Breast cancer; evaluation of risk factors in our local population an institutional based descriptive and prospective study

Evaluation and distribution of established etiological risk factors in patients of breast cancer in our local population. Institution based non-interventional descriptive and prospective study Department of Pathology, Liaquat University of Medical and Health Sciences, Jamshoro from January 2009 to December 2011. One hundred and two cases of breast cancer diagnosed on HE staining were selected for the study. More than 50% were in 4th and 5th Decades of life. 94% were married and 06% were un-married. 65% were in pre-menopausal group and 35% in post-menopause group. 93% had positive history of breast feeding. None of them had ever taken oral contraceptive. Smoking history was present only in 9.80% cases. 27% cases had family history of breast cancer in first degree relative and 13% in 2nd degree relatives. Majority [66.66%] were belongs to lower middle socioeconomic class. Surprisingly in this study marital status, parity, and breast feeding not proved as protective factors against breast cancer

Preoperative informed consent: is it truly informed?

Pre-operative informed consent is an important aspect of surgery, yet there has been no formal training regarding it in Pakistan. This study was done to assess the preoperative informed consent practice. After taking informed permission, a questionnaire was filled in during an interview with 350 patients, who have undergone elective surgical procedures under routine practice conditions from July to October 2010. All the patients were asked a set of standard questions which related to the information they were provided before the operation as a part of standard informed consent practice. Most i.e. 307 [87.7%] patients were informed about their condition but very few 12 [3.4%] were briefed regarding complications. Only 17 [4.9%] patients said they knew about the risks and complications of proposed anesthesia. One hundred thirty-eight [39.4%] patients said that they were allowed to ask questions while giving consent. Most of the time 196 [56%] consent was taken one day before surgery but in few 2 [0.6%] instances it was taken on the morning of surgery and on operation table in some cases 3 [0.9%] as reported by patients. The consent form was signed by the patients themselves in only 204 [58.3%] cases and by their relatives in the rest. About half the number of patients 171 [48.9%] interviewed were satisfied from the information they received as informed consent process. This study highlights the poor quality of patient knowledge about surgical procedures and the inadequate information provided

Compliance with standard precautions: a long way ahead

To find out the knowledge, attitude and compliance with standard precautions among doctors working in a tertiary care hospital. The cross sectional study was conducted during October 2006 in the form of self reporting questionnaire. The questionnaire included question about duration of clinical experience, Hepatitis B Virus vaccination and its antibody titer, knowledge and compliance of Centre for Disease Control [CDC] standard precaution guidelines. They were further asked about reasons for non compliance. Total 120 doctors participated in this study which includes 60% interns, 34.2% residents and 5.8% consultants. Total 95% respondents were vaccinated against Hepatitis B virus but only 27.4% knew their antibody titers. Majority of the doctors, 52.5% didn't know any thing about Centres for Disease Control guideline for standard precautions while 40% of the respondent had some idea and only 7.5% knew them well. Among responders 56.7% changed gloves for each patient and only 39.2% washed hand in between examining patients. Most of the doctors 58.3% said they always wear apron while dealing with patients while 20% wear only when dealing with high risk patients. Protective goggles were not used by any of our respondent. The reasons given for non-compliance included non-availability of protective modalities by 58.3% while 20% were of the opinion that it's not practical. The knowledge attitude and compliance among doctors towards standard precautions is in-adequate. Availability of supplies and awareness programmes for these standard precautions are recommended for better compliance

Enucleation of pancreatic pseudocyst in a patient suffering from chronic pancreatitis

Pseudocysts in chronic pancreatitis have a higher incidence as compared to acute pancreatitis. We report case of a young girl suffering from chronic pancreatitis with pseudocyst formation. The pseudocyst was successfully enucleated, though enucleation has yet to be accepted as a treatment modality

Waiting time for emergency surgeries in a tertiary care public hospital - a performance audit

To find out the waiting time for emergency surgeries and to identify causes responsible for this delay in a tertiary care public hospital.Settings: Surgical Unit IV, Civil Hospital, Karachi.Patients and Patients admitted through emergency for immediate emergency operations during the month of November and December, 2003 were included in the study. For data collection a proforma was made which included diagnosis, operation performed, time of planning immediate surgery, time of surgery, causes responsible for delay apart from demographic information.Main outcome measures: Waiting time for emergency surgeries, different causes responsible for the delay. A total of 45 patients were enrolled in the audit study. Majority of patients 14 [31.1%] were suffering from acute appendicitis. 33 [73.3%] of patients had to wait for more than 3 hours before their emergency surgery. Major cause of this delay in 33.6% of patients was due to surgical team doctor's inefficiency. In 7 [21.2%] patients surgery was delayed due to late night admission and in 6 [18.1%] due to non-availability of cross matched blood. In 5 [15.1%] patients surgery was delayed due to unavoidable causes like busy theatre and arrival of more serious patients. A substantial number of patients needing emergency surgery waited too long for the surgical management. Majority of delays were due to causes which can be addressed to improve the patients care

