Clinical predictors of axillary lymph node metastasis in early breast cancer in Indian patients

Background: Surgical dissection is the accepted mode of staging the axilla in breast cancer. Proper prediction of axillary node positivity can help towards stratifying patients. The primary objective of the study was to assess the clinical factors influencing pathological axillary lymph node positivity in early carcinoma breast.Methods: This was a retrospective study, conducted at a tertiary cancer centre. Case records of all the patients with invasive breast cancer which are clinical T1 and T2 and either N0 or NI, from January 2011 to October 2014 were analysed. Clinical profile of the patient including age, BMI, comorbid, menstrual history, family history, symptoms, site of the lesion, size, single or multi centric origin were analysed.Results: Total of 608 patients of early breast cancer analysed of which 248 had pathological nodal positivity. The age group of 51 to 75 years, BMI ≥30, pre-menopausal patients had significant positive predictive value when compared to post-menopausal. Tumours in lower outer quadrant, central sector and multiple tumours also had positive predictive value. Clinical T2 when compared to clinical T1 stage and MRM when compared to BCS had significant positive predictive value.Conclusions: To conclude in present study age of the patient and clinical location of the tumour and surgery performed emerged as significant independent predictive factors of positive lymph node. Prospective studies are required to further prove the significance of these factors

Bleeding jejunal metastases arising from primary alveolar soft part sarcoma of thigh

Alveolar soft part sarcoma (ASPS) is a rare tumor (0.5–1% of sarcomas) of unknown etiology with a highly characteristic morphology. It tends to occur more often in the younger age group with a predilection for the female sex. Prognosis is generally poor and it often presents with late metastases. Here, we report the case of a 48-year-old female, who presented to the emergency department with a complaint of giddiness and melena. She was a known case of sarcoma ASPS left thigh with pulmonary secondaries. On evaluation, a bleeding tumor in the upper jejunum was found on upper GI endoscopy. As the patient’s hemodynamics were unstable, she had to be operated without further imaging. Post-operative period was uneventful

Effects of pre-operative isolation on postoperative pulmonary complications after elective surgery: an international prospective cohort study an international prospective cohort study

We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05–1.36, p = 0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3 days, with an OR (95%CI) at 4–7 days or ≥ 8 days of 1.25 (1.04–1.48), p = 0.015 and 1.31 (1.11–1.55), p = 0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care. We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05–1.36, p = 0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3 days, with an OR (95%CI) at 4–7 days or ≥ 8 days of 1.25 (1.04–1.48), p = 0.015 and 1.31 (1.11–1.55), p = 0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care