Comparison between on lay and sub lay methods of mesh repair of incisional hernia

To evaluate the repair of incisional hernia by two different methods onlay [Conventional method] and sublay[retromuscular preperitoneal] methods at two different tertiary care centres of Karachi-Pakistan. Patients diagnosed clinically and confirmed ultrasonographi-cally and subsequently operated upon with either methods were included in this study. The primary endpoint was hernia recurrence. Secondary endpoints were operative time, length of hospital stay and postoperative complications of the two methods. A total of 80 patients were allocated in two groups, group A [n=40] underwent incisional hernia repair by sublay method and the remaining in Group B, [n=40] by onlay method. The frequency of wound infection was found significantly higher in the Sublay method of mesh placement [p=0.019]. The frequency of seroma formation was significantly higher in the onlay method of mesh placement[p=0.076] The sublay technique was proven to be very effective, with minimal complications and low recurrence rate.

Choledochorraphy [primary repair] versus t-tube drainage after open choledochotomy

T-tube drainage used to be standard practice after surgical choledochotomy, but there is now a tendency in some canters to close the common bile duct primarily. This study was designed to compare the clinical results of primary closure with T-tube drainage after open choledocotomy and assess the safety of primary closure for future application. This study was conducted at surgical Unit-3, ward 26 Jinnah Postgraduate Medical Centre Karachi, from January 2007 to January 2008. Forty patients were included in this study out of which 20 underwent primary closure and 20 Ttube placements. It was Quasi-experimental, non-probability, purposive sampling. Main outcome measures were operating time, duration of hospital stay, and postoperative complications. SPSS-10 was used for data analysis. The age of patients in the study ranged from 29-83 years. There were 3 male while 37 female patients. Group-1 consisted of 20 patients underwent primary closure after choledocotomy, while Group-2 also consisted of 20 patients underwent T-tube drainage after duct exploration. Mean hospital stay in Group-1 patients was 7.63 days while in group 2 it was 13.6 days. Overall complication rate in group 1 was 15%, biliary leakage in 1 [5%], jaundice in 1 [5%], wound infection in 1 [5%]. No re-exploration was required in Group-1. In Group-2 overall complication rate was 30%, biliary leakage in 2 [2%], jaundice in 1 [5%], dislodgement of T-tube in 1 [5%], wound infection in 1 [5%], and sepsis in 1 [5%] patients. Re-exploration was done in one patient. Primary closure of Common Bile Duct [CBD] is a safe and cost-effective alternative procedure to routine T-tube drainage after open choledocotomy.

Is oil of evening primrose effective for mastalgia, a comparison with danazol

OBJECTIVE: To compare Oil of Evening Primrose and danazol,with respect to efficacy, rapidity of response and side effects in the treatment of mastalgia

STUDY DESIGN: It was quasi-experimental, purposive, non-probability sampling

PLACE AND DURATION: Conducted in surgical unit I and II departments Civil Hospital Karachi over a period of one year

METHODOLOGY: A total of 50 female patients with moderate to severe breast pain who visited the outpatient Surgical Department. All patients were assigned to two groups alternatively 25 in each group given Danazol, oil of evening primrose. Mastalgia in all the patients was gauged before and during the treatment according to the Cardiff, their level of mastalgia assessed and information sought about adverse effects of the drugs

RESULTS: The overall response with Danazol [CBSI 30%, CBS II 14%, CBSIII 6%] in contrast to low response with oil of evening primrose. The patient who was treated with Danazol showed distressing side effects whereas oil of evening primrose had fewer side effectsbreast pain score. All patients were seen at 8 and 12and 24 weeks

CONCLUSION: Danazol offered good pain control but with some undesirable side effects. Danazol should be used in moderate and severe mastalgia

Role of clinical examination and ultrasound in detecting in the size of breast lump and its corelation with pathological specimen size

To assess and compare the role of clinical examination and ultrasound in detecting the size and nature of breast lump in relation to gross pathological specimen size. Retrospective case review analytical study which was conducted in Ward-26, Jinnah Postgraduate Medical Centre, Karachi over a period of two years i.e. September, 2002 to September 2004. All female patients visited outpatient department of Ward-26 with definitive breast lump above 12 years of age were included. Fifty eight patients age ranging froni 15 - 60 years were scanned in study. Out of which 35 patients [60.3%] turned out to be benign and 23 [39.6%] patients malignant cases. The sensitivity and specificity of ultrasonography and clinical examination for benign lesion is 100% but in case of malignant disease the specificity of ultrasonography is 95.7% i.e. in one case ultrasonography did not detect the malignant condition. The digital examination and ultrasonography found comparable and correlated best with gross histopathological specimen in case of benign condition while in case of malignant lesion, tumor size assessed clinically depicted a stronger correlation [r=0.9] with pathological findings while ultrasonography underestimated 6 cases out of 23. Gold standard criteria of histopathological diagnosis confirmed that physical examination measurement remains the method of choice in evaluating the disease preoperatively. The role of ultrasonography in benign lesion is undoubtful but prediction of pathological outcome is not improved by ultrasonography in malignant conditions. The combination of physical examination with ultrasonography significantly improves the accuracy of non-invasive assessment of tumor dimensions