Surgical Treatment Management Research Articles

Role of Medical and Surgical Treatment in Management of the Patients With Prolactinoma: A Single-Center Experience.

Current guidelines recommend dopamine agonists (DA) as the primary therapeutic approach for prolactinomas; however, emerging evidence suggests that surgical intervention can also yield favorable outcomes. To comprehensively evaluate prolactinoma patients undergoing surgical and medical treatments at our pituitary center. Retrospective review of mMedical records from prolactinoma patients treated between 2015 and 2022 was performedwere retrospectively reviewed. The study focused on treatment outcomes and remission rates while investigating factors influencing the success of both treatment modalities in achieving remission. A total of 301 prolactinoma patients were included, of whom 199 were women. Among them, 235 were managed medically, while 66 underwent surgical intervention. The overall remission rates of patients treated with medical and surgery were similar at the final examination (Respectively respectively 82.9% and 81.8%, p=0.114). Factors associated with remission in both treatment modalities included female sex, low initial prolactin levels, small adenoma size, and absence of cavernous invasion. Compared to DA treatment, Ssurgical treatment demonstrated a higher rate of drug-free remission compared to DA treatment for microadenomas, and macroadenomas without cavernous invasion. In cases with cavernous invasion, standalone surgical treatment yielded a low rate of drug-free remission (7.7%); however, when combined with DA therapy post-surgery, remission rates increased to 66.7%. Medical treatment with DAs remains the preferred option for macroadenomas with cavernous sinus invasion, and giant adenomas, with surgery reserved for selected cases to address complications. Conversely, surgery emerges as the most effective modality for achieving remission in patients with microadenomas, and macroadenomas confined to the sella. The recommendation of DAs as first-line therapy for all patients has been withdrawn in the current guidelines, and individual treatment approaches based on tumor characteristics are emphasized. Our results support this approach.

Rectovaginal Fistula Due To Chronic Perineal Tear; A Case Report

An abnormal connection that exists between two epithelial surfaces or lumens of the rectum that reaches into the vagina is known as a recto-vaginal fistula (RVF). RVF is one unfortunate consequence of the underlying condition, such as trauma or surgery. According to the patient recap of the urogynecology clinic at M Djamil Hospital Padang (2023), from January to September, 6 patients had cases of rectovaginal fistula that needed to be repaired. Treatment of the underlying condition, the fistula, and its associated complications all fall under the umbrella of RVF management. Given that obstetrics, procedure is still the main cause in this case, the role of the field of urogynecology in the management of surgical interventions is important to maintain the quality of life of a woman. In this case report we present a case report of a 24-year-old woman with rectovaginal fistula and anal incontinence caused by chronic total perineal tear. The patient complained of feces discharge from the vagina since giving spontaneous birth to the first. Physical examination found defects in the internal sphincter (IAS) and external sphincter (EAS) at 11 until 14 o'clock. The patient then underwent sphincteroplasty and perineorrhaphy and showed improvement after surgical intervention

Navigating Complexity: Anaesthesiology Challenges in Diagnostic Laparoscopy of Malignant Massive Distended Abdomen

A 55-year-old woman with adenocarcinoma rectum and adnexal mass with suspected peritoneal/omental deposits was scheduled for diagnostic laparoscopy to rule out peritoneal metastasis, stage the cancer and decide further management. Shortly after tracheal intubation with the rapid sequence technique, the patient’s saturation level dropped to 88%. This case highlights the importance of ventilatory strategies along with surgical intervention for management and uneventful outcomes.

Pain Management in Surgical Treatment of Facial Fractures: Alternative Approaches to Opioid Use

Study Design Literature review. Objective This review aims to explore current opioid use trends for surgical management of facial fractures, as well as methods and alternative treatments to decrease opioid use. Methods Review of selected literature from Medline and Google Scholar. Results Despite the devastating effects of the opioid epidemic and recent policy changes aimed at reducing unnecessary opioid prescription, opioids remain commonly used for pain management after facial fracture repair. Recently, use of multimodal analgesic therapy has been suggested to decrease opioid dosage utilized for post-operative pain control. Alternatives to medication therapies have been proposed for pain management; however, standardized recommendations for pain management in facial fracture patients remain unclear. Conclusions Further research is required to establish evidence-based recommendations for pain management in craniofacial fracture repair.

