A Comparative Study to Analyze the Effect of Gabapentin with Amitriptyline Versus Pregabalin with Amitriptyline in Neuropathic Pain in Cancer Patients Undergoing Palliative Care

Introduction: Antiepileptics and antidepressant medications are known for managing neuropathic pain. We aim to compare the effects of pregabalin with low‑dose amitriptyline and gabapentin with low‑dose amitriptyline in managing neuropathic pain in cancer patients undergoing palliative care. Materials and Methods: We conducted our study on 160 cancer patients who were having neuropathic pain and were undergoingpalliative care treatment in our institute. It was a hospital‑based, randomized, tertiary cancer center‑based observational study. After taking approval from the institutional ethics committee and taking written informed consent from patients, the patients were divided into two groups and the effect of medicines on incidence of neuropathic pain was observed; the incidence of burning sensation and the incidence of adverse effects of medications were also analyzed. Statistical analysis was done using paired t‑test and SPSS version 20 software. Results: The onset of relief in pain was earlier in the pregabalin group as compared to the gabapentin group. There was more reduction in a burning sensation in the pregabalin group as compared to the gabapentin group. The incidence of headaches was the same in both groups. Nausea and vomiting were more in the pregabalin group but the overall difference in adverse effects was not statistically significant (P > 0.05) Conclusions: In the management of neuropathic pain in cancer patients who are undergoing palliative care, a combination of pregabalin with amitriptyline was found to be more effective in pain relief than gabapentin with amitriptyline.

A Prospective Cross‑sectional Study to Analyze the Effect of Transnasal Sphenopalatine Ganglion Blockin Carcinoma Buccal Mucosa Patients

Introduction: Cancer pain is known to be one of the Most severe pain anyone in life and is the primary reason for discontinuation of treatment.Sphenopalatine ganglion block (SPGB) can be useful in alleviating pain of carcinoma buccal mucosa. The study aims to analyze the effect of transnasal SPGB in pain management of patients suffering from carcinoma buccal mucosa. Materials and Methods: It was a hospital‑based study done on 150 patients with carcinoma buccal mucosa using a prospective cross‑sectional study design. To do statistical analysis, paired t‑test was used having SPSS software. Results: On visual analogue scale, intensity of pain was found to be notably reduced from 7.42±2.02 to 3.45±1.21 (P < 0.0001), after first sitting. Preprocedure and postprocedure morphine requirement were 90.24 ± 30.24 and 60.42 ± 0.93 mg/day (P > 0.05) At the conclusion of study, the results were found to be statistically significant. Conclusion: Transnasal SPGB is beneficial in improving patient compliance and reducing pain scores and morphine requirement in patients suffering from carcinoma buccal mucosa

Histopathological Spectrum of Myxoid Soft‑Tissue Neoplasms in a Tertiary Care Center with a Special Focus on Vascular Patterns: A 13‑Year Compilation

Introduction: Myxoid soft‑tissue tumors are a diverse group of tumors which have similar histomorphology but have varied geneticsequence and clinical outcome, hence differentiating and diagnosing them is a challenge for any pathologist. This study describes the varioushistomorphological spectrum and vascular pattern of various myxoid soft‑tissue tumors. Materials and Methods: This was a retrospective and prospective observational study of myxoid soft‑tissue tumors over a period of 13 years. A total of 224 cases with myxoid morphology were included and were examined morphologically with a special focus on the vascular pattern. SPSS v 24 was used for statistical analysis. Results: The predominant lesions were benign in 164 (73.21%) cases, followed by malignant lesions in 43 (19.19%) cases and intermediate lesions 17 (7.58%) cases. Both benign and malignant lesions showed a male preponderance and were seen to arise predominantly from the extremities. The most common benign myxoid lesions in this study were of neural origin with myxoid neurofibroma constituting 65 (29. 01%) cases, followed by schwannoma 38 (16.9%) cases. Myxoid dermatofibrosarcoma protuberans was the most common intermediatelesion. Tumors with adipocytic differentiation were the predominant lesions among the malignant group, i.e myxoid liposarcoma seen in 17 (7.5%) cases. Conclusions: Vascular pattern in the myxoid lesions are subtle yet crucial in arriving at a histo‑morphological diagnosis. Further studies correlating the vascular pattern with the genetic profile of these tumours can help arriving at a histo‑morphological diagnosisof myxoid lesions.

Comparison of the Locoregional Outcome, Toxicities, and Compliance between Hypofractionated and Conventional Chemoradiotherapy for Head‑and‑Neck Cancers

Introduction:Head‑and‑neck cancer (HNC) treatments are elusive, and the hunt for an appropriate radiation strategy continues.Hypofractionation has the potential to provide several advantages, including a shorter overall duration that reduces rapid repopulation, dosage escalation with a higher biologically effective dose, and patient convenience. Hypofractionation is also beneficial in minimizing the danger of catching an infectious agent by reducing the number of hospital visits during the height of the COVID‑19 epidemic. Materials and Methods: Between January 2020 and August 2021, 120 patients with squamous cell carcinoma of the head‑and‑neck subsites were randomly allocated to either the hypofractionated arm A (n = 60) or the standard fractionation arm B (n = 60) with concomitant treatment. Results:Locoregional tumor response, acute and late toxicity, and compliance were the study’s endpoints. The normal tissue toxicities of each patient undergoing radiation were monitored weekly. Clinical and radiographic evaluations of locoregional control were conducted. Conclusion:Hypofractionation effectively overcomes tumor repopulation in rapidly growing tumors such as HNC, and we conclude in our study that the hypofractionated chemoradiation schedule appears to be more efficacious, with relatively superior locoregional control when compared to conventional chemoradiation with comparable normal tissue toxicities and compliance

Multiple Osseous Metastases in Malignant Phyllodes Tumor

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.

AcralPrimary Malignant Melanoma of Breast: Case Report

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.

Acral Metastasis from Carcinoma Lung Presenting As Pathological Fracture of Index Finger: A Case Report

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

Study of Variation of dose Due to Interfraction Organ Movement in Interstitial Brachytherapy: A Single Institute Experience.

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.