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Background: Low-pressure pneumoperitoneum (LPP) is an attempt to improve laparoscopic surgery. Lower pressure causes lesser inflammation and better hemodynamics. There is a lack of literature comparing inflammatory markers in LPP with deep NMB to standard pressure pneumoperitoneum (SPP) with moderate NMB in laparoscopic cholecystectomy. Methodology: This was a single institutional prospective randomized control trial. Participants included all patients undergoing laparoscopic cholecystectomy for symptomatic gall stone disease. Participants were divided into 2 groups group A and B. Group A—Low-pressure group in which pneumoperitoneum pressure was kept low (8–10 mmHg) with deep Neuromuscular blockade (NMB) and Group B—Normal pressure group (12–14 mmHg) with moderate NMB. A convenience sample size of 80 with 40 in each group was selected. Lab investigations like CBC, LFT, RFT and serum IL-1, IL-6, IL-17, TNF alpha levels were measured at base line and 24 h after surgery and compared using appropriate statistical tests. Other parameters like length of hospital stay, post-operative pain score, conversion rate (low-pressure to standard pressure), and complications were also compared. Results: Eighty participants were analysed with 40 in each group. Baseline characteristics and investigations were statistically similar. Difference (post-operative–pre-operative) of inflammatory markers were compared between both groups. Numerically there was a slightly higher rise in most of the inflammatory markers (TLC, ESR, CRP, IL-6, TNFα) in Group B compared to Group A but not statistically significant. Albumin showed significant fall (p < 0.001) in Group B compared to Group A. Post-operative pain was also significantly less (p < 0.001) in Group A compared to Group B at 6 h and 24 h. There were no differences in length of hospital stay and incidence of complications. There was no conversion from low-pressure to standard pressure. Conclusion: Laparoscopic cholecystectomy performed under low-pressure pneumoperitoneum with deep NMB may have lesser inflammation and lesser post-operative pain compared to standard pressure pneumoperitoneum with moderate NMB. Future studies with larger sample size need to be designed to support these findings. [ABSTRACT FROM AUTHOR]

Mastectomy serves as the main surgical treatment for both invasive and in situ breast carcinoma and large phyllodes tumors. It is associated with skin necrosis, seroma, and surgical site infection in up to 30% of patients. In the present trial, we compared the complications in patients undergoing skin flap elevation by one of the 4 techniques: thick skin flap raised by scalpel(group1), thin skin flap raised with scalpel (group 2), thick skin flap raised with diathermy (group 3), and thin skin flap raised with diathermy (group 4). A randomized trial with superiority hypothesis and 2 × 2 factorial design was conducted at All India Institute of Medical Sciences New Delhi. Mastectomy skin flap necrosis (MSN) was recorded as the main outcome of interest. MSN was noted in 2.5% in group1, 10% in group 2, 7.5% in group 3, and 30% in group 4. MSN was observed in 5% cases with thick flap compared to 20% cases with a thin skin flap (p = 0.007). Raising the flap with scalpel was associated with MSN in 6.25% compared to 18.75% in the diathermy group (p = 0.029). We conclude that raising a thick flap with scalpel is associated with lowest risk of skin flap necrosis. Trial Registration: Clinical Trial Registry- India CTRI/2014/09/004978 [ABSTRACT FROM AUTHOR]

Major mammary duct excision is the standard surgical treatment for patients with periductal mastitis presenting with persistent non-bloody nipple discharge or recurrent subareolar sepsis and mammary duct fistula. The present trial was aimed at comparing outcomes following 1.5-cm ductal cone excision versus conventional 3-cm-long excision, in terms of control of periductal mastitis, occurrence of complications, postoperative pain, and the cosmetic outcome. Patients with non-bloody nipple discharge without imaging suspicious of malignancy and history of lactation in the past 6 months were recruited and randomized into two groups, viz., 1.5-cm ductal cone excision and 3-cm ductal cone excision. After completing triple assessment, patients underwent a procedure under local anesthesia and were followed up at 1, 2, and 4 weeks and 6 months to assess postoperative complications, viz., hematoma, surgical site infection, the nipple–areolar complex (NAC) necrosis, pain, NAC sensation, cosmesis, and recurrence. Sixty patients were recruited in this study. Recurrence of nipple discharge was observed in one patient in each arm. Three patients in the 3-cm duct excision group had a partial necrosis of areola and 2 had complete loss of sensation, whereas none was observed in the 1.5-cm duct excision group. More patients had complained of pain in the former group. A total of 86.67% patients experienced excellent cosmesis in the 1.5-cm duct excision group, whereas only 66.67% reported the same in the 3 cm group. The limited 1.5-cm-long ductal cone excision is a safe and effective procedure in ladies presenting with pathological non-bloody nipple discharge. [ABSTRACT FROM AUTHOR]

