Showing papers by "Tata Memorial Hospital published in 1990"

Testicular dysfunction after cyclophosphamide-vincristine-procarbazine-prednisolone chemotherapy for advanced Hodgkin's disease. A long-term follow-up study.

Abstract: Gonadal functions were evaluated in 92 male patients after treatment for advanced Hodgkin's disease The patients received six to ten cycles of cyclophosphamide, vincristine, procarbazine, and prednisolone (COPP) chemotherapy All patients were in remission and were followed for 1 to 17 years (median, 6) Testicular atrophy was noticed in 89 (967%) patients All patients remained azoospermic during the period of follow-up The testosterone levels did not differ before and after treatment The follicle stimulating hormone levels rose from pretreatment values (mean +/- standard deviation) of 17927 +/- 2199 ng/ml to 57879 +/- 10236 ng/ml after the treatment; the rise was significant (P less than 0001) The luteinizing hormone levels rose from pretreatment values of 10696 +/- 2037 ng/ml to 12737 +/- 3219 ng/ml after treatment; the rise was significant (P less than 005) Testicular biopsy specimens in 19 patients showed germinal aplasia in all cases It is concluded that six or more cycles of COPP chemotherapy for advanced Hodgkin's disease in men leads to permanent sterility

Complications following surgery for cancer of the larynx and pyriform fossa

Abstract: The hospital records of patients undergoing major surgery for cancer of the larynx and hypopharynx at the Tata Memorial Hospital, Bombay, from 1981 to 1985 were reviewed. Different variables were correlated with the incidence of major complications and were analysed to find out significant factors contributing to increased complication rates. Complications included wound infection, pharyngocutaneous fistulae, flap necrosis, carotid blowout, and neo-esophageal stenosis. Postoperative deaths and delayed fatalities were also recorded. The overall fistulae rate was 34.7%, and wound infection occurred in 28% of patients. Prior radiotherapy and the need for pharyngeal reconstruction were found to be significant in determining postsurgical complications. Age, sex, site, stage, cartilage and soft tissue infiltration, preoperative tracheostomy, involvement of resection margins by tumor, and the dose of radiotherapy were not found to influence the complication rates.

Laryngotracheal invasion by well-differentiated thyroid cancer: diagnosis and management.

Abstract: Ten cases of laryngotracheal invasion by well-differentiated thyroid cancer are described. All the patients were over 40 years of age, with a male preponderance of 4:1. A mass in the neck, stridor, and hemoptysis was the common symptom. Bronchoscopy done in six of ten patients revealed an intraluminal tumour in all. Radiographs of the neck showed invasion of the trachea in six patients. Surgery consisted of tracheostomy alone (three of ten), total thyroidectomy with laryngectomy (one of ten), circumferential resection of trachea (one of ten), and total thyroidectomy with tracheotomy and "shaving" of the intraluminal disease in five of ten patients. Adjuvant external radiation, radioiodine, or laser therapy was given when indicated. Of the ten patients, three died and seven survived. Five of seven were alive without disease for 2.5 years or more, and one had skull metastasis 2 years later but no local disease.

Mortality and morbidity of primary pharyngogastric anastomosis following circumferential excision for hypopharyngeal malignancies.

Abstract: Seventy-five patients underwent gastric transposition for replacement of the pharyngoesophagus. These patients had primary or recurrent malignant tumors of the hypopharynx, postcricoid region, and cervical esophagus. The operative procedure consisted of a transhiatal esophagectomy and gastric pull-up to establish gastrointestinal continuity, with a unilateral or bilateral neck dissection where indicated. Seven patients died, a mortality rate of 9.33%. The average hospital stay of uncomplicated cases was 18 days and for complicated cases was 40 days. Immediate restoration of oral intake was achieved in 70.6% of patients. We conclude that gastric transposition after circumferential laryngopharyngeal excision is a procedure with low mortality and acceptable morbidity leading to early relief of dysphagia.

