The aim of this article is to evaluate the role and safety of laparoscopic management of hydatid disease of liver using Palanivelu hydatid system (PHS) 1 with initial results. A prospective study of hepatic hydatid cyst underwent laparoscopic management using PHS, during the period from June 2008 to October 2010, in department of general surgery in a tertiary care institute. Selective patients were included in our study. Preoperatively 2 weeks and post operatively 6 weeks of Albendazole were given. All patients underwent surgery under general anesthesia. Hydatid cyst evacuation and omentoplasty were done with PHS system to prevent spillage. Cyst was irrigated with 2 % savlon. Drainage tube was kept near the cyst. There were 32 patients with 35 liver hydatid cysts operated. The mean operative time was 93.78 (70-180) min. Intraoperative complications were noted in two patients (6.2 %). Conversion was required in one patient (3.1 %). The mean duration of hospital stay was 3-10 days with an average of 5 days. There was no recurrence in mean follow-up of 3 years. There was no mortality with good subjective and objective cosmetic results. The laparoscopic cyst evacuation and omentoplasty using PHS are feasible and safe for treating the hydatid cyst of liver in selected patients. It aids early recovery with good cosmetic results.

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.

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Abstract:Fibroadenomas usually present as single lesion in breast and there are few reports in literature of multiple fibroadenomas in both breasts. Multiple lesions in single breast are seldom reported. We report a rare case of multiple fibroadenomas, 12 in number, in a young girl in left breast. Diagnosis was made ultrasonographically and with aspiration cytology. We managed to remove all lesions with 2 submammary incisions. There was no recurrence seen on follow up of 3 years.

Aims and Objective: Aim of the present study was to compare the clinical efficacy of 0.5% hyperbaric solutions of ropivacaine versus bupivacaine in terms of characteristics of spinal blockade, haemodynamic stability, recovery profile and side effects. Material and Method:The study enrolling 100 patients (age 20-60 years) of either sex, ASA grade I & II were randomly allocated in two groups. Group R received 3 ml of 0.5% hyperbaric ropivacaine with glucose 8.33% and Group B received 3 ml of 0.5% hyperbaric bupivacaine with glucose 8%. After induction, we studied the various parameters of subarachnoid block, hemodynamic variables, recovery and side effects. Result: Hyperbaric ropivacaine had late onset of sensory blockade, equal time to reach maximum dermatome level, early regression and shorter total duration of sensory blockade as compared to bupivacaine. Ropivacaine shows late onset of motor blockade, less degree and total duration of motor blockade as compared to bupivacaine. Ropivacaine was more hemodynamically stable as compared to bupivacaine. Both the sensory and motor blocks were subject to a more rapid recovery with ropivacaine compared with bupivacaine. Hyperbaric ropivacaine was not associated with any side effects intra and postoperatively. Conclusion: 3 ml of hyperbaric solution of ropivacaine 0.5% with glucose 8.33% can produce predictable and reliable spinal anaesthesia for a wide range of surgical procedure.