RESUMO
Blunt injury to abdomen is one of the most common injury caused by road traffic accidents. The advent of newer imaging techniques with high resolution computed tomography scanners (CT scan) has enabled the clinicians to exactly diagnose the extent of the intra abdominal injuries. High grade injuries are commonly managed by surgery but the shift to selective non operative management (NOM) of blunt injuries to abdominal solid organs are one of the most notable trends in the case of trauma. Methods: This study was conducted on 50 patients of blunt abdominal trauma admitted in Guru Nanak Dev Hospital, attached to Govt. Medical College, Amritsar. Patients of all age groups with blunt trauma abdomen were admitted in hospital. Results: In the present study, most common age group affected was 21-40 years (70%); out of which males were more commonly affected (90%); most common mode of injury was road traffic accident accounting for 76% of patients of all age groups. In this study, 2 out of 13 patients expired who were kept on NOM due to liver injuries. Failure to resuscitate these patients was the main cause of mortality. 4 out of 12 operative cases expired. Most common organ injured was liver (50%) followed by spleen (36%). Other organs injured were pancreas and kidney, 6% each. Mortality rate in patients who were receiving NOM was 5.26% while patients who received operative management had mortality rate of 33.3%. Conclusion: Morbidity and mortality can be prevented by timely initial resuscitation and correct diagnosis as well as management (non operative or operative) which depends on patient’s hemodynamic stability and findings of imaging studies.
RESUMO
Background: The aim of the study is to assess the tumor response to neoadjuvant chemotherapy with cyclophosphamide, adriamycin, 5-fluorouracial (CAF regimen) in terms of decrease in breast tumor size (partial or complete clinically).To assess clinically the axillary lymph node status after neoadjuvant chemotherapy (conversion from palpable to nonpalpable). Methods: Thirty female patients of breast cancer were studied for down staging with two cycles of CAF regimen given at interval of 21 days. After 21 days of second cycle patient’s staging noted for effects. Results: Thirty female patients of breast cancer were studied. Maximum no. of patients between 31-40 years, mean age 46 years and median age 45 years, youngest patients 18 years, oldest patients 70 years, 22 patients responded to chemotherapy, out of 22, 1 (3.3%) showed a complete clinical response, 21 (70%) partial clinical response. Pre-menopausal 9/13 (69.2%) and post menopausal 13/17 (76.4%) showed clinical response, statistically not significant difference (df=1, x2=1.33, p>0.05). Change in tumor size 40.09±25.20 sq, cm mean size to 21.88±27.43 sq. cm after chemotherapy was highly significant change (t=6.242, p<0.001). Overall response to chemotherapy was 73.3%, in stage II-87.5%, stage IIIA-75% and stage IIIB-50%. The overall response to axillary lymph node was 56.6%, statistically highly significant (p<0.001). Main side effects nausea and vomiting (60%) and hair loss, 43.3%, but none necessitated stoppage of chemotherapy. As a consequence to primary chemotherapy, conservation surgery (lumpectomy with axillary clearance) could be done in 43.3% of patients.Conclusion: CAF Preoperative chemotherapy regime is a satisfactory modality of treatment for stage II and III breast cancer with positive response rate of 73.3%. The down staging thus obtained permits breast conservation surgery in 43.3% of patients. The chemotherapy regime is well accepted by patients.