Evaluation of Uterocervical Angle and Cervical Length as Predictors of Spontaneous Preterm Birth.

Aim The aim of this article was to evaluate uterocervical angle (UCA) and cervical length (CL) measured at 16 to 24 weeks of gestation using transvaginal sonography (TVS) as predictors of spontaneous preterm birth. Methods In this prospective study, TVS was performed in 159 primigravidas with a singleton, uncomplicated pregnancy at 16 to 24 weeks of gestation to measure the anterior UCA and CL. All the cases were followed until labor to document gestational age at delivery. Results The risk of spontaneous preterm birth was higher in women with obtuse UCA (>95 degrees) with sensitivity of 86.7%, specificity of 93.0%, positive predictive value of 83.0%, negative predictive value of 94.6%, and p -value of <0.001. The difference between the means was statistically significant ( p -value < 0.001). UCAs ≥105degrees and 95 to 105 degrees were found to be significantly associated with spontaneous preterm births at <34 weeks and 34 to 37 weeks, respectively. CL <2.5 cm was found to predict spontaneous preterm births at <37 weeks with sensitivity of 31.1%, specificity of 95.6%, and p -value of <0.001. UCA was found to be a better predictor of spontaneous preterm birth with a higher coefficient of variation (56.4%) when compared with CL (16.9%). Conclusions UCA proved to be a novel ultrasound parameter that can serve as a better predictor of spontaneous preterm births in comparison to CL. A strong correlation exists between obtuse UCA and a risk of spontaneous preterm birth.

Malignant Eccrine Spiroadenoma of Right Temporal region: Reporting of a Rare Case.

Eccrine spiroadenoma arises from adnexal tissue of skin and is usually benign, slow growing and may remain static for decades [1]. Dabska et al. first defined the term malignant eccrine spiroadenoma (MES) in 1972, since then around 100 cases of MES have been found (Alejandra de Andrés Gómez. Malignant eccrine breast spiroadenoma. A case report and literature review [2]). Its very rare kind of tumor can arise either from transformation in benign lesion or can arise de novo. Here we are reporting a case of malignant spiroadenoma arising from transformation of benign lesion, its pathology and treatment.

Surgical outcomes in oral cancer involving the central arch of the mandible in elderly patients: An institutional experience.

BACKGROUNDS: Oral squamous cell cancer (SCC) is one of the most common cancers. The most common age of presentation is fifth to sixth decade. Management of this disease is dictated by stage, age, and related comorbidities. Elderly patients have their own set of limitations as far as their management is concerned. Carcinoma involving central mandibular arch is a challenging disease for surgeons, especially in the elderly. This article describes our experience with the surgical treatment of oral cancer involving the central arch of the mandible in elderly patients. METHODS: Forty elderly (≥60 years) patients with histologically proven SCC of the oral cavity in which disease was involving the central arch of the mandible, were included in our study. Demographic, clinical, and treatment-related factors were recorded. The outcome was assessed in terms of postoperative complications, recurrence, and patient survival. RESULTS: The median age of the patients was 63 years. The male:female ratio was 7:3. A history of oral tobacco use was present in 95% of patients. The most common site of disease was lower alveolus (80%) followed by carcinoma of the lower lip (20%). Majority of our patients (77.3% [30]) were having Stage IV disease. Mandibulectomy was either segmental (62.5%) or marginal (37.5%). Bilateral neck dissection (37/40, 92.5%) was done in most patients. Among all patients, 62.5% (25) received adjuvant radiotherapy. The local recurrence rate after a median follow-up of 30 months was 15% (6). Two-year disease-free survival and overall survival were 89% and 90%, respectively. CONCLUSION: Central arch of the mandible is a difficult disease to treat. It needs a complex and lengthy reconstructive procedure. Comorbidities such as extreme age, diabetes, and pulmonary and cardiac illnesses make it more challenging to manage. With the proper evaluation of comorbidities and avoiding long, cumbersome procedures, we can provide patients a fairly good chance of survival.

Cardiac dose reduction using deep inspiratory breath hold (DIBH) in radiation treatment of left sided breast cancer patients with breast conservation surgery and modified radical mastectomy.

PURPOSE: Deep inspiration breath hold (DIBH) reduces heart and pulmonary doses during left-sided breast radiation therapy (RT); however, there is limited information whether the reduction in doses is similar in patients with modified radical MRM (MRM) and breast conservation surgery (BCS). The primary objective was to determine whether DIBH offers greater dosimetric reduction in cardiac doses in patients with MRM as compared to BCS with secondary objectives of documenting time consumed in counseling, simulation and planning such techniques. METHODS: Thirty patients with diagnosis of left sided breast cancer underwent CT simulation both free breathing (FB) and DIBH. Patients were grouped into two cohorts: MRM (n = 20) and BCS (n = 10). 3D-conformal plans were developed and FB was compared to DIBH for entire group (n = 30) and each cohort using Wilcoxon signed-rank tests for continuous variables and McNemar's test for discrete variables. The percent relative reduction conferred by DIBH in mean heart (Dmean heart) and left anterior descending artery dose (LADmean and LADmax), heart V25,V10, V2 and ipsilateral DmeanLung,V20, V12 were compared between the two cohorts using Wilcox rank-sum testing. A two-tailed p-value ≤ 0.05 was considered statistically significant. Time consumed during FB and DIBH from patient counseling to planning was documented. RESULTS: Patients undergoing BCS had comparable boost target coverage on DIBH and FB. For the overall group (n = 30), DIBH reduced Dmean heart and LAD dose, V25, V10 and V2 doses for the heart and Ipsilateral DmeanLung, V20, V12 which was statistically significant. For individual cohorts DIBH did not significantly reduce the lung (Ipsilateral DmeanLung, V20, V12) and LAD (LADmean and LADmax) doses for BCS while significant reduction in all cardiopulmonary doses was seen in MRM cohort. Despite significant reductions with DIBH in MRM, ipsilateral lung constraint of V12 < 15% was less commonly achieved in MRM (n = 11, 55%) requiring nodal radiation as compared to BCS (n = 3, 30%). Percent reduction in all cardiac and pulmonary dosimetric parameters with DIBH was similar in the MRM cohort as compared to BCS cohort. In total 73.1 ± 2.6 min was required for FB as compared to 108.1 ± 4.1 min in DIBH. CONCLUSION: DIBH led to significant reduction of cardiac doses in both MRM and BCS. Reduction of lung and LAD doses were significant in MRM cohort. All cardiac constraints were met with DIBH in both cohorts, lung constraints were less frequently met in MRM cohort requiring nodal radiation.