ABSTRACT
Objective: To assess late clinical outcomes with image guided intensity modulated radiotherapy [IG- IMRT] in gynecological malignancies
Patients and methods: We have been practicing IG IMRT for gynecological malignancies since January 2009. Here we are presenting our experience with this modern technique at median follow up of 38 months. During whole treatment bladder filling protocol was followed, Both target volumes and critical structures were contoured according to RTOG guidelines. Dose prescribed to clinical target volume [postop bed and nodal volume] was 50.4 Gy in 28 fractions. Cone beam CT [CBCT] scans were taken to quantify the status of target volume and normal structures
Results: 80 patients were evaluated and analyzed who were treated from January 2009 to December 2014. Median age of our patients was 56.5 years. Out of eighty forty four patients [55%] were of carcinoma endometrium and the rest 36 [45%] were of carcinoma cervix. None of our patients experienced late grade 3 or 4 bladder toxicity Although late grade 3 and 4 bowel and rectal toxicity was experienced by single patient. 2.5% patients developed local recurrence, 5% patient developed nodal with distant metastases and 6.25% only distant metastases. Three ol our patients developed lung cancer as second primary during follow up. 76.2% patients are alive with regulaf follow up
Conclusions: Our study concluded that IG IMRI increases patient compliance and reduces long-term side effects in post-operative gynecological malignancies without compromising local-regional control, disease free survival and overall survival
Subject(s)
Adult , Aged , Female , Humans , Middle Aged , Radiotherapy, Intensity-Modulated , Radiotherapy, Image-Guided , Treatment Outcome , Combined Modality Therapy , Pelvis/diagnostic imagingABSTRACT
Background: Plasma Leukocytosis is known to occur in a variety of clinical conditions viz. infections, inflammations and collagen disorders. Apart from these many physiological factors like heat, solar radiation and high altitude also causes leukocytosis. It has been reported that even corticosteroids can cause leucocytosis which is usually polY morphonuclear leucocytosis. Adrenaline administered by various routes like I/M, I/V and S/C is also known to cause a rise in blood leukocytes. It has been reported that even corticosteroids can cause leukocytosis, which is usually polymorphonuclear leukocytosis. Since catecholamines have been implicated in the release of polymorphs from bone marrow into blood in the glucocorticoids induced leukocytosis, this could be a likely mechanism. If so then adrenergic receptors may be mediating this release. Attempt will be made to characterize these adrenergic receptors by studying the effect of some beta blockers on adrenaline induced Leukocytosis. Materials and Methods: The study was conducted in conscious albino rabbit. The rabbits were divided into 3 groups with 6 rabbits in each group beta blockers used in the study were propranolol (0.5mg/kg) and atenolol (0.5mg/kg). Cell counts before drug administration served as control values. Adrenaline was used in the dose of 200microgram/kg. Result: Group1- significant rise in total leukocytes count in the form of 2 peaks, first occurring at 1hr with 21.85% rise and 2nd at 4hr with 41.89 % rise, at 2hr rise was not significant. At 24hr the counts came back to normal values Group2- significant fall in TLC at 1hr +1.2% and at 4hr +5% while at 2hr +2.4%. The fall in TLC at 24hr was insignificant.Group3- significant fall in TLC at 1hr +1.5% and at 4hr +10.2% while at 2hr +7.94%. The fall in TLC at 24hr was insignificant. Conclusion: The beta-blockers Propranolol and Atenolol successfully blocked the rise in blood leukocyte counts induced by Adrenaline which shows that Adrenaline induced leukocytosis occurs through the activation of beta-adrenoreceptors.
ABSTRACT
Background & objectives: Loss of function of adenomatous polyposis coli (APC) has been reported in cancer. The two promoters of APC, 1A and 1B also have roles in cancer. But, the epigenetic role of APC promoters is not yet clear in gallbladder cancer (GBC) and gallstone diseases (GSD). We undertook this study to determine the epigenetic role of APC in GBC and GSD. Methods: Methylation-specific (MS)-PCR was used to analyze the methylation of APC gene. The expression of APC gene was studied by semi-quantitative PCR, real-time PCR and immunohistochemistry (IHC) in GBC, GSD and adjacent normal tissues. Results: Of the two promoters, APC 1A promoter was found methylated in 96 per cent GBC (P=0.0155) and 80 per cent GSD (P=0.015). Exon 1 was downregulated in grade II (P=0.002) and grade III (P=0.0001) of GBC, while exon 2 was normally expressed. Scoring analysis of IHC revealed 0 or negativity in 34.48 per cent (P=0.057) and 1+ in 24.14 per cent (P=0.005) GBC cases suggesting loss of APC expression. Interpretation & conclusions: The present findings indicate epigenetic silencing of APC in advanced GBC. The methylation pattern, followed by expression analysis of APC may be suggested for diagnostic, prognostic and therapeutic purposes in GBC in future.