Endoscopic Third Ventriculostomy versus Ventriculo-Peritoneal Shunt for Infant Hydrocephalus

Objective: To compare the outcome of ventriculo-peritoneal shunt (VP shunt) versus endoscopic third ventriculostomy (ETV) as surgical intervention in management of Infant hydrocephalus. Methodology: A prospective, randomized controlled trial was conducted at the department of Neurosurgery Nishtar University Hospital between June 2023 and November 2023. Study was conducted on 62 pediatric patients with hydrocephalus, all fewer than two years of age, who underwent cerebrospinal fluid (CSF) diversion through either endoscopic third ventriculostomy (ETV) or ventriculoperitoneal (VP) shunt placement. Patients were randomly assigned to one of two treatment groups: ETV or VP shunt. Randomization was done using a computer-generated sequence to ensure unbiased allocation. The ETV group underwent endoscopic surgery to create an opening in the third ventricle to allow CSF to bypass the obstruction. The VP shunt group received a surgically implanted device to divert CSF from the ventricles to the peritoneal cavity. Results: Infection was higher in Group VP than Group ETV as 5 (16.1%) and 1 (3.2%), respectively, (p=0.086). Similarly, obstruction was higher in Group VP than Group ETV as 11 (35.5%) and 9 (29.0%), respectively, (p=0.587). Whereas, surgery was revised 16 (51.6%) in Group VP and 13 (41.9%) in Group Erate TV, (p=0.445). Conclusion: This suggests that ETV presents as a favorable alternative to VP shunt placement due to its reduced risk of postoperative complications and quicker operative duration, while still maintaining comparable efficacy in terms of preventing obstruction, and the necessity for revision surgeries.

Role of descemet's stripping without keratoplasty in management of endothelial disease.

To summarize recent literature on Descemet's stripping only (DSO) in management of endothelial disease with particular focus on Fuchs endothelial corneal dystrophy (FECD). DSO is currently indicated in patients with early FECD, central guttae, and preserved peripheral corneal endothelial cell (CEC) count. Time to corneal clearance may be accelerated and maintained with addition of topical rho-kinase inhibitor (ROCKi). There are reports describing successful use of DSO to treat endothelial disease due to iatrogenic trauma. In patients with transcription factor 4 gene mutation, increased cytosine, thymine, guanine (CTG) triplet repeat load may be associated with DSO failure risk. Emerging pharmacotherapies and cell-suspension treatments may improve procedure effectiveness and expand clinical indications. DSO can be used as the initial surgical treatment in management of symptomatic endothelial disease due to FECD where peripheral CEC function appears preserved. Stand-alone DSO or DSO combined with cataract surgery is effective and postoperative topical ROCKi supplementation will improve time to corneal clearance and CEC count.

“Comparative Evaluation of Laser and Surgical Treatment Modalities of Oral Leukoplakia” -A Systematic Review

Introduction: Oral leukoplakia (OL) is considered a potentially malignant lesion of the oral cavity. Aim: This systematic review aims to evaluate effectiveness of different laser and surgical treatment in management of OL. Materials and Methods: A comprehensive search was done using the MeSH [medical subject headings] terms and keyword search in the electronic databases, namely PubMed and Google Scholar. The search was limited to articles published as full text in English, which were screened by two reviewers for eligibility. Results: The search yielded nine articles out of which seven articles were only included based on the inclusion criteria. The outcome measure evaluated blood loss, pain, malignant transformation, recurrence, healing, scarring, and adverse outcomes. Conclusion: Lasers are more effective in treating OL lesions, but further comparative studies needed to assess their long-term efficacy.

Evaluation of Serum Anti-Mullerian Hormone Level before and after Laparoscopic and Surgical Intervention in Management of Endometriosis

Evaluation of Serum Anti-Mullerian Hormone Level before and after Laparoscopic and Surgical Intervention in Management of Endometriosis

Understanding the path to diagnosis and clinical presentation of patients with PIK3CA-related overgrowth spectrum (PROS) through an innovative patient-centered data platform.

