Young female breast lumps; are all benign?

Objectives: To find out frequency of various diseases and carcinomas in breast lump, its presentation in young female up to age of 35 years

Study design: Retrospective, discriptive

Place and duration: Department of surgery unit II Ghulam Muhammad Mahar Medical College University Hospital Sukkur [GMMC] and Institute of surgery and Medicine [ISM] Hospital Garden road Karachi from November 2007 to June 2013

Methodology: All female patients presenting with breast lumpupto age of 35 years at GMMC Hospital and ISM Karachi from Nov: 2007 to June 2013, medical records of these patients retrospectively reviewed, patients above age of 35 years, having acute mastitis without lump, recurrent cases, inflammatory carcinomatosa were excluded from the study

Results: A total number of 510 females up to age of 35 years were included. Among the benign breast disorders fibroadenoma was 56.86%, breast abscess 7.26% fibrocystic diseases 10.59%, benign phylloides 1.77%, fibrocystic diseases 10.59%, and sebaceous cysts 6.08%. Carcinoma breast found in 11.56% [n=59] in our study, the common histopathology was infiltrating ductal cell carcinoma [59.45%]

Conclusion: The analysis of this study shows increases frequency of breast cancer in young and adolescent female. These findings suggest that females at every age group with breast lumps need specialized care for diagnosis and management

Comparison of laparoscopic appendicectomy [LA] versus open appendicectomy [OA] [a prospective randomizing audit of 1000 cases]

In this study comparison between Laproscopic and Open Appendisetomy with regard the length of operation, complication, conversion rate, postoperative hospital stay and time of return of normal activity has been made in order to assess the benefits and feasibility of the procedures. Prospective Randomizing study. This study is carried out at Shaheed Mohtrama Benazir Bhutto Medical University [SMBBMU] Hospital and At Sachal Medical Centre Larkana with effect from Jan: 2001 to Jan: 2011. All patients with diagnosis of acute appendicitis were enlisted and randomized to either laparoscopic appendisectomy [LA] or Open appendisectomy [OA]. All patients received pre-operative contibiotic. The operative time was calculated beginning with incision or insetion of Trocar till the wound was fully closed. Patients those were converted from LA to OA were considered separately. Assessment regarding the return to normal activity and work determined by questioning during the postoperative follow-up. This randomized study of 1000 cases in which 450 cases underwent OA and 550 patients scheduled for the LA procedure but successfully performed 505 and remaining 55 underwent Lap-Converted open appendisectomy. From this study reveals that the common presentation of appendicitis is simple appendicitis next is perforated appendicitis, while the reasons for lap converted open cases were of appendicular mass, perforated appendicitis, gangrenous appendicitis but 2 cases were noted of having normal appendix with pelvic inflammatory disease [PID]. The conversion rate remains higher in our study. Operative time in OA/LA remain 81/40 minutes. Wound infection rate in OA/LA remain 5.4%/3.0% Hospital stay in OA/LA 5-6/1-2 days. Patient return to normal activity in OA/LA group 14days/7 days. However early return to job found in LA than OA group of patients. After the long assessment of this study also compared with world literature that the LA is superior because of less pain; minimum wound infection, less operative time. Having the, cosmetically acceptable small scar, less hospital stay and early return to normal activity and job. Therefore this is mature time to say that LA is superior procedure in our setup while can replace open appendisectomy [OA]

Over view of laparoscopic cholecystectomy at [SMBBMU] University Hospital Larkana 1920 cases

