Assessment of systemic inflammatory response after total extraperitoneal repair and Lichtenstein repair for inguinal hernia.

PURPOSE: The aim of the study was assessment of the systemic inflammatory response (SIR) intensity by measuring the blood serum levels of high sensitivity C-reactive protein (hsCRP), Interleukin-6 (IL-6) and Total Leukocyte Counts of patients. The estimations were done before and after the patient underwent either open Lichtenstein or endoscopic TEP inguinal hernia repair. This is a prospective observational type of study. METHODS: Sixty patients with a diagnosis of unilateral uncomplicated inguinal hernia were included in the study. Patients were divided into two groups. In the first group, endoscopic total extraperitoneal repair (TEP) was done, while the other group underwent Lichtenstein repair. The patient selection was random. Serum markers for SIR were measured prior to and 24 h post-surgery. RESULTS: Total extraperitoneal repair (TEP) and open Lichtenstein inguinal hernia repair both cause a significant Systemic Inflammatory Response in the body. The rise in serum markers for SIR post-surgery was statistically significant in both the groups. The rise in serum hsCRP and IL-6 concentrations was observed to be equivocal among the two groups. Statistically significant difference was observed in serum TLC rise: Lichtenstein repair group having a higher value. CONCLUSION: Both, open and endoscopic surgical techniques incite a systemic inflammatory response in the body. However, it cannot be conclusively stated that TEP is associated with lesser SIR compared to the Lichtenstein repair on the basis of this study.

Unstable Angina: A Serious Adverse Event following Gemcitabine-Cisplatin Based Chemotherapy.

A 29 year male, with an inoperable adenocarcinoma of gall bladder was initiated on gemcitabine and a platinum compound based chemotherapy. During 4th cycle of chemotherapy, patient complained of chest pain following cisplatin and gemcitabine infusion. ECG was suggestive of acute coronary syndrome, which was successfully managed by antianginal therapy. Fifth cycle of chemotherapy was uneventful. Patient died of cardiovascular collapse before receiving the 6th cycle of chemotherapy. As per Naranjo adverse drug reaction probability scale, causal association of the event with cisplatin and gemcitabine was probable and possible respectively. It is advised to routinely assess the cardiovascular status of patients before and during cisplatin and/or gemcitabine based chemotherapy.

Effect of neoadjuvant chemotherapy on stromal CD10 antigens in breast cancer - a preliminary study.

INTRODUCTION: CD10 is a zinc-dependent peptidase (metalloproteinase). Stromal CD10 expression in breast cancer correlates with poor prognosis, oestrogen receptor negativity and higher grade. CD10 may be a potential target of new cancer therapies as it is involved in cleavage of doxorubicin. AIM: To evaluate the effect of neo-adjuvant anthracycline-based chemotherapy on status of stromal CD10 antigens in breast cancer. MATERIALS AND METHODS: Patients with invasive breast cancer scheduled for anthracycline-based neo-adjuvant chemotherapy were included in the study. Tumor stromal CD10 expression was estimated before and after 3 cycles of chemotherapy, and change in its status was correlated with clinical response to chemotherapy. RESULTS: 16 out of the 29 patients had strong CD10 expression; in these 16 patients, 14 (87.5%) were hormone receptor negative, and 14 (87.5%) had HER-2/neu overexpression. Stromal CD10 expression remained same in 13 out of 29 cases (44.83%) after chemotherapy. There was a change in CD10 expression in the remaining 16 cases (55.17%); in 13 cases (44.83%) it decreased from its pre-chemotherapy status, while its expression increased in 3 cases (10.34%). In cases of complete and partial clinical response, there was no increase in CD10 expression. Where CD10 expression had increased after chemotherapy, there was either a minor response or no response to chemotherapy. In 13 cases where CD10 expression had decreased, 12 cases had a clinical response to chemotherapy. CONCLUSIONS: Strong CD10 expression correlates with hormone receptor negativity and HER-2/neu overexpression. Stromal CD10 expression in breast cancer is not static and changes with neo-adjuvant anthracycline-based chemotherapy. A stable or decrease in CD10 expression correlates with complete or partial clinical response, while an increase in CD10 expression appears to correlate with poor clinical response. A larger series is required to determine the clinical significance of these changes. As stromal CD10 expression and its change with chemotherapy may have a prognostic significance, they should be documented in breast cancer patients before and after chemotherapy.

Lithium-induced enlargement of a lingual thyroid.

Lingual thyroid is a rare developmental anomaly. It is the result of failure of the thyroid to descend from the foramen caecum to its prelaryngeal site. Lithium is a known goitrogen, but has never been reported to cause symptomatic enlargement of the lingual thyroid. We describe a 40-year-old woman, who presented with a foreign body sensation and progressive dysphagia caused by an ectopic lingual thyroid tissue measuring 4 cm x 3 cm x 3.5 cm. She had been taking lithium for treatment of bipolar disorder and had hypothyroidism. Her symptoms were relieved after excision of the ectopic thyroid tissue.

Coccidioidomycosis presenting as liver abscess.

A 26-year-old man presented with pain in the right upper abdomen. Ultrasonography revealed a large solitary right lobe liver abscess, which was treated by aspiration and antiamebic treatment. The patient continued to be symptomatic with the abscess increasing in size. Repeat aspiration revealed a pure growth of coccidioidomycosis, which was confirmed on culture. He was treated with amphotericin-B; the abscess resolved completely and the patient has remained asymptomatic at one-year follow up.

Internal herniation of wandering spleen--a rare cause of recurrent abdominal pain.

A rare case of wandering spleen herniating through a defect in transverse mesocolon, which was managed electively by splenopexy using polyglycolic acid mesh is reported. An enlarged wandering spleen is at constant risk of trauma, torsion and infarction. Internal herniation seems to increase the above risks. Early recognition and elective splenopexy should be the treatment of choice.

An epidemiological study of prevalence of pain in head & neck cancers.

This study was undertaken on 117 consecutive patients referred to a head and neck oncology clinic at a major hospital in New Delhi. 89.5 per cent patients were in clinical stage III or IV at the time of referral. The prevalence of pain was 83.8 per cent with a mean pain duration of 6.2 +/- 5.9 months and a mean pain intensity of 5.0 +/- 2.7 on a modified numerical rating scale ranging from 0 to 10. The mean intensity of pain was not significantly different for age groups or stage of the disease but patients with oro-pharyngeal cancers had significantly higher pain scores than patients with hypopharyngeal cancers (4.6 +/- 3.0 vs 2.9 +/- 2.5, P < 0.05).

Comparison of piroxicam and acetylsalicylic acid for pain in head and neck cancers: a double-blind study.

This double-blind, placebo controlled study compared the analgesic efficacy of piroxicam with acetylsalicylic acid (ASA) in patients having continuous pain with advanced head and neck cancers. They were randomly divided into two groups of 25 patients each; 36 of these 50 patients completed the study. After four days of treatment, there was a significant reduction in a modified numerical rating scale (NRS) of pain in the piroxicam group as well as in the ASA group. There was a concomitant increase in the hours of sleep in the piroxicam group and in the ASA group. The decrease in NRS and the increase in sleeping hours was not statistically significantly different between the two groups. Patients receiving piroxicam had a low incidence of upper gastrointestinal side-effects compared with those receiving ASA. The results of this study suggest that piroxicam can be used as first line treatment in place of ASA in patients with head and neck cancers suffering from moderate to severe pain. The advantages are less frequent dosing, better patient compliance and few side-effects.