Efficacy of hypofractionated radiotherapy in loco-regional tumor control in breast

Objective: To evaluate the efficacy of hypofractionated radiotherapy [HFRT] in locoregional control [LRC] in breast cancer

Study Design: Descriptive case series

Place and Duration of Study: Oncology Department of CMH Rawalpindi, from Jan 2014 to Oct 2014

Material and Methods: Fifty three female patients with histopathologically confirmed breast cancer and Eastern Cooperative Oncology Group performance status [ECOG-PS]

Results: Fifty three female patients with histopathologically confirmed breast cancer and ECOG-PS

Conclusion: It is concluded that HFRT is a simple and effective protocol for LRC in breast cancer in our set up. Large scale randomized trials and longer follow up is needed to confirm the results

Androgen deprivation therapy and cardiovascular risk in patients with prostate cancer

Objective: The objective of this study was to investigate the effects of androgen deprivation therapy [ADT] on risk of subsequent cardiovascular morbidity in men with prostate cancer

Study Design: Quasi experimental study

Place and Duration of Study: Department of oncology Combined Military Hospital Rawalpindi, from Sep 2014 to May 2015

Patients and Methods: Thirty consecutive patients fulfilling inclusion criteria were enrolled. All patients were subjected to medical castration/ androgen deprivation therapy [ADT] with monthly 3.75 mg leuprorelin acetate intramuscular injection until castrate levels of testosterone [<50ng/dL] were achieved. We used Framingham's score for assessment of 10 years cardiovascular risk of individual patient before initiation and after completion of 6 months ADT. Serum lipid profile [fasting], systolic blood pressure, history of smoking, diabetes and antihypertensive medication were recorded. Proforma was designed to get clinical information. A p-value of <0.05 was considered significant. A paired-samples t-test was conducted to compare Framingham cardiovascular risk scores before initiation and after completion of 6 months ADT

Results: We enrolled 30 men with high/intermediate risk localized prostate cancer. Mean age was 63.47 +/- 7.32 years. All patients received 6 months ADT with monthly 3.75mg leuprorelin acetate intramuscular injection. There was a significant difference in Framingham cardiovascular risk scores before [mean +/- sd; 20.95 +/- 7.98] and after [mean +/- sd; 25.72 +/- 6.15] 6 months ADT; t [29] =-4.54, p<0.01, two-tailed. Hence ADT resulted in a significant increase [mean +/- sd; 25.7 +/- 6.15] in 10 years cardiovascular morbidity risk t [29] =-4.54, p<0.01, twotailed. Subset analyses revealed significant increase in fasting serum total cholesterol, triglycerides and Lowdensity lipoprotein [LDL] levels after 6 months ADT [p<0.01, <0.01 and <0.01 respectively] however high density lipoprotein [HDL] remained un-changed [p=0.043] in comparison to pre-ADT values

Conclusion: Androgen deprivation therapy results in significantly increased risk of cardiovascular morbidity in patients with prostate cancer however this relationship between ADT and risk of cardiovascular morbidity may be confounded by unmeasured variables like obesity, atherosclerosis and body mass index [BMI] variations

Frequency of increase in serum tumor marker carcinoembryonic antigen [CEA] levels in primary breast cancer [PBC] patients at the time of diagnosis

Objective: To determine the frequency of increase in serum tumor marker CEA levels in PBC patients at the time of diagnosis

Study Design: Cross sectional study

Place and Duration of Study: Oncology Department of Combined Military Hospital [CMH] Rawalpindi, from January 2014 to November 2014

Material and Methods: Sixty three female patients with histopathologically confirmed carcinoma of breast and age range from 20 to 70 years from Oncology outpatient department [OPD]/indoor patient department at CMH Rawalpindi, were selected. All patients were staged by clinical and radiological work-up that included physical examination, all base line investigations, serum biomarkers, chest radiograph, ultrasound abdomen and pelvis, bone scan, computed tomography [CT] scan/magnetic resonance imaging [MRI] of the chest [optional]. Patients serum carcino-embryonic antigen [CEA] levels were carried out only by blood sampling using chemiluminescent immunoassay with immulite 2000 CEA. Data analysis were done with the help of the Statistical Package for the Social Sciences [SPSS] version 19 software. Cut-off values of serum CEA levels >2.5 ng/ml were taken as elevated

