Carcinoma of buccal mucosa: A site specific clinical audit.

BACKGROUND: Carcinoma of buccal mucosa is the most common cancer of the oral cavity in India. Treatment of oral cancer poses unique reconstructive challenges, owing to the dynamic architecture of the oral cavity. Despite current progress in various treatment modalities, over the past 50 years survival rates have not improved drastically. Although, philosophy on treatment of buccal mucosa carcinoma remains well‑established, due to the relative paucity of reported data, retrospective reviews of institutional experiences are of prime importance. This study provides a detailed insight on this site specific cancer of the oral cavity in the Indian population. AIM: The aim of this study is to analyze our experience with the management of carcinoma of buccal mucosa; associated clinical presentation, outcomes and prognostic factors. SETTINGS AND DESIGN: A retrospective chart review was performed of all cases of primary buccal mucosa carcinoma treated surgically between years 2008 and 2012 in SDM Craniofacial Unit, Karnataka, India. MATERIALS AND METHODS: All cases were analyzed based on patient characteristics, clinical presentation, surgical and adjuvant therapy rendered and treatment outcomes. A retrospective chart review was carried out using the hospital’s data base for the same. STATISTICAL ANALYSIS USED: Kaplan‑Meier methods were used for analyzing disease free survival (DFS). Univariate analysis of prognostic factors was performed with log rank test. RESULTS: The significant variables in univariate analysis were: Overall stage, T‑stage (T1/T2 vs. T3/T4) and nodal status (N0 vs. N+). We found that staging, tumor size and nodal status were significant prognostic factors for DFS. CONCLUSION: The strong influence of overall disease stage, tumor size, nodal status, final histopathological report and habits of tobacco/betel quid chewing, on prognosis; emphasizes the importance of early diagnosis and prevention of carcinoma of buccal mucosa in the Indian population.

Efficiency of routine semen analysis to predict functional and structural integrity of human spermatozoa.

The study is to examine the ability of routine semen analysis to predict the functional and structural integrity of spermatozoa in in vitro conditions. Since large number of subjects were evaluated over a long period of time, the value of routine analysis to prognosticate the functional and structural integrity in the same sample was assessed. Routine semen analysis was done on 354 subjects. In the same sample, functional tests were carried out. The functional tests applied were hypoosmotic swelling test, test for acrosome intactness, nuclear chromatin decondensation test and sperm mitochondrial activity index. A scoring system was adopted for both routine and functional analysis. According to the scores obtained, the samples were categorized into fertile, subfertile and infertile. Analysis of the data indicated that efficiency of routine semen analysis was 38.13%. Prediction of functional integrity by routine analysis of semen specially in subnormal cases is only partly fulfilled. The study also indicates that functional tests are definitely indicated in cases with subnormal score.

Volume of semen as a parameter of its quality.

A total of 1655 semen samples obtained from men who underwent initial semen analysis before enrolling for IVF-ET programme were analysed. The semen samples were categorized arbitrarily on the basis of volume as high (> 4.5 ml), normal (1.5-4.5 ml) and low (< 1.5 ml). The semen parameters studied vis-a-vis volume of the sample were viscosity, osmolality, motility, sperm count and morphology. The different volume groups were also compared to the overall quality of the sample. The study showed that high and low volume semen were associated with high incidence of spermatozoa exhibiting subfertile characteristics. Normal volume per se did not indicate the quality of the sample, however high and low volumes were indicators of semen of subfertile quality. There was an inverse correlation between osmolality and volume of semen sample. Thus the parameter 'volume' gives a rough estimate of the quality of the sample.

Antifertility effects in rats actively immunized with 80 kDa human semen glycoprotein.

A 80 kDa human sperm antigen has been identified using the serum of an infertile woman having circulating antisperm antibodies. The antigen was then purified to homogeneity by gel permeation chromatography using HPLC (protein PAK-125 column) system and on FPLC (superose-12 column) system. The antigen was found to be a glycoprotein. The antigen was mainly localized in the postacrosomal region of the human sperm, while it was localized in the head region of the rat sperm as demonstrated by immunofluorescent staining. The presence of this antigen was also demonstrated in the human prostate and endometrium and in the rat testis; epididymis and the prostate by immunocytochemical staining. The purified protein upon active immunization in female rats caused infertility in 100 percent animals. While in male rats it caused infertility in 90 percent animals. On morphometric analysis of testicular tissue it was observed that there was no significant change in spermatogonia and spermatocytes, but significant decrease in spermatids and sperm number as well as daily sperm production in the immunized male rats. The epididymal spermatozoa were markedly reduced in number and were largely found to be agglutinated. The results suggest that 80 kDa human sperm antigen appears to be a suitable candidate for immunocontraception both in male and female.

