ABSTRACT
To assess the response to Neoadjuvant Chemotherapy [NAC] in Locally Advanced Breast Cancer [LABC] in terms of pathological response, overall survival and feasibility of breast conservation surgery. Case series. King Fahad Medical City [KFMC], Riyadh, from January 2009 to July 2012. All patients of LABC who received NAC and underwent surgery were included. All these patients received the GORG001 regimen [FEC+Docetaxal+Cisplatin +/- Herceptin]. After chemotherapy patients were offered surgery either Modified Radical Mastectomy [MRM] or Breast Conservation Surgery [BCS] +Radiotherapy. Patients were then followed to exclude local or distant metastasis. Results were described in percentage. The median age at the time of diagnosis was 46.8 years. While complete response was achieved in 24 [44.4%] patients, 14 [25.9%] of the patients had partial response and 16 [29.6%] progressed clinically. Surgery was performed in these patients after NAC. Forty [74%] patients had MRM, 14 [25.9%] had BCS; all had axillary lymph node dissection. Invasive ductal carcinoma accounted for 92% of cases. Vascular invasion was present in 12 [22%] of the patients. Estrogen / progesterone receptor positivity was 61%. Thirty nine percent of the patients were Her2 positive. On an average, follow-up of 4 - 51 months in the MRM group, one patient had resection margin [deep] positive and was treated with adjuvant therapy. While in the BCS group after 3 - 26 months of follow-up, one patient had resection margin positive [medial margin] and underwent MRM, while no patient had local or distant metastasis in both the groups. NAC caused down staging of disease in LABC making more conservative surgery feasible. BCC should be considered as an option for treatment of LABC, however, longer follow-up is recommended
ABSTRACT
To compare the outcome of primary repair, both in viable and gangrenous cases of Sigmoid Volvulus. Retrospective study conducted from August 2001 to April 2006. District Headquarter Hospital, Bannu, North West Frontier Province. All patients admitted with large gut obstruction due to Sigmoid Volvulus. After initial investigations and resuscitation, the patients were shifted to the operation theatre where the vascular status of the sigmoid colon was noted, and resection and primary anastomosis was done in all the cases. Patients were allowed orally after 3-5 days, when their bowel sounds returned and they were able to pass flatus and/ or faeces. All patients were discharged home after recovery, and were followed up for a minimum of four months. The outcome of both the gangrenous and the viable gut patients was compared in terms of anastomotic leakage, wound infection, hospital stay and long term complications. The findings were entered onto a proforma and the results compiled and analyzed. Amongst the total 83 patients, there were 72 [86.7%] males and 11[13.3%] females, with an age range of 35-80 years [mean 55 years]. All patients presented with the typical symptoms of intestinal obstruction. Local and systemic signs of toxicity were more common in the gangrenous group. Postoperatively 17 [53.12%] patients in the gangrenous group and 9 [17.64%] cases in the viable group developed paralytic ileus; 2 [6.25%] patients in the gangrenous group developed anastomotic leakage leading to peritonitis; 2 [6.25%] patients in the gangrenous group and one [1.96%] in the viable group developed intra abdominal abscess; eight patients in the gangrenous group and five in the viable group developed wound infection, two of these patients late on developed incisional hernia. The mean hospital stay in the gangrenous group was 10 days as compared to eight days in the viable group. The difference in the outcome of primary anastomosis in both the viable and non viable groups was insignificant. Primary anastomosis can be safely done for acute sigmoid volvulus in both gangrenous and viable gut