Ovarian cancer often presents at an advanced stage with widespread peritoneal and/or extra-abdominal metastases. Complete cytoreduction is the mainstay of treatment for disease confined to peritoneum. But in patients with distant metastases, the role and rationale is less obvious. One of the the most common sites of extra-abdominal disease is the cardiophrenic lymph node (CPLN). In this paper, we described the management of a patient with International Federation of Gynecology and Obstetrics (FIGO) stage IVB epithelial ovarian carcinoma and widespread peritoneal and extra-abdominal metastases to the CPLN, who underwent complete cytoreduction including excision of enlarged CPLN, following neoadjuvant chemotherapy. We examined the literature to determine the prognostic value of enlarged CPLN and their relevance in managing patients with advanced ovarian cancer and found it as an adverse prognostic factor. Transdiaphragmatic excision of CPLN is feasible without major complications. But as its correlation with overall or progression-free survival is not yet evident, large-scale prospective studies are warranted.
Background: Mesh repair is the standard procedure of choice for the ventral hernia repair. The common techniques for this surgery are onlay and sublay repair. But the superior technique between the two is yet to be established objectives. Objectives: We conducted this study to compare the results of Onlay with Sublay mesh repair for the treatment of ventral hernia. Methods: This comparative study was conducted at the department of Surgery, Shaheed Tajuddin Ahmad Medical College Hospital, Gazipur from April 2018 to April 2019. 20 patients withclinically diagnosed ventral hernia were randomized into two groups. The patients in group A had onlay mesh repair while those of group B hadsublay mesh repair. Comparison between the two methods were made in terms of operative time, technical ease, early post operative events specially drain & complication, hospital stay, recurrence. Result: Twenty patients between 20 to 70 years of age among whom 6 are male and 14 are female with different types of ventral hernia including paraumbilical, umbilical, epigastric and incisional, except with defect more than 15 cm were studied. The sublay repair took significantly longer operative time (p = .023). Onlay repair group had more seroma formation, wound infection and recurrence, though not statistically significant. Patients who underwent sublay repair had early removal of drains (3.7 ± .823 days vs 6 ± .738 days) which was significant (p= .000). At the same time sublay repair group had significantly shorter hospital stay than the onlay group (4.5 ± 1.900 days vs 6 ± 1.354 days, p= .023). Conclusion: Sublay repair seems to be a better alternative than onlay repair of Ventral hernia. Randomised controlled trial with larger case numbers is needed to validate the result. Journal of Surgical Sciences (2020) Vol. 24 (2) : 61-65
Background: Breast cancer incidence is increasing in Bangladesh with changing lifestyles, demographic and socioeconomic profiles. But there is no structured data on clinico-morphological pattern of breast cancer in Bangladesh. Understanding the clinical & morphological pattern of breast cancer of this country will help in early detection & prompt treatment of the cancer. Objective: To find out the clinical features of breast cancer & their morphological pattern at a tertiary level hospital. Methods: This is a cross sectional study. Data were collected prospectively from 60 new female patients with diagnosed breast carcinoma admitted to Dhaka Medical College Hospital at different surgical wards over a period of six months starting from 1st August 2010 to 28th February 2011 with the help of pre-designed semi-structured data collection form for clinical & histopathological data. Male patients, severely ill patients and patients unwilling to take part in the study were excluded. Informed written consent was taken from each case. After analysis & compilation the results were presented in tables, graphs and charts. Results: The mean age of breast cancer patients was 37.13 years. The average duration of symptoms of breast cancer patients before first presentation at tertiary level health facilities was 8.9 months. Most of the patients presented to tertiary level health facilities from 6 to 12 months after appearance of first symptom. Painless lump was the commonest presenting complaint with 43 cases, followed by nipple retraction in 24 cases, peu-de-orange in 21 cases, painful lump in 17 cases, ulceration in 12 cases and nipple discharge in 5 cases. 67% had tumor in the left breast whereas 28% had tumor in the right breast. Only 5% cases presented with bilateral involvement. The most frequent location of primary tumor was upper outer quadrant which is 32 cases followed by central in 9 cases, lower outer in 8 cases, lower inner in 6 cases, upper inner in 3 cases and overlapping lesions in 2 cases. Majority of the patient (69%) presented with a tumor size of more than 5 cm whereas only 3.3% patients presented with tumor size of less than or equal to 2 cm. Axillary lymph nodes were involved in most of the cases(86.66%). Infiltrating ductal carcinoma, NOS (which is an abbreviation for nothing otherwise specified) was the commonest (98.33%) histopathological variant. Most of the patients of this series, i.e. 35 patients had poorly differentiated tumor. 4 patients had well differentiated tumor and 21 patients had moderately differentiated tumor. Conclusion: In my study breast cancer is found to be common among relatively younger age group, majority below 40 years. The patients of breast cancer are coming to a tertiary level hospital very late, mostly with clinical features of advanced disease. For better understanding a series of multi centre studies are needed. [J Shaheed Suhrawardy Med Coll 2015;5(2): 49-53]
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