Inaugural hernia repair with poly-propylene darn: safe and cost-effective

To know the safety and cost-effectivity of inguinal hernia repair with prolene darn in respect of morbidity and recurrence rate. Descriptive analytical study. The study was conducted in Saidu group of teaching hospitals, since January 1999 to May 2002. Total of three hundred and eighty six patients collected by non probability convenient sampling technique, and 390 repairs [4-patient with bilateral repair] were included in the study. 180 were indirect, out of these 15 were strangulated, while 210 were of direct vanity. 90 repairs were made under local anaesthetic block, 300 were operated under general anaesthesia. All the patients were discharged on either 1st or 2nd postoperative day. 3 patients [0.76%] were readmitted for wound infection and were discharged on 8th postoperative day. Patients were examined on day 7th and 14th for early complications and then subsequently on 6th month and yearly for 3-4 years, for delayed complications. Ages ranged in our study 20-80 years [mean of 50 years]. 180 patients had indirect hernia [46.15%], while 210 [53.84%] were of direct Varity. Among 390 repairs 15 patients [3.8%] developed superficial wound infection, 5 patients [1.28%] established wound infection. 3 patients [0.76%] developed scrotal heamatoma, only one case [0.25%] was re explored. 20 patients [5.18%] went intro urinary retention, catheterized for 24 hours. 2 patients [0.5%] developed recurrence. 1 patient [0.25%] presented with hydrocele. 2 patients [0.51%] complain of neuralgia at groin. We conclude that Darn repair with polypropylene is safe and cost-effective, and recommend it for primary hernia repair

Two years audit of thoracic surgery department at Peshawar

The aim of the study was to audit all admissions for significant adverse events as well as to assess academic and research activities of our department during last two years. Design: A descriptive audit comprising of surgical, academic and research aspects. Place and Duration: Department of Cardiothoracic Surgery, Postgraduate Medical Institute, Lady Reading Hospital Peshawar from June 2002 to June 2004. Materials and Data comprising of patients demographics, number and type of various surgical procedures, hospital stay, various complications and number of deaths that occurred were entered into database. A computerized record of all academic and research projects was kept. Data base analysis was carried out for determining morbidity and mortality. Analysis of surgical audit showed 2160 procedures. Tube thoracostomy was required in 1030 patients while elective procedures were 1130. Elective thoracic procedures were 969 [85.5%] while elective cardiac procedures were 161 [14.2%]. Various procedures performed included, decortication 103 [9.1%], esophagectomy 73 [6.46%], Hydatid cystectomy 38 [3.36%], closed mitral volvotomy 51 [4.5%], PDA ligation 46 [4.07%], pericardectomy 17 [1.5%], lobectomy 59[5.22%], pneumonectomy 11 [0.97%], thoracoplasty 21 [1.85%], while other thoracic and cardiac procedures were 13.3% and 5.6% respectively. Overall mortality was 3% while morbidity was 3.4%. During this period our department had 17 publications; presented 22 papers in various conferences; has produced three fellows in thoracic surgery, one fellow in general surgery and conducted "First National Thoracic Surgery Course". One assistant professor and one senior registrar have been appointed during these two years. Highest priority should be accorded to surgical audit to determine various risk factors for mortality and morbidity and ultimately to improve patient care. Moreover, all academic and research projects should be completed through mutual efforts of all teaching staff to achieve desired standards of teaching and learning. Accountability of the medical profession can only be achieved through surgical audit. It is high time that this becomes a part of our ward routine and teaching programmes

Breast diseases: a histopathological analysis of 3279 cases at a tertiary care center in Pakistan

To know the frequency of breast diseases in Pakistani females. A retrospective analysis of 3279 breast specimens received over a period of 4 years [1993-1996] at the department of pathology, the Aga Khan University Hospital. Out of a total of 3279 breast specimens, common breast lesions included infiltrating duct carcinoma 37%, followed by fibro adenoma 16.95%, fibrocystic change13.96%, mastitis 6.83% and duct ectasia 5.33%. Majority of the cases of infiltrating duct carcinoma were encountered in the 5th and 6th decades of life. Tumour size was 2 or >2 cms. in 93% of cases and 40% of them showed 3 or >3 positive lymph nodes. Grade I tumours were 11.38%, grade II 59.17% and grade III tumours 29.47%. Correlation of grade with lymph node metastases [3 or >3+ve nodes] showed 15 cases [1.53%] of grade I, 178 cases [18.25%] of grade II and 68[6.97%] cases of grade III tumours. This study shows that in Pakistani females, the most commonly encountered lesion in carcinoma of the breast followed by the benign lesions such as fibro adenoma, fibrocystic disease and others. Breast carcinoma occurs at a younger age group with predominance of high-grade lesions and with frequent lymph node metastasis