e18707 Background: PROS is a group of rare disorders driven by activating mutations in PIK3CA. Overactivation of the PI3K pathway, which regulates growth and proliferation, results in asymmetric malformations/overgrowths. Localized interventions are often not curative and no medical therapy for PROS is approved; however, mTOR inhibitors (ie sirolimus) are used off-label with modest success. Using a patient (pt)-focused approach, we seek to better understand the current path to diagnosis (dx), course of disease, interventions, and pt outcomes to optimize future therapies. Methods: Pts treated in the US are being actively recruited via interactions with pt advocacy groups, pt communities, social media, and allstripes.com. Following research and HIPAA authorization from each pt/guardian, AllStripes’ proprietary real-world evidence (RWE) platform collects pt medical records into a master medical record from which study data are abstracted. All activities are covered under AllStripes’ IRB-approved protocol. To enroll in the PROS cohort, pts must have a confirmed PROS dx via PIK3CA genetic testing. Data completeness and nomenclature are dependent on physician documentation. Results: To date 14 pts (7 female, 7 male) have enrolled; median age at enrollment was 10.5 y (range, 1-38). Of the 14 pts, 71.4% of pts (n = 10) had congenital onset. PIK3CA genetic testing was primarily (n = 12, 85.7%) completed as a part of a multigene panel. The most frequent specialties involved in dx were medical genetics (n = 4, 28.6%) and pediatric heme-oncology (n = 3, 21.4%). Clinical presentation commonly included vascular malformations (n = 8, 57.1%). Most pts were diagnosed with CLOVES (n = 12, 85.7%). Seven pts (50.0%) had documented lesions at dx, median of 2 (range, 1-13) lesions per pt, increasing after dx to 3 (range, 1-14). All pts reported PROS-related complications; 50.0% (n = 7) required hospitalization/ER visit. Musculoskeletal, neurological, and gastrointestinal related complications were each reported by ≥50% of pts. All pts required ≥1 surgery; ≥50% of pts had diagnostic, debulking, vascular, or other procedures. Median number of surgeries per pt was 7 (range, 1-28), corresponding to a median of 0.76 surgeries per pt per year. Eight pts (57.1%) received PROS related medications: 6 (42.9%) received alpelisib, 5 (35.7%) received sirolimus. Conclusions: While each pt is unique, similarities in the path to dx (eg, specialties involved) and disease history (eg, clinical presentation, symptoms experienced) exist. RWE abstracted from medical records rapidly provides data in an otherwise limited field, helping to address key questions. Preliminary results highlight the burden of PROS and the reliance on repetitive surgical interventions for management, suggesting there remains a high unmet medical need for effective therapeutic strategies.

Into a brave new world: Haemophilia A & von Willebrand Disease Surgery with novel therapies.

Haemophilia & von Willebrand disease are both recognised inherited bleeding disorders. With increased access to highly efficient and safe replacement and novel therapies, management of surgical interventions in this group can be safely managed by experienced multidisciplinary teams. To review the evidence for managing surgery in the era of novel therapies. We explore four cases and establish the role of the clinical nurse specialist within the surgical pathway. All of these cases evidence the continued important role of both the multidisciplinary planning prior to any surgical interventions in people with bleeding disorders and the key role of the Nurse Specialist in ensuring this plan is then implemented. Key focuses of communication with all parties involved in the patient journey, performing education for the patient, family and wider healthcare team about the underlying bleeding disorder and the importance of time critical medicines being given on time is essential. These cases demonstrate that individuals with bleeding disorders are at risk of developing other rare conditions alongside their life long condition, in addition to comorbidities associated with ageing. Evidence for rare plus rare is likely to be minimal as demonstrated within the cases, and recognition of how to reach out to international peers in the field is important. Sharing complex case management at national & international meetings and in publication has never been so important.

Conservative versus Surgical Treatment in Management of Closed Mallet Finger:A Systematic Review and MetaAnalysis

Abstract Background Several methods of treatment have been mentioned in management of closed mallet finger injury, as conservative methods using stack splint,dorsal aluminum splint or custom thermoplastic splint, or surgical procedures as direct pinning method, extention block technique or hook plate fixation, there is no consensus for the best method of treatment. Objectives to review and meta-analyze the outcomes of conservative versus surgical treatment in management of closed mallet finger injury and statistically compare between their results of pain, extensor lag, range of motion of distal inter-phalangeal joint. Materials and Methods The review will be restricted to randomized controlled trials (RCTs), clinical trials, and comparative studies, either prospective or retrospective, which studied the outcome of conservative versus surgical treatment in management of closed mallet finger, articles published in English. PRISMA flow chart 950 articles were found using search keywords. By filtration and screening of the title and exclusion of unrelated articles, 150 articles were found. By applications of all inclusion and exclusion criteria, only 55 articles which met all inclusion criteria, 50 studies were systematically reviewed, and 5 randomized controlled trials were fit to undergo a meta-analysis, after conducting meta-analysis we found that P value for pain svore based on visual analogue score (VAS) was 1, extensor lag P value < 0.001, and range of motion P value <0.001. Conclusion No significant differences was found between the conservative and the surgical groups regarding the pain score, distal inter-phalangeal joint extensor lag, and distal inter-phalangeal joint range of motion in treatment of closed mallet finger.

