scholarly journals Comparison of Axillary Exclusion Versus no Exclusion on Seroma Formation after Modified Radical Mastectomy

2021 ◽  
Vol 15 (1) ◽  
pp. 32-35
Author(s):  
Soofia Irfan ◽  
◽  
Muhammad Yaqoob ◽  
Sajid Rehman Randhawa ◽  
Muhammad Faisal Bilal Lodhi ◽  
...  
Keyword(s):  
Radical Mastectomy ◽  
Ethical Review ◽  
Common Side Effect ◽  
Axillary Lymph Nodes ◽  
P Value ◽  
Axillary Lymph ◽  
Modified Radical Mastectomy ◽  
Prolonged Stay ◽  
Group A ◽  
Group B

Background: Accumulation of seroma in axilla and under mastectomy flaps is a common side effect after axillary lymph nodes dissection in mastectomy, which requires repeated aspirations and prolonged stay of the drain causing discomfort to person. Objective: To determine the effectiveness of axillary exclusion technique versus no axillary exclusion in Modified Radical Mastectomy in terms of mean drain output. Study Design: Randomized control trial. Settings: The study was conducted in department of Surgery, Allied Hospital Faisalabad Pakistan. Duration: 1 year from August 08, 2018 to August 07, 2019. Methodology: After permission from Hospital Ethical Review Committee, 60 Patients presenting for mastectomy were included in the study. They were randomly divided into two equal groups of 30 patients each applying computer generated random number table. Group A (underwent axillary exclusion) and Group B (did not undergo axillary exclusion) after modified radical mastectomy. Total amount of fluid collected in drain bag postoperatively was noted till the removal of drain and compared between the groups. Data was entered in a pre-designed proforma. Results: Comparison of axillary exclusion technique with no exclusion after modified radical mastectomy was done, it showed that the mean of the total drain output (+SD) in Group A was 1112.4ml (+66.78) whereas mean output in Group-B was 2184ml (+117.06). (Table No.1). p-value was <0.001 showing a considerable decrease in the total volume of the seroma fluid drained between the two groups. Conclusion: Study concluded that the axillary exclusion technique significantly reduces drain output in patients following modified radical mastectomy as compared to those who do not undergo axillary exclusion.

Comparison of Outcome of one Versus two Drains Insertion for Seroma Formation Following Modified Radical Mastectomy in Breast Carcinoma

2021 ◽  
Vol 17 (1) ◽  
pp. 52-55
Author(s):  
Shiraz Shaikh ◽  
Ambreen Munir ◽  
Shahnawaz Abro ◽  
Shahida Khatoon ◽  
Zameer Hussain Laghari ◽  
...  
Keyword(s):  
Breast Carcinoma ◽  
General Surgery ◽  
Stable Condition ◽  
Radical Mastectomy ◽  
Seroma Formation ◽  
University Hospital ◽  
P Value ◽  
Modified Radical Mastectomy ◽  
Group A ◽  
Group B

Objective: Comparative outcome of one versus two drains insertion for in the term of seroma formation following modified radical mastectomy in breast carcinoma. Methodology: This Prospective Interventional trial was conducted at Department of General Surgery, Liaquat University Hospital Hyderabad from February 2018 to January 2019.  Females with breast carcinoma admitted for modified radical mastectomy were included. Patients were divided into two groups.  Groups I underwent one drain placement and group II underwent two drains placement. All patients were observed to measure and record the volume of the fluid. Patients were discharged from Hospital in stable condition and after removal of drains, and followed up weekly for one month. Data was recorded on self-made proforma and analyzed by using SPSS-20. Results: Total of 80 patients were selected, 38 in group A and 42 in group B. Mean age of patients of group A was 49.08 ± 9.89 years and group B was 51.40 ± 13.59 years. , Excised Mass weight was lesser in group A as compared to group B. Mean volume of drain discharge was significantly higher in Group B 323.43 ± 158.88 ml, while it was in group A 230.29± 200.98, findings were statistically significant 0.013. Seroma formation was statistically insignificant among both groups as 8(21.1%) in group A and   10(23.8%) in group B, p-value 0.768. Conclusion: One-drain and two-drain insertion are equally effective to reduce the seroma formation after modified radical mastectomy; however, one drain insertion leads to more patient compliance and comfort with probably less morbidity and cost.

