Objectives: Oncoplastic breast surgery (OBS) is a revolutionary approach for managing breast cancer. This manuscript aimed to assess the oncological and cosmetic outcomes of OBS in breast cancer. Study Design: Descriptive, prospective study. Setting: Department of Surgery, Madina Teaching Hospital, Faisalabad. Period: January 2018 to June 2019. Material & Methods: Females with invasive breast cancer having 5-6 cm tumour size, Locally advanced tumour after chemotherapy, single tumour and patients < 70 years were included; while patients with fixed tumours, high tumour to breast size ratio, multiple axillary lymph nodes, metastatic cancer & patient’s choice for mastectomy were excluded. Oncological outcome was assessed by; Margin involvement, time lag for chemotherapy, local recurrence and distant metastasis. Cosmetic outcome was detected by score given by patient and an independent surgeon. Results: Thirty two female patients underwent OBS. Mean age of patients was 46.56 yr (SD =10.23). Six patients (18.8%) had central tumors. 3 patients were post neoadjuvant chemotherapy. In 28 patients volume displacement (VD) surgery; while in 4 patients volume replacement (VR) using different flaps like LICAP flap were done. Oncological outcome showed positive margin in one case only, in all other cases clear margins were found. Chemotherapy start time varied from 3 to 8 weeks after surgery (Mean=31.3 days). Delayed time was associated with high BMI and diabetes (P<0.05). Local recurrence or distant metastasis was not noticed in any case. Majority of the patients and surgeon (90%) were satisfied with cosmetic outcome. Conclusion: Oncoplastic Breast surgery is a unique approach to conserve breast even in larger tumours without compromise on oncological principles and cosmesis.

A healthy 22-year-old man received an initial injection of 12 mL of lignocaine/bupivacaine solutions (2 mL test, then 10 mL) into an epidural catheter. This produced a satisfactory regional blockade that seemed to be epidural but, when a supplementary 6 mL injection was given 1 h later, the patient developed impaired motor function as far as the upper cranial nerves, with loss of pinprick sensation to the shoulder. The emergence of fluid dribbling freely from the catheter prompted measurement of the pressure, which was 36 mmHg. The fluid was proved not to be cerebrospinal fluid (CSF) by the absence of glucose (on dextrostix), by the appearance of turbidity with added thiopentone, and later by microscopy. Slow aspiration of 7 mL of the presumed injectate reduced the pressure in the catheter to 8 mmHg, which promptly reversed the additional excessive blockade, allowing surgery to proceed uneventfully. The retrieval of injectate argues strongly that the catheter tip had found its way subdurally, and the promptness of the reversal with aspiration argues for a mechanical rather than a pharmacological cause for the extensive neurological dysfunction after the second injection. Pressure measurement and aspiration may be helpful in other similar cases.

Objective: To compare the effects of intraincisional and intraperitoneal infiltration of local anaesthetic to relieve early postoperative pain in laparoscopic cholecystectomy. Study Design: Randomized Control Trial. Setting: Department of Anaesthesia and Surgery, Madinah Teaching Hospital Faisalabad. Period: July 2017 to March 2018. Material & Methods: A sample of 100 patients with American Society of Anaesthesiologists Physical status (ASA) I and II, undergoing laparoscopic cholecystectomy were selected using simple random sampling technique. Patients were randomly assigned into groups A and B. Group A patients received intraperitoneal infiltration of 20 ml solution of 0.25% bupivacaine and group B patients received intraincisional infiltration of 20 ml solution of 0.25% bupivacaine. Results:  Demographic characteristics were not significantly different in both groups. Our study showed that Group A patients had better pain relief as compared to group B patients. Visual analogue score (VAS) for pain relief at 0, 3,6,12 and 24 hours was statistically different in both groups. The requirement of rescue analgesia between group A and B was found to be12% and 38% which is statically significant (p value 0.003). Conclusion: intraperitoneal infiltration of Bupivacaine offers better postoperative pain relief after laparoscopic cholecystectomy and is associated with less analgesic requirement in early postoperative period.

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ABSTRACT: BACKGROUND & OBJECTIVE: Laparoscopic cholecystectomy (LC) following Endoscopic retrograde cholangiopancreatography (ERCP) is associated with an increased risk of complications. ERCP is associated with increased incidence of complications during LC. Surgery may be performed in same anesthesia with ERCP or up to 6 weeks later. We aimed to determine the benefits of performing LC within 72hrs of ERCP. METHODOLOGY: After institutional ethical approval this prospective cross-sectional study was performed at Madinah Teaching Hospital Faisalabad from April 2019 to June 2020. By performing convenience sampling, all patients undergoing LC after uneventful ERCP in our hospital were included. Study population was divided based on interval between ERCP and Cholecystectomy; Group-A had LC within 72hrs of ERCP, Group B had LC in same hospital stay after 72hrs and Group-C patients were discharged after ERCP and readmitted for LC. Data was collected using custom designed questionnaire, tabulated using Microsoft Excel 2016 and subjected to statistical tests to compare outcomes. Primary outcome was incidence of complications, while operative time, hospital stay and cost were considered as secondary outcomes. p-value of <0.05 was considered significant. RESULTS: Total 75 patients were included in study, 32 in Group-A, 20 in Group-B and 23 in Group-C. Average age was 44.987 ± 14.819 and study population was predominantly female (86.67%). Complication rate, duration of hospital stay and average cost were less in Group A as compared to other groups (p<0.05). Mean operative time in 3 groups was similar. CONCLUSION: LC within 72hrs after ERCP provides superior results in terms of fewer complications, shorter hospital stays and lesser cost.