Combined Orthodontic and Surgical Management for Treatment of Severe Class III Malocclusion with Anterior and Posterior Crossbites

Severe class III malocclusion can be a great challenge, especially in adult patients. This case report describes an adult patient with severe skeletal class III malocclusion and with an obvious maxillary deficiency and mandibular excess causing both anterior and posterior crossbites in addition to a shift in the upper and lower midlines to the left concerning the facial midline. This was complicated by compensatory mechanisms such as the proclination of upper incisors and retroclination of lower incisors. Decompensation of the upper and lower arches was performed combined with upper arch expansion to relieve crowding in the upper arch and correct the posterior crossbite. This was followed by double jaw surgeries, including Le Fort I osteotomy in the maxilla and bilateral sagittal split osteotomy (BSSO) in the mandible. Orthodontic finishing procedures were then used to correct any other dental discrepancies. Remarkable esthetic and functional results were achieved with high patient satisfaction.

ANATOMICAL AND VISUAL OUTCOME OF COMBINED PHACO-VITRECTOMY VS VITRECTOMY ALONE

Introduction
 Separation of Neurosensory retina from RPE(Retinal Pigment Epithelium) is described as retinal detachment. Recently Pars plana vitrectomy has emerged as a preferred surgical treatment for management of uncomplicated primary rhegmatogenous retinal detachment. Various studies have evaluated the results of combined phaco-vitrectomy, the combined approach allows faster visual recovery and has cost effectivity for patient. The rationale of this study is to compare the anatomical and visual outcome of combined phacoemulsification and vitrectomy vs vitrectomy alone
 Materials and methods
 This prospective randomized controlled trial was performed at Eye Unit II Mayo Hospital Lahore (tertiary care eye hospital in Lahore), Pakistan from August 2019 to February 2020. 36 patients full filling the inclusion criteria were divided into two groups 18 patients each. Group A was of combined Phaco-vitrectomy and Group B was of vitrectomy only. The Mann-whitney test as test of significance was applied and P≤0.05 was considered statistically significant.
 Results
 BCVA done Pre-operatively for Group A and B, P-value was > 0.05 which was insignificant. Best corrected visual acuity at first week post operatively was significantly lower in patients in which we used gasses as internal tamponade as compared those in which we used silicon oil as tamponade. The BCVA at 1 month showed improvements in both groups, however the BCVA in group B was significantly lower than group A, P-value being < 0.05. The BCVA at 3 month showed improvements in both groups, however the BCVA in group B was significantly lower than group A, P-value being < 0.05.
 Anatomical Outcome was seen as weather retina was attached or detached. In Group A detachment was present in all follow-ups in 2/18 patients while in Group B detachment was present in all follow-ups in 3/18 patients. The P-value was >0.05 and thus the difference between two groups was insignificant.
 Conclusion
 visual acuity did not differ among the two groups preoperatively and on first follow-up at 1 week. The P value being >0.05 in both. However there was significant difference between the two group at 1 month and 3 months follow up, P value being < 0.05 in each. The visual acuity was significantly better in Group A i.e combined phaco- vitrectomy.
 For anatomical outcome no difference was seen between the groups. The P value was > 0.05. So the visual outcome of group A was significantly better than group B while the anatomical outcome was the same.
 
 Keywords
 Phacoemulsification, Three ports pars plana vitrectomy, best corrected visual acuity, retinal detachment.

Effect of Lepidium Sativum Gel as an Adjunct to Non- Surgical Treatment in Management of Periodontitis Patients Stage (II, III) and Grade (A, B)

Purpose: The current study was conducted to elaborate the clinical and transforming growth factor beta biomarker effect of local application of lepidium sativum gel as an adjunct to scaling and root planing in the therapeutic management of periodontitis patients stage( II, III) and grade(A, B). Subjects and Methods: The current study was conducted on twenty patients were selected in this study with stage (II, III) and grade (A, B) periodontitis. Patients were randomly divided into two group’s ten subjects on each. Group A: (control group) were treated with scaling and root planing alone, group B: (study group) were treated with scaling and root planing with local delivery of lepidium sativum gel. Results: study group showed a significant increase in the clinical parameter like clinical attachment level (CAL), probing depth (PD), bleeding on probing (BOP) and plaque index (PI). Clinical parameters were recorded after one month and three months, transforming growth factor beta biomarker level after one week and four weeks in comparison with control group follow up. Conclusion: Adjunctive use of lepidium sativum with non-surgical therapy showed an improvement in the treatment outcome of periodontitis patient’s stage (II, III) and grade (A, B).

