Safety and radiosensitizing efficacy of sanazole (AK 2123) in oropharyngeal cancers: randomized controlled double blind clinical trial.

Oropharynx is an important site of cancer in India. Global comparison indicates higher incidences in India. Radiotherapy remains an important treatment modality. Efforts to improve loco-regional treatment and prolong survival are areas of focus. Radiosensitizers in hypoxic tumors have shown promise. AIM: To study the safety and radiosensitizing efficacy of sanazole in oropharyngeal squamous cell carcinoma (stage T2-4, N0-3, M0) as phase-II double blind controlled trial in patients treated with conventional radiotherapy. SETTINGS AND DESIGN: Single institutional, randomized, double-blind, placebo-controlled trial. MATERIALS AND METHODS: Group 1 (control; n = 23) received normal saline infusion, group 2 (test; n = 23) received sanazole biweekly 1.25 g intravenous infusion 15 minutes before radiotherapy. Surrogate end points of efficacy were tumor and nodal size; safety parameters were mucositis, salivary and skin reactions, dysphagia, vomiting, dysgeusia and neurological deficit. Investigators blinded to the trial evaluated patients, weekly during treatment for six weeks and thereafter monthly for three months. STATISTICAL METHODS: Non-parametric, Friedman's, Chi square, Mann-Whitney U tests. RESULTS: In the test, 15 (65%) patients had complete response, five (22%) partial/no response, two (9%) died, one (4%) lost to follow up. In the control, five (22%) patients had complete response, 16 (70%) partial/no response, one (4%) died, one (4%) lost to follow up. Short-term loco-regional response was better in the test (DF = 3, 95% Confidence Interval 0.418, 0.452, P = 0.0048). In the test group significant vomiting and one case of grade 3 neurological deficit was observed. CONCLUSION: The study validates the usefulness of sanazole for initial loco-regional control in oropharyngeal cancers.

Preclinical evaluation of the antidiabetic effect of Eugenia jambolana seed powder in streptozotocin-diabetic rats

The world is facing an explosive increase in the incidence of diabetes mellitus and cost-effective complementary therapies are needed. The effects of Eugenia jambolana, a household remedy for diabetes, were studied. Streptozotocin diabetic female albino Wistar rats weighing 150-200 g (N = 6) were fed E. jambolana seed powder (250, 500 or 1000 mg/kg) for 15 days. Diabetic rats fed 500 and 1000 mg/kg seed powder showed an increase in body weight on day 20 in relation to day 5 (6 ± 4.7, 9 ± 7.8 vs diabetic control -16 ± 7.1 g, P < 0.001), a decrease in fasting blood glucose (75 ± 11.9, 123 ± 14.4 vs diabetic control -34 ± 12.1 mg/dl, P < 0.001), a difference in post-treatment fasting and peak blood glucose (38 ± 11.9, 36 ± 14.2 vs diabetic control 78 ± 11.9 mg/dl, P < 0.001), and a difference in liver glycogen (50 ± 6.8, 52 ± 7.5 vs normal control 90 ± 6.6 æg/g of liver tissue, P < 0.001). Tri-terpenoids, tannins, gallic acid, and oxalic acid were the chemical constituents detected in E. jambolana seed. The best results were obtained with an oral dose of 500 mg/kg. Subacute toxicity studies with a single administration of 2.5 and 5.0 g/kg seed powder showed no mortality or abnormality. These data on the antidiabetic effect of E. jambolana seed are adequate for approval of phase 2 clinical trials to evaluate this seed powder as complementary therapy in type 2 and type 1 diabetes.

Fine Needle Aspiration cytology versus Fine Needle Sampling without aspiration. A prospective study of 200 cases.

In the present prospective study of 200 patients with superficial swelling of various sites, FNS followed by FNA were performed. Fifteen cases were excluded due to inadequate material. In the 80 lymph node cases, FNS was diagnostic in 85% cases as compared to FNA in 87.5%. The diagnostic accuracy was higher for FNA (87.5%) than for FNS (81.25%). However FNS smears were much superior qualitatively than FNA smears and for the diagnosis of malignant conditions FNS was found to be much better. Regarding the 68 thyroid swellings, FNS obtained a diagnosis in 82.4% cases while FNA got it in 77.9%. The diagnostic accuracy with FNS (89%) was much better compared to FNA (75%). Of the 27 breast cases FNS yielded diagnostic material in 70.38% cases while FNA was diagnostic in 85.19%, thus establishing definite superiority. However FNS seemed to be better for diagnosing malignant lesions while FNA appeared better for diagnosing benign ones. In the 5 salivary gland lesions and 5 miscellaneous lesions both FNS and FNA fared equally well. On the whole FNS technique was much more patient friendly and gave high class "text book" quality smears while FNA smears gave quantitatively more adequate material. Both the techniques therefore would be complementary to each other.