CONVENTIONAL VERSUS THREE-DIMENSIONAL CONFORMAL EXTERNAL RADIOTHERAPY IN CANCER CERVIX: A COMPARATIVE STUDY FOR COMPLIANCE, RESPONSE AND TOXICITY

2016 ◽  
Vol 1 (2) ◽  
Author(s):  
Richa Gupta ◽  
Piyush Kumar ◽  
D. P. Singh ◽  
Arvind Kumar Chauhan ◽  
Kamal Sahni
Keyword(s):  
Clinical Response ◽  
Three Dimensional ◽  
Common Side Effect ◽  
P Value ◽  
High Dose ◽  
Cancer Cervix ◽  
Conventional Radiotherapy ◽  
Radiation Fields ◽  
Group A ◽  
Group B

INTRODUCTION: Cervical cancer is the second most frequent cancer among Indian women. Radiotherapy is the cornerstone of treatment in all its stages. Three-dimensional conformal radiotherapy (3DCRT) combines multiple radiation fields to deliver precise dose of radiation to the affected area. Tailoring each of the radiation fields to focus on the tumor delivers a high dose of radiation to the tumor and avoids nearby healthy tissue. The present study is done to compare conventional radiotherapy versus 3DCRT in cancer cervix for compliance, clinical response and toxicity. MATERIAL AND METHODS: Fifty patients were enrolled and randomised into two radiotherapy plans with radical intent - Group A treated by conventional radiotherapy and group B treated by 3DCRT. Concurrent cisplatin was delivered on weekly (35mg/m2) or tri-weekly (75mg/m2) basis during external beam Radiotherapy and was followed by High Dose Radiotherapy Brachytherapy. Clinical response and complication assessment were evaluated.Collected data was analyzed using standard statistical methods and softwares to calculate level of significance using “p” value by chi square test. RESULTS: In this study mean age of the patients was 48 years (26-67 years). The anemia was the most common side effect seen in both groups (96% vs 88%, p=0.29). Neutropenia was more in group B (36% vs 44%, p= 0.56). Lower GI toxicity was seen only in patients in group A (20% vs 0%, p=0.018). In follow up there were no significant early rectal and bladder reactions in both groups and 2 patients in each group had late rectal reactions of grade I and II (p= 0.312). No significant skin, bladder and small intestinal toxicity were seen in both groups. CONCLUSION: Conventional radiotherapy gives equally efficacious response though accompanied by toxicities which were acceptable.

scholarly journals Development and validation of a nomogram to predict drainage duration in patients with breast cancer treated with modified radical mastectomy

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Song Wu ◽  
Zechang Xin ◽  
Daxing Sui ◽  
Zhengli Ou ◽  
Haotian Bai ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Nodes ◽  
Radical Mastectomy ◽  
Postoperative Management ◽  
The Body ◽  
Axillary Lymph Nodes ◽  
Axillary Lymph ◽  
Modified Radical Mastectomy ◽  
Suction Drain ◽  
Postoperative Drainage

AbstractAppropriate drainage duration is vital for the postoperative rehabilitation of patients with breast cancer (BC) undergoing modified radical mastectomy (MRM). To provide better and individualized postoperative management for these patients, this study explored independent predictors of postoperative drainage duration in patients with BC. This was a single-center retrospective cohort study. Patients diagnosed with BC and treated with MRM from May 2016 to April 2020 were randomly divided into training (n = 729) and validation (n = 243) cohorts. Univariate and multivariate Cox analyses revealed that the body mass index, serum albumin level, hypertension, number of total dissected axillary lymph nodes, and ratio of positive axillary lymph nodes were independent predictors of postoperative drainage duration in the training cohort. Based on independent predictors, a nomogram was constructed to predict the median postoperative drainage duration and the probability of retaining the suction drain during this period. This nomogram had good concordance and discrimination both in the training and validation cohorts and could effectively predict the probability of retaining the suction drain during drainage, thus assisting clinicians in predicting postoperative drainage duration and providing individualized postoperative management for patients with BC.

scholarly journals Comparison of 4% Topical Hydroquinone versus Combination of Oral Tranexamic Acid and 4% Topical Hydroquinone in the Treatment of Epidermal Melasma

2021 ◽  
Vol 15 (10) ◽  
pp. 3406-3409
Author(s):  
Sarah Riaz ◽  
Najia Ahmed ◽  
Ayesha Anwar ◽  
Moizza Tahir ◽  
Farrah Yousaf ◽  
...  
Keyword(s):  
Tranexamic Acid ◽  
Topical Therapy ◽  
Military Hospital ◽  
Ethical Review ◽  
P Value ◽  
Treatment Groups ◽  
Quasi Experimental ◽  
Group A ◽  
Group B ◽  
Better Than

