Management of patients with breast cancer: are we ready in India for sentinel lymph node biopsy?

Breast cancer is the commonest cancer among women worldwide. Surgery plays an important role in its management. Axillary lymph node dissection has been the standard of care for staging, prognostication and control of axillary disease for almost a century. However, this time-tested paradigm is shifting gradually in the western world, because of the increasing use of screening mammography resulting in the detection of a large proportion of node-negative early breast cancers and a significant incidence of axillary lymph node dissection-related arm morbidity. Minimally invasive and less morbid procedures such as sentinel lymph node biopsy are being used more commonly in the West. However, the western experience cannot be directly extrapolated to the Indian scenario because of the differences in patient profile, treatment standards and expertise available. There is a need to critically analyse these issues before the Indian medical community advocates sentinel lymph node biopsy as a routine procedure for managing patients with breast cancer.

The first successful simultaneous pancreas-kidney transplant in India.

Insulin-dependent diabetes mellitus is associated with renal failure, diabetic retinopathy, neuropathy and vasculopathy. We report the first successful simultaneous pancreas-kidney transplant in India in a young diabetic with renal failure. The dual transplant has cured his diabetes and renal failure and has had a beneficial effect on his neuropathy, retinopathy and quality of life. Obstacles to dual transplant in India include a lack of suitable recipients and a cadaver donor programme that is still in its infancy.