Aim: To audit the breast cancer surgeries and to establish the age groups and stage at which breast cancer patients present in our institution. Study design: Retrospective study Place and duration of study: Department of Surgery, Jinnah Hospital, Lahore from January 1st 2017 to December 31st 2021. Methodology: Four hundred and seventy-one breast cancer patients were sorted out. The data included the stage of presentation of breast cancer, age at presentation, year of presentation, gender and surgeries performed according to stage of carcinoma of breast. Results: The patient of breast carcinoma usually presents for medical help in her forties (31%) while patients presented between 18 to 86 years of age. Most patients however presented in stage III. Frequent sentinel lymph node biopsies with breast conservation surgery. All stage III breast carcinoma patients were treated with MRM and level II axillary clearance. BCS with sentinel lymph node biopsy was done for early breast cancer. Conclusion: Carcinoma of breast presents in earlier age in Pakistan as compared to West. Despite limited resources and non-compliant patient population, we are striving to provide standard treatment to all breast cancer patients. Increase in sentinel lymph node biopsies instead of axillary clearance shows this expedition. Keywords: Breast conservation with sentinel biopsy, Stage, Age

Background: The most common complication after hemorrhoidectomy is almost always postoperative. This dreadful complication makes the patients postpone the treatment even for prolapsing, bleeding, and uncomfortable piles. There are different methods that can be used for reducing pain including performing a lateral internal sphincterotomy (LIS). Better outcome of hemorrhoidectomy combined with lateral internal sphincterotomy has been observed in a few past controlled trials with respect to decreased pain after surgery, and improved and early wound healing. Objective: To compare the mean post-operative pain score in patients undergoing open hemorrhoidectomy with and without lateral internal sphincterotomy for III and IV degree hemorrhoids. Study Design: Randomized control trial. Place and Duration of Study: Department of Surgery, Jinnah Hospital Lahore from 1st July 2021 to 31st December 2021. Methodology: One hundred and twenty patients with diagnosis of III & IV degree hemorrhoids were selected. They were divided in two groups, Group A included patients who underwent open hemorrhoidectomy with lateral sphincterotomy and Group B included patients who underwent open hemorrhoidectomy alone. Standard Milligan Morgan Hemorrhoidectomy was done under local anesthesia. A fine surgical blade was inserted in inter-sphincteric groove with blade parallel to the circular fibers of internal sphincter. Blade was then rotated so that it faces the lumen of the anal canal. With the surgeon’s index finger in the canal, the blade was advanced towards the index finger so as to divide the internal sphincter but not the anal mucosa. Post-operative pain was assessed at first 48 hours post operatively according to ‘Visual Analog Score’. Results: The mean age was 34.6±7.72 in Group A and 34.28±8.09 years in Group B. There were 34 (56.67%) males in Group A and 32 (53.33%) in Group B while 26 (43.33%) females in Group A and 28 (46.67%) in Group-B. The mean pain score was 1.43±0.49 in Group A and 2.03±0.74 in Group B (P=0.001). Conclusion: Open hemorrhoidectomy with lateral sphincterotomy results in significantly lower mean post-operative pain when compared to open hemorrhoidectomy alone Keywords: Hemorrhoids, Open hemorrhoidectomy, Lateral sphincterotomy, Post-operative pain

Background: The papillary carcinoma thyroid is a rare disease in adolescents and children. A high level of suspicion should arouse as soon as the physician comes across swelling in neck. Appropriate management yields a good survival rate. Case history: We present a case of the papillary carcinoma thyroid in a 13-year old girl presented to outdoor of Jinnah Hospital, Lahore with painless swelling in right side of neck for three months. There were associated smaller swelling matted on palpation. No history of palpitations, fever, weight loss and family history of tuberculosis contact or cancer in family. Initial radiology and blood investigations showed an euthyroid goitre. The fine needle aspiration of lymph node only showed reactive hyperplasia. The matted lymph node was partially excised for histopathology as suspicion of tuberculosis existed due to its endemic feature. Later, it was found to be papillary carcinoma of thyroid. Total thyroidectomy was done with neck dissection followed by treatment at nuclear medicine department. Conclusion: Thyroid cancer is quite uncommon in adolescents but strong suspicion should arise when dealing with neck swelling even in this age group. Thorough history, watchful physical examination and timely investigations can save clinician from missing the diagnosis.