Background: Locally advanced breast cancer (LABC) encompasses a heterogeneous collection of breast neoplasia with widely different clinical and biological characteristics. Multidisciplinary therapy has become the treatment of choice for these patients. The present study was undertaken to study the clinical presentation and effects of various modes of management of LABC.Methods: Total 45 patients presented with stage III and inflammatory carcinoma of breast were included in the study and treated with neoadjuvant chemotherapy, followed by surgery and radiotherapy. Clinical and pathological responses to different chemotherapy regimens were assessed according to World Health Organization criteria. Results: Majority of patients were in stage IIIA (55.6%) followed by stage IIIB (37.7%). Lump was most common symptom in all the cases followed by distortion of nipple (35.5%). After neoadjuvant chemotherapy, 70% of cases had clinical partial response and 25% of cases had clinical complete response and all except one case were converted from inoperable to operable cases. Histopathology was found to be infiltrating ductal carcinoma in 91.1% of cases. Flap necrosis (27.2%) and seroma (15.9%) was major complications of surgery while alopecia (88.8%), anemia (62.2%) were major complications of chemotherapy. Follow up data suggested that 77.7% patients doing well. One patient had expired after developing distant metastasis and 20% patients were lost to follow up.Conclusions: Treatment of LABC is multimodal and neoadjuvant chemotherapy converts inoperable cases to operable cases and improves longevity of life of the patient. The results of inflammatory carcinoma remain to be dismal in spite of multimodality treatment.

Background: The aims and objectives of this article were to compare the advantages, disadvantages associated with percutaneous endoscopic gastrostomy (PEG) and nasogastric (NG) tube and also to compare complications, to measure the outcomes in terms of hospital stay, mortality and improvement in nutritional status.Methods: In this prospective and interventional study 25 patients were selected in each group on an alternate basis. Study was conducted on cases of traumatic brain injury and cerebrovascular accident patients admitted in Department of General Surgery, IGGMC for a period of November 2013- November 2015 with a need to provide prolonged enteral nutritional support. Each patient was assessed by a dietician and received a standard enteral feeding according to their body weight. The main outcome was measures at 4 weeks were complications (tube dislodgement, aspiration pneumonia, tube blockade and peristomal infections) and nutritional status.Results: The anthropometric parameters (mid arm circumference, biceps skin fold thickness and triceps skin fold thickness) and serum albumin showed a rise in PEG group at 4 weeks when compared to baseline (0 week) whereas they showed a decline in NG group at follow up (4 weeks). The NG group has got higher mortality 4 (17%) when compared to PEG group 2 (7%) due to aspiration pneumonia. Hence, PEG is better tolerated with lesser complications better nutritional support as assessed by the anthropometric parameters at 4 weeks.Conclusions: We conclude that whenever feasible percutaneous endoscopic gastrostomy (PEG) feeding is a choice over nasogastric (NG) feeding in patients requiring long term enteral support.

Background- When radical mastectomy with en bloc resection of the axillary contents was the primary treatment for Breast Cancer(BC), the existence of discontinuous metastases or the exact knowledge of patterns of spread of axillary lymph node(ALN) metastases was not a major concern. In the current era where surgical options for BC include incomplete axillary dissections or ALN sampling, this knowledge of lymph node spread is essential for making appropriate therapeutic decisions.Axillary dissection is an essential component of breast cancer surgery, intending to control local recurrence and classify the tumor (pN) stage. Hence the present study is undertaken to study level III ALN dissection in operable cases of breast cancer. Method- A total of 55 patients underwent Modied Radical Mastectomy (MRM) with complete axillary clearance. Demographic data and perioperative details, axillary clearance, histopathological evaluation, surgical outcome and complications were noted. Result- The majority of studies, age group was from 41-50 years (45.45%). Commonest tumor size was 2-5cm (70.91%). The most common stage was III-A(43.64%). Commonest quadrant was the upper outer (30.91%). Commonest histological type was ductal (94.55%) and grade was grade II( 61.82%). Average lymph node dissected per case was 14.3. Percentage of patients with level III lymph node involvement is 50.91% and among them, most common stage –III-A (53.57%), grade- grade II(67.86%), type- ductal (96.43%), quadrant- upper outer (39.29%), tumour size- 2-5cm (64.29%). Level III “skip metastasis” was found in 1 patient (1.8%).34.5% patients had postoperative pain. Conclusion- In a low-middle-income country like India, we advocate axillary clearance up to level III in all operable cases of breast cancer with minimal or no morbidity. However, Randomised Controlled Trials or Meta-analysis should be done for further clearance.