Chemoradiation for organ preservation in the treatment of muscle invasive bladder cancer: our institutional experience

Aim: To assess outcome of chemoradiotherapy for organ preservation in muscle invasive bladder cancer

Material and Methods: 41 patients treated between January 2010 to January 2015 were evaluated in the present study. All patients T staged ranging from cT2-T4a and had undergone maximal transurethral resection of bladder tumour [TURBT]. After maximum bladder tumour resection patients were treated with Radiotherapy with or without concurrent chemotherapy. 8 weeks after completion of treatment response was assessed by check cystoscopy, urine cytology and CECT scan Abdomen. Data regarding the toxicity profile, initial complete response rates at 3 months, occurrence of loco regional or distant failure and survival was recorded

Results: Age ranged between 45- 84 years, [mean age 65.44]. Radiotherapy dose planned ranged from 60 Gy/30fr to 70.3 Gy/37 fractions to primary target and 59.2 Gy/37fractions to the nodal disease. PTV volume ranged from 69-548.9 cc. 23 patients received concurrent chemotherapy weekly. 11 patients have cystitis [5 Gr 1, 4 Gr II and 2 Gr III]. 5 patients have myelosuppression. 10 patients have acute gastrointestinal toxicity [5 Gr-I, 4 Gr-II, 1 Gr-III]. At the time of analysis follow up ranged from 3-42 months [median follow 1 year].The DFS at 42 months was 54%. Out of 39 patients 3 were lost to follow up [2 in partial bladder group and 1 in whole bladder group]. Out of 36 patients 24 [66.6%] are disease free, 4 [11.1%] patients had recurrence for which 2 underwent salvage cystectomy whereas 2 patients received palliative chemotherapy. Five patients developed distant metastases [4 bone and 1 brain metastasis]

Conclusion: Bladder-preservation therapy for muscle-invasive bladder cancer is a valid substitute in selected cases with long-term efficacy similar to radical cystectomy, with the additional advantage of preserving excellent bladder function in the majority of long-term survivors

GIST: institutional experience at SRMS-IMS, India

Gastro-Intestinal Stromal Tumors [GIST] is a malignant, non-epithelial, mesenchymal tumor of the digestive tract that is not uncommon in clinical practice nowadays; diagnosis being based upon immuno-histo-chemical analysis of the resected or biopsied [FNAC] specimen. Abdominal lump with or without intra-luminal bleed is a common mode of presentation. Early diagnosis and appropriate management with surgery and/or Imatinib therapy improves recurrence free survival and may impact overall survival. We present here our institutional experience of four patients, admitted in Onco-Surgery Dept., with pain abdomen and upper/lower gastrointestinal bleed, which, on subsequent workup were diagnosed to be cases of GIST, were appropriately managed according to their disease stage and show recurrence-free survival on follow-up

65- year old female with synchronous HIV and extramedullary plasmacytoma of maxillary sinus

Extramedullary plasmacytoma in the head and neck region is a rare malignant neoplasm comprising approximately 3% of all the plasma cell neoplasms and less than 1% of head and neck tumors. This extraskeletal lesion is a unifocal, monoclonal, neoplastic proliferation of plasma cells. Some investigators believe that this lesion represents the least aggressive part of the spectrum of plasma cell neoplasms which extends to multiple myeloma. Therefore, plasmacytoma is believed to have clinical importance. We report a case of extramedullary plasmacytoma in the right maxillary sinus of a 65-year-old HIV positive female as a clinical rarity with review of the relevant literature

rare case of primary solid intrarectal dermoid

Primary rectal teratomas are rare and only few cases have been reported in the literature worldwide. These usually occur in females. These are usually cystic but very rarely solid variants may occur. We present a case of a solid intra-rectal dermoid arising primarily in rectum from postero-lateral wall. Excision biopsy was done per rectally. Histology revealed the presence of squamous epithelium, fat cells, hair follicles, cartilaginous material and columnar lining of glandular structures suggestive of mature teratoma. It is usually benign but may become malignant, therefore complete resection is advised

Hyperosmolar hyperglycemic non ketotic coma and rhabdomyolysis; an uncommon clinical encounter

Rhabdomyolysis is usually attributed to trauma. However there is an association of rhabdomyolysis with hyperosmolar states. Recognition of this association will enable better management of the patient and reduce the burden on the care taker by preventing the onset of complications that can prove fatal. It is also important to realise that hyperosmolar coma can be the presenting complaint of a diabetic seeking medical attention for the first time

