Background: Carcinoma of the esophagus and gastroesophageal junction is an aggressive disease with limited survival. Standard management consists of multimodality therapy, incorporating chemotherapy, radiation, and surgery. Objectives: We aimed to understand the obstacles in treating patients with resectable esophageal cancer with neoadjuvant chemoradiotherapy followed by surgery. We also assessed the disease outcomes in the patients who completed surgery. Materials and Methods: We included patients with resectable esophageal carcinoma who received neoadjuvant chemoradiation between March 2017 and August 2019 at the Homi Bhabha Cancer Hospital in Sangrur, Punjab, a tertiary care center in rural India. As surgery for esophageal cancer was not performed at our center, patients had to be referred to a higher center for this. Patients were divided into two groups, based on the therapy they received following neoadjuvant chemoradiation: those who completed surgery (Group A) and those who did not (Group B). The pathologic response rates were noted. The disease-free survival (DFS) and overall survival (OS) were compared between the two groups. Results: A total of 55 patients (32 in Group A and 23 in Group B) were included the study. In Group A, complete pathologic responses were noted in 19 (59.4%), partial responses in 11 (34.4%) and poor responses in 2 (6.2%) patients. The major reasons for not undergoing surgery were patient refusal as they were feeling better after chemoradiation (8, 34.8%) and the presence of advanced inoperable (5, 21.7%) or metastatic disease (3, 13%) on imaging after chemoradiation. The median DFS in Group A and Group B was 8 months (range, 0–38 months) and 14 months (range, 0–29 months), respectively, and the 2-year DFS was 57.8% and 73.3%, respectively ( P = 0.28). Median OS in Group A and Group B was 17 months (range, 3–43 months) and 17 months (range, 2–31 months), respectively, and the 2-year OS was 52.6% and 53.5%, respectively ( P = 0.70). Conclusions: Implementing neoadjuvant chemoradiation followed by surgery for resectable esophageal cancer in a center where esophageal cancer surgery cannot be performed is challenging. Among patients who undergo surgery following neoadjuvant chemoradiation, complete pathologic responses occur in 59.4% patients, and clinical outcomes appear to be similar to those reported in the literature.
ENGLISH/ ABSTRACT (ENGLISH/ ABSTRACT (ENGLISH/ ABSTRACT (ENGLISH/ANGLAIS ANGLAIS ANGLAIS ANGLAIS)) This original work assesses the vitamin D status of healthy, asymptomatic cohort of post- menopausal women in Karnal, Haryana, northern India, located at a latitude of 28°42'N. The prevalence of vitamin D deficiency is 52.37 %, while that of vitamin D insufficiency is 14.28 %. The mean serum 25(OH) vitamin D level is21.0± 13.5ng/ml. This paper highlights the high occurrence of low vitamin D levels in a prosperous state of north west India.
Spontaneous rupture of kidney is a rare clinical entity. A 35-year-old female presented in emergency with left flank pain and features suggestive of haemorrhagic shock. Investigations showed rupture of kidney with perinephric haematoma. Emergency left nephrectomy was done. Patient was discharged in satisfactory condition. Nephrolithiasis with secondary bacterial infection rarely presents as spontaneous kidney rupture. In presence of haemorrhagic shock management is emergency surgery.
Endometrial carcinoma (EC) data from India are very sparse. We did a retrospective analysis of our patients registered at this peripheral cancer center based in rural Punjab and studied their outcome.Ninety-eight Stage I and II EC patients with endometroid histology registered at our institute from January 2015 to April 2020 were studied for demography, histopathology, treatment received, and outcomes. FIGO 2009 staging and new European Society for Medical Oncology (ESMO) risk group classification was used.Our patients had a median age of 60 years (range 32-93 years). There were 39 (39.8%), 41 (42.0%), 4 (4.1%), 12 (12.2%) patients in the low risk, intermediate risk (IR), high intermediate risk, and high risk groups, respectively, as per new ESMO risk classification. Two (2.0%) patients had incomplete information to assign them to a particular risk group. Fifty (46.7%) patients underwent complete surgical staging and 54 (50.5%) patients received adjuvant RT. With a median follow-up of 27.0 months, there were 1 locoregional and 2 distant recurrences. There were 8 deaths in total. Three-year overall survival for the entire group is 90.6%.The risk group determines adjuvant treatment in endometrial cancer. Patients operated at dedicated cancer center tend to have better surgical staging and thus better outcome because of better risk stratification and grouping for adjuvant therapy. IR histology was more common in our group of patients, which is variable as compared to available literature.
This study aims to compare the efficacy of antiseptic dressings, hyperbaric oxygen therapy, and recombinant human platelet derived growth factor (rhPDGF) for two reasons: i) to reduce the incidence of lower limb amputations in diabetic foot ulcer; ii) to limit the duration of stay in the hospital. A prospective randomized trial was conducted on 60 patients with stage III and IV diabetic foot ulcers (International Association of Enterostomal Therapy classification) and patients were divided randomly in three different therapy groups - antiseptics, hyperbaric oxygen therapy, recombinant platelet derived growth factor, with 20 patients in each group. Patients were managed initially on inpatient and then on outpatient basis till the ulcer healed completely. Results among three groups were compared using unpaired T test and the level of significance was set at P<0.05 using ANOVA. This study compares the efficacy of hyperbaric oxygen therapy, antiseptic dressings, and rhPDGF in grade III and IV diabetic foot ulcers. P value (0.0348) was significant for complete wound contraction while p value healing time (0.6534) and ulcer size (0.0593) in the groups was not significant. PDGF is safe, effective and easy to apply. Results are comparable with hyperbaric oxygen (HBO) therapy and cost of treatment is lower than other therapies. Diabetic foot ulcer management requires multidisciplinary and aggressive approach. PDGF should be recommended for all grade III and IV diabetic foot ulcer at least 8 weeks old. HBO is equally good an option but has limitations and side effects.