Functional and Disability Assessment Among Hispanics With Zone 2 Flexor Tendon Injuries: Comparative Study Between Flexor Digitorum Superficialis Repair and Flexor Digitorum Superficialis Excision.

Introduction:Flexor tendon lacerations in zone II have been reported to be the most complicated of all tendon injuries. Currently, there is no consensus on treatment in surgical management for patients with flexor tendon laceration of flexor digitorum profundus and flexor digitorum superficialis (FDS). The aim of this study was to evaluate whether the repair of FDS tendons provided superior functional outcomes compared with FDS excision in Hispanic patients.Methods:Total active motion, original Strickland criteria, and the disability of arm shoulder and hand questionnaire were provided postoperatively at 3 and 6 months to all consecutive Hispanic patients who underwent zone II flexor tendon repair. The cohort was divided into two groups, those who underwent FDS repair and those underwent FDS excision.Results:Functional and disability outcome analysis showed a notable improvement with FDS repair using total active motion, Strickland criteria, and disability of arm shoulder and hand score at the 3 months postoperative interval. No statistical differences were identified regarding functional and disability outcomes at the 6-month evaluation between both groups.Conclusions:Among Hispanics, the FDS-repaired group had similar functional and disability outcomes at their 6 months postoperative evaluation compared with the FDS-excised group. Increased awareness for tendon rerupture during the initial 3 months of index surgery is recommended for FDS-excised patients.

Effect of Adjunctive Use of Propolis Gel with Non Surgical Treatment in Management of Chronic Periodontitis

Purpose: The goal of this study was to evaluate the clinical effect of propolis gel associated with non surgical therapy in the management of chronic periodontitis. Subjects and Methods: Thirty chronic periodontitis patients were selected in this study with probing depth not less than 5 mm in each site. Patients randomly divided into three groups ten subjects on each. Patients in Group1 were treated with scaling and root planning and local delivery of propolis gel with chitosan polymer. Patients in group 2 were treated with non surgical therapy and propolis gel with polyox polymer. Patients in group 3 were treated with non surgical therapy alone. The clinical parameters were assessed at baseline, 1 month and 3 months. Results: Clinical parameters showed a favorable improvement in group received propolis gel with polyox polymer than the group received propolis gel containing chitosan polymer. Conclusion: Adjunctive use of propolis with polyox polymer to non surgical therapy showed favorable results over use of propolis with chitosan polymer in patients with chronic periodontitis.

Динамика содержания C-реактивного белка в сыворотке крови при анестезиологическом обеспечении хирургических вмешательств

Динамика содержания C-реактивного белка в сыворотке крови при анестезиологическом обеспечении хирургических вмешательств

Endoscopic Third Ventriculostomy versus Ventriculo-Peritoneal Shunt for Infant Hydrocephalus

Introduction: Patients with hydrocephalus, which is the most pediatric neurological disorder, undergo Cerebrospinal fluid (CSF) diversion through third ventriculostomy or ventriculo-peritoneal shunt. Up to date, the optimal hydrocephalus treatment modality is not clear. Aim: We compared the outcome of endoscopic third ventriculostomy (ETV) versus ventriculo-peritoneal shunt (VP shunt) as a second surgical intervention in management of Infant hydrocephalus concerning success rate and complications. Patients and Methods: We conducted an observational study of 52 children with hydrocephalus (congenital or acquired) in whom CSF diversion was performed using either ETV or VP shunt in randomized control trial. Results: During the period examined, 52 children, 26 underwent ETV and 26 underwent VP shunt. The mean age was 11.0 ± 4.3 months in ETV and 11.3 ± 4.7 months in VP shunt. Postoperative infection in the ETV group was lower than in the VP shunt group (23.1% vs. 53.8% P = 0.045). Regarding operating time, In ETV group operation duration was 46.9 min and 64.3 min in the V-P shunt group (P = 0.13). There was no statistically significant difference between the two study groups regarding the rate of obstruction, change in occipital frontal circumference (OFC) or the need of revision surgery. One year survival for VP shunt group vs. ETV group was 46.2% vs. 65.4% respectively. Conclusion: ETV associated with lower rates of postoperative infection and shorter operation time with no significant difference in rates of obstruction, change in OFC and revision surgery in comparison to VP shunt.