Results: Sixty three female breast cancer patients with histopathologically confirmed carcinoma of breast revealed elevated serum CEA levels in three stages of the disease. The median age was 47 years [range, 20-70 years]. Fifteen [23.8%] patients had family history of the breast cancer. Invasive ductal carcinoma [IDCA] was the commonest histology with 60 [95.23%] patients. Most of the patients had advanced stage of the disease. Node positive cases were 53 [84.1%]. The frequency of abnormal CEA levels were varying from stage II to stage IV. Elevated serum CEA levels were noted in 4 [28.6%] of stage II, 19 [76%] of stage III and 17 [77.3%] patients of stage IV, respectively. Overall percentage increase in levels of serum CEA from stage I through IV were 0%, 6.34%, 30.2%, 26% respectively. The sensitivity of serum CEA in our primary breast cancer [PBC] patients was 63.5%

Conclusion: It is concluded that serum CEA had significant sensitivity in detecting breast cancer in our population. Elevated serum CEA levels were seen in various stages of our PBC patients

Frequency of raised urinary trypsinogen-2 in acute pancreatitis

Objectives To determine the frequency of raised Urinary Trypsinogen-2 in diagnosed patients of acute pancreatitis

Methodology Settings Patients in emergency refer to General Surgery ward-3 Jinnah Post Graduate and Medical Centre Karachi. Duration Six months, started from 20-01-2012 to 19-07-2012. Study Design Cross sectional descriptive study. Subjects and Methods All cases of Acute Pancreatitis diagnosed by Upper Abdominal Pain, Raised Serum Amylase and/or Serum Lipase and Abdominal CT Scan findings, were included in the study. Urinary Trypsinogen-2 dipstick test was done. All patient related data including age, gender, sex and raised Urinary Trypsinogen-2 or normal, was recorded. Data analysis was done on SPSS version 10. Frequency and percentage was calculated for gender and raised trypsinogen-2. Age and gender wise stratification was done to see the effect of these variables on outcome

Results Mean age of the patients was 38.14 +/-7.42 years. The minimum age was 24 years, while the maximum age was 63 years. Raised urinary trypsinogen-2 level was present in 55 [65.5%] patients. Stratification of age group shows, that 40 [66.7%] patients in age group

Conclusion The frequency of raised Urinary Trypsinogen-2 in diagnosed patients of acute pancreatitis was found to be high

Therapeutic effects of whole brain radiotherapy with carboplatin as radiation sensitizer in management of brain metastasis

To determine the efficacy of whole brain radiotherapy [WBRT] with carboplatin as radiation sensitizer in metastatic brain disease in our adult population. Quasi-experimental study. Department of Oncology, Combined Military Hospital [CMH], Rawalpindi, Pakistan from July 2011 to September 2012. Forty two patients with metastatic brain disease having ECOG performance status [PS] 3 or less with normal hematological and biochemical profile were treated with WBRT with 6MV Photon beam on linear accelerator using parallel opposed lateral beams to a dose of 30 Gys in 10 fractions. Carboplatin was administered in a dose of 150 mg/m2 on day 1 and 6 of WBRT. Improvement in PS and radiological response on CT scan/ MRI brain before and 30 days after the WBRT using response evaluation criteria in solid tumors [RECIST] was evaluated. Out of 42 patients, 38 [90%] showed improvement in PS, 4 [10%] showed either no improvement or worsening of PS [p< 0.001]. Seventeen [41%] patients had complete response, 19 [45%] had partial response, 3 [7%] showed stable disease and 3 [7%] had progressive disease. None of the patients showed grade 3/4 toxicity during treatment. WBRT with carboplatin as radiation sensitizer is effective in palliation of patients with metastatic brain disease

Giant goiter: not uncommon in endemic areas of Pakistan. a 10 years experience

Objectives: To determine the prevalence of giant goiter and morbidity after surgery and to compare the data with the national and international literature

