Objective: To compare the occurrence of hypocalcemia in patients undergoing subtotal and total thyroidectomy. Study Design: Comparative prospective study. Place and Duration of Study: Surgical departments of Ayub Teaching Hospital, Abbottabad and Combined Military Hospital, Rawalpindi, from Mar 2018 to Feb 2020. Methodology: A total of 171 patients were selected for this study and they were divided into 2 groups. Group 1 consisted of 95 patients undergoing Total thyroidectomy whereas group 2 had 76 patients undergoing Subtotal thyroidectomy. It was a comparative prospective study and the groups were made by convenience sampling. The data was analyzed by SPSS-23. Results: In total thyroidectomy group Hypocalcemia was detected after 48 hours in 34 patients (35%) while in subtotal thyroidectomy group hypocalcemia was detected in 20 patients (28%). Tests for hypocalcemia were also done after two months of surgery and low levels were detected in 7 patients (7.5%) who had total thyroidectomy and in 2 patients (5%) in the group undergoing subtotal thyroidectomy. There was no significant difference in hypocalcemia after 48 hour (p=0.22) and 2 months postoperatively (p=0.6) between patients of Total Thyroidectomy and Subtotal Thyroidectomy. Conclusion: Total thyroidectomy is not associated with increased risk of permanent hypocalcemia as compared to Subtotal thyroidectomy. Because of its advantages Total thyroidectomy should be the preferred surgical procedure for patients presenting with benign euthyroid multi nodular goiter.

Objective: To describe the technique and results of mucosectomy; A surgical technique that is easy to perform, and has a lower morbidity and complication rate as compared to standard appendectomy in cases of complicated appendicitis. Study Design: Quasi-experimental study. Place and Duration of Study: Surgical - A Unit, Ayub Teaching Hospital, in Abbottabad, from Mar 2017 to Mar 2019. Methodology: Patients included were those who presented with appendicular mass, phlegmon, recurrent appendicitis, appendicitis in uncommon locations, presence of adhesions, those cases of appendicular mass and phlegmon which was either not responding to medical treatment, or diagnosed per operatively being clinically not palpable or not seen on ultrasound. Per operative and post-operative variables were documented and analyzed. In mucosectomy, thesubserosal portion of the appendix i-emuscularis and mucosa of the appendix was dissected out from the serosa after ligation of the appendicular base, or ligation done after delivering the appendix out of the serosa. The serosa that was adherent to the surrounding gut, omentum or other viscera was left intact. Results: A total of 192 patients were included in this study, half of which underwent standard appendectomy and a mucosectomy was performed on the rest. The mean time of surgery was 30 ± 1.2min as compared to the standard appendectomy group (55min ± 3.6). More than half of the patients undergoing standard appendectomy required extension of the incision (56.2%), only 8% required so from those on whom mucosectomy was performed. Per operative hemorrhage was seen in 32.2%, however inmucosectomy group only 1%.

Objective: To outline diagnostic difficulties and problems in the treatment of Idiopathic Granulomatous Mastitis Study Design: Prospective observational study. Place and Duration of Study: Breast clinic, Combined Military Hospital Rawalpindi, from Aug 2019 to Jul 2020. Methodology: Patients with tender mass with or without signs of inflammation, mass with abscess, sinus formation, and with recurrent abscesses were included. Those cases were labelled as IGM whose histopathology showed granulomatous mastitis with no evidence of malignancy and tissue cultures were negative. Patients with mild to moderate symptoms were treated with reassurance, analgesia and multivitamins. Abscesses were treated with incision & drainage and empirical antibiotics for 1-2 weeks. All these patients were followed at 1, 3, 6 and 12 months. Results: A total of 35 patients fulfilled the criteria for Idiopathic Granulomatous Mastitis and were included in the study. Two patients had lactational abscess, 3 had bilateral disease and 1 patient was with diabetes 0% patients were having mass with abscess; spontaneous resolution was observed in majority of them with a few requiring incision and drainage. Of 31.4% presented with tender mass only; majority of them resolved with observation, except mass excision in two patients, 19.7% presented with discharging sinuses with underlying mass; among them 71% responded to conservative treatment while 29% were treated with anti-tuberculous therapy for recurrent sinuses. 8.5% presented with spontaneously ruptured abscesses with sinuses; they were managed conservatively. Conclusion: We concluded that Idiopathic Granulomatous Mastitisis a benign self-limiting disease which can be effectively managed with conservative treatment.