Comparative evaluation of efficacy and safety profile of three anti-tuberculous regimens in Mangalore.

The aim of our study was to evaluate and compare the therapeutic efficacy & safety profile of three different antituberculous regimens for pulmonary tuberculosis. The study sample size included 90 newly diagnosed, sputum positive patients of pulmonary. tuberculosis. 30 each from different groups. The parameters studied were, therapeutic efficacy included weight gain, cough, sputum examination and safety profile: nausea, vomiting, anorexia, gastritis, hepatitis, jaundice diarrhoea, rashes, dizziness, tingling & numbness, flu like symptoms & joint aches. Group-I showed statistically significant weight gain when compared to Group-II. Improvement in cough and conversion to smear negative were seen in 100% of patients in Group-I, 83.3% of patients in Group-II and 93.3% of patients in Group-III. Therapeutic efficacy was highest with Group I regimen, followed by Group III and Group II which was least efficacious. Group II also registered; the maximum cost and highest incidence of adverse effects.

Topical phenytoin in diabetic ulcers: a double blind controlled trial.

Data of 57 patients who completed the trial and 13 who did not, were analysed. With phenytoin, there was a marginal: increase in the reduction of mean ulcer area and acceleration of effect 3rd on 4th week. With control: the number completing the trial was larger: response to treatment was better in grade II ulcers, Table IV. This study has the hall marks of a real clinical trial, has raised the possibility of wound healing properties of phenytoin and confirms the results of others.

Coronary atherosclerosis in Mangalore--a random post mortem study.

A study was undertaken in Mangalore, South Kanara District of Karnataka, India to evaluate the rising prevalence of coronary artery diseases in our country. Seventy hearts were analysed, at post-mortem, between December 1996 and December 1997. The coronary arteries and the myocardium were examined, both grossly and histologically, to relate them with regard to the age and gender of the deceased. Fifty five hearts were from males and 15 were from females. Forty eight (68.59%) hearts were proven to be afflicted with coronary atherosclerosis. Twenty seven of these had three or four vessel disease. A total of 192 sections from the four major epicardial arteries of the 48 hearts were examined. Of these, 124 showed atherosclerosis (with 37 in advanced stages), of which 103 were occlusive lesions while the remaining 21 were fatty streaks. Severe stenosis (grade III or IV) was commonest in the left anterior descending artery. Twenty one (30%) of the 70 hearts showed histological evidence of myocardial ischaemia. Of these 6 were from females and 15 were males. Myocardial ischaemia was found to have no correlation to the severity of stenosis.

FNAC diagnosis of mucinous carcinoma of male breast--a case report.

Mucinous carcinoma of the male breast is a very rare tumour. So far only about 8 cases have been reported in the literature most of which were diagnosed after surgical resection. Fine-needles aspiration biopsy even though a well established procedure for the evaluation of breast masses in female there are only occasional reports of aspirates form male breast masses. We herein-present one case of mucinous carcinoma of breast in a 65 year old male diagnosed by fine needle and confirmed by histopathology.

Connective tissue stromal changes in tumours and tumour-like lesions of the breast.

Between June 1994 and December 1995, one hundred and fifteen tumours and tumour-like lesions of the breast were studied in the Department of Pathology, Kasturba Medical College, Mangalore. Neoplasms constituted 80.9% and tumour like lesions accounted for 19.13%. Among the tumours, 51.6% were benign and 48.4% were malignant. Tumour-like lesions included the entire spectrum of fibrocystic disease. Tumours were common between 2nd and 8th decades while tumour-like lesions were uncommon above 6th decade. Whereas benign tumours exhibited ground substance, collagen and reticulin fibres in varying amounts, tumour-like lesions and carcinoma showed more of collagen fibres and less of ground substance. Elastosis and lymphoplasmacytic infiltrate were prominent features in carcinomas rather than in benign lesions.

Neurogenic appendicopathy--role of enterochromaffin cells in its pathogenesis.