Incidence of abnormalities in sperm morphology as an indicator of its fertilizing potential.

A retrospective analysis was carried out to assess the correlation of sperm morphology with the occurrence of fertilization in vitro of human oocytes. Seventy women who were subjected to in vitro fertilization procedure were taken up for this study. The cytological smears of semen were evaluated for the morphological characteristics of spermatozoa. Instances where in vitro fertilization did not occur (group II) had significantly (P less than 0.001) higher morphological abnormalities (head defects) when compared with those where fertilization occurred in vitro (group I). The results indicate that evaluation of sperm morphology with special reference to head abnormalities has diagnostic potential in human in vitro fertilization.

Comparison of four different ovarian stimulation protocols in an in vitro fertilisation & embryo transfer programme.

Four different ovarian stimulation protocols were evaluated in an in vitro fertilisation and embryo transfer programme in 208 women (228 treatment cycles). In the rigid protocol (RP), 100 mg of clomiphene citrate (CC) was given from day 3 to day 7 of the menstrual cycle and 300 IU of human menopausal gonadotropin (hMG) was given from day 5 of the menstrual cycle. In the individualised protocol (IP) the same drugs and doses were used as in RP, but the day of initiation of CC depended on the length of the individual's menstrual cycle and hMG was administered from the last day of CC. In the programmed protocol (PP), ovarian function was suppressed with oral contraceptive pills (ethinyl estradiol 30 micrograms and norethisterone 1 mg) started on day 5 of the menstrual cycle for 45 to 70 days. Considering the last day of pill intake as day 0, CC was given for 5 days from day 5 and hMG (300 IU) from day 7. In the alternate day protocol (ADP), 100 mg of CC was administered from day 2 to day 6 and hMG (300 IU) was given on alternate days from day 2 to day 8 or day 10 of the cycle. In all the women, hCG (5000 IU) was administered when the diameter of at least 2 follicles was greater than or equal to 16 mm and estradiol levels were 300 pg/ml/dominant follicle. Patients not showing such a response were not treated further. The cardinal events of IVF-ET such as number of good responders, incidence of oocytes harvested, fertilised and embryos transferred per cycle were compared and it was concluded that the pregnancy rates were highest in women treated by the PP.

Scanning electron microscopy in the assessment of sperm morphology.

The advantages of using scanning electron microscope (SEM) vis-a-vis light microscope (LM) to assess sperm morphology was studied. The semen samples obtained from 15 fertile (group I) and 25 infertile (group II) men were processed by routine procedures for LM and SEM. The usually described sperm abnormalities were identifiable with greater resolution. Sperm abnormalities were significantly more in group II, as compared with group I (P less than 0.001) by both methods. Abnormalities of different regions, like thinning of midpiece, were scored higher in SEM than in LM. The abnormality of aggregation or retraction of mitochondrial sheath was clearly visible under SEM and missed by LM. Apart from detection of certain subtle abnormalities, SEM has advantages of rapid screening, accurate quantitation directly from the screen, zooming to higher magnification and automation.

Ultrastructure of spermatozoa & non spermatozoal cells in human semen in genital tract infections.

With a view to ascertain the possible etiology fo the morphological abnormalities seen in spermatozoa of semen from genital tract infections, 16 semen samples were studied. Samples were selected on the basis of each of them having 10-12 pus cells per high power field. Apart from routine semen analysis, the sperms were subjected to electron microscopic studies. Alterations in the ultrastructure of spermatozoa and non-spermatozoal constituents of the infected semen samples were studied. The possible etiology of a wide spectrum of abnormalities in semen found to be associated with genital infection is discussed.

Estimation of daily sperm production in rats and monkeys.

Daily sperm production in rats and monkeys were estimated by extended histometric method. Individual seminiferous tubules were separated, fixed, processed and embedded. Semi-thin sections were stained with toluidine blue and the different cell types quantitated with Chalkley's eye piece. The daily sperm production estimated was compared with that obtained by the homogenization method. The results indicate that daily sperm production obtained by both the methods were comparable. The present histometric method has an added advantage of requiring very small amount of biopsy material to give precise daily sperm production estimations.