To evaluate the safe technique in patient with cholelithiasis either simple or with acute cholecystitis and to highlight the better method in which patient can be prevented from future complication. Experimental Study. This study was conducted at University Hospital of Shaheed Mohtrama Benazir Bhutto Medical University, Larkana with effects from Jan 2005 to Jan 2011. Total number patient 1920 underwent lap chole, while 184 were admitted in acute state from casualty and Out Patient Department of university hospital. The mean age was 11-75 years, male and female ratio 1:3 with regard the 184 in acute cholecystitis among those patients reach to hospital within 24hours were 85, from 24-48hours were 65 patients while from 48-72 hours were 34 patients. While remaining patient were managed as elective cases. The operative time taken in elective cases were 30 minutes but in acute cases it was 90 minutes so average time was 60 minutes. The overall conversion rate is 2.86% but in acute case the conversion rate 8.15%. Post operative average hospital, stay remain's 1 day in elective cases but in acute Cholecystitis where conversion to open were performed the hospitalization minimum 6 maximum 7 days. The wound infection seen in 49 cases [2.8%]. Lap chole is a reliable and safe in management of cholecystitis either with or without cholelithiasis having simple or acute cholecystitis, while certain factors are responsible for conversion include delayed arrival more than 72 hours, empyema and bleeding while contradictory to international literature our study suggest that conversion rate is high in acute rather than elective Cholecystitis. So it is concluded that emergency lap chole is a safe and cost effective due to on time surgery and patient can be prevented from future complication. Therefore early lap chole is safe and can be performed in simple and complicated Cholecystitis while literature have proved that lap chole also safe in pregnant lady with certain limitation of like height of fundus

Carcinoma of rectum

To document our experience of management of carcinoma of rectum. Design: Descriptive study. Place and Duration Chandka Medical College Hospital, of five years duration. Subject And The Study spread over a period of 5 years from 1998 to 2003. The data was recorded on a structured Performa. Fifty patients of rectal carcinoma were diagnosed and managed at Chandka Medical College Teaching Hospital Larkana over a period of 5 years. The male to female ratio was 3.2:1, 80% patients presented with bleeding per rectum. On digital rectal examination [DRE], in 70% the tumor was at lower rectum, 20% at middle rectum and 10% at upper rectum. On histopathology, 90% cases were reported as adenocarcinoma. According to Duke's classification, 50% were in stage-III. 60% [30 patients] were managed with abdomino-perineal resection. The mortality was 4%. We conclude that carcinoma of rectum can be diagnosed at early stage in patients presenting with symptoms of ano-rectal conditions when examined properly including DRE, proctoscopy and biopsy of suspected lesions

Basal cell carcinoma

The objective of the study is to document results of various modes of treatment in cases of basal cell carcinoma. This is a five year retrospective study conducted between January 1994 and December 1998 at Chandka Medical College and Larkana Institute of Nuclear Medicine and Radiotherapy [LINAR].The cases were collected from surgical wards and Larkana Institute of Nuclear Medicine and Radiotherapy, where cases were referred from Dermatology OPD directly. The total number of patients under study were 46. Surgery was done in 12 cases [2696] and Radiotherapy in 23 cases [50%], in remaining 11 cases [24.096] combination of surgery, radiotherapy and chemotherapy were given when one mode of treatment failed.The youngest patient was of 30 years, while the eldest was of 90 years. The male to female ratio was 1:1.The majority of patients were field workers. In surgery group only one recurrence out of 12 cases [8.33 96] occurred, while in radiotherapy group 11 recurrences occurred out of 23 [47.82%] cases. In our study, surgery had better results than radiotherapy

Experience of first 100 cases of laparoscopic surgery

Laparoscopic surgery has become a standard surgical treatment for elective cholecystectomy. Elective and emergency appendectomy is also now been done routinely. This study was carried out at Larkana, Sindh, Pakistan, to document the first 100 cases of laparoscopic surgery. It included 78 cholecysectomies and 22 appendesectomies with special reference to conversion. Seven patients were converted to open cholecystectomy with conversion rate of 8.97%. Laparoscopic cholecystectomy is a safe procedure with minimum scars for all patients with cholelithiasis. However we still have a higher rate of conversion in acute cholecystitis. The conversion rate is likely to reduce with the passage of time and experience