Objective: comparison of efficacy of topical 4% hydroquinone monotherapy with combination of oral tranexamic acid and topical 4% hydroquinone in the treatment of epidermal melasma Study design: Quasi experimental study Study period and place: Dermatology OPD, Pak Emirates Military Hospital Rawalpindi from July 2018 to January 2019. Methodology: Total 80 patients presenting with epidermal melasma were selected from outdoor patient department after applying the inclusion criteria and consent was taken from selected patients. Study was started after getting permission from hospital ethical review board. Two treatment groups were made after dividing patients by using alternate method. Treatment with topical 4% hydroquinone alone was started for group A patients and combination of capsule tranexamic acid (250 mg two times a day) along with topical 4% hydroquinone were started for group B patients for the next 6 months. Evaluation of patients through detailed history, clinical and wood’s light examination before starting therapy and after of 24 weeks of treatment was done for both groups. Efficacy of treatment was assessed via Modified MASI score. Results: Hydroquinone monotherapy was effective in 21 (52.5%) patients among group A while in group B patients, combination treatment i.e. oral tranexamic acid and topical hydroquinone, was effective in 31 (77.5%) patients (p value= 0.01). Conclusion: Effectiveness of Hydroquinone 4% topical therapy combined with oral tranexamic acid for epidermal melasma is better than topical 4% hydroquinone alone. Key words: Epidermal melasma, oral tranexamic acid, topical 4% hydroquinone.

Comparison of Efficacy of I/V Tramadol and Bupivacaine Irrigation through Drains after Modified Radical Mastectomy

2021 ◽  
Vol 15 (11) ◽  
pp. 3007-3011
Author(s):  
Zarqa Rani ◽  
Iqra Mushtaq ◽  
Mehreen Akram ◽  
Zahra Ishrat
Keyword(s):  
Breast Cancer ◽  
Urinary Retention ◽  
Controlled Trial ◽  
Radical Mastectomy ◽  
Breast Cancer Surgery ◽  
Modified Radical Mastectomy ◽  
Increased Risk ◽  
Significant Difference ◽  
Group A ◽  
Group B

Background: Severe postsurgical pain continues to be hard to manage in patients who experience breast cancer surgery. Badly managed pain can lead to meager patient satisfaction, prolonged hospital stay, and increased risk of complication by analgesics, and may be a reason in the development of long-lasting pain. Aim: To compare the efficacy of Intravenous Tramadol and Bupivacaine irrigation through surgical drains after Modified Radical Mastectomy in patients with carcinoma breast. Methods: This was a randomized controlled trial conducted in the Department of Anesthesia, Mayo Hospital Lahore. Total 70 female patients aged 18-70 years undergoing radical mastectomy for CA breast diagnosed on histopathology were selected. Patients were divided into two groups A and B through simple random sampling technique. Group A received intravenous Tramadol. Group B received Bupivacaine through surgical drains. Results: At 0, 2, 4 and 6 hour postoperatively no significant difference was seen in severity of pain in both treatment groups. In Group-A at 0, 2, 4 and 6 hour postoperatively, 68.8%, 71.4%, 57.1% and 60% respectively had reported no pain while in Group-B at 0, 2, 4 and 6 hour postoperatively, 48.6%, 65.7%, 45.7% and 54.3% patients had reported no pain. Complaints of Nausea, vomiting, sedation, urinary retention was higher in patients in Tramadol Group as compared to Bupivacaine Group. Conclusion: Results of this study demonstrated that bupivacaine administrated through surgical drain was equally effective as intravenous tramadol for controlling postoperative mastectomy pain with less side effects. Keyword: Breast Cancer, Acute Pain, Analgesia, Tramadol, Bupivacaine, Radical Mastectomy, Nausea, Vomiting, Sedation, Urinary retention, Hypotension

scholarly journals COMPARATIVE STUDY OF SEROMA FORMATION IN HARMONIC SCALPEL VERSUS ELECTROCAUTERY IN POST MODIFIED RADICAL MASTECTOMY

2021 ◽  
Vol 71 (2) ◽  
pp. 451-53
Author(s):  
Muhammad Farooq Shahid ◽  
Taseer Ibrahim ◽  
Muhammad Ali Muazzam ◽  
Hummaira Chaudhry ◽  
Usman Shah Bukhari ◽  
...  
Keyword(s):  
Harmonic Scalpel ◽  
Radical Mastectomy ◽  
Seroma Formation ◽  
Military Hospital ◽  
Modified Radical Mastectomy ◽  
Quasi Experimental ◽  
Group A ◽  
Group B ◽  
Surgery Department ◽  
Mean Time

