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Locoregional recurrences from breast cancer represent a heterogeneous group of disease that poses a therapeutic challenge and needs a multidisciplinary team management. The incidence of local recurrence after breast conservation surgery ranges from 10 to 22% and 5–15% after mastectomy at 10-year follow-up. Management of locoregional recurrence depends on tumor biology, stage at presentation, and prior local and systemic therapy. With improvements in diagnostic, pathological, and surgical techniques, radiation and systemic therapy approach, outcomes in these patients have improved. In this review, we discuss the risk factors, prognostic factors, surgical and reconstruction options, re-irradiation, and role of systemic therapy to define a reasonable treatment approach without compromising oncologic safety and achieve good cosmetic and survival outcomes.

Introduction: Thymoma comprises 20% of all mediastinal neoplasms and 50% of all primary tumours in the anterior compartment. Thymic surgery has undergone a paradigm shift in approach from being transcervical to video assisted. Video assisted thymectomies in selected patients can decrease the inherent morbidities of a trans-sternal approach, while achieving similar therapeutic benefits. Aim: To analyse the technical key points, morbidity and outcomes associated with video assisted thymectomy in early stage thymoma (Modified Masoaka stage I or II) with myasthenia gravis. Materials and Methods: The present study was a retrospective observational analysis of 24 patients with thymoma and Myasthenia Gravis Foundation of America (MGFA) class II to IV myasthenia gravis who underwent video assisted thoracoscopic thymectomy in institution from May 2013 to May 2018. All patients with thymomas which on Contrast Enhanced Computed Tomography (CECT) did not show infiltration of the surrounding structures and were

Conventional chordomas occur most commonly in the sacral region. Currently, wide local excision remains the only hope for a cure in this disease. However, given the substantial morbidity caused by sacrectomy, a delicate balance needs to be established. This study elaborates our experience in managing these complicated cases with the help of a multidisciplinary team approach and outlines the various surgical and functional outcomes of sacrectomy. This was a retrospective observational study. Ten cases of biopsy proven sacral chordoma underwent en bloc resection by a posterior approach from 2011 to 2018 after multidisciplinary evaluation. Data collected and analyzed included demographics, extent of the disease, and operative parameters such as operative time, estimated blood loss, level of vertebral resection, level and number of the most caudal nerve roots preserved, surgical margins, soft tissue, or spinal reconstruction. Postoperative outcomes included time to recurrence and neurological function at 1 year. Mean size of the tumor was 116.1 mm. Three (30%) patients had positive margins. The median time to recurrence was 32 months. Four patients eventually succumbed to the disease due to local or distant recurrence. Bladder and bowel functions were excellent in those with preserved S3. Two patients remained wheelchair bound; the rest were able to walk with or without support. Management of sacral chordoma remains an onerous journey for both the treating surgeon and the patient. A multidisciplinary team approach, with careful preservation of sacral nerve roots, negative surgical margins, and excellent postoperative rehabilitation, can achieve optimum results.

Traditional medical pedagogy is increasingly being threatened by sophisticated diagnostic and prognostic techniques. In a busy OPD, the impatient but eager clinician tends to bypass classical teachings and proceeds to diagnosis based on imaging and other findings. An unusual presentation of melanoma made us realize the importance of basic clinical methods and, how robust and relevant they remain, even in the present era.

Principal Objectives: Knee OA accounts for more than 80% of the joint disorder and as per an estimate in US population, it affects at least 19% of adults aged 45 years and older. In patients of Osteoarthritis knee there is pain and limitations in joint mobility. The pathological features of Knee Osteoarthritis (KOA) include the articular cartilage degeneration, remodelling of subchondral bone, osteophyte formation, ligamentous laxity, and weakening of periarticular muscles. Materials and Methods: The present study was conducted in the Department of Orthopaedics, Rohilkhand Medical College, Bareilly to assess the effect of Proximal Fibular Osteotomy in osteoarthritis of the knee from May 2018 to May 2019. Results: The operation time, blood loss during operation and post op rehabilitation period are significantly shortened in the observation Group. The VAS score (Post-Operatively) is remarkably lessens with notably decreased rate of post-operative complications such as injury to common peroneal nerve, infection, deep vein thrombosis, and deformity recurrence. Conclusion: The short-term clinical and functional effects of proximal fibular osteotomy on varus KOA are excellent.

