Epithelial ovarian cancer at a cancer hospital in a developing country.

OBJECTIVES: To analyze records of patients seen with malignant epithelial ovarian cancer at a tertiary care cancer hospital in Pakistan and obtain information on factors as laterality, histology, CA-125 levels, and stage of the disease, determine age at presentation and, assess menopausal status of the patients. Also, to review results obtained in light of data published in indexed journals. PATIENTS AND METHODS: We analyzed 544 cases of malignant ovarian epithelial tumors registered at the Shaukat Khanum Memorial Cancer Hospital and Research Center from December 1994-December 2003. RESULTS: Mean age at presentation: 48.1 years (SD 13, range 4-82 years); commonest histological sub-type: serous cystadenocarcinoma (28.6%); most frequently seen stage: 3 (43.5%), followed by stage 4 (22.4%); post-menopausal: 56.8% of the women; bilateral disease: 41.2% of the women; and Cancer Antigen-125 (CA-125) level: elevated in 70% of the females. CONCLUSIONS: Stage at presentation in majority of the cases was advanced as compared to that seen in the west. With only minor variations, our findings seem consistent with those reported in other local studies. However, it is imperative to conduct an extensive population-based study to understand the impact of, and develop strategies for the management of ovarian cancer in Pakistan.

Colovesical fistula: not a contraindication to elective laparoscopic colectomy.

PURPOSE: Traditionally, diverticular fistula was thought to be a contraindication for laparoscopic colectomy. The advent of hand-assisted laparoscopy has allowed repair of a diverticular fistula to be technically feasible laparoscopically. We present our experience with laparoscopic colectomy in patients with diverticular fistulas. METHODS: Patients with colovesical or colovaginal fistulas secondary to diverticular disease were consecutively entered into a database over a five-year period. All operations were electively performed by a single group of colorectal surgeons. Patient demographics, American Society of Anesthesiologists classification, type of surgery, operating time, hospital length of stay, and early and late complications were recovered by chart review. These results were then compared to results from a group of patients who had undergone elective laparoscopic colectomy for recurrent diverticulitis during the same period by the same group of surgeons. RESULTS: Altogether, 40 consecutive operations for diverticular fistulas were performed, 36 of which were started laparoscopically (90 percent). The average patient age was 65 years and the average American Society of Anesthesiologists class was 2. Patient demographics were similar among the group with recurrent diverticulitis (n = 149). The average hospital stay was 6.2 days for the fistula group and 4.4 days in the recurrent diverticulitis group. The average operating time was 220 minutes for the fistula group vs. 176 minutes for the uncomplicated group (P < 0.002). The conversion rate was significantly higher in the fistula group (25 percent vs. 5 percent, P < 0.001). There were no postoperative anastomotic leaks or bleeding episodes requiring reoperation in the fistula group. CONCLUSIONS: Diverticular fistula should no longer be considered a contraindication for laparoscopic colectomy. These cases are more complex, as evidenced by the longer operating times and higher conversion rates when compared with resections for uncomplicated recurrent diverticulitis. Although the length of hospital stay was longer for patients who underwent laparoscopic colectomy for diverticular fistula, those whose operations were completed laparoscopically had the same outcome as patients with uncomplicated disease. We anticipate that minimally invasive surgery will become the standard of care for colovesical fistula, as it now is for uncomplicated diverticular disease.

Postfixation pseudoaneurysm of the superficial femoral artery in femoral shaft fracture.

This case report describes a young female child presenting with a painful, expansile swelling at the medial aspect of her right thigh which had followed an open reduction internal fixation of a closed fracture of mid-shaft of right femur. An angiogram confirmed pseudoaneurysm of the superficial femoral artery probably caused by overpenetration of the drill bit or any sharp instrument while applying dynamic compression plate. It was treated surgically by resection of the aneurysm, reconstruction with inter-positional sephanous vein graft and removal of the hard-ware.