ABSTRACT
Background: Breast lump is a common complaint of women presenting to surgeons. Most of them are benign, careful evaluation, exact diagnosis and definitive treatment is mandatory to rule out cancer. The diagnosis of breast cancer is suggested on clinical examination. Currently a combination of three tests, i.e. clinical examination, radiological imaging (mammography, ultrasonography) and pathology called as triple assessment test is used to accurately diagnose all palpable breast lumps. Together they give sensitivity of 100%. The triple assessment is taken as positive if any of the three components, two are positive or positive report of FNAC and negative only if all of its components are negative for malignancy.Methods: This study was conducted in the Department of Surgery, P.D.U Medical College, Rajkot, Gujarat over a period of 2 years. A total of 100 patients with a breast lump were selected more than 15 years of age. A detailed history, focused clinical examination, radiological imaging and FNAC were used as diagnostic tools for screening of the patients. The aim of this study was to evaluate accuracy of modified triple assessment in the preoperative diagnosis of patients with breast carcinoma.Results: Results shows sensitivity and specificity of all the modalities used in triple assessment when combined together was 100% and 99.3%, respectively. Positive predictive value was 93.3%, negative predictive value was 100%, p-value was highly significant (p<0.0001). We conclude that modified triple assessment is a very useful diagnostic tool to evaluate patients with breast lumps and an overall accuracy of 98%.Conclusions: Thus, triple assessment is an easily available, cost effective, least invasive, rapid and patient compliant diagnostic tool for diagnosis of breast lump.
ABSTRACT
Background: Intestinal anastomosis is an operative procedure that is of central importance in the practice of surgery. Intestinal anastomosis after resection of bowel may be of various types and techniques. This prospective comparative study is performed to evaluate the safety in term of anastomotic leak of single layer interrupted extramucosal technique as compared to conventional double layer technique. Methods: The patients selected for this study are those who were admitted with various clinical conditions requiring resection and anastomosis of small or large bowel presented to P.D.U. Medical College & Hospital, Rajkot between a period of August 2012 to December 2014. A total of 50 patients were included in the study. All the patients above the age of 18 years and less than 60 years, requiring intestinal anastomosis on emergency or electively, were included in the study and those requiring anastomosis to esophageal, gastric and duodenal anastomosis were excluded and randomly allotted single layer and double layer groups and results such as anastomotic leak rate, duration for anastomosis, number of suture material required noted. Results: Mean duration required for single layer anastomosis was 19.6 minutes and for double layer anastomosis was 29.5 minutes and double number of suture material used in double layer anastomosis with equal anastomotic leak rate (6%) in each group. Conclusions: Single layer interrupted extramucosal technique required significantly less duration for anastomosis, is cost effective with no significant difference in anastomotic leak rate and as safe as conventional double layer technique.