Introduction: The upper cervical spine includes the atlas (C1) and Axis (C2). The anatomy of upper twovertebrae is unique from each other. Atlanto-axial articulation is the most unique, mobile segment of spine,which largely depends on ligamentous supports based on integrity of odontoid for its stability. Historically,atlanto-axial subluxation was treated by reduction and fusion of C1-C2 joint. However, High riding vertebralartery precludes the placement of posterior trans-articular screw, which is liable to injury during screwplacement. Socomputed tomography scans can be used to evaluate the risk of “high riding” vertebral arteryduring the management of atlanto-axial subluxation. Hence, anterior trans-articular screw fixation techniqueavoids the course of high riding vertebral artery.Material and Method: Nine patients underwent NCCT cervical spine with 3-D reconstruction and clinicalevaluation of pain was done by recording the VAS score done pre operatively and after surgery.Results: All surgical cohorts underwent anterior C1-C2 fixation with an average follow up for 24 months.All patients were assessed as per fixed protocol of our local hospital guidelines of orthopaedics department.Pain score was clinically evaluated by VAS score before and after surgery yielding 90% excellent result.Conclusion: Anterior Trans-articular C1-C2 screw fixation isa minimally invasive technique with less bloodloss, shorter skins car and faster post-operative recovery. It is an appropriate technique for stabilization ofAtlanto-Axial instabilities.

Introduction: Back pain and spinal deformity are common presentation in majority of senile osteoporoticvertebral compression fracture. Vertebroplasty provides pain relief with correction of spinal deformity andleast period of hospital stay.Material and Method: Twenty patients underwent vertebroplasty and clinical evaluation of pain was doneby recording the VAS score done preoperatively and after surgery.Result: Percutaneous vertebroplasty with 1 year followup.VAS score 52% were excellent,14% good and34% fair result.Conclusion: Vertebroplasty is useful in management of vertebral compression fracture which are refractoryto conservative treatment & helps in early mobilization.

BACKGROUND With increasing incidence of thyroid carcinoma, the optimal management of central lymph nodes remains an unanswered question although central neck nodes represent the most common site of recurrence. The aim of this study was to determine the morbidity of prophylactic central neck dissection in differentiated thyroid cancer and to evaluate histopathological correlation between nodal metastases and histological features. METHOD This was a prospective, observational study of 2 years duration (May 2017 to May 2019) involving 30 patients with proven differentiated thyroid cancers and clinicoradiologically negative lymph node with no history of neck surgeries. They all underwent total thyroidectomy with bilateral central neck dissection. Surgical outcomes in the form of transient or permanent hypoparathyroidism, transient and permanent recurrent nerve palsy were assessed along with histopathological correlation of primary tumor with central node positivity. DISCUSSION Classical histology (p = 0.05), >4 cm tumor size (p = 0.04), lymphovascular invasion (p = 0.04) and multifocality (p = 0.04) were all significantly associated with increased risk of central lymph nodal metastasis. The incidence of transient and permanent hypoparathyroidism was 36.3% and 10% respectively. Metastatic lymph node ratio of >60% is significantly associated with increased preablative serum thyroglobulin levels. Around 35% of the pT1 or T2 lesions were upstaged for postoperative radioiodine ablation CONCLUSION An important role of prophylactic central neck dissection may lie in male patients, age > 45years, tumor size >4 cm, extrathyroidal extension, lymphovascular invasion and multifocality in accurate staging and can be performed with minimal morbidity at a high volume center.

The study was aimed to investigate on “Bioregeneration of granular activated carbon adsorbed with analytical-grade hydroquinone compound in sequentially adsorption and biodegradation process.” Initially, the adsorption study of hydroquinone compound was carried out at all optimized conditions until their saturation point, which was achieved within a contact period of 12 h. When the equilibrium level was achieved, a mixed bacterial culture isolated from activated sludge (suited in Rajkot city) has been first acclimatized to the two different concentrations of hydroquinone compound. The experiments are conducted to determine the extent of bioregeneration under specific conditions. It was achieved 37%.

Approximately 95% of cases occur in developing countries 3 . In India, more than 1000 lives are lost every day due to TB despite the availability of modern diagnostic aids and treatment 3 . Tuberculosis kills over 1.7 million people worldwide every year and nearly 40% of patients with active tuberculosis remain undiagnosed because of the poor sensitivity of the current, century old diagnostic method 4 . The situation is further exacerbated with the increasing incidence of drug resistant TB.