Breast lumps in adolescent and young female: are all benign?

Objective: To analyze the pattern of presentation and pathology of breast lump in adolescents and young female patients

Methods: Medical records of female patients below 30 years presenting with palpable breast lump at Liaquat University Hospital during August 2008 to July 2009 were retrospectively reviewed. Patients having acute mastitis, inflammatory carcinoma and recurrent malignant or benign lesions were excluded from study

Results: A total of 214 patients were included in study. Mean age was 22.11 years. Approximately 46% of the patients were at the age 20 or less. Most common mode of presentation was painless lump in 61.22% followed by pain and lump in 20.56%.The histopathology of resected specimen showed that fibroadenoma was the most common lump while benign phylloides was the least common. Carcinoma breast was identified in 25 cases, of which 3 cases were at age 20 or less. The commonest histopathology was infiltrating duct cell carcinoma [60%], followed by lobular carcinoma [16%], scirrhous carcinoma [12%] and medullary carcinoma in 8 %. The Paget's disease was found in 4%

Conclusion: We found an increased frequency of breast cancer in comparatively younger age. These findings suggest that any female patient with palpable breast lump should preferably be managed by surgeon with special interest and training in breast diseases

Efficacy of strictureplasty in tuberculous strictures of small intestine

To assess the efficacy of strictureplasty for tuberculous stricture of small intestine. This is a retrospective descriptive study, conducted at Liaquat University Hospital Jamshoro [LUH] during period of 5 years from July 2004 to June 2009. Sixty patients of small intestinal tuberculosis presented with stricture of small intestine and underwent strictureplasty were the subject of this study. The procedure was done conventionally in all cases, in 70% intestine was closed in two layers while in remaining it was done as single layer. Early complications were seen in 23 cases which included anastomotic leakage with fistula formation [9 cases [15%]], burst abdomen [5 cases [8.34%]] and subdiaphragmatic abscess [9 cases [15%]] The late complications observed after mean follow up of two years include intestinal obstruction that necessitated readmission was seen was in 9 cases [15%], however the re-exploration was required in five cases. Incisional hernia was seen in 9 cases [15%].Though the post operative complications are frequent after strictureplasty yet the procedure is safe and simple for tuberculous stricture of small intestine as it requires minimum expertise, less operative time and above all preserve gut's length

Epidermoid inclusion cyst of the perineum- a rare case report in a 50 years old male

A 50 year old male presented with a history of mid line painless swelling in the perineum for last 4 years. The patient's only concern was a perineal swelling which was gradually increasing in size. Clinical examination mimics subcutaneous lipoma with soft lobulated surface with positive slip sign. The base line investigations were within normal limits. Complete surgical excision of the cyst performed. Histopathology confirmed epidermal inclusion cyst with no evidence of malignancy. Patient discharged on next day. The follow-up visits were un-remarkable. Perineal epidermal inclusion cyst is a rare entity and only few cases have been reported

therapeutic efficacy of pharmacological versus non-pharmacological measures in the management of post burn itch

To standardize the management protocol of post burn itch by comparing therapeutic efficacy of pharmacological with non-pharmacological measures. A prospective, clinical investigative and quasi-experimental study. This study was conducted at Burn emergency Unit, Liaquat University of Medical and Health Sciences Jamshoro for the period of 18 months from January 2006 to June 2007. A total of 80 patients were included in the study, and equally divided into 2 groups. Group A received an oral antihistamine with topical Ibuprofen while Group B received olive oil massage followed by wearing of compressive garments. The demographic data and initial assessment of the severity of itch on linear descriptive scale was made by the research team; while subsequent data for the entire study period was obtained by the attending burn clinician who was blind to the allocated regimen. Results were analyzed using computer statistical software SPSS Group A included 40 patients with 23 males and 17 females having mean age of 28.13 [SD +/- 13.03] and mean body surface area affected 15.387% [SD +/- 5.408] and mean itch scale of 5.500 [SD +/- 2.219]. Group B comprised of 40 patients with 21 males and 19 females with a mean age of 29.38 [SD +/- 14.35] with mean affected body surface area of 16.150% [SD +/- 5.555] and mean itch scale of 5.350 [SD +/- 1.762]. The main outcome measure was the improvement in burn itch. The results after 12 weeks of treatment for both groups showed a remarkable improvement in Group B when compared to Group A [p-value 0.000 and 0.365 respectively]. The non-pharmacological measures are superior to the pharmacologic measure with respect to their clinical efficacy and their improvement is highly significant after 4 weeks of treatment

