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Background: To determine the frequency of carcinoma of gallbladder in patients with cholelithiasis. Material & Methods: It was a descriptive study conducted at the Department of Pathology Peoples Medical College Nawabshah, from January 1985 to December 2004. During the above mentioned period 1138 specimens of cholecystectomy for cholelithiasis with cholecystitis were received, out of which 1109 were included in the study being 89.5% females and 10.5% were males. The clinical data, surgical pathology reports and haemotoxylin & eosin stained slides were obtained from the record, all the cases were reviewed and results were tabulated. Results: No case presented with gallbladder mass. The commonest complaint was pain in epigastrium in 70% of cases. Carcinoma was found in 65 cases. The frequency of carcinoma of gallbladder was found in 5.9% of cases. Conclusion: Present study highlights the importance of careful gross and histopathologic evaluation of gallbladders otherwise removed with the history of chronic or acute cholecystitis. It is further concluded that the frequency of carcinoma of gallbladder is less common in this part of the country.

Background: This study was conducted to highlight the importance of mammary tuberculosis, by determination of its frequency, clinical presentation and laboratory investigations in our set-up. Material and Methods: It was a retrospective study performed at Department of Pathology, Nawabshah Medical College, Nawabshah. The data was collected from the file record of these patients from January 1997 to December 2006 and the results were tabulated. Results: Nine cases of tuberculosis were diagnosed in 396 lumpectomy/mastectomy specimens. Age of these patients ranged from 18 to 42 years. All were married women belonging to poor socio-economic class, bearing on average five children. One patient was pregnant and three lactating mothers. Associated pulmonary tuberculosis was present in three cases. Previous history of tuberculosis was present in one case and history of tuberculosis in the family was seen in five cases. Mass with or without ulceration /abscess / discharging sinus was the clinical presentation in all the cases. Axillary lymphadenopathy was seen in five cases. Fever and pain with history of weight loss was seen in all the cases. All the patients were found to be anaemic with high erythrocytes sedimentation rate. The total leukocytes count ranged from 4.2 - 7.2 x 109/l. Mantoux test was positive in all the cases. Acid fast bacilli in the breast tissue were seen in only one case. The diagnosis was made on histological grounds by the presence of chronic granulomatous inflammation with caseating epithelioid granulomas and Langhan’s type of giant cells. Conclusion: The frequency of tuberculosis in our study is 2.3% in the patients with lump in the breast. Doctors should keep tuberculosis in the differential diagnosis of breast lump.

Background: Typhoid perforation of ileum is a serious complication of typhoid fever. There are different surgical methods of repairing the perforation. The aim of this study was to report the surgical experience regarding treatment of typhoid ileal perforation in our setup. Material & Methods: It wa a retrospective, observational study carried out at Departments of Surgery Unit I and Pathology, Peoples Medical College and Hospital Nawabshah from July 2003 to June 2008. Forty-four patients were admitted through causality as cases of acute abdomen, 28 (63.63%) were males and 16 (36.36%) females, with age range of 10-45 years. The diagnosis of typhoid perforation was made on clinical grounds, laboratory investigations, x-ray, ultrasound examination, and operative findings. Exploratory laparotomy was carried out and perforations were managed. The variables studied in the post operative period were wound infection, wound dehiscence, entero-cutaneous fistula, residual abscess, mortality, hospital stay and incisional hernia. Results: Fever with abdominal pain and distension were the symptoms in all subjects followed by diarrhoea, vomiting and constipation Widal test more than 1:320 was positive in 35(79.45%) cases and typhi dot (IgM in all cases and IgG in 15) was positive in all cases. Blood culture was positive in 32 (72.7%) cases. X-ray abdomen revealed pneumoperitoneum in 22 (50%) cases. Ultrasound shows free peritoneal collection in 40 (90.90%) cases. On operation the abdominal cavity was heavily contaminated in 12 (27.27%) patients while in 32 (72.72%) patients the peritoneal cavity was having moderate contamination. 36 (81.81%) patients had single perforation & 8 (18.18%) patients had more than one perforation. In 32 (72.72%) patients perforations after freshening the ulcer were closed by single layered interrupted extra mucosal technique with vicryle 2/0, 4 (9.09%) needed resection & anastomosis & in remaining 8 (18.18%) loop ileostomy was made. Conclusion: The typhoid ileal perforation still carries high morbidity and mortality. The typhoid ileal perforation should always be treated surgically. There are many operative techniques to deal typhoid ileal perforation but no one is fool proof. Regardless of the operative technique timely surgery within 24 hours with adequate and aggressive resuscitation is a way to decrease the morbidity and mortality.

Background: The aim of the study was to find out the frequency and histopathologic type of various testicular tumors in correlation with age of the patients in our setup. Material and Methods: It was a retrospective, descriptive study carried out at the Department of Pathology, Peoples Medical College, Nawabshah, Pakistan. All testicular tumors diagnosed from January 1991 to December 2005 were included in the study. The clinical data and surgical pathology reports with haematoxylin & eosin stained slides were obtained from the record. All the cases were reviewed and results tabulated. The patients were divided into six age groups and the tumors classified according to the pathological classification of testicular tumors. Results: During this period 73 cases of testicular tumors were diagnosed in the department. All cases were diagnosed as germ cell tumors (100%); consisting of 57 (78.1%) cases of single histologic type and 16 (21.9%) cases of mixed germ cell tumors. Most of the cases presented in the 3rd and 4th decades. Seminoma was found to be the commonest tumor in 27 (37%) cases, embryonal carcinoma in 29 (27.4%) cases, teratocarcinoma in 11 (15.1%) cases, yolk sac tumor and teratoma each in 5 (6.8%) cases, embryonal carcinoma with seminoma in 3 (4.1%) cases and teratoma with seminoma in 2 (2.8%) cases. Conclusion: In this study the ages of the patients and the frequency and histopathological findings in testicular tumors, with few exceptions are similar to other studies from different parts of the world, confirming the worldwide similarity of these parameters.

Foreign body in urinary bladder being unusual in clinical setting presents as a diagnostic dilemma with vague history. Bladder calculi are uncommon in adults and usually result either from obstruction or foreign bodies. The present case report describes a young girl presenting with cysticism. Investigations revealed a bladder calculus encrusted on trans-urethrally inserted abortion stick in the urinary bladder that warranted surgery. Endoscopic manipulation was successful. Postoperative period was uneventful.

Background: To evaluate the efficacy, safety and results of a newer technique, using Mauermayer stone punch for percutaneous bladder stone removal in children. Material and Methods: It was a prospective study from November 2000 to November 2004, in the Department of Urology, Peoples Medical college hospital Nawabshah, Pakistan. One hundred and thirty children having vesical calculi of various sizes were included in this study. The procedure is based on principal of percutaneous removal of bladder stones, using ordinary trocar cannula under video-cystoscopic visualization and Stone punch to extract/fragment the stones. These children were evaluated by detailed history, clinical examination, ultrasonography, Radiography of urinary tract, urine routine examination, urine culture and blood urea. These patients, who were otherwise candidates for open cystolithotomy, were treated percutaneously using suprapubicapproach. Results: Satisfactory results were obtained in almost all cases having solitary and multiple stones. In selected cases urethral damage, operating time, hospital stay and cost can be decreased to minimum with this simple technique. Conclusion: This study shows that suprapubic percutaneous route can be employed as an alternative procedure to previously reported different percutaneous modalities where percutaneous nephrolithotomy instruments, laparoscopic instruments, percutaneous vacuum sheaths and other trocar and stone forceps have been utilized for removal of vesical calculi.