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Background: Breast cancer is a very common cancer among females. In which most recurrence (around 75%) occurs within the initial 5 years after diagnosis, especially within 3 years. Recurrence after 20 years is very less reported in the last few decades. Case Information: We are presenting a case of a 67-year old female patient presented with pleural based nodules suggestive of lung metastasis followed by brain metastasis. After reviewing history we came to know that the patient was a previously treated case of breast carcinoma treated 22 years back with mastectomy. Conclusion: We report late recurrence of breast cancer occurring 21 years after mastectomy suggesting that possibility of recurrence in carcinoma breast with 21-years latency period although rare should be taken into consideration when making decisions regarding patients who may need long term follow up.
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BACKGROUND: Evaluation of a HDR- interstitial brachytherapy plan is a challenging job. Owing to the complexities and diversity of the normalization and optimization techniques involved, a simple objective assessment of these plans is required. This can improve the radiation dose coverage of the tumour with decreased organ toxicity. AIM: To study and document the various dose volume indices and parameters required to evaluate a HDR interstitial brachytherapy plan by Volume normalization and graphical optimization using MUPIT (Martinez Universal Perineal Interstitial Template) in patients of carcinoma cervix. SETTINGS AND DESIGN: Single arm, retrospective study. METHODS AND MATERIALS: 35 patients of carcinoma cervix who received EBRT and HDR brachytherapy using MUPIT, were selected. The dose prescribed was 4 Gray/Fraction in four fractions (16Gy/4) treated twice daily, at least 6 hours apart. CTV and OARs were delineated on the axial CT image set. Volume normalization and graphical optimization was done for planning. Coverage Index (CI), Dose homogeneity index (DHI), Overdose index (OI), Dose non-uniformity ratio (DNR), Conformity Index (COIN) and dose volume parameters i.e. D2cc, D1cc, D0.1cc of rectum and bladder were evaluated. STATISTICAL ANALYSIS: SPSS version 16 was used. RESULTS AND CONCLUSION: CI was 0.95 ± 1.84 which means 95% of the target received 100% of the prescribed dose. The mean COIN was 0.841 ± 0.06 and DHI was 0.502 ± 0.11. D2cc rectum and bladder was 3.40 ± 0.56 and 2.95 ± 0.62 respectively which was within the tolerance limit of this organs. There should be an optimum balance between these indices for improving the quality of the implant and to yield maximum clinical benefit out of it, keeping the dose to the OARs in limit. Dose optimization should be carefully monitered and an institutional protocol should be devised for the acceptability criteria of these plans.
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Introduction: Vaccination in adult life is important not only to prevent deaths but also to improve survival and reduce complications and severity of certain communicable diseases. It is a bitter fact that adult immunization coverage is below even 2 % in most of the countries. Knowledge and attitudes related to adult vaccination among medical professionals should also be emphasized as a starting point. Objectives: to assess knowledge, attitude and practice of adult immunization among resident doctors and to estimate adult immunization status among the respondents. Materials & Methods : A cross sectional study was carried out in resident doctors (junior residents and 1st year residents) of tertiary care medical institutes of Ahmedabad city, Gujarat. On the basis of the eligibility criteria (those who gave consent) 244 participants were finally got enrolled for the present study. Pre-tested questionnaire was use for data collection. Results: Mean age of study participant was 26.43 years and mean experience was 1.95 years. Among all adult vaccination status, Hepatitis B vaccination coverage was the highest (75%) followed by Human Papilloma Virus vaccination coverage which was 24.5% (25 out of 102 female). Most of the participant had correct and complete knowledge of vaccines named hepatitis B (82.4%), Rabies 187 (76.6%), Hepatitis A (70.9%), dPT/dT(69.7%) and Pneumococcal (66.4%). Conclusion: Hepatitis B was found to be the “best known, best practiced” adult vaccine thus far. There were wide variations with regards to attitude and practices of different adult vaccines among the respondents.