Carcinoma of caecum presenting as mega intussusception and rectal mass

Carcinoma of colon and rectum are second commonest cancer cause of death in United Kingdom. Because, right colon has a large caliber, a thin and distensible wall and faecal content is fluid, so, carcinoma of right colon may attain a large size before it gives specific symptoms. Any complication like acute appendicitis or intussusception may draw early attention, when curative resection is possible. In this report, an unusual presentation of carcinoma of caecum is reported

Clinicopathological profile and surgical management outcomes in patients suffering from intestinal tuberculosis

To determine the mode of presentation in intestinal tuberculosis and effectiveness of various surgical procedures adopted in our set up. A descriptive study. Liaquat University Hospital, Hyderabad from June 1996 to May 1998 and Muhammad Medical College Hospital Mirpurkhas, Sindh from April 2002 to March 2004. One hundred-twelve cases of intestinal tuberculosis were studied, which were operated and diagnosis was confirmed on biopsy. Data collection included detailed history particularly duration of symptoms, respiratory complains, dietary habits and bowel habits. At Liaquat University Hospital, 1872 patients were admitted, 386 [20.61%] were operated for abdominal complains [acute, sub-acute or chronic intestinal obstruction or perforation] and 80 [4.27%] were diagnosed as having intestinal tuberculosis. Meanwhile, 624 patients were admitted in Muhammad Medical College Hospital Mirpurkhas. Of these, one hundred-seventy [27.24%] were operated for abdominal pathology and 32 [5.12%] cases were proved as intestinal tuberculosis on histopathology. Out of total 112 cases of intestinal tuberculosis, 64 [57.20%] were male and 48 [42.80%] females. Age ranged from 8 to 55 years with majority in 2nd and 3rd decades. Resection and anastomosis of small gut, limited right hemicolectomy, right hemicolectomy, stricturoplasty, ileostomy, adhenolysis and evacuation of pus were the procedures adopted for management. Post-operative complications were seen in 30.65% of patients with wound infection on top, however, mortality remained 3.57%. The mortality of intestinal tuberculosis is high due to delay in diagnosis and under dosage or irregular anti-tuberculous treatment. In complicated cases, surgery is indicated. When multiple strictures or perforations are present, resection and end to end anastomosis is required. In case of caecal mass [fungating type], right hemicolectomy can be performed and in cases where extensive adhesions are present and there is fear of iatrogenic perforation, in attempts to mobilize right colon, limited right hemicolectomy shall be performed

pattern of diseases in a surgical unit at a tertiary care public hospital of Karachi

Objective: To study the pattern of diseases in patients admitted in a surgical unit of tertiary care public hospital in Karachi

Design: Descriptive retrospective analysis of patients admitted from January 1, 2004 to June 30, 2004

Setting: Surgical Unit IV, Civil Hospital, Karachi

Results: A total of 501 patients, 284 [56.7%] males and 217 [43.3%] females were admitted during a six months period in Surgical Unit IV of Civil Hospital, Karachi. Out of these 296 [59.1%] patients were admitted through OPD, 190 [37.9%] came from emergency and 15 [3%] from other units. The majority of patients i.e. 114 [22.8%] had gastrointestinal related diseases followed by hernia 94 [18.8%], hepatobiliary diseases 69 [13.8%], ano-rectal diseases 37 [7.4%], abscesses 35 [7%], trauma 28 [5.6%], thyroid diseases 20 [4%], testicular and scrotal related problems 19 [3.7%], breast diseases 17 [3.4%] and tetanus patients 10 [2%]. Diabetes mellitus was the commonest associated disease seen in 60 [12%] patients. Four hundred forty-one [88%] patients were discharged after successful treatment while 10 [2.2%] expired during the study period

Conclusion: This study revealed that the commonest cause of admission was gastrointestinal related problems including acute abdomen, followed by hernias and hepato-biliary diseases, while diabetes mellitus was the most common associated disease