Study Design: A prospective, observational study

Place And Duration: Department of Surgery, Fauji Foundation Hospital, Rawalpindi from May 1999 to April 2008

Methodology: All patients with giant multinodular goiter [Grade IV] were operated and prevalence of compilations was recorded meticulously, and data compared with national and international literature

Results: A total of 744 patients operated and majority were female 94.89% [n=706] from 5[th] decade of life i.e. 35.75% [n=266]. Giant multinodular goiter [Grade IV] found in 26.08% [n=194]. Among them, 96.90% [n=188] were euthyroid. Near total thyroidectomy was done in 59.79% [n=116] patients, total thyroidectomy in 28.86% [n=56] and subtotal thyroidectomy in 11.35% [n=22] patients. Transient hypocalcaemia was the commonest complication observed, in 8.24% [n=16] patients followed by seroma formation- 7.21%, [n=14]. Permanent hopoparathyroidism-2.66%, [n=4], Permanent recurrent laryngeal nerve injury-1.03%, [n=2], transient recurrent laryngeal nerve palsy-4.63%, [n=9], postoperative bleeding-1.03%, [n=2] and wound infection noticed in 2.57% [n=5] patients

Conclusion: Giant goiter is not uncommon in our setup, with expected high postoperative complications so surgery should be done by experienced hands in the centers where all facilities are available. Public awareness should be created by health authorities and organizations regarding prevention and early treatment

Analysis of risk factors and demographic pattern of carcinoma breast in Pakistani women and literature review

OBJECTIVE: To analyze the risk factors and demographic pattern of carcinoma breast with literature review among patients reporting in surgical department

STUDY DESIGN: A prospective descriptive study

PLACE AND DURATION: This study was conducted in the Department of surgery PESSI Hospital Islamabad from February 2009 to March 2011

SUBJECTS AND METHODS: Sixty two female patients of all ages presenting with the clinical features of carcinoma breast were included. A questionnaire was filled with information gained in OPD and in wards

RESULTS: Majority of patients [n=26, 41.94%] were from 5 decade. Age varies from 35 years to 80 with mean age of 53.22 +10.23. Age of menarche was 12 to 18 years. Most of women [61.30%, n=38] were postmenopausal with mean postmenopausal period 9.61+7.77 years. Mean age at first pregnancy was 21.24+3.32 years and majority of patients were married [n=61, 98.39%], multiparous [n=60, 96.77%], lactated [n=59, 95.16%], had no family history [n=60, 96.77%] or use of oral contraceptives [n=58, 93.54%]

Duration of symptoms ranged from two months to three years [Mean duration 07.67 + 02.91 months]

Painless lump [n=48, 77.41%], lump with ulceration [n=16, 25.80%], nipple discharge [n=12, 19.35%] and weight loss [n=8, 12.90%] are the commonest presentations among patients

CONCLUSION: Low risk factors are commonly observed in contrast to high risk factors which are rarely observed among our patients in this study and after national literature review. It is concluded that different demographic factors responsible for low or high risk in breast cancer mentioned in literature should be re evaluated in our country

Is there any change in the pattern of clinical staging of ca breast at time of reporting in OPD during last two decade

OBJECTIVE: To evaluate the pattern of clinical staging of carcinoma breast among patients at the time of reporting in surgical department and to analyze any change in pattern of presentation in last two decades

STUDY DESIGN: It was a prospective analytic study conducted in the Department of Surgery, Punjab Employees Social Security Hospital, Islamabad from March 2009 to February 2011

SUBJECTS AND METHODS: Sixty two female patients of all ages presenting with the diagnosis of carcinoma breast were included. Clinical staging was assessed through clinical examination and investigations followed by operative findings and histopathology

RESULTS: Majority of patients were from 5 [n=26, 41.94%] and 6 [n=20, 32.26%] decade of life. Duration of symptoms ranged from 2 months to 4 years. Lump was fixed to skin in 46.78% [n=29] and to underlying structures in 29.03% [n=18]. Left breast was involved in 82.25% [n=51]. Regarding tumor size, 46.78% [n=29] were T4, 29.03% [n=18] were T3, lymp nodes were palpable in 66.13% [N1 40.32, N2 22.58%] and distant metastasis was found in 14.52% [n=9] patients. TNM clinical stage was IIB in 38.71% [n=24], IIIB in 33.87% [n=21] and IV in 14.52 % of patients. 33.88% [n=21] patients reported 7-9 months after initial symptoms and 27.42% [n=17] reported after more then one year of symptoms

