Effect of Flap Fixation Technique in Modified Radical Mastectomy on Incidence of Postoperative Seroma Formation.

OBJECTIVE: To determine the efficacy of flap fixation technique on formation of postoperative seroma after modified radical mastectomy. STUDY DESIGN: Quasi-experimental study. PLACE AND DURATION OF STUDY: General Surgery Department, PIMS Hospital, Islamabad, from August 2014 to February 2015. METHODOLOGY: This study included 70 female patients, aged 16 to 70 years, undergoing modified radical mastectomy, randomly divided into two groups of 35 each, Group A (flap fixation) and Group B (non-flap fixation). Flap fixation was done by suturing flaps by absorbable, fine suture to underlying pectoralis fascia to obliterate the dead space. Two closed suction drains were used in both groups. Patients were discharged on the second postoperative day. Patients and their attendants were thoroughly educated about record of drain output. Patients followed in OPD after one week. Drains were removed when fluid output was less than 50 ml/day. After removal of drains, patient were again called for weekly follow-ups in surgical OPD. Formation of seroma was diagnosed clinically as collection of fluid under the mastectomy flaps and axilla seen as fluctuant, non-tender swelling. Data was collected on proforma designed for the study and analysed by SPSS version 20.0. RESULTS: Flap fixation group had 2 (5.7%) cases of seroma formation while control group had 3 (8.6%) cases of seroma formation. The difference between both groups statistically was insignificant (p=0.643). CONCLUSION: Flap fixation technique has no statistically significant effect on reducing frequency of seroma formation in patients undergoing modified radical mastectomy.

Expression analysis of human epidermal growth factor receptor type 2 transcripts in breast cancer cohort and its association with clinical features.

AIM OF STUDY: Increased expression of human epidermal growth factor receptor type 2 (HER2) is significantly associated with poor prognosis in breast cancer patients. However, data on HER2 at transcript levels in Pakistani mammary tumor affected females is still limited. In the current study, HER2 transcripts were explored in breast cancer cohort and correlated with various clinical parameters. MATERIALS AND METHODS: Freshly excised tumors along with adjacent normal background tissues of 94 patients were collected at the time of surgery and immediately stored in RNAlater ® solution. Clinical data for these samples (disease stage, grade, age, and menopausal status) was also retrieved after a subsequent follow-up. Isolation of RNA and cDNA synthesis was done using an already established protocol. HER2 expression was evaluated using the quantitative real-time polymerase chain reaction (qRT-PCR) technique while ß-actin was used as an internal control. RESULTS: In the given cohort, 31 (33%) patients were found positive for HER2. These tumors showed a pronounced increase in HER2 as compared to controls (P = 0.0004). Interestingly, the significant relevance of high HER2 mRNA among moderately differentiated tumor tissues in comparison to controls was also observed (P = 0.02). A significant association of HER2 levels with premenopausal status was also reported. CONCLUSION: Based on these findings, early screening of HER2 using qRT-PCR should be incorporated for breast cancer patients of Pakistani population diagnosis.

Non-conventional transmission of hepatitis C: a true possibility ignored.

OBJECTIVE: The exact mode of hepatitis C virus (HCV) transfer remains elusive in a vast majority of cases. We examined the possibility of non-conventional transmission of HCV by person-to-person contact. METHOD: A questionnaire based, prospective study was conducted at Pakistan Institute of Medical Sciences (PIMS) from July-October, 2006. Patients with compensated chronic hepatitis B (CHB) &/or C (CHC) were registered for 6 month interferon (IFN) therapy. All candidates furnished information about age, gender and mode of transmission. The unanswered queries were interpreted as "missing data". After omission of cases with hepatitis B virus (HBV) infection alone, the remaining persons included in the present study were placed in: Group-A: Multifactorial transfer involving conventional (blood borne) and non-conventional modes; Group-B: Unifactorial transfer by non-conventional routes only; Group-C: No identifiable risk factor. Unlike conventional routes, the non-conventional modes represented likelihood of CHB &/or CHC by exposure to household contacts, to persons with hepatic cirrhosis and during traveling. RESULTS: Initially, 879 patients (mean age: 35.52 +/- 9.1 years) were registered. After exclusion of 25 subjects with HBV infection only, the remaining 854 were included. Of 854 cases, 830 (97.18%) were infected with HCV and 24 (2.81%) had co-infection with HBV & HCV. According to the mode(s) of transmission, Group-A: 515 (60.30%); Group-B: 136 (15.92%) and Group-C: 203 (23.77%) cases were identified. Dental treatment: 278 (32.55%) was the commonest conventional risk factor in Group-A. The non-conventional transfer of HCV in Group-A was mainly suggested by household contact: 222 (25.99%). Groups-A and -B combined, the sum of any non-conventional risk factor was comparable with and even higher than the leading haematogenous routes in Group-A. Groups-B and -C combined, HCV infection in 339 patients (39.69%) was apparently acquired by non-conventional modes, most probably by person-to-person interaction. CONCLUSION: Non-conventional transmission of HCV is a genuine possibility which is currently underestimated.

Mesenteric lipoma leading to small gut strangulation and short gut syndrome.

A rare case of mesenteric lipoma was presented to us as acute abdomen. His abdominal x-ray showed dilated small gut. Ultrasonography of abdomen revealed dilated small gut loops and minimal amount of free fluid in the peritoneal cavity. On exploration, most of the small gut was gangrenous and tightly twisted twice around its mesentery that contained a lump which was confirmed as lipoma on histopathology.