Evaluation and correlation of clinicopathological and radiological findings of axillary node positivity in clinically node negative carcinoma breast

Background: In 2015, there will be an estimated 155,000 new cases of breast cancer and about 76,000 women in India are expected to die of the disease. By the time a breast lump becomes palpable for clinical detection, it is usually advanced. We conducted a study to compare the status of axillary lymph node between the radiologicaland histopathological finding with the clinically negative lymph mode in carcinoma breast in order to limit the axillary lymph node dissection.Methods:This prospective study 50 female patients of carcinoma breast freshly detected and those with non-palpable axillary lymph admitted in S.C.B M.C.H, Cuttack, were included in the study.Results:The mean age of the patients was 51.26 years with standard deviation of 12.26 years with a range of 20 to 80 years. All 50 cases included in the study was done mammography of both breast and among them BIRADS IV 18 cases, BIRADS V 19 cases, BIRADS VI 5 cases and 08 cases were benign. 44 (88%) patients had Karnofsky performance score of 90-100 and 6 (12%) patients had score of 80-90. None (0.00%) of the patients had <80 performance score. Out of the 50 cases enrolled in the study, 04 were underwent wide local excision, 09 were breast conservation surgery and 37 were modified radical mastectomy along with axillary clearance.Conclusions: Higher sensitivity due to axillary ultrasound helps to reduce surgery time as patients with positive axillary lymph nodes directly get an Axillary Lymph Node Dissection (ALND) without preceding Sentinel lymph node biopsy (SLNB).

A clinical study of management of wounds using vacuum assisted dressings

Background: The application of controlled levels of negative pressure has been shown to accelerate debridement and promote healing in many different types of wounds. Vacuum assisted closure (VAC) has proved its efficacy for wound dressing leading to faster wound healing and shorter hospital stay. The aim of the study was to determinethe advantage of vacuum assisted closure over conventional dressing in SCBMCH hospital.Methods:The study was conducted at general surgery wards of SCB Medical College hospital. After debridement of the wound vacuum assisted dressing was applied. Control group was given conventional dressing.Results:In the study sample 10% patients were less than 40 years,76% belonged to 41-60 age group and 7% were more than 61 years of age, 60% male and 40% female. Wounds were located in the foot 27 (54%), leg 19 (38%), sole 2 (4%) and forearm 2 (4%). Patients with sterile pre (VAC), culture and sensitivity was not turning non sterile after VAC, but 90% non-sterile turns sterile after vacuum assisted dressing. In 5 days 25% of granulation tissue formed in VAC dressing whereas only 10% in case control. Similarly, in 10 days it was 40% for VAC and 25% in case of control. Finally, in 15 days it was 70% in case of VAC and 40% in case of control.Conclusions:VAC results in better healing, with few serious complications, and a promising alternative for the management of various wounds.

Prevalence of enteric pathogens in HIV patients with chronic diarrhoea and their relationship with CD4 count

Background: HIV presently accounts for the highest number of deaths attributable to any single infective agent. Opportunistic infections (OIs) and associated complications account for a considerable proportion of such mortality. Diarrhoea is among the most common symptom of HIV infection. During the natural course of HIV infection, there is a progressive loss of CD4 T cells. Autors’ aim is to study the prevalence of enteric pathogens in HIV patients with chronic diarrhea and their relationship with CD4 count.Methods: We analysed 186 HIV positive patients out of which 126 had chronic diarrhea and 60 patients presenting without diarrhea as controls. The faecal samples were subjected to microscopic examination. Zeihl Neelson’s Stain for mycobacterium, Kinyoun’s acid fast stain for microsporodia, stool culture for salmonella and shigella. All patients had barium meal contrast studies, USG of abdomen and pelvis. FNAC of peripheral lymph nodes and finally CD4+ Tcell count using BD FACS.Results: Total of 68,10,01 patients of HIV diarrhoea with identifiable cause had CD4 <200, 200-250 and >350 respectively. Among HIV diarrhoea without any identifiable cause 22, 17, 08 patients had CD 4 <200, 200-250 and >350 respectively. All diarrhoeal stool samples with Isopora had CD 4 <200, M. tuberculosis 26 patients CD4 <200, 12 had 200-350 and 03 had >350. Microsporodium 03 patients had CD4 >350. Finally, among stool samples with Cyclospora, E. histolytica, Giardia and Strongyloides all patients had CD 4<200.Conclusions: The present study highlights the importance of testing intestinal pathogens in HIV. Chronic diarrhoea was more common in patients with low CD4 counts.