Sentinel node localization in breast carcinoma

To determine the success rate of sentinel node dissection and the sensitivity of sentinel node to determine the presence of axillary node metastasis in women with clinically node negative breast cancer. Case series. Place and Duration of Study: The study was conducted at Department of General Surgery Pakistan Institute of Medical Sciences, Islamabad [PIMS] and Nuclear Oncology and Radiotherapy Institute, Islamabad [NORI] from January 2002 to December 2003. A total of 15 patients of early carcinoma breast were recruited in the study. Five patients were injected with radiocolloid and later with isosulfan blue in the subareolar region. Ten patients were given isosulfan blue only. All the patients were subjected to standard axillary clearance after sentinel node biopsy through separate incisions. Sentinel node was examined by intra-operative frozen section and all of the dissected lymph nodes were examined histopathologically for tumour deposits. Sentinel lymph node was successfully excised in all the cases 15/15 [100%]. In 14 of the patients the sentinel node pathology was truly predictive of axillary nodal status. Sensitivity of the test was 93.33% and the positive predictive value was 100%. Sentinel node biopsy should be followed by standard axillary lymph adenectomy until the results of multiple prospective randomized trials define the role of this technique in the management of carcinoma breast

Pattern of dynamic intestinal obstruction in adults

To evaluate the causes of dynamic intestinal obstruction at PIMS Islamabad. Material and This was a prospective study of 75 consecutive cases of dynamic intestinal obstruction, conducted in department of surgery at Pakistan Institute of Medical Sciences, Islamabad from 1st August 1998 to 31st December 1999. Those patients who improved with conservative treatment and did not undergo laparatomy were excluded from the study. All patients who underwent laparatomy for management of their disease were included. Laparatomy findings were recorded and where necessary specimen was taken for histopathology for confirmation of final diagnosis. In this study of 75 cases, 100% patients presented with pain and distension of abdomen, other symptoms were less in frequency. Males were 38 and females were 37 with male to female ratio of 1.01:1. Tuberculosis was the leading cause of [36%] dynamic intestinal obstruction followed by carcinoma of the large gut and postoperative adhesions. Only two patients had small bowl malignancy and intessusception, and one patient was with meckle's diverticulum. Tuberculosis is emerging as a leading cause of dynamic intestinal obstruction. Therefore it is time to run more efficiently the tuberculosis control programme in Pakistan, before it is too late