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Background and Aims: To study and compare the time taken, success and ease of awake tracheal intubation using lightwand-guided ILMA and LMA CTrachTM after application of manual in-line stabilization, in adult patients with simulated cervical spine injury
Methodology: Eighty adult patients were randomized into two groups. In ILMA-LW group trachea was intubated using lightwand-guided ILMA and in LMA CTrachTM group using CTrachTM LMA. After anesthetizing patient's airway with topical local anesthetic, manual in-line stabilization was applied by an assistant, study device was inserted and trachea was intubated through it. The time taken, success and ease of tracheal intubation was noted. The observations of the study were compiled and analyzed statistically. Fischer's exact test and Chi-square test were used for qualitative data. Quantitative data within groups was analyzed using paired t-test and non-parametric Wilcoxon signed rank test and for quantitative data between groups, Student's t-test and Wilcoxon Mann Whitney test was used. The level of statistical significance was taken as p < 0.05
Results: The mean time required for tracheal intubation was 47.86 +/- 11.76 sec in ILMA-LW group as compared to 64.84 +/- 15.97 sec in LMA CTrachTM group [p < 0.001]. Success of tracheal intubation was 87.5% and 80% in group ILMA-LW and group LMA CTrachTM respectively [p = 0.363]. Ease of intubation, number of adjusting maneuvers and intubation attempts, hemodynamic parameters, post-operative oropharyngolaryngeal morbidity and patient's experience of the procedure were comparable between the two groups
Conclusion: In patients with simulated cervical spine injury after application of manual in-line stabilization, awake tracheal intubation through lightwand-guided ILMA [ILMA-LW] was significantly faster than LMA CTrachTM with comparable success and ease of intubation
ABSTRACT
Optimum pain relief after thoracotomy is essential to reduce atelectasis and postoperative pneumonias. The aim of this prospective, double blind, randomised controlled trial was to compare the analgesic and adverse effects of three concentrations of fentanyl with 0.2% ropivacaine in thoracic epidural in patients undergoing thoracotomy and thoracomyolpasty. After getting approval from Ethical Committee, this study was performed in 60 patients of either sex, aged 18-60 years, American Society of Anaesthesiology [ASA] grade I to III. Informed consent was taken from all of the patients, who were recruited and divided into three groups of 20 patients in each group. Patients scheduled for elective thoracotomy surgery were enrolled in the study. Patients with preexisting motor and sensory deficit, addicted to hypnosedative drugs, on chronic opioid or analgesic therapy, sensitive to local anaesthetic or study medication, or having contraindications to regional anesthesia were excluded from this study. In patients, with whom communication difficulties prevented reliable assessment, were also excluded. Patients received either 2.5micro g/ml [Group I], 5.0micro g/ml [Group II] or 7.5micro g/ml of fentanyl [Group III] respectively, with ropivacaine 0.2% via thoracic epidural. Postoperatively, pain at rest, on coughing and with ambulation was assessed using a visual analogue scale [VAS] and observer verbal ranking score [OVRS] at 2, 6, 12 and 24 hours. Sedation scores were also noted. Adverse effects were simultaneously assessed. There was no significant difference in the baseline characteristics between the three groups. The number of patients with episodes of unsatisfactory pain relief, i.e. a VAS scores >40 and OVRS >2, at each of the four assessments postoperatively, was higher in Group I than with Group II or Group III [p < 0.05]. In Group III, four [20%] patients had a sedation score >3 compared with one [5%] in Group II. No patient in Group I had a sedation score >3 [p < 0.05]. In addition, all patients experienced pruritus in Group I compared with 10% and 5% in Group II and Group I respectively. 30% of the patients had emetic symptoms in Group III, compared to 20% and 5% in Group II and Group I respectively [p < 05]. We conclude that a thoracic epidural bolus of 10 ml ropivacaine 0.2% with fentanyl 5.0 micro g/ml provides the optimal balance between pain relief and sedation
Subject(s)
Humans , Male , Female , Pain, Postoperative/prevention & control , Fentanyl , Amides , Thoracotomy/adverse effects , Analgesia, Patient-Controlled , Comparative Study , Prospective Studies , Pain MeasurementABSTRACT
To study the comparative effects of parenteral and oral glutamine therapy on biochemical parameters and reduction in the hospital stay of critically ill patients. Randomized controlled trial. 120 critically ill patients aged 16-60 years admitted to Trauma Ventilatory Unit, Trauma centre King George Medical University, Lucknow. The patients were randomly divided into 3 equal groups, 40 in each group: Group A [control group] received no glutamine; Group B received oral glutamine 20 g/d for 5 days and Group C received l-alanyl-l-glutamine dipeptide 0.3 g/kg/d by intravenous infusion for 5 days. Complete blood count was done at regular intervals of 24 hours. Total proteins and serum albumin were recorded at 5 day intervals. Single blinding was done. The total leukocyte counts [TLC] levels in all the three groups increased after the treatment and the observed increase was least evident in Group C [18.7%], followed by Group B [32.5%] and it was the highest in Group A [38.2%]. A similar observation was made for CRP and lymphocyte levels in all of the three groups. However, a significant decrease was found in total protein and albumin levels. The mean duration of hospital stay of Group C was the least followed by Group B and Group A. Parenteral glutamine in a dose of 0.3 g/kg/d was more efficacious than 20 g/d oral glutamine in increasing/decreasing in the biochemical parameters after the therapy. The duration of hospital stay was similar in all the groups after treatment