Role of serum leptin level as a marker of severity of pre eclampsia

To explore the possibility of serum leptin being a marker of severity of pre-eclampsia, so that risk of imminent eclampsia and eclampsia can be reduced. This observational study was conducted at a private hospital of Hyderabad from 31st July to 1st December 2007. Forty primipara with same age, body mass indices and gestational age were included in this study. Twenty women had raised blood pressure in third trimester of pregnancy and 20 women with a normal blood pressure in third trimester of pregnancy. The exclusion criteria included history of diabetes, twin pregnancy, chronic hypertension, liver or renal disease. After counselling and affordability of laboratory testing their blood sample was taken for serum leptin, uric acid, serum creatinine and urine for albumin. The serum leptin level was measured by radio-immunoassay [RIA] kits. All data was filled in a pre-designed proforma after taking detailed history and examination. Statistical analysis was performed on SPSS. Student's t-test was applied where applicable. Mean systolic and diastolic blood pressure between pre-eclamptic and control group showed a marked difference [p<0.001] ranging from 149.50 +/- 3.44 and 104.40 +/- 3.03 as compared to control 107 +/- 1.56 and 74.50 +/- 1.49 respectively, similarly proteinuria was present in 20 [100%] cases of pre-eclampsia and 07 [35%] of normotensive women. Mean serum leptin level was significantly high in preeclampstic [79.380 +/- 3.287], when compared with a control group [27.825 +/- 1.050]. Mean serum uric acid in pre-eclamptic [5.040 +/- 0.147] showed significant changes than control [3.600 +/- 0.141], while serum creatinine level was insignificant in both groups. It has been observed that Mean +/- SEM value of serum leptin level was much higher in severe pre-eclamptics [76.418 +/- 5.056] than in women with mild pre-eclampsia [40.856 +/- 2.807]. All the parameters correlated positively and significantly with increased blood pressure. Elevated plasma leptin concentration appears to be a marker of pre-eclampsia independently or along with other parameters of pre-eclampsia could be used to reduce the severity of pre-eclampsia thus avoiding risk effects of pre-eclampsia to mother and foetus. This study still needs more research work to prove our results

Therapeutic effects of honey versus silver sulphadiazine in the management of burn injuries

To determine the therapeutic effects of honey versus silver sulphadiazine 1% in the management of burn injuries, in our set up. A quasi-experimental study. Burns emergency unit, department of Plastic Surgery Liaquat University Hospital, Hyderabad - Sindh form January 2002 to December 2003. Eighty patients having age range of 4 to 62 years with burn involving 10% to 40% body surface area were studied. Patients presenting with chemical or electric burn, and those with full thickness burn were excluded. Majority of cases was males. Patients were divided in two groups. One group received treatment with honey while other received silver sulphadiazine. Honey used was natural and unprocessed. Patients treated with honey showed rapid wound healing with no apparent local or systemic side effects. Mean duration of healing in honey treated group was 15.3 days. While in other group, mean was 20 days. Patients treated with honey did not develop growth of any pathogenic organism. However, 32[80%] patients treated with silver sulphadiazine showed growth of different pathogenic organisms necessitating the use of systemic antibiotic therapy accordingly. In honey group, only 3[7.5%] patients developed contracture as compared to 7[17.5%] patients treated with silver sulphadiazine. After complete healing, itching/pruritus was complained by 13[32.5%] patients treated with silver sulphadiazine while only 2[5%] patients complained so treated with honey. The burn wounds are healed rapidly by using honey with minimum scarring and pigmentation as compared to silver sulphadiazine. Use of honey in these patients can be cost effective in terms of treatment and hospital stay. However, to develop more confidence with the use of honey in burn wound management, more studies with larger sample size are needed