Pharmacologic and surgical therapies for patients with Meniere\u2019s disease: a protocol for a systematic review and meta-analysis

BackgroundHearing loss is one of the leading causes of disability in Canada and worldwide, with more than one million Canadians enduring a hearing-related disability. Meniere’s disease (MD) is a chronic condition of the inner ear, manifesting as a triad of disabling symptoms, including attacks of vertigo, fluctuating sensorineural hearing loss (SNHL), and tinnitus. Impacts on quality of life are severe, particularly with respect to restrictions in social participation and physical activity, fatigue, and reduced capacity to work. Anxiety and other psychological disorders may result from the restrictions imposed on life, the constant uncertainty of vertigo attacks, and fluctuating SNHL, with neuroses and depression affecting 40 to 60% of sufferers of intractable MD. There is a need to establish the benefits of previously studied interventions with greater certainty. The planned systematic review and meta-analyses/network meta-analyses (NMAs) will assess the relative effects of competing pharmacologic and surgical interventions for management of MD in adults.MethodsAn experienced medical information specialist in consultation with the review team will develop the electronic search strategies. We will search various databases including MEDLINE, Embase, and the Cochrane Library with no date or language restrictions for published literature, and key clinical trial registries for in-progress and completed trials. Screening of the literature will be performed by two reviewers independently using pre-specified eligibility criteria, and quality of the included studies will be assessed using the Cochrane Risk of Bias tool. We will resolve disagreements through consensus or third-party adjudication. When applicable, meta-analyses and NMAs will be pursued to compare interventions in terms of their effects on outcomes, including frequency and severity of vertigo, occurrence and intensity of tinnitus, changes in hearing and speech recognition, quality of life, and harms. Separate analyses exploring the effects of pharmacologic and surgical approaches will be performed.DiscussionOur planned systematic review will provide informative evaluations of existing treatments for management of Meniere’s disease. The findings will inform practitioners as to the relative benefits and harms of the existing competing interventions for MD, offer optimal clinical treatment strategies, identify evidence gaps, and determine promising therapies for evaluation in future trials.Systematic review registrationPROSPERO CRD42019119129

“LOCAL COMPLICATIONS OF PERIPHERAL INTRAVENOUS CHEMOTHERAPY – ANALYSIS IN CARCINOMA BREAST PATIENTS”

Aims: To identify and record the local reactions at the site of IV cannula in women with carcinoma breast during peripheral intravenous chemotherapy treatment. To find out the incidence of these reactions and correlations with various factors.
 Method- Prospective Observational Studywas done with evaluation of 559 individual peripheral intravenous chemotherapy cycles given in carcinoma breast patients from June 2013 to September 2015.
 Results: 1 in every 5 carcinoma breast patients receiving peripheral intravenous chemotherapy developed local complications. (20.92% in adjuvant cases and 18.55% in neoadjuvant cases). Pain followed by induration and altered skin color were the most common complications. Extravasation was present in 6.44% cases.other complications commonly noted were tingling sensation in IV applied limb, edema, thrombophlebitis, cellulitis and ulcer. IV cannula application on ipsilateral site (in limb on side of breast cancer) is associated with RR=2.08. IV cannulation over the wrist have 1.57 times (RR=1.57) and multiple puncture attempts to secure IV cannula is associated with 1.97 times (RR=1.97) more risk of developing local complications following peripheral intravenous chemotherapy. Elderly age >50yrs, small of large calibre IV cannula (no 18 G and No 24 G) have more local complications.
 Conclusions: Occurrence of local complications after peripheral intravenous chemotherapy in carcinoma breast patient is common. Vigorous monitoring of patient with repeated and frequent examination of site of chemotherapy cannulisation must be done during the complete chemotherapy infusion process and detailed records must be kept at every stage. A generalised chemotherapy infusion guidelines and protocol should be established according to the hospital occurrence. Active Patients participation in monitoring is advised. More multicentre studies are required to create a data base of venous damage occurring following intravenous peripheral chemotherapy and to formulate standard guidelines and protocols to reduce the rate of complications. Precaution, and care during peripheral intravenous chemotherapy can prevent development of local complications and remove the need for surgical intervention for management of the complications, thus, reduce the hospital stay, additional diagnostic procedures and treatment, stress in the life of the patients' relatives, extra work load on the health personnel and economic loss accordingly.