Breast cancer screening is defined as the evaluation of symptom free, otherwise healthy looking females of child bearing age or postmenopausal women for early detection of breast cancer. Screening mammography is the most common and widely practiced breast cancer screening modality across the world. The other modes of breast cancer screening being practiced across the world are: breast self-examination (BSE), clinical breast examination (CBE), digital breast tomosynthesis (DBT), ultrasonography (USG), magnetic resonance imaging (MRI), and identification of certain genetic oncogenes. The major merits of breast cancer screening programs are: early diagnosis, sorting out and prevention of risk factors, and timely treatment to lessen the morbidity (5 years localized stage survival rate is 99%, regional disease 84% while metastatic breast cancer 5 year survival rate is 23%); it also reduces overall 20% mortality rate. The major demerits of breast cancer screening are: overdiagnosis (19% from the perspective of a woman invited to screening), high cost, ionizing radiation (lifetime attributable risk to develop breast cancer is 3/10,000), false positive biopsy recommendation (about 8/1000), false negative results 11/10,000), and their consequences. Worldwide, most of the countries recommend biennial screening for breast cancer at 50–74 years of age. However, some countries recommend screening mammography earlier, starting at the age of 40 years until 70–74 years based on higher breast cancer incidence rate in those countries. This article provides a detailed review of merits, demerits, and recent recommendations for screening programs being practiced across the world.

Congenital agenesis or absence of vermiform appendix is extremely rare. This case report entails a 25-year-old male who developed symptoms and signs of acute appendicitis. Despite an extensive surgical exploration, the vermiform appendix could not be found. The postoperative investigation did not reveal any abnormality, and the patient was diagnosed as a case of nonspecific abdominal pain (NSAP) and appendicular agenesis.

A prospective study was conducted to look for prevalence of cleft lip and palate in a population presenting to a surgical unit in a teaching hospital. Objectives: To see prevalence of cleft lip and palate alone, lip and palate combined, right or left sided, male to female distribution, and possible factors responsible for clefting. Study Design: A prospective study. Setting: Surgical Unit II at Allied Hospital Faisalabad. Period: March 2009 to March 2010 for one year. Materials and Methods: Total 55 patients were treated in year 2009 out of total 17900 (0.3 %) patients admitted in all surgical wards and 6508 patients admitted in surgical unit II (0.8%). Patients were divided into three groups, cleft lip alone (group A), cleft palate alone (group B) and combined cleft lip and palate (group C). Children up to the age of 5 years with congenital abnormality were included in study. Results: Out of 6508 patients admitted in surgical unit II 55 patients (0.8%) had cleft lip and palate defect. 55 patients were divided in three groups. In group A, 32 patients presented with cleft lip alone ( 58.1 % ), 16 ( 29 % ) were males and 16 ( 29 % ) were females, 21 patients have left sided ( 38 % ), 4 right sided (7.27% ) and 7 patients have bilateral ( 12.72 % ) defects. 2 patients (3.63 %) had family history of cleft lip and both were males. In group B, 12 patients ( 21.8 %) had cleft palate alone, 7 patients ( 12.72 % ) were males and 5 patients ( 9 % ) were females, 10 patients ( 1.18 % ) had soft palate only while 2 patients ( 3.63 % ) had compete ( hard and soft ) palatal defect. In group C, 11 patients, had cleft lip and palate combined ( 20 % ), 6 patients were males ( 10.9 % ) and 5 patients ( 9 % ) were females, 8 patients ( 14.54 % ) had only soft palate defect while 3 patients ( 5.45 % ) had complete palatal defect associated with 8 patients ( 14.54 % ) left sided unilateral lip defect and 3 patients ( 5.45% ) had bilateral cleft lip. All patients were operated without any mortality. Ages of mothers at earliest were 16 and 18 years, 3 cousin marriages, ( 5.45 % ) all fathers were smokers, belonged to poor socio economic families and no history of mother's exposure to radiation, drug abuse during gestational life. Conclusion: As it is obvious from this study that all patients belongs to poor socio economics group, and all fathers were smokers, 3 patients born in parents who had cousin marriages ( 5.45 % ) 2 patients ( 3.63 % ) with family history, cleft lip and palate are multifactorial congenital abnormalities, runs in families and is influenced by various environmental factors. Key words:Cleft, Lip Palate, smoking, poor socio economic groups.