CONCLUSION: Majority of patient still report to hospital in advanced stage of carcinoma breast and there is no change in this trend during last two decades. Government institutions, electronic and print media and NGOs should take active part in creating awareness against carcinoma breast among females

Synovial Sarcoma - Inguinal Region A Rare Finding

A 25 years old male presented with suspicion of lymphadenitis over right inguinal region and exploration was inconclusive. Later on patient presented with recurrence and extensive ulcer at the same place which was diagnosed synovial sarcoma on histopathology. Case was managed by Neo-adjuvant chemotherapy followed by surgery

Single incision laparoscopic cholecystectomy [SILS]

Single incision laparoscopic surgery is a rapidly emerging technique worldwide. The primary goal of the surgery is invisible scar. The objective of this study was to share our initial experience with the rest of world. From October 2009 to April 2010, single port surgery was offered to 30 patients of symptomatic gallstones. The data collected prospectively included age, sex, operative time, complications, pain and reason for conversion. Thirty SILS cholecystectomies were attempted and 27 were completed successfully. The mean operative time was 80 minutes [ranges 50-180min].Three patients needed further ports to complete the operation. All patients were discharged on 2[nd] postoperative day except one who had severe abdominal pain. This patient was discharged on 6[th] postoperative day. Two patients had mild umbilical wound infection, one patient was readmitted for pain management. SILS Cholecystectomy is a safe, feasible and without visible scar surgery in the hands of trained laparoscopic surgeons but needs more studies before it is recommended

Sensitivity and specificity of bi-rads scoring system in carcinoma of breast

To find out the sensitivity and specificity of mammogram according to BI-RADS scoring, in correlation with pathological findings so as to develop protocol for biopsy in patients presenting with clinically palpable breast lump or nipple discharge. Cross sectional study. Jinnah Postgraduate Medical Centre, Surgical unit 1 [Ward 3] Karachi, from July 2007 to June 2008. Female patients who presented with clinically palpable breast lumps or nipple discharge in general surgical OPD were examined and referred for mammography. Ultrasound examination was also done where considered necessary. The final diagnosis regarding the lump or nipple discharge as shown in the mammography was made and patients sent for biopsy [FNAC/ Trucut/ excision biopsy]. The mammographic diagnosis was compared with the histopathological report. Fifty patients were examined of whom 47 clinically suspected patients had confirmation of diagnosis on biopsy while 3 were found negative. Forty one suspected cases on BI-RADS mammogram were true positive that revealed 87.2% sensitivity of BI-RADS mammogram while 6 cases were false negative. All three cases of negative on biopsy were true negative that revealed hundred percent specificity. In this way positive predictive value was also hundred percent with negative predictive value of 33.3%. Overall diagnostic accuracy of mammogram was 88% when compared with histopathological diagnosis. Mammography can be used as an important diagnostic tool for the diagnosis of breast diseases and where there is doubt, diagnosis should be made by means of triple assessment i.e. clinical examination, mammography, and histopathology