Clinico-pathological features and prognosis of breast cancer in different religious communities in India.

Abstract: A study of clinical and pathological features, patterns of relapse and prognosis of breast cancer in various religious communities--viz. Hindu, Muslim, Christian and Parsi--was undertaken among 4377 evaluable cases treated at Tata Memorial Hospital between 1965 and 1982. Of these 82.4 per cent were Hindus, 7.3 per cent Muslims, 7.4 percent Christians and 2.7 percent Parsis. The mean age at diagnosis was 55 years for Parsis which was 7 to 8 years older than that for the other communities. There were no remarkable differences in histological tumour type or grade; except that parsis had higher incidence of uncommon histological types, such as dust carcinoma in situ and colloid carcinoma, and had a slightly more favourable grade distribution. When classified according to the TNM system (UICC 1978), the Parsis had the most favourable stage at presentation followed by Christians, Hindus and Muslims in that order. This trend was highly statistically significant (p less than 0.001). Despite this significant differences between stage of disease at diagnosis, no differences in the overall 5-year survival was observed between the communities. This remained true even after matching for disease stage and menopausal status. Even the Parsis, in whom the disease was detected relatively early, failed to register a survival advantage. Much work need to be done with regard to early detection of Breast Cancer in India.

Primary lymphoma of bone: experience of 39 cases at the Tata Memorial Hospital, India.

Abstract: Primary lymphoma of bone (PLB) is an uncommon clinical entity and a rare presentation of non-Hodgkin's lymphoma. At the Tata Memorial Hospital, over a period of 10 years from 1976 to 1985, 39 cases with a diagnosis of PLB were seen. Twenty-seven cases completed the prescribed treatment and were evaluable for treatment response. Eight patients (21%) presented in clinical stage I (E), four patients (10%) in stage II (E), and 27 patients (69%) in stage IV (E). All of the evaluable patients except two were treated with combination chemotherapy, which consisted of cyclophosphamide, vincristine, and prednisolone in 18 patients, and seven patients received Adriamycin in addition. The majority of patients received six courses of chemotherapy extending over 8 to 12 months. External radiotherapy was given to all except one patient, who had surgery as local treatment. Five patients had generalised relapse, one of which had in addition a local relapse. Five were resistant to treatment. Overall and disease-free survival by Kaplan-Meier method at 60 months are 66% and 56%, respectively.

Risk of hypoparathyroidism after surgery for carcinoma of the thyroid.

Abstract: The reported incidence of postoperative hypoparathyroidism varies from 3% to 32%, and many surgeons are reluctant to perform a total thyroidectomy because of the risk of permanent damage to the parathyroid glands. We prospectively studied three groups of patients for evidence of acute parathyroid damage: group A consisted of 29 patients with total thyroidectomies; group B, 21 controls with partial thyroidectomies; and group C, 29 patients with total thyroidectomies that had been performed several months to years earlier. Functional status of the glands was measured by serum parathormone, calcium, and phosphorus levels. Although these levels fell postoperatively, they remained within normal limits. None of the long-term follow-up patients (group C) was found to have hypoparathyroidism, leading us to conclude that this risk may be overstated in the literature.

Multifocal extranodal lymphomas: an expression of homing phenomenon.

Abstract: The present study analyses 27 patients with primary lymphoma involving multiple extranodal sites. Eight patients were found to have multiple extranodal involvement at presentation while in 19 patients

Natural killer and lymphokine-activated killer cell functions in chronic myeloid leukemia.

