Post-operative pain management has been a constant challenge to many of the surgeons. There is a need for developing newer modalities which can provide good analgesia with fewer side effects. A randomized clinical trial was designed with a sample size of 60 patients, which were divided into two groups. These were randomized to receive intramuscular diclofenac sodium injection (Group A) or diclofenac diethylamine transdermal patch (Group B) after 1 hour from the time of spinal anaesthesia. Statistical analysis was done using UNPAIRED t-test and Mann-Whitney test. It was concluded that diclofenac diethylamine transdermal patch is effective in the management of post-operative pain after inguinal hernia mesh repair. Pain scores were significantly lower in diclofenac patch group. Meantime of rescue analgesia is longer in diclofenac patch group. Demand for rescue analgesia is lower in diclofenac transdermal patch group. However there is a need for broader studies to confirm the above results.

OBJECTIVE:To study the Local Recurrence and metastasis pattern after BreastConserving Surgery for early breast cancer. MATERIALS AND METHODS: From 2010 to 2014 in department of surgery in VIMS Bellary, 70 patients with stage I or II invasive breast carcinoma were treated with breast-conserving surgery, radiation and chemotherapy. In this study we investigated the prognostic value of clinical and pathological factors in early breast cancer patients treated with BCS. All of the surgeries were performed by a single surgical team. Recurrence and its risk factors were evaluated. KEYWORDS: Breast Cancer; Breast Conserving Surgery; Recurrence, Metastasis. INTRODUCTION:Breast conserving treatment (BCT), including primary tumor excision, axillary node dissection (Determined in advance or decided following sentinel node sampling) and external beam radiation treatment (RT) and chemotherapy to the breast, is considered standard of care for women with early-stage breast cancer in most countries. Six prospective randomized clinical trials comparing BCT to mastectomy in stage I-II invasive breast cancer did not show any significant difference between the long-term overall survivals of two treatments. (1) An important incidence of ipsilateral breast tumor recurrence (IBTR) for stage 0, I and II patients following BCT. (2) has been observed after 20 years of follow-up: 8.8% following quadrantectomy plus RT. (3) and 14.3% following tumorectomy plus RT. (4) In particular, IBTR rates are remarkably high in patients omitting the radiation treatment: 23% at 10 years following quadrantectomy. (5) and 39% at 20 years following tumorectomy. (4) The main treatment of breast cancer is surgery, including breast conserving surgery (BCS) or mastectomy. BCS means resection of tumor with clear margins and acceptable cosmetic outcome. Lymph node involvement and tumor size are known as the most important clinical prognostic factors in breast cancer. [5] In the past, molecular markers such as p53 have been investigated for determining prognosis but the result of these studies are sometimes not identical.This may be due to genetic diversity of patients and heterogeneity in malignant tumors. [6,7,8] In this study, we evaluated the local recurrence and metastasis of the patients treated with BCS for breast cancer considering clinical and pathological grading.

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Keloids and hypertrophic scars remain a nagging problem even with the emergence of multiple modalities in their treatment. The wide range of modalities used for their treatment also point out that no single treatment is definitively superior. AIMS: The aim of this study was to define the role of Bleomycin and to confirm its effectiveness in the management of keloids and hypertrophic scars. SETTINGS AND DESIGN: This was a prospective clinical trial involving 40 patients with hypertrophic scars and keloids. METHODS AND MATERIAL: Patients were followed for 1year in department of general surgery VIMS Bellary, treated with four monthly intralesional injections of Bleomycin. Assessment of the size of keloids and hypertrophic scars was done at the beginning, at the time of stopping the therapy and during the follow-up. EXCLUSION CRITERIA: patients under 18 years were not considered suitable for this treatment; pregnant and women likely to become pregnant women were not enrolled in the study. STATISTICAL ANALYSIS USED: The response to treatment was divided into the following categories: <25 percent flattening=poor response, 26-50 percent flattening=fair response, 51-75 percent flattening=good response and >75 percent flattening = excellent response. RESULTS: Of the forty patients, 27(67.5%) showed excellent response, 6(15%) showed good response, 4(10%) showed fair response and 3(7.5%) showed poor response. There was complete resolution of symptoms in 24 patients (60%) and improvement in the other 16(40%). CONCLUSIONS: In the treatment of hypertrophic scars and keloids, the intralesional injection of Bleomycin is very effective and safe.