Puerperal breast abscesses; percutaneous ultrasound guided drainage compared with conventional incision and drainage

The aim of this study was to compare the management of puerperal breast abscess by ultrasound guided percutaneous drainage v/s incision and drainage with special attention to resolution time and complications. Allied Hospital Faisalabad. Jan 2005- June 2007. 60 patients with puerperal breast abscess were studied. Patients were divided into two groups randomly after informed consent. In Group A; patients were treated with percutaneous drainage under local anesthesia while Group B patients were treated by conventional incision and drainage, and results were compared with reference to resolution time and complications rate using student's t-test. By percutaneous method abscess healed in 5-8 days time. Recurrent abscess was found in one case [3%], milk fistula formation in one case [3%] and no residual abscess was found. There was no scar formation, induration or distortion of the breast parenchyma. Breast-feeding was interrupted in four patients [13%] only due to milk fistula [one case], recurrent abscess [one case] and patient's own preference [two cases]. On the other hand by conventional method healing took 15-25 days with pain and discomfort of daily dressings, scarring and cessation of breastfeeding in most of the cases. Percutaneous ultrasound guided placement of suction drainage catheter in puerperal breast abscess for 5-8 days is less invasive, high resolution rate, scarless, low complication rate and preserves the function of breast-feeding as compared to conventional incision and drainage

Obstructive jaundice; experience at teaching hospital

[1] To find out the commonest causes of obstructive jaundice [2] To find the age group most affected by obstructive jaundice and male to female ratio in these cases [3] to define the ratio of malignant and benign conditions leading to obstructive jaundice. [4] To suggest the best possible mode of treatment. Descriptive study. Allied and DHQ Hospitals Faisalabad. Novemberl999 to September 2004. 62 patients admitted through outpatient and emergency departments were included. All the patients were subjected to clinical evaluation and available investigations to reach the provisional diagnosis, which was confirmed by operative finding and histopathological reports. The maximum cases of obstructive jaundice due to benign cause were observed in the age group of 31-50 years whereas malignant jaundice maximally affected the age group of 31-60years. Male to female ratio was 1:2.44. Choledocholithiasis was the commonest benign cause of obstructive jaundice. Carcinoma gall bladder was the commonest malignancy causing obstructive jaundice. CBD exploration and stone extraction was employed to treat the cases of Choledocholithiasis. Majority of the cases with malignant jaundice were offered internal biliary drainage through bilioenteric anastomosis or external biliary drainage using T-tube. Choledocholithiasis is the commonest benign cause of obstructive jaundice. Carcinoma gall bladder is the commonest malignancy causing obstructive jaundice. Curative surgery is only possible for treatment in benign cases. Palliative surgery in the form of external or internal biliary drainage could be employed in malignancy due to advanced stage of disease at the time of presentation

Appendicectomy in younger females; what should be the better approach?

Females have a high negative appendicectomy rate. In this study our goal was to ascertain if there was a significant reduction in negative appendicectomy rate in our hospital with the increasing use of elective laparoscopy along with Alvarado scoring and ultrasonography in the females of childbearing age. Cross sectional study. Emergency department, Allied Hospital Faisalabad. Females of age 12-40 year with pain in right iliac fossa were studied from November 2005 to April 2006. Patients were divided into three groups on the basis of Modified Alvarado Score [MAS]: Group I: patients [score <5] discharged, Group II: patients [score 5-7] put on observation for 36 hours and elective laparoscopy was done. Group III: Patients [score 8 and 9] underwent emergency open appendicectomy and negative appendicectomy rate was calculated. In group II any complication associated with delaying appendicectomy for 2 days were identified. One hundred and thirty female patients presented with pain in right iliac fossa. 33 patients were having MAS <5 [group I], 44 patients were having MAS 5-7 [group II]. Out of these 35 patients underwent diagnostic laparoscopy. Only two patients [5.7%] in this group needed conversion to open appendicectomy due to perforation. 53 patients had MAS 8 and 9 [Group III]. Ultrasonography excluded four patients with gynecological findings and mass formation. 49 patients underwent emergency appendicectomy. Four females [8.1%] were having negative appendicectomy as proved on histopathology. Diagnosis and treatment of acute appendicitis in younger females can be improved with appropriate use of Alvarado score, ultrasonography and laparoscopy

Lower G.I.T. bleeding; Role of sigmoidoscopy

To find out the most common cause of lower Gastrointestinal tract bleeding in our setup as diagnosed with sigmoidoscopy 2. To measure the frequency of colorectal carcinoma with special reference to age and sex distribution 3. To compare the assessment of findings in prepared and unprepared gut on sigmoidoscopy. Prospective, descriptive study. Eight months study [January 2002 to June 2003]. Surgical Unit Ill, Allied Hospital/PMC Faisalabad. 50 cases presented with mild to moderate lower GIT [Gastrointestinal tract] bleeding and underwent sigmoidoscopy and biopsy and histopathology reports were studied. The most common cause of lower GIT bleeding as diagnosed by sigmoidoscopy was non specific colitis [46%] followed by colorectal carcinoma [18%], ulcerative colitis [16%] and a small percentage of benign rectal polyps, villous adenoma, and carcinoid tumour. Colorectal carcinoma was an important cause of lower GIT bleeding. In this study most of the cases of colorectal carcinoma presented in younger age group [55.5% < 40 year age group]. Male to female ratio was found to be 2:1. Sigmoidoscopy in unprepared gut had good results as compared to prepared gut. Faecal matter obscured the vision in any two cases only in unprepared cases. Rigid sigmoidoscopy is an early and valuable initial diagnostic procedure for the detection of cause of lower GIT bleeding, especially in a case of colorectal carcinoma, as early detection saves human life in this case