Introduction: Locally advanced breast cancer (LABC) is a subset of breast cancer characterized by the most advanced breast tumours in the absence of distant metastasis. Treatment of LABC has evolved from a single modality treatment to multimodality management. Neoadjuvant chemotherapy (NACT) is increasingly being used to treat patients with LABC. This study assessed tumour response after NACT using clinical changes, Response Evaluation Criteria in Solid Tumors (RECIST) criteria and pathological report. Methodology: This study was a prospective as well as retrospective observational study carried out in the department of general surgery, Dr. Sampurnanand Medical College, Jodhpur. All the patients admitted with stage III (IIIA, IIIB, IIIC) were included in the study after obtaining approval from the institutional ethical committee. Clinical response was assessed by RECIST criteria (clinical complete response (cCR), clinical partial response (cPR), clinical progressive disease (cPD), and clinical stable disease (cSD)) and pathological response by histopathological report (pCR). Response of various molecular subtypes was noted. Results: Among 31 patients included in the study, cCR observed in 22.58% cases, cPR observed in 61.29% cases while cPD and cSD seen in 3.22% and 12.90% cases, respectively. Pathological complete response (pCR) observed in 19.35% cases. Favourable response seen with human epidermal growth factor receptor 2 (HER2) overexpression (cCR = 50%, pCR = 37.50%) followed by triple negative (cCR = 25%, pCR = 25%) molecular subtypes. Conclusions: It can be concluded that molecular subtype determination helps in deciding treatment protocol in patients with LABC with HER2 overexpression and triple-negative breast cancers having a better clinicopathological response to NACT than luminal subtypes. NACT results in downstaging of tumours, thus, help in achieving surgically clear margins and elimination of micrometastases which decreases the recurrence rates and morbidity/mortality of patients.

Background: Aim of this study was to validate thoracic trauma severity score (TTSS) in assessing the requirement of mechanical ventilation, mortality, and predicting prognosis in chest injury patients.Methods: This study was conducted in department of general surgery, Dr. S. N. Medical College, Jodhpur, Rajasthan, from December 2018 to September 2019. This was a single centred, prospective, observational study, conducted in 110 patients, aged >18 years, of isolated chest injury, excluding polytrauma patients. Data was summarized in the form of proportions, histograms and tables to show relationships of parameters with results. Data was presented as mean±SD and proportions as appropriate. Chi square test, z test or t tests were used wherever necessary for association analysis between categorical variables. Diagnostic test characteristics for mortality and complications was calculated from the ROC curves. A two sided of p values of less than 0.05 was considered statistically significant.Results: Most common mode of chest injury was blunt trauma and most common age group affected was 42-54 years. Maximum mortality was seen in TTSS between 16-20, shows higher the TTSS more the mortality. Ventilator requirement was more in high TTSS. Patients with higher TTSS had longer hospital stay as compared to patients with lower TTSS.Conclusions: On application of TTSS on admission, TTSS had direct correlation with need for oxygenation, ventilator need, duration of hospital stay, mortality or outcome in chest trauma patients. Thus we recommend TTSS as a good useful score for evaluation of prognosis, outcome and mortality in chest trauma patients.

Background: HIV infection affects the differential diagnosis of surgical disease nutritional status and life expectancy. Some have suggested that HIV infection may also influence post-operative wound healing and complication rates. Others have stated that HIV infection should have only minor influence on decision-making for many surgical conditions and therefore standard surgical approaches are appropriate.  Methods: All HIV positive patients admitted in general surgical wards were divided into two groups- 1. Conservative, 2. Operative. Operative patients were placed into 4 subgroups according to CDC surgical wound classification-Clean, clean-contaminated, contaminated and dirty-infected. Patients were followed up in post-operative ward till discharge or mortality. At the time of discharge outcome were rated as-Good, fair and poor.Results: Patients between age 31-30 and 41-50 years were commonly and equally affected (60.6%). Farmer males were predominantly involved in all age groups except of age group >50 years. 28 (84.85%) patients were on ART therapy. Most common affected body part is abdomen (60.60%). In 22 (66.67%) cases operative procedure done; among them 14 (63.63%) were emergency and 8 (36.37%) were elective. Fistulectomy (25%) was commonest in elective surgeries and open appendicectomy (35.71%) was commonest in emergency surgeries. In 4 cases systemic complications occurred and one case had local complication. 30 patients were discharged in satisfactory condition and 3 patients expired.Conclusions: No significant correlation between survival outcomes (mortality and morbidity) with hospital stay (p=0.444), between type of operation (emergency or elective) and mortality (p=0.502) and demographic and clinical variables (age, gender, hospital stay, effective antiretroviral therapy (ART) duration) to survival outcome of HIV patients.