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To see the percentage, the different groups affected and pattern of injury by road traffic accidents among patients attending a unit of surgery in a teaching hospital. Objectives: To see the percentage of trauma among patients admitted in one surgical unit of a tertiary hospital in one year and to compare this with the patients admitted in all surgical units of same tertiary unit. To evaluate the pattern of trauma, male to female ratio, affected age groups, mechanism of injury, the organs affected, and the mortality rate in one surgical unit of a tertiary hospital of 3rd most populated city of Pakistan during one year. Study Design: Prospective study. Setting: Surgical Unit II at Allied Hospital Faisalabad. Period: January 2009 to February 2010. Materials and Methods: Patients admitted during this period for road traffic accidents in surgical unit II of Allied Hospital Faisalabad were 94 (4.8 %) out of total 1956 patients presented and admitted in surgical unit II during this year. Total number of patients admitted in all surgical units of this hospital were 7388 while 21,400, patients received and admitted by all other specialties through emergency units of Allied Hospital Faisalabad. Patients with road traffic accidents admitted in surgical unit II through emergency unit of this hospital were part of this study. Among these 94 patients 78 patients (82.97%) were adults and 18 children (19.14%). Patients with all other emergencies modalities and minor injuries treated and discharged from emergency were excluded from this study. Results: Out of 1956 patients admitted in Surgical Unit II from total 7388 of all surgical admissions and 21400 all emergencies ward patients, 94 patients (4.8%, 1.27%, and 0.439% respectively) were injured by road traffic accidents. Out of these 94 patients, 78 patients (82.97%) were adults and 18 children (19.14%) patients. 58 patients (61.70%) were males and 36 patients (38.29%) were females. 43 patients (45.74%) were pedestrians, 10 patients were (10.63%) on bicycles, 26 patients were (27.65%) on motorcycle while 15 patients (15.95%) were in other vehicles. 52 patients (55.31%) developed head injuries, 10 patients (10.93%) blunt trauma abdomen, 5 patients (5.31%) blunt trauma chest and 26 patients (27.65%) skeletal injuries (10 patients forearm bones fracture, 6 patients with fracture mid-shaft of tibia, another 5 patients with fracture lower 1/3rd of femur and 5 patients with hand bones fracture). All patients were treated by combined specialty trauma surgeons. 3 patients (3.19%) died out of which 2 patients (2.12%) with severe head trauma and one pedestrian (1.06%) with blunt trauma abdomen and lower chest. All other patients survived and recovered with some morbidity. Conclusion: Road traffic trauma is one of major dilemma of our society. 94 road traffic accidents causalities were admitted during one year in one surgical unit of a tertiary care center and 3 patients died. It is an alarming sign to properly protect people, educate general population, employ dedicated road safety staf...

A prospective study was conducted to see presentation and management of coloniccancer presenting to a surgical unit in a teaching hospital at Faisalabad. Objectives: To knowdifferent presenting symptomatology like abdominal mass, pain, intestinal obstruction, alteredbowel habits, rectal bleeding, age co-relation, sex distribution, anatomic location among coloniccancer patients and management done for these patients. Study Design: A prospective study.Period: February 2009 to March 2010 for one year. Material and Methods: Total 8 patients werediagnosed and treated for colonic cancer presenting in a single surgical ward. Patients with ageabove 14 years were included in study while patients presenting with trauma and metastaticdisease for other carcinoma were excluded. Results: Among 8 patients diagnosed for coloniccancer, age’s range from 26 to 50 years at maximum, 2 patients (25 %) were males and 6 patients(75 %) were females. Only one patient (12.5%) presented with single complaint of left iliac fossamass, 2 patients (25 %) with only single complaint of rectal bleeding as a presenting symptomwhile all other 5 patients (62.5%) presented with more than one or two symptoms at the sametime. Among 5 patients presented with more than one symptom all had presented with abdominalmass associated with additional symptoms like, one patient (12.5%) developed intestinalobstruction with left sided abdominal mass, another one patient (12.5%) left sided abdominalmass with alternate diarrhea and constipation, another one patient (12.5%) right sided masswith pallor, one patient (12.5%) had constipation with left sided mass while another one patient(12.5%) developed abdominal pain, weight loss and palpable left sided abdominal mass. Patientswere staged according to TNM staging system. All patients were above stage II and Dukes B. Allpatients were operated in Surgical Unit II at Allied Hospital Faisalabad. Left hemi-colectomy wasdone for 2 patients; right hemi-colectomy was done for single patient presented with mass andanemia on right side, sigmoid resection with colostomy for one patient, Hartmann’s procedurefor another one patient and single stage resection with primary anastomosis for one patient. 2patients underwent abdomino-perineal resection with end colostomy. Conclusion: This studytells that majority of the patients with colon cancer presented with left sided abdominal mass andother associated symptom, the age’s range from 26 to 50 years. Disease affected 6 females out oftotal 8 patients. Two patients underwent APR with end colostomy while other patients were treatedwith alternate procedures like primary anterior resection with anastomosis or end colostomy