Introduction:Elective surgeries all around the world were deferred as the world was hit by COVID.COVID patients occupied most of the hospital facilities.There was uncertainty on the testing methods and the effect of COVID on postoperative course.Cancer patients were greatly affected, as the risk of disease progression is high with delay.We present our experience of managing cancer surgeries at a rural cancer center.Methodology: Patient's data from 1.1.20 to 31.05.21 was retrieved from electronic medical records and departmental logbook.Result: A total of 1105 major surgeries were performed.Breast (42.4%), head and neck (20.2%) and gynae-oncology (16.4%) comprised the majority.Majority were ASAI and ASAII and median age was 54 years.Major complications (Clavien -Dindo IIIb and IV) were seen in 22 patients and mortality was seen in 5 patients.Conclusion: Since most of the world is uncertain about the duration of this pandemic hence oncosurgeons need to stick to the Latin phrase of "primum non nocere" i.e. first do no harm.Extraordinary situations like these calls for extraordinary measures, which no guideline will tell.Every institution must make a policy, which suits their patient population and resources.
Introduction: Ureteral Double J Stenting (DJS) is commonly done prior to endourological interventions for various indications. Aim: To compare Urine Culture (UC) with DJ Stent Culture (SC) in patients with indwelling ureteral stents prior to endourological intervention and to evaluate the clinical significance of SC with postendourological intervention sepsis. Materials and Methods: A prospective single centre observational study was conducted in the Department of Urology, Army Hospital Research and Referral, New Delhi, India, from August 2017 to March 2019. A total of 100 patients underwent DJS prior to definitive endourological intervention. Patient's demographic profile was recorded along with preoperative, intraoperative and postoperative parameters. UC was also recorded at these intervals along with SC. The data was analysed and compared using Statistical Package for the Social Sciences (SPSS) software. Results: Intraoperative UC of 14 patients were colonised, SC was colonised in 11 patients. Six patients developed Urosepsis, Postoperative UC was colonised in four patients. The Sensitivity, Specificity, Positive Predictive Value (PPV) and Negative Predictive Value (NPV) of intraoperative UC for detecting stent colonisation with identical pathogens were 63.64%, 92.13%, 50.00% and 95.35%, respectively. Patients with colonised intraoperative UC, SC cranial tip and SC caudal tip had sepsis rates of 28.6%, 50%, and 44.4%, respectively. The sensitivity and PPV of SC in predicting postoperative sepsis were low at 83.33% and 45.45%, respectively, whereas the specificity and NPV were high at 93.6% and 98.8%. A 15.8% of diabetic patients and 50% immunocompromised patients developed urosepsis. E.Coliwas the commonest isolated pathogen from UC and SC. On univariate logistic regression analysis, operative time, positive intraoperative UC, positive SC were associated with postintervention sepsis. While on multivariate analysis, none of these factors were associated with postendourological intervention sepsis. Conclusion: Performing routine SC may not be cost effective but could be recommended in cases at higher risk of developing postoperative urosepsis such as those with Diabetes Mellitus (DM) or immunocompromised patients and those expected to take longer operative time.
Müllerianosis of the urinary bladder is a rare entity with less than 30 cases reported. It encompasses a mixture of different types of Mullerian lesions like endometriosis, endocervicosis, and endosalpingiosis. It typically affects the women of reproductive age group. The symptoms vary from hematuria and dysuria, to pelvic pain, which may be associated with menstruation. It can mimic a malignant tumor clinically and radiologically; hence, it is important that a correct diagnosis is rendered in these cases to avoid unnecessary radical procedures. Herein we report a case of mullerianosis of the urinary bladder in a young female and discuss the important differential diagnosis and various treatment modalities.
'%3e%3ccircle r='20' fill='%23008'/%3e%3ccircle r='17.5' fill='%23fff'/%3e%3ccircle r='3.5' fill='%23008'/%3e%3cg id='d'%3e%3cg id='c'%3e%3cg id='b'%3e%3cg id='a' fill='%23008'%3e%3ccircle r='.875' transform='rotate(7.5 -8.75 133.5)'/%3e%3cpath d='M0 17.5.6 7 0 2l-.6 5L0 17.5z'/%3e%3c/g%3e%3cuse xlink:href='%23a' transform='rotate(15)'/%3e%3c/g%3e%3cuse xlink:href='%23b' transform='rotate(30)'/%3e%3c/g%3e%3cuse xlink:href='%23c' transform='rotate(60)'/%3e%3c/g%3e%3cuse xlink:href='%23d' transform='rotate(120)'/%3e%3cuse xlink:href='%23d' transform='rotate(-120)'/%3e%3c/g%3e%3c/svg%3e)