Carcinoma thyroid in multi and uninodular goiter

To determine the frequency and profile of carcinoma in multi-nodular goiter and solitary thyroid nodule. Case series. Surgical Unit-I, Ward-3 of Jinnah Postgraduate Medical Center, Karachi, from January 1999 to January 2009. Cases with solitary thyroid nodules and multi-nodular goiter were included. Patients under 12 years of age, cystic benign lesion in solitary thyroid nodules or those multi-nodular goiters, which were not causing pressure symptoms, cosmetic problems or sign of malignancy were excluded. In solitary thyroid nodule, hemithyroidectomy was done and if histopathology examination revealed carcinoma thyroid then completion thyroidectomyw as done. In multi-nodular goiter sub-total thyroidectomy done. Results were described as frequency percentages and mean. Out of 379 patients of multi-nodular goiter only one patient was found to be papillary carcinoma [0.25%]. In 220 patients of solitary thyroid nodules, 93 patients were diagnosed as carcinoma of thyroid [42.27%]. Others diagnosed in solitary thyrid nodule were thyroid adenoma, colloid goiter, thyroiditis and multi-nodular goiter. The frequency of papillary carcinoma in 65.95% occurring females of 12-30 years of age and being multifocal in 6.45% follicular carcinoma in 23.49%, medullary carcinoma in 7.44%, analplastic carcinoma in 2.12% and lymphoma in 1.01%. Female were predominantly involved and papillary carcinoma was common in 12-30 years of age [7.63%] and follicular was common in 30-40 years of age [68.18%. 6.45% of papillary carcinoma was found to be multifocal in nature. Frequency of carcinoma of thyroid is very high in solitary thyroid nodule [42.27%], but markedly low in multi-nodular goiter. Papillary carcinoma is the most common variety, most of in younger female

Value of total leucocyte count and C-reactive proteins in the diagnosis of acute appendicitis

To find out the predictive value of total leucocytes count and C-reactive proteins [CRP] in the diagnosis of acute appendicitis. Cross sectional study. Surgical unit 1, Department of Surgery, Jinnah Postgraduate Medical Center Karachi, from November 2006 to April 2007. A total of 50 patients attending emergency department with provisional diagnosis of acute appendicitis were included. All patients were evaluated by clinical features and their total leucocytes count and C-reactive protein levels were checked and compared with histopathological report which is gold standard for the diagnosis of acute appendicitis. Positive predictive value of total leucocyte count was 90.6% and negative predictive value was 44.4% with accuracy of diagnosis of 74%. Positive predictive value of C-reactive protein was 97.1% and negative predictive value was 62.5% with accuracy of diagnosis of 86%. The diagnosis of acute appendicitis can be made confidently with excellent history and proper examination. Total leucocyte count and C-reactive protein levels estimation can be helpful in the diagnosis of doubtful cases of right iliac fossa pain. When measured together it increases their diagnostic value

Early experience of sentinel lymph node biopsy in breast cancer

To assess the results of sentinel lymph node biopsy in breast cancer. Case Series. Surgical Ward 3, Jinnah Postgraduate Medical Centre Karachi, from April 2007 to March 2009. In this study patients with biopsy proven carcinoma breast and clinically negative lymph nodes in the axilla were included. Patients with history of previous breast surgery, clinically palpable lymph nodes, Stage IV disease, bleeding disorders, chronic liver disease or history of allergic reaction to the dye were excluded. The study patients underwent sentinel lymph node mapping and dissection. One ml of gentian violet or methylene blue dye injected into the peritumoral area followed by one minute massage. Simple mastectomy or wide excision with axillary clearance was done after 30 minutes of injection. This study was conducted on 35 patients with the age range from 28 years to 68 years. In all the patients diagnosis was infiltrating ductal carcinoma. Wide local excision with axillary clearance was possible in only two patients with clinically stage 1 disease. In rest of the patients simple mastectomy with axillary clearance was done. According to the tumor size; T1 was observed in 15 patients, 72 in nine, T3 in six and T4 in five patients. In all patients [n 15] with T1 tumor, stained lymph node was positive in eight patients while tumor metastasis in the remaining lymph nodes removed by axillary clearance showed involvement in six patients. In patients with T2 masses, tumor involvement was seen in both groups of lymph nodes in six patients. In three patients with T4 tumor, sentinel lymph nodes were negative for tumor metastasis however in rest of the lymph nodes tumor involvement was seen in four patients. In patients with T3 masses, three showed involvement of the entire axillary lymph node group and sentinel lymmph node as well. If sentinel lymphnode is involved by the tumor, axillary clearance should be done irrespective of the tumor size. Sentinal node biopsy should be avoided in patients with T4 lesions