Abstract: The natural killer (NK) and lymphokine-activated killer (LAK) cell activities of peripheral blood lymphocytes from chronic myeloid leukemia (CML) patients in remission and from healthy donors have been studied. Regression analysis to compare both cytotoxic responses in individual donors and the frequency of LAK cell precursors was also carried out. About 42% of CML patients in remission showed low NK activity (less than the mean percentage NK activity of healthy donors — 2 SD) and were categorised as low NK responders. The stage of remission or the drugs used to bring about remission did not influence the NK status. The LAK activity of low NK as well as normal NK responder CML patients was significantly low against the NK-sensitive K562 cell line and the NK-resistant VIP (melanoma) and T-24 (bladder carcinoma) tumor targets, as assessed by linear regression analysis. Allogeneic leukemic cells were more resistant to killing, especially by patients' LAK cells. The frequency analysis of LAK cell precursors revealed a significant reduction in the LAK cell progenitor frequency in CML patients in remission.

The occurrence of variant Ph translocations in chronic myeloid leukemia (CML): a report of six cases.

Abstract: Variants of Philadelphia chromosome (Ph) translocation were detected in six of 95 Ph positive chronic myeloid leukemia (CML) patients (6.3 per cent). Two of these patients showed a Ph variant of 'simple' type, involving chromosomes 10 and 12. In four patients, the variant Ph was of 'complex' type involving a third chromosome:chromosomes 1, 6, 7 and 12 in addition to 9 and 22. Two of these resulted in the occurrence of a 'masked' Ph. In addition to variant Ph translocations, variant breakpoints such as q12 (two patients) and q13 (one patient) on chromosome 22 were observed in another three patients with t(9;22).

Radiation therapy in early glottic carcinoma: significance of prognostic factors and dose fractionation.

Abstract: A retrospective analysis of 208 cases with early glottic cancers treated by radiation therapy is presented. Early T1 (156 cases) and T2 (52 cases) lesions accounted for only 43 per cent of all glottic tumours that presented at the Tata Memorial Hospital between 1975-80. A markedly predominant male to female ratio of 22:1 was noted with 66 percent presenting in the fifth and sixth decades of life. Radical Radiation therapy was delivered with two different regimens according to the then prevalent physician preference. Regimen 1 delivered 50 Gy/15 frs. in three weeks and regimen 2 with 60 Gy/24 frs./5 weeks. The actual total survival and disease free survival was 92 per cent and 85 percent for T1 lesions and 82 percent and 67 percent for T2 tumours respectively. Minimal tumour volume involving a unilateral mobile vocal cord had the best prognosis. With extension to more lengths of cord and/or involvement of the anterior commissure or with tethering or fixation of the cord the prognosis was adversely influenced. In T1 lesions, the shorter course with the higher fractionation dosage levels showed improved local controls. However, the results were not statistically significant. This was not so in the T2 lesions probably due to small number of cases. Treatment failure was recorded in 19 per cent cases of which 90 per cent was seen in the first two years after treatment. Persisting laryngeal oedema confirmed a high index of suspicion towards recurrent disease. A radiotherapeutic technique using proper patient positioning and accurate beam direction with total dosage level above 1850 rets and TDF between 101-106 values is the recommended optimal treatment. In conclusion, an understanding of the prognostic features and an appropriate dose fractionation schedule allows optimization to effectively control early glottic tumours and retain function in the majority of patients.

Folded, bipaddled composite flap in head and neck reconstruction

Abstract: A series of 34 patients repaired by folded, bipaddled composite flaps for head and neck cancer surgical defects is presented. Pectoralis major composite flap was used in 33 patients on musculovascular pedicle and 1 patient had a latissimus dorsi composite flap free-tissue transfer. The pectoralis major rib, osteomyocutaneous flap was utilized in 6 patients who had lesions of the mouth floor and anterior mandibular arch. The incorporated rib was used as a vascularized bone graft for the stability of mandibular fragments. Thus, one regional composite flap used in bipaddled fashion enabled the reconstruction of mucosal, skin, and mandibular arch defects.

Secondary carcinoma of testis--a clinicopathologic study of 10 cases.