To see the percentage, the different groups affected and pattern of injury by roadtraffic accidents among patients attending a unit of surgery in a teaching hospital. Objectives: Tosee the percentage of trauma among patients admitted in one surgical unit of a tertiary hospitalin one year and to compare this with the patients admitted in all surgical units of same tertiaryunit. To evaluate the pattern of trauma, male to female ratio, affected age groups, mechanismof injury, the organs affected, and the mortality rate in one surgical unit of a tertiary hospital of3rd most populated city of Pakistan during one year. Study Design: Prospective study. Setting:Surgical Unit II at Allied Hospital Faisalabad. Period: January 2009 to February 2010. Materialsand Methods: Patients admitted during this period for road traffic accidents in surgical unit IIof Allied Hospital Faisalabad were 94 (4.8 %) out of total 1956 patients presented and admittedin surgical unit II during this year. Total number of patients admitted in all surgical units of thishospital were 7388 while 21,400, patients received and admitted by all other specialties throughemergency units of Allied Hospital Faisalabad. Patients with road traffic accidents admitted insurgical unit II through emergency unit of this hospital were part of this study. Among these94 patients 78 patients (82.97%) were adults and 18 children (19.14%). Patients with all otheremergencies modalities and minor injuries treated and discharged from emergency wereexcluded from this study. Results: Out of 1956 patients admitted in Surgical Unit II from total 7388of all surgical admissions and 21400 all emergencies ward patients, 94 patients (4.8%, 1.27%,and 0.439% respectively) were injured by road traffic accidents. Out of these 94 patients, 78patients (82.97%) were adults and 18 children (19.14%) patients. 58 patients (61.70%) were malesand 36 patients (38.29%) were females. 43 patients (45.74%) were pedestrians, 10 patients were(10.63%) on bicycles, 26 patients were (27.65%) on motorcycle while 15 patients (15.95%) werein other vehicles. 52 patients (55.31%) developed head injuries, 10 patients (10.93%) blunt traumaabdomen, 5 patients (5.31%) blunt trauma chest and 26 patients (27.65%) skeletal injuries ( 10patients forearm bones fracture, 6 patients with fracture mid-shaft of tibia, another 5 patients withfracture lower 1/3rd of femur and 5 patients with hand bones fracture ). All patients were treated bycombined specialty trauma surgeons. 3 patients (3.19%) died out of which 2 patients (2.12%) withsevere head trauma and one pedestrian (1.06%) with blunt trauma abdomen and lower chest. Allother patients survived and recovered with some morbidity. Conclusion: Road traffic trauma isone of major dilemma of our society. 94 road traffic accidents causalities were admitted duringone year in one surgical unit of a tertiary care center and 3 patients died. It is an alarming signto properly protect people, educate general population, employ dedicated road safety staff andfollow rules and regulation of traffic authorities.

A prospective study was conducted to look for prevalence of cleft lip and palate ina population presenting to a surgical unit in a teaching hospital. Objectives: To see prevalenceof cleft lip and palate alone, lip and palate combined, right or left sided, male to femaledistribution, and possible factors responsible for clefting. Study Design: A prospective study.Setting: Surgical Unit II at Allied Hospital Faisalabad. Period: March 2009 to March 2010 forone year. Materials and Methods: Total 55 patients were treated in year 2009 out of total17900 (0.3 %) patients admitted in all surgical wards and 6508 patients admitted in surgicalunit II (0.8%). Patients were divided into three groups, cleft lip alone (group A), cleft palatealone (group B) and combined cleft lip and palate (group C). Children up to the age of 5 yearswith congenital abnormality were included in study. Results: Out of 6508 patients admitted insurgical unit II 55 patients (0.8%) had cleft lip and palate defect. 55 patients were divided inthree groups. In group A, 32 patients presented with cleft lip alone ( 58.1 % ), 16 ( 29 % ) weremales and 16 ( 29 % ) were females, 21 patients have left sided ( 38 % ), 4 right sided (7.27% )and 7 patients have bilateral ( 12.72 % ) defects. 2 patients (3.63 %) had family history of cleft lipand both were males. In group B, 12 patients ( 21.8 %) had cleft palate alone, 7 patients ( 12.72% ) were males and 5 patients ( 9 % ) were females, 10 patients ( 1.18 % ) had soft palate onlywhile 2 patients ( 3.63 % ) had compete ( hard and soft ) palatal defect. In group C, 11 patients,had cleft lip and palate combined ( 20 % ), 6 patients were males ( 10.9 % ) and 5 patients ( 9% ) were females, 8 patients ( 14.54 % ) had only soft palate defect while 3 patients ( 5.45 % )had complete palatal defect associated with 8 patients ( 14.54 % ) left sided unilateral lip defectand 3 patients ( 5.45% ) had bilateral cleft lip. All patients were operated without any mortality.Ages of mothers at earliest were 16 and 18 years, 3 cousin marriages, ( 5.45 % ) all fathers weresmokers, belonged to poor socio economic families and no history of mother’s exposure toradiation, drug abuse during gestational life. Conclusion: As it is obvious from this study thatall patients belongs to poor socio economics group, and all fathers were smokers, 3 patientsborn in parents who had cousin marriages ( 5.45 % ) 2 patients ( 3.63 % ) with family history,cleft lip and palate are multifactorial congenital abnormalities, runs in families and is influencedby various environmental factors.