One hundred cases of neurogenic appendicopathy were histochemically studied for schwann cells and enterochromaffin cells. The early phase, labelled as neuro-appendicopathy (29 cases) showed minimum to moderate number of extraepithelial enterochromaffin cells without neurogenous hyperplasia. In 53 cases, there was intra and submucosal neural hyperplasia with increase in the extraepithelial enterochromaffin cells, representing the active phase. The late phase known as obliterative neurogenic appendicopathy, showed extraepithelial enterochromaffin cells and schwann cell proliferation of variable grades (18 cases). The origin of extraepithelial enterochromaffin cells is related to proliferating nerve plexus, rather than epithelial enterochromaffin cells.

Mast cell numbers in lymphnode lesions.

Mast cells were counted in 50 axillary lymphnodes draining breast carcinoma and 50 other lymphnodes from various sites with different histological lesions. All the lymphnodes, except those with tuberculous lymphadenitis were associated with increase in the number of mast cells. Highest number of mast cells (mean 172.80/mm2) were found in filarial lymphadenitis and lowest in tuberculous lymphadenitis (mean 8.87/mm2). In the axillary lymphnodes draining breast carcinoma, higher mast cell count was observed in reactive nodes. As these lymphnodes showed micro-metastasis the mast cells gradually decreased in number, and with extensive metastasis only few mast cells were seen. On comparison, the reactive lymphnodes draining breast carcinoma and other reactive nodes, the latter were associated with more mast cells.

Paneth cell metaplasia in colonic adenocarcinoms.

The junctional mucosa of 49 colorectal carcinomas were studied for Paneth cell metaplasia. Twenty two cases (44.89%) showed Paneth cells in the junctional mucosa. The carcinomas were seen mainly in the age range of 51 to 60 years (38.4%) The occurrence of Paneth cell metaplasia was higher in the vicinity of tumours of ascending colon and in well differentiated grades of adenocarcinomas. This probably indicates the reactive host response in the junctional mucosa which is of better prognostic significance.

Relation of mast cell, nerve and fibrosis in appendix.

The relationship of mast cells, nerves and fibrosis was studied in 50 cases of Appendix using simple histochemical technique. In the mucosa, the mast cell number was greater in the early stages of fibrosis. Both in the mucosa and submucosa mast cells were found closely associated with neural tissue. As the fibrosis increased this association between mast cells and neural tissue was retained only in the submucosa.

Mast cell count in surgically resected appendices.

Two hundred appendices were studied for mucosal and submucosal mast cell counts. In histologically normal appendices mucosal mean mast cell count (47.63/sq mm) was more than submucosal mean mast cell count (44.27/sq mm). Those patients who were aged under 15 and above 46 years showed more mean mucosal mast cell count compared to others. In acute appendicitis both mucosal and submucosal mast cells were decreased and in subacute appendicitis their count was found to be intermediate between normal and acute appendicitis.

Pleomorphic xanthoastrocytoma.

Pleomorphic xanthoastrocytoma is an unusual brain tumour of children with a favourable prognosis. The tumour takes origin from subpial astrocytes of the cerebral cortex. Histologically proliferation of spindle cells, mono and multinucleated giant cells containing lipid droplets and the absence of necrosis are distinctive features. Herein we report the morphological and immunophenotypical features of a case of pleomorphic xanthoastrocytoma.

Extragonadal germ cell tumours in Mangalore with review of the literature.

In the present study 32 extragonadal tumours, reported in 38 years (1956 to 1994) from the department of pathology, Kasturba Medical College, Mangalore were analysed. These were seen predominantly in infants and children mainly affecting females. The commonest sites of these tumours were sacrococcygeal region (46.88%) followed by retroperitoneum and mediastinum. The rarest sites were mesentery, fallopian tube and suprasellar region in the cranial cavity. Histologically 27 out of 32 cases were teratomas, 75% of which were benign.

Hibernoma of scalp: case report and review of literature.

Hibernomas are uncommon, benign neoplasms of adipose composed of brown fat. A review of the world literature revealed about 115 cases. These tumors are asymptomatic and slow-growing, commonly seen in the the interscapular region. We herein present the third documented case of a scalp hibernoma.

Incidence of primary bone tumours and tumour like lesions in and around Dakshina Kannada district of Karnataka.

A total of 523 cases of primary bone tumours and tumour like lesions in and around Dakshina Kannada district of Karnataka were diagnosed over a period of 36 years. About 39% of these tumours were malignant and the remaining benign. Among the malignant tumours the highest incidence was of osteosarcoma (45.7%) followed by Ewing's sarcoma (19.4%). Osteochondroma was the most frequent in the benign tumour category (30.3%). Peak incidence of tumour was in the 2nd and 3rd decade of life with a male preponderance. The most commonly affected bones were femur, tibia and humerus in that order. Results indicate a significantly higher incidence of primary bone tumours in this part of India.