Post orchiectomy management in stage II testicular seminoma.

Twenty eight patients with stage II A and twenty patients with stage II B testicular seminoma were treated at this institute between January 1982 and December 1988. The three year crude survival observed in this retrospective analysis was 82% and 75% respectively. Post orchiectomy infradiaphragmatic radiotherapy was the mainstay of the treatment. In stage II A 4 patients were administered adjuvant chemotherapy as well. Prophylactic Mediastinal Irradiation (PMI) was not employed as a routine in this subgroup. Eight patients (28%) relapsed (Mediastinal Nodes--4, Pulmonary--3, Scrotal--1). In stage II B twelve patients were treated with primary abdominal radiotherapy and of them 4 were delivered PMI as well. Induction chemotherapy was administered in remaining 8 patients. Seven patients (35%) relapsed (Pulmonary-4, Mediastinal Nodes-3). Mediastinal recurrence was noted only in those who were treated with abdominal radiotherapy alone. Though salvage chemotherapy proved successful in 5 of the seven patients (70%) with nodal relapse, none of the patients with extranodal relapse responded to subsequent chemotherapy. For stage II A we recommend abdominal radiotherapy alone and for stage II B Induction chemotherapy is advised keeping radiotherapy reserved for residual mass. We do not advocate PMI as a routine in stage II testicular seminoma as no survival benefit is observed.

Insulin administration reverses the metabolic and electrocardiographic changes in acute myocarditis induced by Indian red scorpion (Buthus tamulus) venom in experimental dogs.

Acute myocarditis was produced by injection of 4 mg/kg Indian red scorpion (Buthus tamulus) venom in dogs. Several rhythm changes, conduction defects, infarction-like pattern and many other ECG abnormalities; hyperglycemia, reduced insulin secretion, rise in free fatty acids along with fall in triglycerides; depletion of glycogen content of atria, ventricles, liver and skeletal muscles was noticed within 20-30 minutes after scorpion envenomation. Ten units of crystalline insulin was given i.v. at this time. All the arrhythmias, conduction defects and other ECG abnormalities disappeared after intervention with insulin. The sinus rhythm persisted for a duration of 120 minutes till the animals were sacrificed. Reduction in free fatty acids along with a rise in triglycerides; glycogenesis in liver, cardiac and skeletal muscles was observed at the time when ECG tracing was normal. It is suggested that catecholamines released during autonomic storm in scorpion poisoning suppress insulin secretion. These in turn result in glycogenolysis; lipolysis resulting in increased free fatty acids and produce arrhythmias. Insulin administration results in glycogenesis; lipogenesis and stops arrhythmias.