Outcome of stapled haemorrhoidectomy versus Milligan Morgan's haemorrhoidectomy

To compare the postoperative outcome of stapled haemorrhoidectomy and conventional Milligan Morgan's open haemorrhoidectomy. Comparative study. Surgical Unit 1, Ward-3, Department of Surgery, Jinnah Postgraduate Medical Centre, Karachi, from March to September 2006. Sixty patients of late 2nd, 3rd and 4th degree haemorrhoids were selected for admission from the outpatient department after taking informed consent. Patients with concomitant anal disease [e.g. fissure, abscess, fistula, ano-rectal cancer etc.] were excluded. Two groups of thirty each were made, one for Milligan-Morgan open haemorrhoidectomy and another for stapled haemorrhoidectomy, in which excision of a ring of mucosa proximal to the haemorrhoid[s] was done thus, interrupting the blood supply but maintaining continuity of the rectal mucosa. The operative time was measured in minutes. Postoperative pain was assessed through VAS. Bleeding was measured as no, mild, profuse. Other post-operative complications during hospital stay like urinary retention, anal stenosis etc. were noted. Student t-test, chi-square test and repeated measured analysis of variance were applied to compare the variables. The mean age was 40.7 +/- 11.6 years. A majority [53.3%] of patients [combined% in both groups] had third degree haemorrhoid. The mean length of operative time was found statistically insignificant between open and stapled groups [19.6 +/- 5.9 vs. 22.4 +/- 7.2 minutes, p=0.974]. However, the mean length of postoperative hospital stay was significantly less in the stapled than open haemorrhoidectomy group [3.37 +/- 2.2 vs. 2.03 +/- 0.81 days, p=0.003. Mean postoperative pain [observed by VAS] in the stapled group was significantly less than the open haemorrhoidectomy group [4.43 +/- 1.25 vs. 7.37 +/- 0.72]. The proportion of postoperative bleeding, infection, anal tag, urinary retention, tenderness on digital rectal examination and wound discharge was higher in open than stapled haemorrhoidectomy group, but statistically insignificant [p < 0.05]. There was a significant difference between Milligan Morgan's and stapled haemorrhoidectomy for postoperative pain and hospital stay. However the mean length of operative time was insignificantly different

phase II study of cisplatin and 5-fluorouracil combination chemotherapy and concurrent thoracic radiation in squamous cell carcinoma of lung

To evaluate the efficacy and toxicity of cisplatin, 5-fluorouracil combination chemotherapy and concurrent thoracic radiation in squamous cell carcinoma of lung. A prospective, non randomized, quasi-experimental, phase II study which was conducted in the Department of Clinical Oncology Mayo Hospital/KEMC Lahore. This study was conducted from September 2002 to May 2004. Twenty two patients of histopathologically confirmed squamous cell carcinoma of lung were enrolled. Stage III B or stage IV patients requiring radiation therapy for control of local symptoms were included. These patients were treated with chemotherapy and concurrent chest radiation. The treatment regimen included cisplatin 80mg/m2 on day one and day "28" and 5-FU 750mg/m2 day 1-4 and day "28-31". Radia-tion was started on day one and a tumor dose of 50 Gy was delivered in 25 fractions. Common Toxicity Criteria and RTOG criteria were used to assess toxicities. Miller's criteria were used for response evaluation. Responses were evaluated two weeks after the completion of concurrent chemoradiotherapy. All the twenty two patients completed the planned treatment. Complete response was not achieved in any patient. Partial response was seen in 15 patients [68.18%], stable disease in five patients [22.73%] and progressive disease was seen in two patients [9.09%]. CTC Grade-II nausea was seen in eight patients [36.36%], vomiting in five patients [22.73%] and mucositis in six patients [27.27%]. Grade-III neutropenia was observed in three patients [13.64%] and Grade-III mucositis and diarrhea in five patients [22.72%] each. Grade-IV neutropenia was seen in two patients [9.09%]. Cisplatin and 5-Fluorouracil combination chemotherapy concurrent with 50 Gy radiation is an effective and well tolerated treatment modality for this subset of lung cancer patients

