Asian Journal of Pharmaceutical Research and Health Care

Ravi Ranjan ¹, Vivek Srivastava ², Mumtaz A. Ansari ³

Affiliations
1 Junior Resident, Department of General Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi − 221005, Uttar Pradesh, IN
2 Associate Professor, Department of General Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi − 221005, Uttar Pradesh, IN
3 Professor, Department of General Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi − 221005, Uttar Pradesh, IN

Abstract

This study aims to compare the outcome of Total Extra Peritoneal (TEP) hernia repair procedure with or without using mesh fixation device. A total of 60 patients with clinically diagnosed, non-recurrent, uncomplicated symptomatic inguinal hernias were randomized into two groups: 30 patients to TEP with fixation of mesh and 30 patients to TEP without fixation of mesh. Visual Analogue Scale (VAS) was assessed during the immediate postoperative period at 1, 6, and 24 hrs and at 1 week and at 3 months of follow-up. We analyzed demographic profile, symptoms and examination findings, operative variables, postoperative complications, stay in hospital and cost of treatment. The mean ages were 45.8±13.74 years for the non-mesh fixed group and 55.47±16.74 years for the mesh fixed group. The patients in the mesh fixed group were significantly older than non-fixed group (p = 0.017). After 1, 6 and 24 hours of surgery, the mean VAS score was significantly low in non-fixed group (p=0.003, p=0.033 and p=0.047 respectively). After 1 week and 3 months of surgery, the VAS score was comparable in both the groups (p=0.126, p=0.183). The mean duration of surgery in both the groups were comparable (p=0.258). The mean analgesic use in mesh fixed group was 1.42±0.62 and in non-fixed group was 1.18±0.57 which was comparable (p=0.124). Prior to discharge, the mean analgesic use was significantly less in non-fixed group (p=0.003). On comparing complications, urinary retention was significantly less in non-fixed group (p=0.0.028). The mean length of hospital stay and mean time to return to normal activities were significantly less in non-fixed group (p=0.026 and p<0.001 respectively). In non-fixed group, the cost of treatment was significantly low (p<0.001). TEP repair is feasible and safe without mesh fixation device.

Keywords

Inguinal Hernia, Mesh Fixation, Total Extra Peritoneal (TEP) Repair.

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Mumtaz Ahmad Ansari ¹, Anand Kumar ¹, Afreen Ali ¹, Awgesh Kumar Verma ¹, Mohit Mangla ¹, Pratik K. Jha ¹, Vivek Srivastava ²

Affiliations
1 Department of General Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi-221005, U.P., IN
2 Department of General Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi-221005, U.P., IN

Abstract

Developing new therapeutic methods and exploring other possible future strategies in Triple Negative Breast Cancer (TNBC) is an area of interest. Angiogenesis is one such sought for area that can even serve as a targeted therapy in this subset of breast cancer. The objective of the study was to evaluate the prognostic factors in TNBC patients with emphasis on angiogenesis. Prospectively 120 patients with histologically confirmed breast cancer from June 2015 to July 2019 were included. The Colour Doppler evaluation of breast lump and axilla in terms of RI, PI and Vmax was done. Patients were categorized as having ‘high’ or ‘low’ RI, PI and Vmax on the basis of their mean value. Immunohistochemistry (IHC) was performed on viable tumour blocks obtained from mastectomy specimen using CD31 vascular endothelial staining. The idea was to obtain Microvascular Density (MVD) by counting all immunostained vessels at magnification of 400x. The association between TNBC and non TNBC with well-known Doppler parameters, tumour size, clinical lymph node status, number of positive lymph nodes, tumour grade, stage of disease and hormonal receptor status was investigated. Also the association between high and low MVD with these prognostic parameters were evaluated. A total of 120 patients were included in the study with the mean age of 42.43±7.73 years (range 30-65 years). The mean RI, PI and Vmax were 0.92±0.26, 2.19±1.84 and 16.52±10.70 respectively. The comparison between TNBC and non-TNBC with prognostic parameters showed significant association with age of patients, duration of disease, use of oral contraceptive pills (>1 year), tumour size, histological grade, RI and MVD (p=0.041, p=0.011, p=0.002, p=0.029, p=0.026, p=0.014 and p=0.007 respectively). The MVD value >13.17 (high) was found in 45 (37.5%) patients while 75 (62.5%) patients had low MVD value (<13.17). The high MVD (>16.52) was significantly associated with tumour size (p<0.001), axillary lymph node (p=0.022), clinical stage (p=0.015), histological grade (p<0.001), RI (p<0.001), ER status (p<0.001) and HER2 over expression (p=0005). TNBC is a subset of breast cancer showing aggressive biological behaviour as seen by presence of poor prognostic marker and increased vascularity.

Keywords

Colour Doppler, CD31, Micro-vessel Density, Triple Negative Breast Cancer.

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