Max Healthcare

About: Max Healthcare is a healthcare organization based out in New Delhi, India. It is known for research contribution in the topics: Population & Medicine. The organization has 391 authors who have published 410 publications receiving 14404 citations.

A multi-institutional real world data study from India of 3453 non-metastatic breast cancer patients undergoing upfront surgery.

Abstract: The present analysis reports the clinical, pathological, treatment profile and overall survival (OS) and disease-free survival (DFS) outcomes of consecutive breast cancer patients from three Indian centres, who underwent curative surgery as their first treatment. Among the 3453 patients, stage I, II, and III cases were 11.75%, 66.79%, and 21.64%, respectively while hormone receptor positive/HER2 negative, triple negative (TNBC) and hormone receptor any/HER2 positive cases were 55.2%, 24.2% and 20.6%, respectively. The five-year OS in the entire cohort, node-negative and node-positive patients were 94.1% (93.25–94.98), 96.17% (95.2–97.15) and 91.83% (90.36–93.31), respectively, and the corresponding DFS were 88.1% (86.96–89.31), 92.0% (90.64–93.39) and 83.93% (82.03–85.89), respectively. The five-year OS in hormone receptor positive/HER2 negative, TNBC and HER2 subgroups were 96.11% (95.12–97.1), 92.74% (90.73–94.8) and 90.62% (88.17–93.15), respectively, and the corresponding DFS were 91.59% (90.19–93.02), 85.46% (82.79–88.22) and 81.29% (78.11–84.61), respectively. This is the largest dataset of early breast cancer patients from India with survival outcome analysis and can therefore serve as a benchmark for future studies.

C. R. Berney: “The Endoloop technique for the primary closure of direct inguinal hernia defect during the endoscopic totally extraperitoneal approach”

Abstract: We thank Christoph Berney for his interesting publication, in which he once again draws attention to the important problem of seroma formation in large direct or medial inguinal hernias following endoscopic totaly extraperitoneal patch plasty (TEP) [1]. It can cause patient discomfort and anxiety and often mimics an early hernia recurrence. Its volume is proportional to the size of the preperitoneal dead space after reduction of the hernia. For every direct (medial) defect found in the Hesselbach’s triangle and measuring more than 1.5 cm in diameter, Berney recommends systematic plication with a single (occasionally two) Endoloop Ligature of PDS II. From his results, Berney concluded that his technique is safe, efficient, and very reliable for the prevention of postoperative seroma formation [1]. In the ‘‘Guidelines for laparoscopic (TAPP) and endoscopic (TEP) treatment of inguinal hernia’’ of the International Endohernia Society, it is pointed out on page 2,793 that for large or medial hernias, the extended transversalis fascia should be inverted and fixed to Cooper’s ligament [2]. However, to prevent chronic inguinal pain, no tacks should be used here. Suturing the extended transversalis fascia to Cooper’s ligament is a safer technique [3]. Reduction of this fixed space can effectively prevent the problem of postoperative seroma formation, which manifests externally as a persistent protrusion and is therefore also known as a pseudorecurrence [4]. This postoperative problem also obviates the need for punctures, with their attendant risk of infection. If this fixed space is not reduced in the manner described by Berney or by us, this serohematoma, giving rise to clinical protrusion of the inguinal skin, can be misinterpreted as an early recurrence and in the past has led to reoperations because of a suspected early recurrence [4]. While describing his TEP technique, Berney also states that he uses an anatomic polyester mesh with a lateral slit and fixes each mesh with 2 ml fibrin glue. In the Guidelines, it is pointed out on page 2,816 that there is no evidence to support the use of a slit in the mesh for laparoscopic inguinal hernia repair. One study found some of the recurrences to be associated with insufficient closure of the mesh slit. This could argue against slitting the mesh at all [2]. Nor is it generally necessary to use fibrin glue to fix meshes for the TEP technique. In the Guidelines of the International Endohernia Society, it is recommended on page 2,816 that for the TAPP and TEP technique for hernia types LI, II and MI, II, defined in the EHS classification, all forms of fixation can be dispensed without any increase in the recurrence rate. This, on the one hand, rules out any risk of acute and/or chronic inguinal pain induced by tack fixation and, on the other hand, markedly reduces the costs incurred. Based on our own experiences, mesh fixation can be omitted in more than 95 % of TEP cases [3]. F. Köckerling D. A. Jacob (&) Department of Surgery and Center of Minimally Invasive Surgery, Vivantes Hospital, Neue Bergstr. 6, 13585 Berlin, Germany e-mail: dietmar.jacob@vivantes.de

Minimally Invasive Anal Fistula Treatment (MAFT)—An Appraisal of Early Results in 416 Patients

Abstract: Minimally invasive anal fistula treatment (MAFT) was introduced to minimize early postoperative morbidity, preserve sphincter continence, and reduce recurrence. We report our early experience with MAFT in 416 patients. Preoperative MRI was performed in 150 patients initially and subsequently thereafter. The technique involves fistuloscope-aided localization of internal fistula opening, examination and fulguration of all fistula tracks, and secure stapled closure of internal fistula opening within anal canal/rectum. MAFT was performed as day-care procedure in 391 patients (93.9 %). During surgery, internal fistula opening could not be located in 100 patients (24 %). Seven patients required readmission to hospital. Mean visual analog scale scores for pain on discharge and at 1 week were 3.1 (1–6) and 1.6 (0–3), respectively. Mean duration for return to normal activity was 3.2 days (2–11 days). Fistula recurrence was observed in 35/134 patients (26.1 %) at 1 year follow-up. MAFT may be performed as day-care procedure with benefits of less pain, absence of perianal wounds, faster recovery, and preservation of sphincter continence. However, long-term results from more centers are needed especially for recurrence.

Microvillous inclusion disease--an ultrastructural diagnosis: with a review of the literature.

Abstract: Microvillous inclusion disease is a rare disorder of infancy associated with protracted diarrhea. This malady reveals distinct ultrastructural changes. The surface enterocytes of the duodenum show vesicles lined with microvilli and the surface microvilli are poorly formed. The authors present one case of microvillous inclusion disease with a review of the literature.