Objective: To compare the frequency of seroma formation in harmonic scalpel vsunipolar electrocautery in post modified radical mastectomy (MRM). Study Design: Quasi experimental study. Place and Duration of Study: General Surgery Department, Pak Emirates Military Hospital Rawalpindi, from Jul to Dec 2017. Methodology: Eighty women with breast carcinoma planned for modified radical mastectomy were included in the study with inclusion and exclusion criteria and divided in equal group A (Harmonic) and group B (Unipolar cautery). Randomization was performed by lottery method for both groups. A standard level III clearance was performed. All patients were followed up on weekly basis and seroma formation was evaluated in both groups. Results: Mean age in group A and B was 51.36 ± 11.04 years vs 52 ± 11.19 years (p>0.05). Mean duration of complain in group A and B was 1.675 ± 0.47 months vs 1.775 ± 0.42 (p>0.05). Mean time of procedure in group A and B was 110.00 ± 4.71 mins vs 100.875 ± 5.14 (p>0.05). Mean body mass index in group A and B was 30.217 ± 4.99 kg/m2 vs 30.210 ± 5.31 kg/m2 (p>0.05). Seroma formation in group A and group B patients were found to be 5 (12.5%) vs 10 (25%) with (p>0.05). Conclusion: Frequency of seroma formation in harmonic scalpel is lower than electrocautery in post modified radical mastectomy, so it can be safely performed along with harmonic scalpel with reduced duration of drainage and seroma formation.

scholarly journals Comparison of Team Based and Traditional Teaching Methods in Forensic Medicine: on the Basis of Assessment Tools

2021 ◽  
Vol 11 (01) ◽  
pp. 31-34
Author(s):  
Shahid Kamran ◽  
Muhammad Sajid Khan ◽  
Jamil Ahmed Siddiqui ◽  
Natasha Mustafa ◽  
Waqar Shaikh ◽  
...  
Keyword(s):  
Forensic Medicine ◽  
Teaching Methods ◽  
Assessment Tools ◽  
Ethical Review ◽  
P Value ◽  
Cross Sectional ◽  
Team Based Learning ◽  
Group A ◽  
The Mean ◽  
Group B

Objective: To compare two different teaching methods in Forensic Medicine on the basis of assessment tools. Study design and setting: A cross sectional analytical study was conducted at the Department of Forensic Medicine at Al-Tibri Medical College and Hospital, from February to August 2019 Methodology: Total 100 students of third year MBBS were included in this study after taking ethical approval from the ethical review committee. These students were randomly divided into two groups of 50 students each, with Group A being taught through the traditional didactic lectures and Group B by Team Based Learning (TBL). Both groups were assessed using different assessment tools. Each assessment was of 25 marks and for comparison of marks, independent “t” test was applied comparing the mean value through SPSS version 20.0 and the level of significance was taken at < 0.05. Results: The students involved in Team Based Learning performed superior than teacher centered strategy. In Group A, the students were taught via traditional lecture-based method and Group B was introduced to Team Based Learning. The mean score of assignment in Group A and Group B showed P value <0.001 that showed significantly higher grades in student-centered teaching. Conclusion: Team based learning showed significant successful results in all assessment methods, therefore, it has been concluded through our study that Team Based Learning is a more effective method of teaching Forensic Medicine and it helps in making learner autonomous.

Comparison between Scissors and Electrocautery in Seroma Formation Following Modified Radical Mastectomy (MRM)

2020 ◽  
Vol 23 (2) ◽  
pp. 87-89
Author(s):  
Hasnat Zaman Zim ◽  
SM Amjad Hossain ◽  
Abul Bashar Mohammad Khurshid Alam ◽  
Samia Shihab Uddin
Keyword(s):  
Axillary Dissection ◽  
Skin Flap ◽  
Tertiary Care ◽  
Radical Mastectomy ◽  
Seroma Formation ◽  
Modified Radical Mastectomy ◽  
Chi Square ◽  
Significant Difference ◽  
Group A ◽  
Group B

