Multimodality therapy for locally advanced breast cancer

In the present study, 20 patients with locally advanced breast cancer were treated with a combined modality strategy from September 1999 to June 2002. Their age ranged from 30-65 years with a mean of 50 years. Thirteen patients were postmenopausal and seven patients were premenopausal. Fourteen cases were in stage IIIb, while six cases were in stage IIIa. A metastatic work up was done and all patients were found to be free from distant metastases before neoadjuvant chemotherapy. The patients received three cycles of different regimens of neoadjuvant chemotherapy. Fourteen patients received 5-flurouracil, adriamycin, cyclophosphamide [FAC], three patients received 5-flurouracil, epirubicin, cyclophosphamide [FEC], two patients received 5-flurouracil, novantrone, cyclophosphamide [FNC]and one patient received cyclophosphamide, methotrexate, 5-flurouacil [CMF]. 90% of the patients had partial responses to the neoadjuvant chemotherapy [the tumor decreased more than 50% of its size]; while only two patients did not respond to treatment. Modified radical mastectomy was done for all patients. Postoperatively, all patients received adjuvant treatment, radiotherapy 5000 cGY, 25 fractions, 3-4 cycles of further adjuvant chemotherapy [FAC, FEC, CMF and FNC] and hormonal treatment, tamoxifen 20 mg/day. The patients were followed up for a variable period of time ranging from 12-24 months. No local recurrence was detected in all patients. Only two patients developed distant metastasis. Disease free survival was 90%. This multimodality approach to locally advanced breast cancer rendered most of the patients disease-free and produced an excellent local control rate

Experience in the use of plastic mesh in the repair of difficult hernias and abdominal wall defects

Polyrophylene [Marlex] or polyester [Mersilene] mesh was used for the repair of difficult hernias and abdominal wall defects in 65 patients whose ages ranged from one day to 70 years. The cases included one exomphalos major, 12 inguinal hernias, 12 para-umbilical hernias, two recurrent epigastric hernias, 29 incisional hernias and two patients with abdominal wall defects. In two patients concomitant bowel anastomosis was performed. The Marlex mesh used in 45 patients while Mersilene mesh was used in 20 cases. The operative procedure includes identification of the edge of the hernia defect, if direct repair is possible the mesh is inserted as onlay graft, otherwise the mesh is inserted over the peritoneum and sutured to the surrounding musculo-aponeurotic layers. Antibiotics were administered routinely and closed suction drainage was applied to all cases. Post operative wound infection occurred in only one case, but there was no need to remove the mesh in any patient. Follow up for periods up to seven years revealed recurrence in only one patient