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Introduction : Phyllodes Tumors (PT) arises from intralobular stroma of breast, accounts for 0.3 to 1% of all primary breast cancers. Only few cases of PT metastatic to bone have been reported so far. Case report : A 33 years old female was presented with a 3 month history of pain and swelling of right thigh and functional deformity of right leg. She had a past history of post lumpectomy with metastasis to left iliac bone; histopathology was suggestive of malignant phyllodes tumor (MPT). She had a pathological fracture of her right femur. Later she developed metastases to multiple bones. Palliative irradiation was considered for left iliac bone, right femur and right scapular metastasis. She then received adriamycin and ifosfamide chemotherapy and zolendronic acid. Currently, she has no symptoms and in a stable condition. Conclusion : MPT is an aggressive neoplasm of the breast with high rates of local recurrence and distant metastases. The limited role of surgery, chemotherapy and irradiation gives a poor prognosis. The metastases occur in a swift manner and average survival is less than 2 years.
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Metastasis to acral skeleton is uncommonly encountered in routine clinical practice. Originating frequently from lung, breast or gastrointestinal malignancies & these are often associated with an underlying widespread disease. Timely diagnosis and intervention are important for improvement of the quality of life of these patients. Here we report a case of pathological fracture of proximal phalanx of left index finger in a case of carcinoma of left lung treated with radiotherapy with good pain palliation.
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Introduction : Guillain-Barré syndrome (GBS) is a common cause of acute peripheral neuropathic disease. Electrodiagnostic studies (EDX) are important in diagnosis, classification, treatment and prognosis. Objective : To evaluate & define the early and common parameters of EDX for diagnosis of GBS. Methods : EDX of total 95 patients with clinical diagnosis of GBS were reviewed & analyzed. Results : Out of total 95 patients of GBS, 75 were demyelinating, 13 were axonal and 7 were of mixed type. In demyelinating group, there were 42 men and 33 women from ages 8 to 86; Hoffman reflex was absent in 100% patients; median sensory nerve action potential (SNAP) amplitude was abnormal in 66.6%patients compared to sural SNAP in 19.6%; F wave abnormalities, temporal dispersion and conduction block were found in 64%, 42.2% and 45% respectively. In axonal group, there were 7 men and 6 women from ages 11 to 83; compound motor nerve action potential (CMAP) amplitude was abnormal in (84%) studies & most commonly in tibial nerve. Conclusion : In demyelinating GBS, abnormal Hoffman reflex was found to be the most sensitive test and sural nerve sparing is frequently noticed. In axonal GBS, low CMAP in lower extremity was found the most sensitive test for diagnosis of GBS
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Introduction: Concurrent chemo-radiation is the main treatment in locally advanced cervical cancer. The change of bladder and rectum volume may lead to change in the positions of these structures and target volume during MUPIT implant which may lead to variation in dose to the organ at risk and target. Materials and Methods: Ten patients of gynecological malignancy were included. MUPIT template was positioned under anesthesia. CT scan was done for the contouring of bladder, rectum, and target and for planning purpose which generates plan (P1). CT scan was repeated before the third fraction of the treatment (CT2). The resultant plan (P2) was analyzed qualitatively and quantitatively. Results: Bladder volume variations of 88.18% to -68.15% were noted. This change in volume lead to differences in the maximum dose in bladder between fractions. The maximum dose variation ranged from 62.53% to -21.49%. The rectal volume variation ranges 11.71% to -46.20% due to the rectal filling. High variation in maximum dose to the rectum were observed which might be due to rectal filling. CTV volume is increased by 19.48% while in other by 19.05% and in all other patients the volume is decreased. CTV volume maximum decreased by 30.54% which might be due to decrease in edema developed during procedure. The volume variation in CTV is in range of19.48% to -30.54%. Conclusion: It is proposed that re-planning using repeat CT scan is required before third fraction implementation.