Abstract: Ten cases of metastatic carcinomas to the testis are recorded in the last 17 years from Tata Memorial Hospital (TMH). There were two from kidney and four each from prostate and gastrointestinal tract carcinomas. The age of the patients ranged from 40 to 82 years with a mean of 57 years. The disease was unilateral in eight cases and bilateral in two. The testicular mass preceded the symptomatology of the primary lesion in a single case. The disease was an incidental finding in three prostatic carcinomas, where bilateral orchidectomy was performed as a therapeutic procedure. Hydrocele was associated in three cases. Grossly the tumour deposits were nodular or diffuse. Microscopically involvement of the interstitial parenchyma, with sparing of the tubular structures of the testis, epididymis and retetestis and special stains for mucin were helpful in the diagnosis. Lymphatic emboli were present in six cases and vascular emboli in three. The spermatic cord was involved in two cases.

The Pattern of Malignant Lymphoma in India: A Study of 1371 Cases.

Abstract: A retrospective clinical and histopathological analysis was performed of 1371 patients with Non-Hodgkin's lymphomas presenting between January 1981 and December 1985. Pathologic material was reviewed and classified according to the modified Rappaport classification. The most common histologic type encountered was diffuse histiocytic lymphoma (29.5%), followed by diffuse poorly differentiated lymphoma (28%). A very low incidence of nodular lymphomas (10.6%) was seen. Twenty three percent of the patients had clinically stage 1 disease; 24.6% stage 11; 25.9% stage 111 and 26.2% stage IV disease. Bone marrow involvement was seen in 22.6% of patients. B symptoms were seen in 23.9% of patients. Primary extranodal lymphoma was seen in 307 (22.4%) patients. The commonest site of extranodal involvement was head and neck (36.1%) followed by gastrointestinal tract (24.4%). Treatment results could be analysed in only 599 patients. The response rate was 89% and complete response was seen in 67.5% patients. The overall survival for treated patients was 37.5% after 36 months, which is comparable to that reported by other investigators. This series is compared with different series reported from Asian as well as Western countries in order to highlight some common features as well as other major differences.

Continuous cyclophosphamide, doxorubicin, vincristine, and prednisolone. A new, innovative protocol for diffuse aggressive lymphomas.

Abstract: One hundred eight patients with aggressive non-Hodgkin's lymphoma (high and intermediate grade) were treated with a new protocol: continuous cyclophosphamide, doxorubicin, vincristine, and prednisolone (CHOP). They were evaluated for long-term survival and pretreatment characteristics predictive of response and survival. Continuous CHOP protocol consists of initial 8 weeks of intensive chemotherapy with cyclophosphamide, doxorubicin, vincristine, and prednisolone, followed by local/cranial radiotherapy and maintenance therapy. Complete remission (CR) was achieved in 84 of 108 (78%) patients; seven (6%) had a moderate response and 17 (16%) had a poor response. A statistically significant difference in CR rate was found only in patients with different stages. Seventeen of 84 (20%) complete responders have had a relapse of the disease. The median survival has not been reached. Results show an actuarial disease-free survival (DFS) of 77% for the 84 patients who had a complete response. The overall survival for all patients was 53% at 5 years of follow-up. The difference in DFS at the end of 5 years between different stages, main histologic subgroups, and age groups was not statistically significant. The toxicity observed was acceptable. Thus continuous CHOP appears to be an effective protocol for the treatment of intermediate-grade and high-grade lymphomas.

A study of the concentration of micro and macro nutrients in blenderised liquid diet in nasogastric feeding

Abstract: Neutron activation analysis was used to determine the amount of macro (Na, K, P, Ca) and trace elements (Fe, Co, Zn, Mo, Se) present in the blenderised liquid diet in nasogastric feeding of patients having throat cancer.