Comparison of two methods for predicting difficult intubation in obstetric patients

Preoperative airway assessment for prediction of difficult laryngoscopy and intubation was done using the modified Mallampati test and Wilson risk sum score in three hundred and seventy two obstetric patients undergoing elective as well as emergency Cesarean section under general anesthesia. 25 [6.7%] patients had laryngoscopy grade III or IV of whom 24 [6.4%] patients were difficult at tracheal intubation. Mallampati class III or IV predicted 15 of the 23 patients while Wilson risk sum score >/-2 predicted 9 of the 14 patients in whom tracheal intubation was difficult. As a screening test for prediction of difficult intubation Wilson risk sum score was less sensitive [36%] but had almost same specificity [98.5%] and positive predictive value [64%] in comparison to modified Mallampati test [62.5%, 97.7% and 65% respectively]. When used as a predictor of difficult laryngoscopy sensitivity, specificity and positive predictive value for modified Mallampati test were 60%, 97.6% and 65% respectively and for Wilson risk sum they were 36%, 98.5% and 64% respectively, but when both tests were combined as predictors [with either of tests positive] sensitivity improved to 100% while specificity was marginally decreased to 96.2% and positive predictive value [64.8%] remained almost the same. There was no significant association between age and laryngoscopy grade III or IV but there was significant [P < 0.01] relationship with weight and external laryngeal manipulation. The advantage of the above tests lies in, incorporating them into the preoperative protocol, rather than using them as sole predictors of difficult laryngoscopy and intubation

Effect of Sarcostemma acidum stem extract on spermatogenesis in male albino rats / 亚洲男科学杂志(英文版)

<p><b>AIM</b>To evaluate the possible antifertility activity of Sarcostemma acidum (Roxb) Voigt. stem extract in male rats.</p><p><b>METHOD</b>Male rats were given 70% methanol extract of S. acidum stem orally at dose levels of 50 and 100 mg/kg/day for 60 days. Fertility was evaluated with mating test. Sperm motility and sperm density in cauda epididymides were also assessed. Biochemical and histological analyses were performed on blood samples and on the reproductive organs.</p><p><b>RESULTS</b>S. acidum stem extract resulted in an arrest of spermatogenesis without any systemic side effect. Sperm motility as well as sperm density was reduced significantly. Treatment caused a 80% reduction in fertility at the 50 mg dose and complete suppression of fertility at the 100 mg dose. There was no significant change in RBC and WBC count, hemoglobin, haematocrit, sugar and urea in the whole blood and cholesterol, protein and phospholipid in the serum. The protein and glycogen content of the testes, fructose in the seminal vesicle and protein in epididymides were significantly decreased. Cholesterol in the testes was elevated. Treatment at both of the doses caused a marked reduction in the number of primary spermatocytes (preleptotene and pachytene), secondary spermatocytes and spermatids. The number of mature Leydig cells was decreased, and degenerating Leydig cells was increased proportionately.</p><p><b>CONCLUSION</b>S. acidum stem extract arrests spermatogenesis in male rats without noticable side effects.</p>

Osteosarcoma of breast - A case report

Sarcoma of breast is usually of the spindle cell variety. They arise from intracellular fibroadenoma or follow previous radiotherapy. Unusal bone forming sarcoma are rare entity especially osteosarcoma in pure form is seldom seen. We are reporting a case of osteosarcoma of the breast. The patient underwent radical modified mastectomy and received post operative adjuvant chemotherapy. She is presently disease free with a follow up of 5 months

Bronchogenic carcinoma, experience in Benghazi, Libya

Lung cancer was diagnosed in 130 patients durting eight years period in apopulation living in Benghazi area, Libya. The series comprised 124 men and 6 women, with a male to female ratio of 20.6:1. the diagnosis was confirmed histologically in all cases. Squamous cell carcinoma was the most common histological type of tumour in men, followed by adeno carcinoma and small cell carcinoma, whereas in the women adeno carcinoma was the most common tumour. All the females and two males were life long non smokers, whereas all other males were smokers or exsmokers. Crude incidence of primary lung cancer was 3.34 per 100.000 population per year, while incidence among males 40 years and above was 32.37 per 100.000 population per year. However the age standardized incidence rate was 10.5 per 100.000 population per year which is less than any developed countries