Diagnostic Accuracy of MRI in Breast Cancer-A Study of 156 Cases

Background: Background- MRI helps in detection of multicentric and multifocal disease in the same breast as well as in identification of synchronous lesions in contralateral breast. MRI imaging done with dedicated breast coil and thin section imaging of the axilla is an effective tool in determining the axillary lymph node metastasis in newly diagnosed cases of breast cancer. Aims-To study those interpretation criteria of MRI that serve to increase the sensitivity and specificity of identifying non-mass like enhancement, multi centricity and nodal characteristics in breast cancer patients undergoing breast conservation surgery. Methods: Retrospective analysis of 156 patients was conducted in the Department of Radio diagnosis; Max Hospital, New Delhi, from September 2011 to June 2014. Both were correlated for tumor size, multifocality, multicentricity, extension of DCIS, nodal characteristics, extension to nipple and contralateral breast lesions. Results: In our study, detection of NMLE on MRI had a sensitivity of 89% and specificity of 78%. Lymph nodes with cortical thickening had a higher sensitivity (86% vs 65%) but lower specificity (69 % vs 89 %) than fatty hilum. Sensitivity was high for post lumpectomy with positive surgical margins and post NACT patients (100%). Conclusion: MRI has a high sensitivity in detection of breast cancer lesions. The detection of multicentric/ multifocal lesions in the same as well as contralateral breast and non-mass like enhancements is critical in deciding breast conservation surgery.

SVC Obstruction Secondary To Indwelling Central Venous Catheter – A Case Report

SVC obstruction is attributed to intraluminal and extraluminal causes. A 55 year lady, known diabetic was diagnosed with carcinoma left breast. The preoperative PET scan showed FDG avid index lesion with enlarged axillary nodes but none in neck or thorax. In this case, carcinoma breast -associated hyper coaguable state and infection may have promoted thrombus formation rather than the CVAD.

Angiosarcoma – A Case Report

Angiosarcoma is an aggressive malignant tumor of vascular origin. We present a case of secondary angiosarcoma in a 66 year old female patient, who presented with a history of left breast wide local excision with intraoperative brachytherapy.The only chance of curative treatment for secondary angiosarcoma is extensive surgery, preferably with resection of all irradiated tissue.

Effect of fluvoxamine and N-methyl-D-aspartate receptor antagonists on shock-induced depression in mice.

We have earlier demonstrated that NMDA receptor antagonists possess antidepressant effect and also they show a synergism with imipramine. The present study attempts to investigate whether NMDA receptor antagonists also interact with selective serotonin reuptake inhibitors. The study was conducted in albino mice using shock-induced depression model. The mice were placed on a grid floor and shock delivered were of 2 sec duration with a 9 sec interval for 1 h. Twenty four hours later depression was measured by an open field test followed by a forced swimming test. Presentation of inescapable foot shock significantly reduced ambulation (from 159.50 +/- 5.42 to 80.50 +/- 4.61) and rearing (from 22.10 +/- 2.15 to 11.30 +/- 1.32) in the open field arena and increased immobility duration in the forced swimming test (from 82.20 +/- 3.51 to 158.90 +/- 4.61). Pretreatment with fluvoxamine, MK-801, ketamine and the combination of fluvoxamine with either of the NMDA antagonists antagonised shock-induced depression. Haloperidol and ketanserin pretreatment modified the effect of these agents. These findings suggest an interaction of NMDA receptor antagonists with fluvoxamine, and an involvement of brain dopaminergic and tryptaminergic mechanisms in the behavioural suppression observed after inescapable foot shock.

Interaction between N-methyl-D-aspartate receptor antagonists and imipramine in shock-induced depression.

In the past few years, literature has accumulated describing manifestation of seizures following administration of certain antidepressants. Such reports are of particular importance because depression is a frequent psychiatric problem associated with epilepsy. Therefore, in the view of the fact that NMDA receptor antagonists have been reported to reduce behavioural deficits and have been shown to be anticonvulsant, it was considered imperative to study their antidepressant effect using shock-induced depression model in mice. Presentation of inescapable foot shock significantly reduced ambulation and rearing in the open field arena and increased immobility duration in the FST. Pretreatment with imipramine, MK 801 and ketamine significantly prevented the effect of shock. Also, the combination of imipramine with either of the NMDA antagonists antagonised the effect of shock. Haloperidol, prazosin and ketanserin pretreatment modified the effect of these agents. These findings suggest an antidepressant effect of the NMDA receptor antagonists, and a complexity of neurotransmitter mechanisms, which are responsible for the occurrence of behavioural effects in shock-induced depression model.

Tobacco use in Mizoram, India: sociodemographic differences in pattern.

A study on tobacco use was carried out in Aizawl district of Mizoram, India, to assess the prevalence and pattern of tobacco use. An area served by two Sub-health Centers representing town and village population were selected for a household survey. 375 people (age 10 years and above) were interviewed about their habits of taking tobacco. Use of tobacco was high among males (56.6%) and females (45.7%), but the high prevalence of smoking among males (42.3%) and chewing among females (27.9%) indicates the existence of sex differences in tobacco use pattern. Age and occupation had significant association with tobacco use but influence of education was very low and its association was not significant. Mean age for start of tobacco chewing and smoking for males and females varied significantly. However, the mean age of start for adolescent and young age (10-29 years) tobacco users was 17.2 years (SD +/- 2.3). Though there are some limitations to this study, these findings revealed differential patterns of tobacco use which is valuable information for prevention effort.

Plantar acral melanoma--an experience from a regional cancer centre, India.

This is a retrospective analysis of all plantar acral melanomas treated at the Cancer Institute (WIA) Madras between January 1981 and December 1990. Acral melanomas constitute 26% of all melanomas in this population, the sole of the foot being the dominant site (35 of 36 cases). We have found that it is more common in the lower socioeconomic strata, occurs often over weight bearing areas and is usually advanced at presentation. The projected five year survival was 51% while the five year disease free survival was only 22%. Pathological nodal status was found to be the only factor significantly influencing survival in this study. Wide local excision was found to give results equivalent to radical amputation and is strongly recommended since it gives a much better quality of life with a disease that has an overall dismal prognosis.