Background: Pancreaticoduodenal injuries are considerably associated with high morbidity and mortality due to delayed diagnosis   and subsequent delay in treatment. This makes the treatment of these injuries challenging. We have studied the presentation, diagnosis, management and outcome of these complex injuries. Methods: A prospective observational study was done at general surgery department, Government medical college Nagpur from October 2020 to September 2022. Mortality, morbidity, and various treatment modalities were evaluated. Results: Thirty two patients presented to the Trauma care center with history and symptoms suggestive of isolated pancreatic, duodenal, and combined pancreaticoduodenal injuries. Most of the injuries were blunt trauma cases. The ratio of hemodynamically stable: unstable was 1:1. Majority injuries were to pancreas followed by duodenum and combined organ injuries. Most of cases were diagnosed by CT scan. In this study 56% of cases had a non-operative line of treatment while 44% underwent surgical intervention. Among the patients operated 5 died, within 7 days of admission due to post-operative complications-hemorrhage, sepsis, aspiration pneumonia, and anastomotic leak. Two patients died due to delayed complications due to the development of pancreatic fistula and enterocutaneous fistula. Mortality rate was 27.2% in this study. Conclusions: Early presentation and prompt diagnosis is the key to the management of such injuries. Patients managed conservatively need close monitoring, repeated assessments, and long-term follow-up.

Background: Axillary lymph node sampling is considered as one of the most pivotal investigations in determining the lymph node status in management of carcinoma breast. The present study attempts to assess sensitivity, specificity and positive predictive value of axillary four node sampling (FNS) in management of carcinoma of breast, and its efficacy in downstaged patients.Methods: A total of 35 patients, node negative operable cases of carcinoma breast and locally advanced breast cancer (LABC) patients downstaged after 3 cycles of neoadjuvant chemotherapy, were enrolled. Lymph node mapping was done by injecting 3 - 5 ml of methylene blue dye, just before surgery. Level 1 lymph nodes stained by methylene blue were sampled and axillary dissection was carried out, level 3 lymph nodes were identified and sampled, rest of the axillary dissection specimen was sent as a separate sample for histopathological examination , node positivity was compared in level 1 and level 3 , and conclusions were drawn.Results: The sensitivity, specificity for FNS in node negative operable cases were found to be 83.33% and 91.3% respectively.  The negative and positive predictive value were found to be 95.40% and 71.42% respectively. Specificity of FNS in LABC downstaged patients was found to be 40%.Conclusions: Targeted four node sampling using methylene blue dye can be considered as an alternative method for sentinel lymph node. Further study should be conducted to establish it as a reliable method for axillary lymph node staging.