Management options of basal cell carcinoma in surgery

To describe the prevalence, mode of presentation and various surgical options of reconstruction in the management of basal cell carcinoma. Descriptive Study. This study was conducted at Nishtar Hospital, Multan from 2006 to 2009. 60 patients were taken in this study. A separate file was maintained for each patient. A thorough history and full physical examination was conducted, relevant investigations were carried out. Out of sixty cases, 50 [83%] were male and 10 [17%] were female. Majority of the patients presented to us above the age of 45 years and the incidence of BCC increases with the age. The male to female ratio was 5:1. Out of 60 cases 26 [20 male, 6 female] 43.3% were farmer, 16 [all male] 26.6% wee construction workers, 10 [8 male, 2 female] 16.6% were unemployed and 8 [all female] 13.3% were household. No patient presented before 5 years after the development of the lesion. 34 [30 male, 4 female] 56.6% for the last 6-10 years, 20 [16 male, 4 female] 33.3% for the last 11-15 years, 2 [all male] 3.3% for 16-20 years and 4 [2 male, 2 female] 6.6% had lesions for > 20 years. Delay in presentation has an overall negative effect on the outcome

Which is better in care of volvulus sigmoid colon? primary repair or double barrel colostomy

Volvulus refers to torsion of a segment of the alimentary tract, which often leads to bowel obstruction. Sigmoid volvulus is the most common form of volvulus of the gastrointestinal tract and this condition is responsible for 8% of all intestinal obstruction. Sigmoid volvulus is particularly common in elderly persons. To compare the outcome of double barrel colostomy versus primary repair after on table lavage in cases of volvulus of sigmoid colon. Comparative study. This study was conducted in the Department of Surgery, from April 2010 to September 2010 in Nishtar Hospital, Multan. This study was conducted in the Department of Surgery, from April 2010 to September 2010 in Nishtar Hospital, Multan. A total of 100 patients were included in the study. Majority of the patients in the age group 41-50 years. Out of 100 patients, 80 [80%] were male and 20 [20%] were female. Out of 100 patients, 40[40%] belonged to Baluchistan, while 30 [30%] from DG Khan, 10 [10%] from Sindh and remaining 20 [20%] from Multan. It is concluded from the study that morbidity and hospital stay was significantly lower in patients with Group-A [sigmoidectomy and primary anastomosis after on table lavage] as compared to group-B [sigmoidectomy + double barrel colostomy], so economic burden and morbidity related to colostomy can be prevented

Endoscopic dilatation in cases of benign oesophageal stricture: experience at Nishtar Hospital, Multan

Endoscopic dilatation is most widely practiced mode of management in cases of benign oesophageal strictures. It is relatively simple and effective in most cases. Moreover, the procedure carries few complications in experienced hands. The objectives of this study were to establish the safety of Endoscopic dilatation in cases of benign oesophageal strictures in local setup and to evaluate the improvement of dysphagia score following the procedure. It was a prospective/Cohort-hospital based study, conducted from December 2006 to January 2008 at Surgical Unit-1, Nishtar Hospital, Multan. A total of 55 patients with the provisional diagnosis of benign oesophageal stricture were included in the study. Five patients were found to have malignant strictures and were subsequently excluded. Oesophagoscopy was done with rigid oesophagoscope while dilatation was performed with Maloney bougies in most patients. However, in some patients with difficult strictures, dilatation was done "under fluoroscope over the guide wire", using Savary Gillard's dilator system. The data was analyzed with SPSS version 10.0 to formulate the results. The male to female ratio was 1.5:1. Mean age of the sample was 34.50 +/- 4.75 years. The most common [64%] cause of benign stricture was corrosive intake. All the patients presented to us with history of dysphagia and patients with GORD [14%] had previous history of heart bums of long duration. More than half, 29 [58%] strictures were seen in upper 1/3[rd] of oesophagus. Most of the strictures [86%] were either less than 1cm [42%] or 1-3cm [44%]. All biopsy reports shown benign nature of the stricture. After dilatation therapy, average improvement in the dysphagia score was 2/5 to 3.4/5. Dilatation interval also increased with regular dilatations. Our patients required repeat dilatation after a mean of 16 weeks. Postoperative chest pain was observed in 20 [40%] patients and it was mild in intensity and relieved within six hours. Two patients [4%] developed haematemesis post-operatively. Patients with stricture due to GORD were put on proton pump inhibitors. Endoscopic dilatation is effective and safe procedure in cases of benign oesophageal stricture. It substantially improves dysphagia score postoperatively. Difficult strictures can be safely managed with dilatation under fluoroscopic control

Use of 12.5 mm poly venyl ethylene [Pve ] hose pipe as a traction stent for palliation of dysphagia in advanced/ inoperable carcinoma esophagus

From March 2000 to November 2003, 39 PVE funneled hose pipe pieces were inserted as esophageal stents in 27 males and 12 females with mean age of 60 years [range=42-82 years]. Average hospital stay was 7 days [range = 5-20 days]. Procedure related morbidity was 40% while mortality was 10.25%. There was little effect of age, sex, type and level of tumor on morbidity and mortality. In patients who could be discharged home, dysphagia score improved form average of 4.2 to 2.5. Average post procedural survival was 4.2 months. 7 [20%] patients required readmission for stent malfunction. Only five of them required a second procedure to re-establish the passage. Slipping of stent occurred in only one case where a second stent was inserted. Our technique for manufacturing and insertion of the stent is described. Review of literature and a discussion to support our practice is included. We conclude that although self expanding metallic stents are the current gold standard world wide for palliation of dysphagia due to advanced carcinoma of esophagus, a molded PVE stent can be used in place of conventional traction and pulsion tubes where affordability is a problem. Using the described technique a reliable relief of dysphagia with acceptable morbidity and mortality rates can be achieved