Summary Four mg of lorazepam was given intravenously 5 min prior to thiopental anaesthesia in 5 clinically healthy dogs weighing 14 ± 2 kg and aged about 10–12 months. Animals required only 7.0 ± 1.5 ml of 5% thiopental sodium to achieve surgical anaesthesia which lasted about 30.4 ± 3.3 minutes. There was adequate muscle relaxation and loss of pedal and palpebral reflexes. Five min after administration of lorazepam, there was no appreciable change in various cardiopulmonary dynamics. However, there was moderate arterial hypertension, tachycardia and arterial hypoxemia 15 min after the onset of the thiopental anaesthesia. There was no respiratory depression. The lorazepamthiopental combination was also attempted in 16 clinical cases varying from repair of fractures of long bones (9), mammary tumour (2), ear haematoma (1), ear cropping (1), tail gangrene (2) and rectal prolapse (1). This combination of anaesthesia proved extremely useful for orthopaedic surgery as the muscle relaxation was adequate and reduction of the fractured ends was comparatively easier. Zusammenfassung Untersuchungen zur Eignung von Lorazepam für die Prämedikation bei der Thiopental‐Anästhesie des Hundes Bei fünf klinisch gesunden Hunden (Gewicht: 14 ± 2 kg; Alter: 10–12 Monate) wurden 5 min vor der Induktion einer Thiopental‐Anästhesie 4 mg Lorazepam intravenös verabreicht. Zur Erreichung einer operationstauglichen Narkose, die 30,4 ± 3,3 min anhielt, genügten für die Tiere 7,0 ± 1,5 ml einer 5%igen Natrium‐Thiopental‐Lösung. Die Muskelrelaxation sowie die Ausschaltung der Reflexe war hinreichend. Fünf min nach Verabreichung von Lorazepam ergaben sich keine deutlichen Veränderungen von Parametern der Herz‐ und Lungenfunktion. Jedoch wurde 15 min nach Beginn der Thiopental‐Anästhesie ein mäßiger arterieller Hochdruck, eine Trachycardie und eine arterielle Hypoxämie beobachtet. Eine Atmungsdepression trat nicht auf. Die Kombination von Lorazepam und Thiopental wurde auch bei 16 klinischen Fällen erprobt, nämlich bei der operativen Behandlung von Frakturen langer Knochen (9), von Mamma‐Tumoren (2), eines Ohrhämatoms, beim Kupieren der Ohren (1) sowie bei der operativen Behandlung von Schwanz‐Gangränen (2) und eines Rectum‐Vorfalls. Die betreffende Kombination erwies sich insbesondere für die orthopädische Chirurgie als sehr gut geeignet, da die Muskelrelaxation angemessen war und die Reposition der Bruchenden leicht durchgeführt werden konnte.

Background: Platelet-rich plasma (PRP) can potentially enhance healing of chronic non-healing ulcer by increasing the delivery of various growth factors from the α-granules contained in platelets. Aim of this prospective randomized study was to evaluate the efficacy of autologous PRP versus normal saline (NS) at chronic non healing ulcer in relation to wound healing on the basis of ulcer size reduction, duration of healing, complete or partial healing and side effectsMethods: Fifty four patients with chronic non-healing ulcer were randomly divided into two equal groups: PRP group (treated with PRP) and NS group. Observations were made regarding pain, slough, discharge, granulation, reduction in ulcer size and volume on every 7th day till 4 weeks.Results: Reduction in area and volume of ulcers at the end of treatment was 12.27±4.10 cm2 and 6.88±5.26 cm3 in PRP group and 9.25±1.89 cm2 and 4.25 ±1.05 cm3 in NS group. In PRP group 59.25% had no discharge, 74.08% had no slough, 62.97% had no pain while in NS group no patient was without discharge, 14.81% patient had no slough, 74.07% had minimal pain on 28th day. In PRP group 22.22% ulcers were completely healed while in NS groups all ulcers were partially healed.Conclusions: PRP is more effective than NS on chronic non-healing ulcers as it causes more rapid healing, rapid relief from pain and early decrease in discharge and slough in all age groups and sex; irrespective of type, size, site, duration and etiology of ulcer.