ABSTRACT
Objectives: This study was conducted to compare the sedative ef! cacy of bupivacaine 0.5% with lignocaine 2% plus adrenaline in epidural anaesthesia by using BIS monitor
Study design: A randomized, double blind study
Methodology: Sixty patients, ASA physical status I or II, of age group 20-65 yrs, undergoing elective gynaecological surgery under epidural anaesthesia, were randomly but equally placed into two groups [group-B and group-L]
Patients received [2ml/segment] bupivacaine 0.5% or lignocaine 2% with adrenaline in group-B and group-L respectively, to achieve a sensory block up to T8 level. After con! rmation of sensory blockade, propofol infusion was started at a rate of 100 micro g/kg/min to get a BIS value of " 80 and the time was measured [onset time]. Surgery was allowed to start immediately after the onset time. Propofol infusion was titrated to maintain the BIS value at 60-80. Infusion was stopped at the end of surgery. The time taken to reach the BIS of#90 was recorded as 'recovery time. The amount of propofol consumed for onset of sedation and total amount consumed during the surgery were noted and compared
Results: There was no signi! cant difference regarding demographic data and onset time in both groups [P>0.05]. Recovery time was signi! cantly prolonged in group-B than group-L 5.57+1.25 min and 4.38+0.94 min respectively [P<0.05]. Dose of propofol consumed for onset of sedation was signi! cantly low in group-B than group-L, 17.13+4.22 mg vs. 27.77+8.39 mg respectively [P<0.05]. Total amount of propofol consumed was also signi! Cantly low in group-B than group-L, 140.33+34.59 vs. 184.80+38.21 respectively [P<0.05]
Conclusion: We conclude that epidural block with 0.5% bupivacaine is associated with less propofol consumption as compared with 2% lignocaine with adrenaline to maintain BIS 60-80 and hence is more effective
ABSTRACT
The aim of this double-blind, prospective, randomized, controlled study was to compare the effect of addition of ketamine; fentanyl and saline with propofol anesthesia on hemodynamic profile and laryngeal mask airway [LMA] insertion conditions in oral clonidine premedicated children. 180 children [age 2 - 10 years] were at first given oral clonidine [4 microg/kg] 90 minutes before operation, and then were randomly allocated to receive either ketamine 0.5 mg/kg [n=60], fentanyl 1 micro g/kg [n=60] or 0.9% normal saline [n=60] before induction with propofol 3.0 mg/kg. Insertion of LMA was performed within 1 minute of injection of propofol. Heart rate and mean blood pressure were noted 1 min before induction [baseline], immediately after induction, before and after insertion of LMA for up to 3 min. Following LMA insertion, 6 subjective end points were noted-mouth opening, coughing, swallowing, patient's movement, laryngospasm, and ease of an insertion. LMA insertion summed score was prepared depending upon these variables. LMA insertion summed score was nearly similar in ketamine and fentanyl group, which were significantly better than saline group [P<0.004]. Mean blood pressure and heart rate were maintained in ketamine than with fentanyl or saline group. Incidence of prolonged apnea [>120 secs.] was higher in fentanyl group compared to ketamine and saline group. Even in oral clonidine premedicated children, addition of ketamine with propofol provides hemodynamic stability and comparable conditions for LMA insertion like fentanyl propofol with significantly less prolonged apnea
Subject(s)
Humans , Male , Female , Ketamine , Fentanyl , Sodium Chloride , Propofol , Clonidine , Hemodynamics , Laryngeal Masks , Premedication , Child , Prospective Studies , Double-Blind MethodABSTRACT
Anaplastic thyroid carcinoma is an uncommon, highly aggressive malignancy usually presenting in the elderly. An eighteen year old boy was recently diagnosed as anaplastic carcinoma of the thyroid. PET/CECT scan performed for staging, revealed a large FDG avid heterogeneously enhancing thyroid mass with bilateral jugular venous thrombosis, which also showed increased FDG uptake, thus pointing toward tumor thrombus. To our knowledge, this is the first case wherein the PET/CT diagnosis of tumor thrombosis from anaplastic thyroid carcinoma was made in a young patient
ABSTRACT
We report an unusual case of a young male with cerebellar hemangioblastoma treated previously for medullary carcinoma of thyroid, whose PET/CT scans revealed a constellation of findings that suggested the rare Von Hippel Lindau syndrome. The diagnosis was clinched by confirming the findings on whole body contrast enhanced computed tomography [CECT] and contrast enhanced magnetic resonance imaging [CEMR]. The report highlights the need to carefully evaluate subtle findings on PET/CT that could be missed or misinterpreted as other diagnoses. It also adds to the existing literature of two cases with Von Hippel Lindau syndrome and medullary carcinoma of thyroid