Randomized, clinical trial on diathermy and scalpel incisions in elective general surgery.

BACKGROUND: Since a long time skin incisions have routinely been made with scalpels. Now a day there is a shift in trend from this method to electrosurgical skin incisions. However, fear of bad scars and improper wound healing has prevented its wide spread use. This Study aimed to compare both methods of skin incisions for different variables. OBJECTIVES: The aim of this study was to examine incisional time, blood loss during incision and postoperative wound complications and pain with both methods of skin incision. PATIENTS AND METHODS: A prospective, comparative and randomized study was conducted at different hospitals of Hyderabad and Nawabshah, Pakistan from 1(st) of December 2009 to 30(th) of November 2011. The study included patients of either sex above the age of five years with general surgical pathology who were to undergo surgery. these candidates were randomly put into two groups. In Group A patients incision was made with a scalpel and in group B with diathermy. Data was analyzed for age, sex, comorbid illness, incisional time, blood loss during incision making and postoperative pain and wound complications. RESULTS: A total of 283 patients completed the follow-up and were included in the final analysis. Group A comprised of 143 (50.53%) patients; 83 (58%) males and 60 (42%) females with a mean age of 36.03 years. Amongst the 140 patients of group B, there were 85 (60.7%) males and 55 (39.3%) females with a mean age of 36.52 years. Twenty-five (17.48%) patients of group A and 27 (19.28%) of group B had comorbid illnesses. Mean incision time was 8.9025-sec/cm(2) for group A and 7.3057 sec/cm(2) for group B patients. Mean blood loss during incision making was 1.8262 mL/cm(2) and 1.1346 mL/cm(2) for group A and B patients, respectively. Pain was 5.2957 for group A patients on day one and 3.1181 for group B patients. Pain score was 2.1049 and 1.6206 on day two and 0.8191 and 0.7192 on day five, for group A and B patients, respectively. Postoperative wound complications were noticed in 26 (18.18%) patients of group A and 22 (15.71%) patients of group B. CONCLUSIONS: Diathermy incision is a safe and expedient technique. It takes less time than scalpel incision and loss of blood is also lower during incision. Diathermy is associated with lesser post-operative pain and complications than the scalpel incision. Diathermy should be method of choice in general elective surgery.

Late presentation of breast cancer: a dilemma.

OBJECTIVE: To asses factors responsible for late presentation of breast cancer in Nawabshah. METHODS: This descriptive study was conducted at a private and a public sector hospital of Nawabshah, Pakistan, from Jan 2004 to Dec 2008. RESULTS: Sixty females were admitted and selected as study subjects during the study period with mean age of 43.5 +/- 10.38 years and range (28-80 years). Patients with poor economic status were 49 (81.6%) and remaining 11 (18.3%) were from middle class. Sixteen (26.6%) patients were literate, with 3 of them being educated to secondary level. In our study 58 (96.6%) patients with breast carcinoma noted lumps in respective breasts as incidental findings in breast self-examination. Only in 2 (3.3%) patients family physicians noted a lump and referred them to a proper health care facility. Fifty-eight (96.6%) patients belonged to rural areas. In 95% patients, first visit regarding the breast symptoms was made after 6 months of initiation of symptoms. Three (5%) patients in this study presented in stage I, 15 (25%) in stage II, 23 (38.3%) in stage III and 19 (31.6%) in stage IV. CONCLUSION: Most cases of breast cancer presented in advanced stage probably due to poor economic status, illiteracy and negligence by patients or their family members and general practioners.

Closure of elective abdominal incisions with monofilament, non-absorbable suture material versus polyfilament absorbable suture material.

BACKGROUND: Closure of abdominal incisions with different suture materials has been a matter of great controversy. Polypropylene and Polylactide with Polyglycolide are among the commonest suture materials used for closure of abdominal incisions. Objectives of this study were to assess optimal suture material used for closure of elective abdominal incisions and to see complications associated with these suture materials. METHODS: This prospective, comparative, randomised study was conducted at public and private sector hospitals of Nawabshah and Hyderabad from 1st Jan 2005 to 31st October 2009. All patients who underwent abdominal surgery under the investigators' supervision were included in the study. Patients were divided into 2 groups on even or odd numbers. In group-A patients' incision was closed with monofilament, non-absorbable Polypropylene (Prolene) No. 1 suture material and in group-B incision was closed with Polyfilament, absorbable, co-polymer of Polylactide with Polyglycolide (Vicryle) No. 1. RESULTS: A total 274 patients were finally analysed for closure of elective abdominal incisions, with 138 (50.4%) patients in Group-A and 136 (49.6%) patients in Group-B. Vicryle was found superior in knot security and suture handling. Superficial wound infection was found in 5.79% patients of Group-A and 6.61% of Group-B. Discharging sinus was found in 3.62% of Group-A vs 0.73% of Group-B. Burst abdomen was seen in 2.17% patients in Group-A and 1.47% in Group-B. Incisional hernia was present in 4.34% of Group-A and 0.73% patients of Group-B. No patient in Group-B developed persistent pain at incisional site while it was found in 8.69% patients of Group-A. CONCLUSION: Polylactide is an optimal suture material in closure of elective abdominal incisions.