Background and Objective: Seroma is encountered as the commonest complication after mastectomy. Though various factors are suspected in causation of seroma, in this prospective study we tried to evaluate role of two different surgical technique of MRM in causation of seroma formation. Materials and Methods: In this observational comparative study, a total 90 patient of early breast carcinoma who had undergone Modified Radical Mastectomy (MRM) in 3 tertiary care hospitals of Dhaka were divided into 2 groups. In Group A, we used electrocautery for raising the skin flap and axillary dissection while in Group B we used curved Metzenbaum scissors to raise the skin flap along with aid of suture ligation for axillary dissection. Incidence of seroma formation was compared in both the groups. Results: Incidence of seroma was significantly higher with use of electrocautery. Results in both the groups were compared by Chi-square method, and statistically significant difference in incidence of seroma formation was found between two groups. Conclusion: Breast surgery, as MRM does not support injudicious use of electrocautery. Journal of Surgical Sciences (2019) Vol. 23(2): 87-89

scholarly journals Thoracic fascial planes blocks in operative bed of modified radical mastectomy and their role in alleviating post-mastectomy pain: a prospective randomized study

2021 ◽  
Vol 9 (1) ◽  
pp. 6
Author(s):  
Mohamed F. Abdelhalim ◽  
Mohamed A. Elbegawy
Keyword(s):  
Breast Surgery ◽  
Randomized Study ◽  
Radical Mastectomy ◽  
Modified Radical Mastectomy ◽  
Pain Scores ◽  
Lower Pain ◽  
Group A ◽  
Metastatic Activity ◽  
Group B ◽  
Better Than

Background: Proper pain management after modified radical mastectomy is crucial for improving postoperative outcomes, reducing tumor recurrence, enhancing anti-metastatic activity and achieving excellent patient`s satisfaction. Thoracic fascial planes (TFP) blocks are novel, and safe analgesia modalities to control postmastectomy pain. This study was designed to assess the efficacy and safety of intraoperative TFP blocks for providing postoperative analgesia after modified radical mastectomy.Methods: During the period from March 2020 to April 2021, 30 females (ages 25–67 years) were scheduled for elective MRM and selected randomly to one of two groups; group-A included 15 patients who underwent MRM and anesthetized with both general anesthesia and regional anesthesia (TFP blocks), group-B included 15 patients who underwent MRM and anesthetized with only general anesthesia.Results: The group-A had statistically significantly lower pain scores. The time of first rescue nalbuphine dose post-operatively was statistically significantly longer in group-A compared to group-B. The total 24h nalbuphine consumption and postoperative non-steroidal ketorolac requirements/48h were significantly lower in group-A compared to group-B. Satisfaction score in group-A was statistically significantly better than that in group-B.Conclusions: Intraoperative thoracic fascial planes blocks are simple, safe, and highly effective analgesic modalities after breast surgery.

scholarly journals A study showing efficacy of harmonic scalpel over electrocautery in modified radical mastectomy

2017 ◽  
Vol 4 (4) ◽  
pp. 1422 ◽  
Author(s):  
Anandaravi B. N. ◽  
Praveen P. Nair ◽  
Mohammed Anwar Aslam
Keyword(s):  
Blood Loss ◽  
Axillary Dissection ◽  
Breast Tissue ◽  
Harmonic Scalpel ◽  
Operating Time ◽  
Radical Mastectomy ◽  
Modified Radical Mastectomy ◽  
Drainage Volume ◽  
Group A ◽  
Group B

Background: The dissection in breast surgeries can be done using sharp scalpel and scissor dissection and high frequency electrocautery. Rarely, radiofrequency ablation and laser had been used in some limited trails. This study aims to prove the efficacy of harmonic scalpel over electrocautery in modified radical mastectomy operation.Methods: In this study, we included 40 patients with operable breast cancer. The patients were randomized into two equal groups by closed envelope technique to do modified radical mastectomy either using harmonic scalpel (group A) or using electrocautery (group B). The efficacy of two procedures were compared intraoperatively and postoperatively. The intraoperative parameters used were total time taken for surgery, time taken for axillary dissection, time for raising the flaps and time taken dissection of the breast tissue and the amount of blood loss. The post-operative parameters used were total drainage volume, days of drainage and seroma formation.Results: Our study showed use of harmonic sclalpel in modified radical mastectomy, resulted in reduction in total operating time (t= 4.037, p=0.00) as well as reduction in time taken for axillary dissection (t=3.66, p=0.001) and the amount of blood loss (t=3.02, p=0.00). The total drain volume (t=3.031, p=0.004) and the days of drainage (t=5.97, p=0.00) were also less with the harmonic scalpel dissection as compared to electrocautery.Conclusions: The use of harmonic scalpel in modified radical mastectomy shortens the operating time, axillary dissection time, amount of blood loss and drainage volume and drainage day and hence the hospital stay.

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