Objective: To compare the recurrence rate of breast carcinoma between modified radical mastectomy and breast conservative surgery in patients of breast cancer. Material and methods: This randomized controlled was conducted at Department of Surgery, Akhtar Saeed Medical and Dental College Lahore from September 2020 to June 2021. Total 70 females with breast cancer from last 3 years (any stage), age between 30-60 years with ASA grade I, II and III were selected. In group A MRM was performed while in group B, conservative surgery was performed. Recurrence of breast cancer between the both groups was compared. Results: Mean age of patients was 44.47 ± 9.41 years with age range 30-60 years. Mean age of patients of study group A and B was 43.57 ± 9.89 years and 45.37 ± 8.95 years respectively. In study group A (MRM group), recurrence of breast cancer was found in 6 (17.14%) patients while in study group B (Conservative surgery group), recurrence of breast cancer was noted in 15 (42.86%) patients. Difference of recurrence of breast cancer between the both groups was significant with p value 0.019. Conclusion: Findings of this study showed higher frequency of recurrence of breast cancer in cases managed with conservative surgery as compared to MRM. Most of the cases belonged to 3rd decade of life. Among non-obese cases, significant difference of recurrence was seen. Most of the cancer cases were multiparas but difference of recurrence was not significant. Higher number of married cases were reported with breast cancer and difference between conservative surgery group and MRM group was significant. Keywords: Breast cancer, recurrence, MRM, conservative surgery

Introduction: Corrosive intake is a social dilemma in our society and it is a leading cause of morbidity due to malnutrition caused by inability to feed through natural route in the victims. Some kind of procedure is needed to reestablish the natural route in survivors. This is usually accomplished by feeding jejunostomy mostly done by open method. Objective: This study was meant to compare the outcome of LFJ and OFJ. Materials and Method: This prospective randomized controlled trial was carried out at PGMI / AMC / LGH, Lahore for 1 year. During the period total of 60 patients were selected. In Gp A the LFJ while in Gp B the OFJ was performed. Outcomes of both were compared for pain, infection, bleeding, duration and cost of procedure. DM, HTN and ASA grades were accounted for while performing logistic regression. Age and sex stratification for outcome analysis was done. This study was approved by the ethical review committee of LGH, Lahore. Results: The mean age of all cases was 27.70 ± 9.79 years. The male to female ratio was 1:5. After 72 hours of surgery, 1 (3.3%) cases in LFJ and 27 (86.67%) cases in OFJ had pain with significantly lower pain in LFJ with a p-value < 0.001. Blood loss in LFJ was (11.03 ± 2.1 ml) as compared to OFJ (27.2 ± 5.4 ml). After 2 wks one of the cases (3.3%) in LFJ and 6 (20.0%) cases in OFJ had infection with p-value < 0.05. Mean time for LFJ (47.4 ± 4.3 min) was less than needed for OFJ (58.6 ± 7.7 min). Conclusion: It was concluded that LFJ was better than OFJ in terms of having less pain, bleeding, infection and duration of procedure, while cost of LFJ was exceptionally high.

<p>Acute appendicitis is one of the most common surgical emergencies. The clinical diagnosis augmented with the laboratory and radiology reports qualifies the patient for appendectomy. Mistreated patients in emergency, during the acute episode, sometimes present with a mass in the right iliac fossa with adhesions of the omentum and associated peritonitis. Appendico-cutaneous fistula is an uncommon presentation of appendicitis. It may present as a sinus with discharge. We report a case of a young female who presented with appendicocutaneous fistula.</p>

Objective: To find diagnostic precision of APACHE II score in predicting mortality in poly Trauma patients within first 24 hours of hospitalization. Study Design: Cross Sectional study. Setting: Emergency Department of Lahore General Hospital. Period: 2018-2019. Materials & Methods: A total of 270 patients who fulfilled selection criteria were enrolled in the study. To calculate APACHE II score, age, vitals, CBC level, Glasgow coma scale score and chronic health points were measured. Patients were classified as per their APACHE II score. After calculating APACHE II score patients were managed according to trauma severity and followed up till 24 hours to note the mortality. Data was analyzed in SPSS v. 20. Results: The mean age of patients was 38.53 ± 11.67 years with 173(63.91%) male and 97(36.09%) were female patients. Out of 270 cases, in hospital mortality occurred in 99(36.5%) while other 171(63.5%) were alive within 24 hours of admission. According to APACHE II score, 99(36.5%) cases had > 11.5 score and rests of 171(63.5%) had APACHE II ≤ 11.5. The sensitivity, specificity, PPV, NPV and diagnostic accuracy of APACHE II was 89.16%, 93.2%, 88.1%, 93.84% and 91.74%. Conclusion: According to this study, high accuracy of APACHE II for prediction of in-hospital mortality with high sensitivity, specificity, PPV, NPV and diagnostic accuracy as 89.16%, 93.2%, 88.1%, 93.84% and 91.74%. Using APACHE II in future we can devise an efficient treatment plan for poly trauma patients to reduce the probability of hospital mortality.

This report discusses a case of 15 years oldyoung boy who surprisingly presented late with huge congenital diaphragmatic hernia having stomach, part of colon, small bowel, spleen, tail of pancreas and left kidney.