Carcinoma of the breast is undoubtedly one of the commonest cancers rather the most common in women. And as it again is one of those cancers which actually is painless,hence mostly presents late. Lymphadenopathy generally is thought to be a bad prognostic sign in any given case of carcinoma : and removal of all the draining lymph nodes in carcinomas subjected to surgery is rather more cumbersome .Over the last few decades the surgery for carcinoma breast moved from very aggressive “Halsted’s radical mastectomy” to modified radical mastectomy.
The amazing locoregional benefit of MRM is so very useful and is a standard practice for almost all carcinomas.This very old women had a stage III carcinoma breast with huge axillary lymph nodes and was subjected to MRM.she had amazing recovery with minimal morbidity and is disease free now.
Swelling ParotidThick pus drained
Abscess deep lobe of parotid: An interesting patient.
As I most of the times say that the whole approach to any patient, may it be of any specialty of medicine is somewhat tailored in developing countries specially a country like mine: Pakistan and that mainly is because of many reasons, including decreased manpower and reduced resources.
This in turn leads to some amazing and interesting events while managing patients. A patient comes to our surgery clinic with this swelling in the left parotid region for the last one and a half year and clinically is diagnosed as a case of benign parotid tumour. The FNAC report though just elaborates an inflammatory cells pattern. An initial plan of superficial parotidectomy was made. As a routine we don’t get an ultrasound of a suspected benign parotid tumor.
The patient also had slight pain in the region for the last two weeks but was thought to be because of mild nerve compression. A last minute suggestion of a team surgeon to get an ultrasound showed an abscess in deep lobe of parotid. The most interesting fact was that it was actually an enlarged parotid with deep seated abscess. An incision and drainage was done last week and an interval parotidectomy is planned.
The concept of damage control surgery was a revolution in managment of patient having very poor prognosis specially management of trauma patients.generally teh concept evolves around a two stage procedure while taking care of potential hypothermia,coagulopathy,etc.
In developing countries like a city name sargodha in pakistan the concept of damage control is further modiefied (actually beacuse of decreased resources),and the two stage procedure are done but there is no availability of surgical ICU,so the patients for example with sever liver injury are operated and in case of grade 3 or grade 4 injury only a huge pack is placed in the liver area.
The patient then is shofted to normal ward with routine monitoring and lator is opened again after 48 hrs .Around 50 percent of patients do have adequate hemostasis and survive teh catastrophic trauma,initially thought to be a case of 100 percent mortality.
Though a lot can be improved but already encouraging results are observed with these modifeid or compromised procceedings.
dochassan 