The fibroadenoma is considered as a manifestation of aberration in normal development and involution (ANDI); however, its exact etiopathogenesis is poorly understood. We investigated the role of oestrogen (ER) and progesterone receptors (PR) in Fibroadenoma, to assess the ER and PR expression in epithelium and stroma of fibroadenoma and to co-relate this expression with the response to centchroman therapy. Fifty ladies with 65 fibroadenomas were investigated. Tissue from core biopsy of lesions was stained for estimating the ER and PR expression in the epithelial cells and in stroma. Patients received tablet centchroman 30 mg daily for 3 months, and the response to therapy was evaluated. A regression ≥ 30% in largest dimension of fibroadenoma on sonography was considered a significant response. The association between the response and ER and PR expression in epithelium and stroma was assessed. In the epithelium: ER positivity = 62.5%; PR positivity = 93.75%. In the stroma, the ER positivity = 2% and PR positivity = 8.3%. Response to centchroman was observed in 33/48 = 68.7%. Among the 33 responders, 23 lesions expressed ER in epithelium, while 10 lesions were ER negative. The relative risk of regression with "ER positivity of epithelium" as exposure = 1.38 (95% CI; 1.35–1.40, p = 0.12). Among responders, 30/33 exhibited PR positivity in epithelium. Expression of ER and PR in the epithelium of fibroadenoma is associated with significant regression in size with 3 months of therapy with centchroman. [ABSTRACT FROM AUTHOR]

Lactational breast abscess results from inadequate or partially treated mastitis. Recently, needle aspiration or catheter suction drainage is being adopted in place of incision and drainage. We planned to evaluate the effectiveness of needle aspiration versus vacuum suction drainage in resolution of puerperal breast abscess. One-hundred-twelve mothers with lactational breast abscess were randomized to either ultrasound-guided needle aspiration or vacuum suction drainage. These patients were followed up on alternate days and assessed for complete resolution of breast abscess, pain in the breast on Visual Analog Scale (VAS) of 0–10, day of return to normal breast feeding, number of aspirations needed, recurrence of abscess and total cost of care. In the suction drain group, 98% of mothers enjoyed complete resolution within 10 days as compared to 87% of mothers treated with needle aspiration. Mean VAS at first follow-up was 2.89 in aspiration group and 2.62 in suction group. The VAS reduced to 0.74 in aspiration group and 0.53 in suction drainage group, at the last follow-up. The mean day of recovery was 7 days for aspiration and 5.73 days for suction. Most patients required 3 aspirations. The mean drainage time was 4.5 days. Vacuum suction drainage is the more effective method for achieving resolution of lactational breast abscess and offers greater patient satisfaction compared to needle aspiration. [ABSTRACT FROM AUTHOR]

Background: Lipomas are benign adipocytic tumours. Surgical excision is the gold standard for treating such lipomas, but it results in unaesthetic scarring. Methods: A total of 126 patients were randomised into two groups. The patients in Group A underwent mesotherapy (n = 66) and those in Group B underwent surgery (n = 60). The patients in Group A group received six sessions of mesotherapy treatment at 2-week intervals. Both groups were followed up for 12 weeks, during which they were assessed for complications arising from treatment, reduction of the size of the lipoma and cosmetic outcomes. Results: The overall mean age of the patients was 32.93 (± 10.1) years old and the mean volume of the lipomas was 2.29 (± 3.8) mL. A 55.86% (P = 0.0032) mean reduction in the volume of lipomas was noted in the patients who received mesotherapy, while one patient showed a gain of 16% by volume. The patients in Group A (cosmetic score ≥ 4: 63%) were happier with the treatment than those in Group B (cosmetic score ≥ 4: 21%). Conclusion: Our findings indicate that mesotherapy modestly reduces the volume of lipomas with very few and minor complications and excellent cosmetic outcomes. [ABSTRACT FROM AUTHOR]