Frequency of infection in cholelithiasis

To determine the frequency of infection in cholelithiasis and find common infecting organisms with their antibiotic sensitivity. A descriptive study. This study was conducted in Surgical Unit - I, Jinnah Postgraduate Medical Centre [JPMC], Karachi, Pakistan, from April 2001 to March 2002. First 100 cases of cholelithiasis, selected and operated by open or laparoscopic cholecystectomy were included in this study. Patients with acute cholecystitis, history of jaundice, stones and / or dilated common bile duct were excluded from the study. Ultrasound was the main tool for pre-operative diagnosis. During cholecystectomy, bile was aspirated and specimens were sent to laboratory for microbiological examination. The results were recorded on a proforma. Out of 100, 36 patients had positive bile culture. The most common organism was E. coli [17 patients] followed by Klebsiella [9], Pseudomonas [6], Staphylococcus aureus [2], Salmonella [1] and Bacteroids fragalis [1] patient. In this study, most of the biliary organisms were highly sensitive to the 2nd generation cephalosporins and quinolones. From the bacteriological assessment, it seems that both endogenous and exogenous contamination were the causes of wound sepsis. It was also found that the infection of bile did not increase the risk of postoperative wound infection when prophylactic perioperative antibiotics were used

Toxicity profile and objective response of paclitaxel in metastatic breast cancer

To evaluate the efficacy and toxicity of 1-hour weekly Paclitaxel in metastatic breast cancer along with evaluation of overall survival. A phase II interventional trial. Oncology Department, Combined Military Hospital, Rawalpindi, between August 2001 to July 2003. Thirtysix patients were enrolled in the study. All patients with histologically confirmed and bidimensionally measurable metastatic breast cancer who had received previously either chemotherapy or hormone therapy were included in the study. Paclitaxel was administered in 1-hour weekly infusion in a dose of 100 mg/m2 for 12 doses. All patients had received previous chemotherapy with either CAF or CMF. Twenty five patients had also received hormone therapy, 61% had two or more metastatic sites involved, and lung was the common site of involvement. Complete response was observed in 4 [11.1%] patients, partial response in 14 [38.8%] patients, with an overall response rate of 50.0%. Clinical benefit was 94.4% and median overall survival was 11 months. Treatment was well-tolerated with no grade 3 or 4 toxicity. Common side effects were arthralgias, myalgias and neutropenia. Treatment with 1-hour weekly infusion of Paclitaxel is a well-tolerated chemotherapy with a substantial degree of efficacy in patients with metastatic breast cancer

Tuberculous mastitis

To find out the different clinical presentations of breast tuberculosis and its treatment outcome. Design: An observational study. Surgical ward 3 of Jinnah Postgraduate Medical Centre, Karachi from June 2001 to November 2003. Fifty consecutive female patients above 13 years presenting with breast lump, multiple sinuses, axillary lymphadenopathy, and cold abscess were included in the study. Medical records of the patients presented were reviewed and analyzed. Data was collected regarding the patient's name, age and marital and lactational status. Clinical Examinations and investigations were carried out by triple assessment i.e. clinical, radiological and histological / cytological evaluation. The commonest presentation was a solitary breast lump in 30 [60%] patients, breast lump with axillary lymphadenopathy in 13 [26%]. Four [8%] patients presented with generalized breast swelling [edema] with ipsilateral axillary lymphadenopathy. Two [4%] presented with breast abscess and axillary lymphadenopathy and one [2%] with axillary sinus and breast lump. Upper outer quadrant was most frequently involved in 29 [58%] of patients. Thirty two [64%] cases were secondary to tuberculosis in other sites, mostly [40%] from tuberculous axillary lymphadenitis. Forty eight [96%] patients responded well to one year antituberculous treatment with complete disappearance of the lumps except 2 patients who had shrinkage of lump size only, underwent excision of lump. Solitary lump and enlarged lymph nodes are the commonest presentation of mammary tuberculosis. Early diagnosis and treatment is necessary to prevent disfigurement of breast. Antituberculous therapy is the treatment of choice. Surgery should be reserved for unresponsive lumps

Dermatofibrosarcoma protuberans

Dermatofibrosarcoma protuberans is a rare, locally aggressive, rarely metastatic skin tumor which tends to recur. A 45-year-old female presented with dermatofibrosarcoma protuberans on her breast as a recurrent nodule after excision. Lump was re-excised with wide margins and irradiated. Follow-up was done monthly for two years, with no recurrence