Locoregional recurrence after management of carcinoma breast

To determine the rate of locoregional recurrence, disease-free interval, site and pattern of locoregional recurrence and the significance of different factors for predicting locoregional recurrence in patients with stage II and III carcinoma breast. Descriptive study. Surgical Unit-1, Jinnah Hospital, Lahore from September 2001 to December 2002. Criteria for including patients in this study was female patients with stage II and III carcinoma breast who presented in our unit from 1995-2002 and underwent surgical [modified radical mastectomy, simple mastectomy with axillary sampling] and non-surgical [chemotherapy, radiotherapy, hormonal therapy] treatment of carcinoma breast. Record of 98 patients was evaluated for rate of locoregional recurrence, disease-free interval, site and pattern of locoregional recurrence and different clinical factors like stage of carcinoma, tumour size, lymph node status and histopathology were assessed for association with locoregional recurrence. After a mean follow-up of 3.5 years, 17 patients developed locoregional recurrence. Mean disease free interval in stage II was 30 months and only 9.5 months in stage III. Lymph node positivity was associated with locoregional recurrence [p-value<0.05]. Chest wall was commonest site of recurrence [73%]. Single spot recurrence was common in stage II whereas multiple spot recurrence and field change was more common in stage III. Addition of radiotherapy to surgery decreased the locoregional recurrence but chemotherapy had no significant effect on prevention of locoregional recurrence. In this series 17.34% patients developed locoregional recurrence for mean follow-up duration of 3.5 years. Mean disease-free interval was 20.52 months. Lymph node involvement had significant correlation with LRR

Modified radical mastectomy; morbidity during early postoperative period

Modified radical mastectomy is the operation of choice in an operable breast cancer in this part of the world. This operation has fewer complications than radical mastectomy

Objectives: To identify the early complications of Patey's modified radical mastectomy. Design: Descriptive study. Setting: Department of Surgery, Allama Iqbal Medical College/Jinnah Hospital, Lahore. Period: From Nov 1998 to Aug 2003

Material and Methods: 114 consecutive patients undergoing modified radical mastectomy were studied and followed up to 30[th] post operative day. All patients were female, with age range of 35-67 years. The hospital stay was 8-21 days

Results: Wound infection was the commonest complication occurring in 19 patients [16.6%]. Seroma formation occurred in 17 patients [14%]. While haematoma occurred in 4 patients [3.5%]. Marginal necrosis of flap was seen in 6 patients [5.2%], where as the extensive flap necrosis occurred in 2 patients only [1.75%]. One patient developed early lymph edema of the arm and partial limitation of the shoulder joint movements. At the end of 30th day, all complications resolved except for lymph edema of arm

Conclusions: The procedure of modified radical mastectomy gave good results as far as early morbidity due to surgical procedure itself is concerned. Morbidity can be further deceased by detailed assessment of the patients preoperatively

Perforated appendicitis versus non-perforated appendicitis

Of 156 patients with acute appendicitis, seen during 24 months, 21 had perforated. Age over 30 years especially in males, duration of symptoms over 48 hours, pulse rate on admission exceeding 1007 minute, generalised abdominal tenderness, leucocyte count in excess of 10,000 mm3 and a neutrophilia in excess of 70 percent, characterized patients with appendicular perforation. The rate of complications was five times greater and the mean hospital stay nearly twice as much in the perforated group