Axillary lymph node dissection (ALND) is an important step in the management of node‐positive operable breast cancer. It is associated with large amount of axillary drainage and increased risk of wound‐related infection. Tranexamic acid (TA) has antifibrinolytic property and is being extensively used in controlling blood loss. However, its role in reducing axillary drainage after ALND is still not well‐established. The aim of this study is to evaluate the effectiveness of TA in reducing the axillary drainage, early removal of the drain, and decreasing the wound‐related infection in breast cancer patients undergoing ALND. This is a prospective nonrandomized double‐armed cohort study. Total of 47 patients were included in the TA group and 46 in the nontranexamic (NTA) group. All the patients in TA group received a single dose of intravenous (IV) TA at the time of induction followed by oral TA for five days after surgery. Both TA and NTA groups had similar proportions of locally advanced breast cancers (57.4% vs 56.5%, P =.90). Majority of them underwent modified radical mastectomy (MRM) (70.2% vs 67.4%, P =.76). Patients in TA group had significantly lower axillary drainage (440 ml vs 715.5 ml, P =.003) with earlier removal of the drain (8 vs 11 days, P =.046). Seroma formation (19.1% vs 32.6%, P =.13) and wound‐related infection (4.3% vs 8.7%, P =.43) were nonsignificantly lower in the TA group. Tranexamic acid reduces axillary drainage and facilitates early removal of the drain after axillary lymph node dissection. [ABSTRACT FROM AUTHOR]

Mastalgia is the commonest cause of visit to the breast clinic. The present study was conducted to assess the efficacy of complete estrogen blockade (CEB) with centchroman and LHRH analog goserelin in the treatment of recalcitrant mastalgia. This is a prospective cohort study of 10 patients with recalcitrant mastalgia. Recalcitrant mastalgia was defined as bothersome breast pain with pain scores of six or more on breast pain chart, lasting for at least 7 days in a month even with therapy with first-line drugs for 3 months. The reduction of VAS to 3 or less at 4 weeks of initiation of treatment was the primary objective. Patients meeting the inclusion criteria received CEB for 3 months and were followed for 3 months to see for their symptom relief/recurrence. The pain scores were recorded. Side effects of the drug were noted. The mean pain score at start of study was 7.8. At 4 weeks of initiation of treatment, pain score became zero in five patients and reduced to less than three in three patients. These responders had maximum pain score of 3 during the follow-up period. None of the patients had adverse effect of the magnitude to request cessation of the treatment. There was no difference in characteristics of patients who responded from those who did not. No differences were seen among women with cyclical or noncyclical mastalgia. Complete estrogen blockade is safe and effective for treatment of recalcitrant mastalgia having a good post-treatment effect. [ABSTRACT FROM AUTHOR]

Breast pain or mastalgia is the common symptom in the breast. The two most common concerns of patients presenting with mastalgia are: the fear that breast pain is a symptom of breast cancer and the presence of severe pain that affects a woman's quality of life. Breast pain requires thorough assessment and should be investigated in the same manner as any other breast symptom. We conducted a systematic review of treatment for breast pain. We searched various reviews, randomized controlled trial, and observational studies over Pubmed and Medline via internet. Searches were carried out on MEDLINE (1950-present), EMBASE (1980-present), and CINAHL (1981-present) using the NHS Evidence Healthcare Databases Advanced Search interface. A further search was also carried out on Cochrane Database of Systematic Reviews (issue 12 of 12, Dec 2011) and Central Register of Controlled Trials (issue 4 of 4, Oct 2011). If no abnormality is found in the breast on assessment, then a combination of reassurance, breast support brassiere, and topical NSAID gel massage are usually effective. Antiestrogen (centchroman/tamoxifen) therapy for 3 to 6 months is the second-line treatment of choice. Danazol may be used in resistant cases. Gamma-linolenic acid or evening primrose oil though commonly prescribed is not effective. [ABSTRACT FROM AUTHOR]