Changing practice of rectal cancer surgery in Pakistan

To describe the presentation and pathology of rectal cancer, and to evaluate the local experience after total mesorectal excision at a tertiary care hospital in Pakistan. A retrospective study of two hundred cases of carcinoma rectum that had undergone total mesorectal excision at Liaquat University Hospital Jamshoro Pakistan was carried out from January 1998 to December 2007.The cases were admitted through outpatient and emergency departments. The demographic details of each patient and variables such as clinical presentation, tumor location, Dukes staging, TNM staging, operations and complications were recorded on proformas. Each patient was followed up at two months for one year, every four months for three years and annually thereafter. Male to female ratio being almost equal 1.6:1, Age ranged from 14-70 years. Site of tumor at upper one third 25%, middle one third 30% and lower one third 45%. Majority of patients [more than 62%] were in Dukes B Group. There were no postoperative deaths, complications occurred in a total of 59 [29.5%] patients, which were mostly colostomy related [13.0%]. The abdominal wound infection 5%, anastomotic dehiscence 1.0%, urinary tract infection 5%, and impotence occurred in 1.5%. In 20% patients' local recurrence was detected. Total mesorectal excision is a safe and feasible technique for rectal cancer surgery with acceptable perioperative morbidity and adequate local disease control

Gynaecomastia: management in a developing country

Gynaecomastia is a benign enlargement of male breast. It is common in the general population, resulting from various pathophysiological mechanisms. The aim of this study was to describe the presentation and outcome of treatment for gynaecomastia at a University Hospital in Pakistan. A three year retrospective study was carried out of one hundred men with gynaecomastia. Patients were evaluated in detail clinically and by appropriate investigations. They were counseled and kept on hormonal therapy for three months. Surgery was considered for patients with long standing gynaecomastia, failed medical therapy and for cosmetic reasons. Post operative complications and patient's satisfaction was assessed. Most [90%] cases were idiopathic. Other causes were liver cirrhosis in 4 cases, testicular tumour in two, thyrotoxicosis in one and drug induced [use of cimetidine and Kushta] in two. Carcinoma of the breast was diagnosed in one patient. Most of the patients had bilateral, non tender lump in the breast. Three cases of idiopathic gynaecomastia resolved on danazol. Eighty-eight cases underwent surgical treatment. The mean age of patients who underwent surgery [n=88] was 30.5 +/- 9.59 years. Most of the patients belonged to 21-30 years age group. Major indications for surgery were failure of medical treatment [45.5%] and cosmetic reasons [34.0%]. Mean operating time for subcutaneous mastectomy was 42.2 +/- 3.70 [36-48] minutes. Mean hospital stay after subcutaneous mastectomy was 5.2+2.44 [2-10] days. The only postoperative complication noted was wound infection [24%]. Seventy -two [81.8%] were satisfied with the results of their surgical treatment. Gynaecomastia is the common condition affecting male breasts and most common cause of gynaecomastia is idiopathic. Secondary gynaecomastia may regress in size by treating the primary cause. Idiopathic gynaecomastia do not respond to danazol so they needed surgical treatment. Subcutaneous mastectomy through a periareolar skin incision is a valid procedure for treatment for gynaecomastia and provides satisfactory cosmetic and provides satisfactory cosmetic results