Obesity and response to neoadjuvant chemotherapy in breast cancer

The prevalence of obesity is rising worldwide including Sub-Saharan Africa just as the incidence of breast cancer is rising in same region with increasing morbidity and mortality. Obesity or overweight has been identified as a risk factor for breast cancer and both have been associated with poor outcome of breast cancer treatment. The objective of this study was to assess the effect of obesity /overweight on clinical response to Adriamycin Cyclophosphamide-Paclitaxel (AC-P) regimen neoadjuvant chemotherapy in patients with breast cancer. A prospective observational of 39 female patients with breast cancer. A prospective observational study of newly diagnosed breast cancer patients with palpable breast lumps on neoadjuvant chemotherapy of AC-P regime. Age of the patients, tumour size, stage, estrogen, progestogen and HER2 receptor status were noted. Height measured in metres and weight measured in Kilograms were recorded and Body Mass Index (BMI) calculated .Tumour size measured at presentation, then after first, third, sixth and eighth doses to determine response as defined by the UICC method such as complete clinical response, partial clinical response, stable disease and progressive disease. BMI was then categorized into Normal weight 25kg/m2 and Overweight 25-30kg/m2 and Obese 30kg/m2. 43.6% were obese, 33.3% were overweight and 23.1% were normal weight. Thirty percent of overweight /obese patients had complete clinical response 2 compared with 77% of low/normal weight patients and this was statistically significant (X2 =6.53, p 0.015). 76.7% of the overweight/obese were premenopausal compared with 23.3% who were post menopausal, and this is statistically significant.(X2 =5.84, p 0.024). Obesity/ overweight is associated with poorer clinical response to neoadjuvant chemotherapy in the cohort of patients studied

Experience with Lichtenstein Hernioplasty in Sagamu

Background: Newer methods have evolved to address the major drawback of the traditional methods of hernia repair. These emphasize the use of prosthetic materials to strengthen the posterior wall of the inguinal canal without tension. Although Lichtenstein hernioplasty, like other newer methods, is associated with low recurrence rates, it is not commonly used in our clinical setting.Objective: To review the outcome of Lichtenstein hernioplasty using polypropylene mesh in a resource-poor setting.Methods: The hospital records of patients who had Lichtenstein hernioplasty between the year 2004 and 2013 in a six-bed private surgical clinic and who were followed up over a two- to ten-year period, were studied. Demographic data, clinical features, operative findings and outcome measures like post-operative complications and recurrence rates, were recorded.Results: There were 62 patients (with 69 hernias) of which 2 were females with the age range of 12-84years. 50 hernias (72.5%) were of the inguinoscrotal type, 39 patients (63.0%) had right inguinal hernias, 5 (7.2%) hernias were obstructed and 8 (11.2%) hernias were recurrent. Six (9.7%) had emergency surgery, 46 (74.2%) had surgery under local infiltrations and 15 (24.2%) had spinal anaesthesia. Scrotal oedema (4.3%), haematoma (1.4%), and hydrocoele (1.4%) were the early complications recorded. One recurrence of hernia occurred in a patient who had repair of twice recurrent hernia. The mean duration of follow-up in years was 5 (S.D 2.5) years.Conclusion: Lichtenstein repair of inguinal hernia was a safe and effective procedure in the private clinical setting

Abdominal injuries in olabisi onabanjo university teaching Hospital Sagamu, Nigeria: Pattern and outcome

Objective: The aim was to study the pattern and outcome of abdominal trauma managed by Laparotomy in Olabisi Onabanjo University teaching Hospital Sagamu (OOUTH), South Western Nigeria.Method: This is a retrospective study. The records of the patients were retrieved and relevant data extracted such as age, sex, occupation, address, cause of injury, vital signs on admission, abdominal signs, other injuries, number of units of blood transfused, investigations, indications for surgery, operative findings, procedure carried out, complications and outcome.Results: Seventy seven subjects were reviewed. There were 23 females (29.9%), and 54 males (70.1%). The age range was 3years to 68years, 32 patients (41.6%) were in 20-30 years age group. The mechanism of injury was blunt trauma in 61 (79.2%) and penetrating injury in 16 patients (20.8%). Road traffic accident was the commonest cause of injury, in 53 patients (68.8%). 42 patients (54.5%) had extra abdominal injuries. Positive paracentesis abdominis was the commonest indication for surgery, in 53 patients (68.8%). The spleen was the most commonly injured organ, in 31 patients (40.2%) while the organs were normal in 4 patients (5.2%). The complication observed includes acute renal failure, in 5 patients (6.5%), multiple organ failure in 5 patients, and wound infection in 8 patients (10.4%). Ten patients died. (13%)Conclusion: Splenic rupture is the most common abdominal injury treated by Laparotomy in OOUTH Sagamu and the commonest cause is road traffic accident. Mortality was due mainly to acute renal failure and multiple organ failure