Outcome of Adjuvant Concurrent Chemo-Radiation in Operated Locally Advanced Rectal Cancer.

Background: Rectal cancer is one of the most common cancers in Kashmir, India. The clinical course of patients treated with surgery alone has been characterized by a high death rate and also by the pain and disability associated with pelvic recurrence of the tumor. Adjuvant radiation combined with chemotherapy has been studied for prevention of such recurrences. We treat more than 200 rectal cancer patients annually at our center. Most of the patients registered at our center are those who have been already subjected to surgery at the peripheral hospitals. We studied role of 5-fluorouracil (5-FU) and calcium leucovorin concurrently with radiotherapy in Dukes’ stage B2 and C and toxicities thereof in the adjuvant setting. Objective: To assess the outcome of concurrent chemoradiation in operated locally advanced treated cancer patients. Materials and Methods: In operated Dukes’ B2 and C rectal cancer patients, we conducted a prospective non-randomized study comprising of 40 patients between 2012 and 2014. Patients were treated with two hours protracted infusion of calcium leucovorin 500 mg/m2 on day 1 followed by 5-fluorouracil 500 mg/m2 on days 1 to 5 and repeated four weekly for total of six cycles. Radiotherapy of 45 Gray in 20 fractions was delivered concurrently with chemotherapy for first two cycles. Results: Combination of chemotherapy and radiotherapy in a concurrent setting appears to be more efficient in reducing local recurrence rates and improving survival than either modality alone. Toxicities with this schedule were mostly gastrointestinal mucositis, but no treatment interruption was needed. Conclusion: A combination of 5-fluorouracil and radiotherapy can be administered in operated locally advanced rectal cancer patients.

Injuries to the Spine Mechanics : Anatomical and Orthopedic Aspects.

Vertebral injuries can occur as isolated injuries or may be associated with other injuries. Recognition of the level of injury is important along with the mechanism of injury. The article describes the various types of injuries of the vertebral column along with the main mechanisms and the difference between the types of injuries in the vertebral column.

A Five Year Retrospective Study of Bed Utilization Trends in a Tertiary Care Teaching Institution.

Healthcare resources need to maintain pace with the increasing population and expectations. A hospital bed is a very important but limited healthcare resource. This 5 year study analyses the trends in the various bed utilization indices, bed utilization being an objective measure of the efficiency of any hospital management system. The study indicates that although the various indices fall within the described optimal, there is yet a lot of reserve on the available resources particularly so far as a hospital bed is concerned. The study emphasizes the role of analysis and assessment of bed utilization indices with a view to improving utilization of this scarce resource.

Importance of lymphatic’s in dissemination of breast cancer-Anatomical, pathological, surgical and prognostic implications.

Background: The Breast cancer is one of the most common cancers in females with many subtypes. Breast cancer can spread via hematogenous route as well as lymphatic routes. Knowledge of the lymphatic drainage of breast is required not only for the performance of surgical procedures but also in planning therapeutic radiation, predicting sites of locally recurrent disease. The lymphatic drainage of the breast is considered rich, and identification of the major pathways allows a surgeon to predict the sites most commonly containing lymph-borne metastases. Careful inspection and palpation of Axillary, supraclavicular and parasternal sites for nodal involvement is thoroughly performed for recording location, size, consistency, shape, mobility, fixation, and other characteristics of any palpable lymphadenopathy. Local implications of lymphatic obstruction can be Preau D orange appearance and edema while as distant manifestations can be involvement of Nodes along with dissemination to other organs. The further the lymphatic dissemination , the lesser the favourable prognosis . Pathologic stage combines the findings from pathologic examination of the resected primary breast cancer and axillary or other regional lymph nodes. This connotes the importance of Status of Lymphatics in Breast Cancer .

The gem in gastrocnemius: the fabella -Anatomical and radiological perspective.

Background: Sesamoid bones are small seed like bones which can be found in the hand, knee, and foot. Their unique structure works to protect the tendon, and to increase its mechanical effect. Examples of sesamoid bones include the os acromiale, os styloideum, metacarpal and hallux sesamoids, patella, os trigonum, os calcaneus secundarius, accessory navicular, os peroneum, and os intermetatarseum. The Sesamoid bones are so named because they resemble a sesame seed. WE present a brief description about Fabella , a small Sesamoid bone occasionally found in the lateral head of Gastrocnemius muscle, its surgical and medicl importance. Presence of Fabella can be confused with certain Orthopedic Problems.

Vestibular schwannoma: anatomical, medical and surgical perspective.

The term "acoustic" is a misnomer, as the tumor rarely arises from the acoustic (or cochlear) division of the vestibulocochlear nerve. The correct medical term is vestibular schwannoma, because it involves the vestibular portion of the 8th cranial nerve. They are benign, rather rare tumors. They expand in size and grow larger; they can push against the brain. While the tumor does not actually invade the brain, the pressure of the tumor can displace brain tissue.