Sensitization of chronic myeloid leukemia cells to adriamycin cytotoxicity by clofibrate

Abstract: Clofibrate (CPIB), an antihyperlipidemic agent, was employed as a drug response modulator in this study to evaluate its action, if any, on adriamycin (ADR) cytotoxicity in adriamycin insensitive chronic myeloid leukemia (CML) cells in vitro. Inhibition of (3H)-thymidine incorporation was used as a measure of DNA biosynthesis inhibition. A marginally toxic concentration of CPIB [0.001% (v/v)] was utilized to evaluate the cytotoxicity in CML cells exposed to ADR 5 and 10 micrograms/ml. A heterogeneous response was observed in 16 different CML blood samples, 9 samples displaying a synergistic, 3 an additive and 4 a less than additive inhibition of DNA biosynthesis when exposed to the combination of ADR and CPIB. The cytotoxic effect induced by ADR alone and in combination with CPIB was found to be irreversible. The data suggest that the cell membrane modulating drug CPIB is effective as an adjuvant to enhance the antiproliferative action of ADR.

Amphotericin B-related thrombocytopenia. A report of two cases.

Abstract: Thrombocytopenia is a rare side effect of amphotericin B. Two patients with acute leukaemia in remission who developed severe thrombocytopenia during amphotericin B therapy are reported. Thrombocytopenia recovered after the withdrawal of the drug in one patient and after reducing the dose in the other patient.

Reconstruction following limb-sparing en bloc resection of the shoulder girdle--Tikhoff-Linberg procedure.

Abstract: The Tikhoff-Linberg procedure is a limb salvage technique that permits a resection of the shoulder girdle with preservation of neuromuscular function of the upper extremity. Though shoulder movements are lost, useful wrist and hand functions are retained. Reconstruction was carried out in four patients to provide stability and thus facilitating function. To date, there is no local recurrence but one patient with osteosarcoma succumbed from lung metastasis within one year of surgery.

Fibro osseous lesions of cranio facial bones.

Abstract: In a review of all tumours and tumour like lesions of the craniofacial bones between the years 1963 and 1980, 19 cases were diagnosed as fibro osseous lesions. The mean age of occurrence was 23.8 years with a slight male predominance (1.6:1). The clinical and histological aspects of the various lesions, the problems in diagnosis and the impact of diagnosis on clinical behaviour are discussed.

Has adjuvant treatment of breast cancer had an unfair trial

Abstract: Cancer of the breast is not a single disease but rather a conglomeration of many biologically heterogeneous entities. ' It is therefore likely that therapeutic responses to adjuvant treatment are not uniform. Some subgroups of patients possibly respond better to chemotherapy whereas others derive more benefit from endocrine treatment. There might yet be other subgroups of patients either who are resistant to both forms of treatment or in whom treatment is detrimental. The clinical trials of adjuvant treatment of breast cancer conducted so far have been primarily designed to assess the overall efficacy of specific therapeutic regimens across all biological variations of the disease. Few were prospectively designed to cope with the problems of multiple subgroup comparisons, and fewer were large enough to sustain reliable results based on analysis of subsets. Significant effective therapeutic responses in some biological subgroups might have been missed because they were diluted, or perhaps even nullified, by the outcome in other subgroups in which treatment may have had little or detrimental effect. The modest absolute benefit (6-7%) noted in an international overview of such trials may, therefore, reflect the average of variable responses, both in degree and in kind, across different biological subgroups of breast cancer.2

Proton NMR Relaxation Times and Trace Paramagnetic Metal Contents: Pattern Recognition Analysis of the Discrimination Between Normal and Pathological Tissue of the Gastrointestinal Tract and Bone Marrow

Abstract: From the time of the very earliest studies by Damadian et al. (1973) it was postulated that NMR water proton relaxation times had potential for the diagnosis of cancer. However, this overstated the position and there was subsequent criticism of the approach relating to both the relaxation times themselves (Bottomley et al. 1987) and statistical aspects of the samples (Herbert 1986). Nevertheless, many NMR studies by workers the world over have shown clear discrimination between cancerous and noncancerous tissues, as exemplified by many of the data generated by Ranade and co-workers using in vitro NMR measurements and taking care to provide meaningful controls (Shah et all 982a–c).