Background: Sore throat is a common and distressing post-operative complication following endotracheal intubation that contributes to patient discomfort. Several pharmacological and nonpharmacological methods may be used to attenuate post-operative sore throat. In literature, there is no study evaluating dose-dependent effectiveness of ketamine nebulisation, neither has there been a study to assess patient acceptability with ketamine nebulisation. The prime objective of this study was to assess graded doses of ketamine nebulization in attenuation of post-operative sore throat and patient acceptability and satisfaction. Materials and Methods:90 patients between age group of 18 and 60yrs of ASA physical status 1 and 2 of either sex undergoing surgeries in supine position under general anaesthesia lasting for > 1hr, were randomly allocated into three groups. Group A received 0.5mg/kg, group B received 1mg/kg and group C received 1.5mg/kg body weight of nebulized preservative free ketamine for 15mins, 5mins before intubation. The patients were then assessed for acceptability to ketamine nebulization. At the end of the surgery post-operative sore throat was assessed at 0, 2, 4, 6, 8, 12 and 24hrs.Results: Nebulized ketamine at a dose of 0.5mg/kg was comparatively less effective than 1 mg/kg and 1.5 mg/kg and the difference was statistically significant. 1mg/kg and 1.5mg/kg of nebulized ketamine are better and equally effective in reducing the incidence and severity of post-operative sore throat. There was no statistical difference in the acceptability scores to the different doses of nebulised ketamine. Conclusion:Nebulized ketamine is well accepted by all patients and effective in reducing the severity of post-operative sore throat without any untoward effects. However larger population studies and estimation of serum ketamine levels is needed to find out a better dose of ketamine for nebulization to prevent the incidence and severity of post-operative sore throat.

96 Background: Wire localized lumpectomies for non-palpable breast lesions is not yet a widespread practice in Pakistan. Shaukat Khanum Memorial Hospital is one of the few centers practicing this technique. It remains an effective and cost efficient procedure .The aim of this study is to evaluate wire-guided localization for nonpalpable breast cancer following neoadjuvant chemotherapy focusing on post-operative outcome and survival rate. Methods: It is retrospective analysis of consecutive series of patients treated at SKMH with BCS after wire localization for nonpalpable breast cancer following neoadjuvant chemotherapy from August 2005 to December 2011.The records were reviewed for patient, radiological, histological and surgical characteristics. The tumor volume analysis was calculated according to the Krekel et al method. Data was analyzed using SPSS (Version 19). Kaplan Meier curves were used to conduct survival analysis with respect to stage at presentation and pathological response to therapy. Results: A total of 195 patients were reviewed. The rate of positive margins; taken as less than 2mm, following initial BCT was 9.7%. Out of the 19 patients with positive margins 13 had re-excision of margins and 2 had completion surgery. One patient refused completion surgery. The rate of local recurrence was 6.6% and distal recurrence 17.9%.Out of 49 patients with recurrence 6 patients (12.24%) had both loco-regional and distal recurrence. The median resection ratio was 16.39. The median survival was 44 months (SD 17.162). There was a significant survival benefit (p = 0.03) in patients presenting at an early clinical stage whereas some clinic yet statistically non-significant survival advantage in patients undergoing surgery following complete radiological response after chemotherapy. Conclusions: Wire localized lumpectomies in post neoadjuvant chemotherapy patients at our institution has a low recurrence rate and an internationally acceptable re-excision rate. The size of the specimen can be optimized further. Early detection and management remains the mainstay of treatment for breast cancer. Patient education and screening are goals that are yet to be achieved on the grand scale in Pakistan.

Background Breast lymphomas constitute a rare disease entity. To date, limited relevant data have been reported. We therefore here present a review of breast lymphoma patients treated at a single centre over 20-year period, focusing on histological types, treatment modalities and outcomes. Method We identified patients who were diagnosed and treated for breast lymphoma at a single centre from January 1995 to January 2014 and extracted data regarding patient demographics and clinical data. Results Twenty-seven patients with breast lymphoma were identified, of which 3 were males. Median age at diagnosis was 37 years (range:22-76 years). Chemotherapy was main stay of treatment and 55.6% patients also received radiation to affected breast. At our institute, only 3 patients, all with progressive disease, had surgery performed to achieve local palliation. Complete response after chemotherapy was seen in 63% patients and partial response in 7.4%, while 26% patients demonstrated disease progression. The mean follow up was 46.8 months. Seven patients (33.3%) who were alive at last follow up, as well as 1 patient who died, survived more than 5 years after diagnosis. Conclusions Patients with breast lymphoma should receive aggressive treatment, with combination of chemotherapy and radiation therapy. Surgery should be limited for diagnosis and palliation of local symptoms in cases of progressive disease.