations done was collected on a proforma. Results mainly as frequencies were analyzed using software SPSS 16.0

Results: A total of 207 female patients presented in the OPD with breast complaints. 15 patients were lost to follow up before a definitive diagnosis could be made; therefore they were excluded from the study. Out of 192 patients 21.9% had mastalgia followed by fibroadenoma [19.3%], breast abscess [15.6%], carcinoma breast [13.5%], fibrocystic disease [6.25%], duct ectasia [5.7%], acute mastitis [4.7%], no disease [4.2%], nipple eczyma [2.1%]. Benign phylloides tumour, chronic mastitis, prominent axillary tail, cracked nipple were each 1% and 3 patients presented with mammary fistula [0.5%], accessory nipple [0.5%], and lipoma [0.5%]

Conclusion: Breast diseases make a sizeable portion of the general surgical practice. In our set up benign diseases are far more common than the malignant ones. Mastalgia is the commonest breast problem. Malignancy of breast presents usually in late stages

Efficacy of cervicothoracic sympathectomy versus conservative management in patients suffering from incapacitating Raynaud's syndrome after frost bite

Raynaud's syndrome is a known complication of cold injuries. Stress, smoking and metabolic diseases may further aggravate the disease course. The purpose of this study was to determine the efficacy of Cervico-thoracic sympathectomy as compared to conservative management in severe Raynaud's syndrome after frostbite. This non-randomized controlled trial was conducted at Railway Hospital, Rawalpindi and Islamic International Medical Complex, Islamabad between January 1999 and June 2006. All patients sustained severe cold trauma in the mountain ridges of Himalayas in Kashmir. In all cases, an informed consent was obtained from patients and families. All operations performed were free of charges. Out of the total 48 patients who developed incapacitating Raynaud's syndrome of the upper limbs after frost bite, 17 patients underwent thoracic sympathectomy through anterior supraclavicular route. Remaining 31 patients were treated conservatively and were placed in the control group. Data was collected on pre-designed proforma and assessed using SPSS [version 11]. Chi-square test was applied to assess the effectiveness of the two treatment modalities. All operated cases initially showed improvement in symptoms and incapacitation. Among sympathectomised patients, 11 patients became symptom free and 3 patients showed mild but improved symptoms. Two patients after initial transient improvement developed incapacitating symptoms requiring further treatment, one patient developed gangrene of distal phalanx nine month after sympathectomy requiring amputation of the finger. Frequency of attacks and duration between the attacks reduced in all operated patients of cervical sympathectomy [p<0.05] as compared to conservative management. Cervical sympathectomy is a very effective modality of treatment in patients having severe Raynaud's disease of upper limbs secondary to frost bite

Extracorporeal shock wave lithotripsy

To determine the outcome of patients undergoing extracorporeal shock wave lithotripsy [ESWL] for treatment of upper urinary tract calculi [renal and ureteric], and to note role of double-J [DJ] stents in these patients. A cross-sectional analytical study. Department of Urology, Rawalpindi General Hospital, Rawalpindi, from February 1999 to July 2001. Record of patients who underwent ESWL for renal and ureteric stones was retrieved and analyzed using statistical program, SPSS version-10 and Epi-Info 2000. In some patients pre-ESWL DJ stents were placed because of various reasons like solitary kidney, large stone volume etc. Patients were divided in two groups, Group I, in whom DJ stents were not placed, and Group II, in whom DJ stents were placed. ESWL was performed in each subject in standard way employing piezoelectric lithotripter E.D.A.P. LT 02X. Patients were evaluated for stone clearance fortnightly with X-ray or ultrasound. Four hundred and thirty-two patients, 68.8% male and 31.2% female, underwent ESWL. Mean age of patients was 37.7 ' 13.1 years. Majority of patients [78.47%, n=339] had renal, while rest had ureteric stones. Group I and II included 408 [94.4%] and 24 [5.6%] patients respectively. Renal stones were present in 78% [n=318] of Group I and 87.5% [n=21] of Group II patients. Mean size of stones in Group I and II patients was 10.91 ' 4.6, and 10.4 ' 4.7mm. Stone clearance was 96.3% and 100% in Group I and Group II patients respectively. Significantly more ESWL sessions were required for stone clearance in Group II [p-value 0.03]; in addition Group II patients had significantly more complications [p-value 0.01]. ESWL is an effective procedure. Pre-ESWL stenting is associated with increased numbers of ESWL sessions and more complications