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Majeed T.A.,Mahavir Cancer Sansthan | Deshpande R.K.,Sl Raheja Hospital | Upadhaya S.,Sl Raheja Hospital | Deshmukh S.A.,Sl Raheja Hospital
Indian Journal of Surgical Oncology | Year: 2010

Internal jugular vein is one of the major contributors to the venous drainage from the intracranial structures. Neck dissections which necessitates ligation of internal jugular vein leads to significant alteration of cerebrospinal fluid pressures in the range of three times for unilateral ligation to five times in cases of bilateral ligation. Agenesis of internal jugular vein merits concern prior to central venous cannulation and ligation during radical neck dissection for metastatic nodes in head and neck cancers. © 2011 Indian Association of Surgical Oncology.

Singh J.K.,Ss Hospital And Research Center | Chauhan R.,Mahavir Cancer Sansthan
Reviews on Recent Clinical Trials | Year: 2015

Cervical cancer has a major impact on the lives of Indian women with an estimated 122, 844 new cases of cervical cancer in the year 2012. About 80% of these cases present in a locally advanced stage leading to high morbidity and mortality. Because of lack of public awareness and infrastructure for screening and early detection in developing countries, this late presentation is likely to continue in the coming years. Radiation therapy has been the treatment of choice for patients with locally advanced cancer cervix. Many clinical trials and meta-analyses have shown a significant improvement in overall and progression-free survival with decreased local and distant recurrences with the use of concurrent chemotherapy with radiation. Most of these trials have been done in women from developed countries where the patient and disease profile are entirely different from ours. Recently, few trials from India have also shown promising results in locally advanced cancer cervix with concurrent chemoradiotherapy but toxicities remain a major concern. Further exploration is required for the use of concurrent chemo radiation prior to incorporating it into routine clinical practice. © 2015 Bentham Science Publishers.

Reena S.,Patna Medical College and Hospital | Reecha S.,Patna Medical College and Hospital | Kaushal K.,Danapur Railway Hospital | kumar V.P.,MahavirCancer Sansthan | Singh J.K.,Mahavir Cancer Sansthan
Journal of Clinical and Diagnostic Research | Year: 2014

Laryngeal squamous cell carcinoma (SCC) in adolescents is a rare clinical entity and behaves aggressively. The mechanism of laryngeal oncogenesis is complex. Further studies need to be done to know the role that human papilloma virus plays in laryngeal SCC in adolescents.We report a rare case of laryngeal SCC in a 12-year-old boy presenting with cutaneous forehead metastasis.

Heroor A.,Fortis Hospital | Panjwani G.,Mahavir Cancer Sansthan | Chaskar R.,KDA Hospital
Indian Journal of Surgery | Year: 2015

This study aims to document demographic and intraoperative variables and short-term postoperative outcomes in patients being operated by laparoscopy-assisted colorectal surgeries and assessing the magnitude of impact of the learning curve on surgical results. This study included 101 patients with colonic or rectal pathology getting operated for laparoscopy-assisted colorectal surgeries carried out by the same surgeon over 5 years (2008 to 2013). The patient data was retrospectively analyzed for pre-decided variables. Also, comparison was made between the surgeries performed during the learning curve of initial 30 cases with subsequent operations. Laparoscopic colorectal surgeries give satisfactory results in terms of intraoperative parameters like surgical duration, blood loss, and clinico-pathologic parameters like lymph nodal resection and distal and circumferential margins. Patients undergoing laparoscopic colorectal surgeries fare better in short-term postoperative period while early long-term outcomes appear similar as compared to the standard open colorectal surgeries. The surgical outcomes, both intraoperative and early postoperative, improve significantly once the learning curve is negotiated. Laparoscopic Surgery can be safely used as an alternative to conventional open colorectal surgeries without compromising on oncological principles. © 2015, Association of Surgeons of India.

Singh A.,Mahavir Cancer Sansthan | Kumar R.,Mahavir Cancer Sansthan | Singh J.K.,Mahavir Cancer Sansthan | Tanuja,BMD College
Research Journal of Biotechnology | Year: 2012

Investigations on female Swiss albino mice in order to evaluate the long term toxicity of orally administered DEHP at a dose of 20 mg/kg/bodyweight/day for a period of six weeks on biochemical parameters of liver showed a decrease in body weight that was statistically not significant (P>0.05) in two weeks while it was statistically very significant (P<0.01) in four and six weeks DEHP treated groups of mice. The relative weight of liver increased in treated groups and the changes in liver weight were statistically not quite significant (P>0.05) in two weeks treated mice whereas it was statistically extremely significant (P<0.001) in four and six weeks treated mice. The increased SGPT level was statistically significant (P<0.01) in two weeks treated mice while it was statistically extremely significant (P<0.001) in four weeks and six weeks treated mice. Increase in serum ALP level in DEHP treated groups was statistically significant (P<0.05) in two weeks, statistically very significant (P<0.01) in four weeks and statistically extremely significant (P<0.001) in six weeks treated groups. The serum level of albumin and total protein decreased progressively from second week to sixth week and the decreased value was statistically not significant (P>0.05) in two weeks while statistically very significant (P<0.01) in four weeks and found statistically extremely significant (P<0.001) in six weeks treated group.

PubMed | Mahavir Cancer Sansthan
Type: Journal Article | Journal: Journal of clinical oncology : official journal of the American Society of Clinical Oncology | Year: 2016

16570 Background: Cervical cancer is a clinically staged malignancy according to FIGO Staging System. The 1994 revision of FIGO staging system is the currently internationally accepted staging system. Being a subjective method, with inter observer variations, it has certain limitations. The surgico pathological TNM staging is however a more accurate and objective method of staging. The purpose of the present article is to compare the clinical FIGO stage with post operative TNM stage in sixty two cases of carcinoma cervix treated with surgery.Sixty two patients of early cervical carcinoma were treated with surgery from Jan. 2002 to Dec. 2007 in the department of surgical oncology at Mahavir Cancer Sansthan. A retrospective analysis of these cases was performed. All the patients underwent a thorough clinical evaluation and were staged as per FIGO staging system pre operatively. A punch biopsy was taken from the growth. An ultrasound of the whole abdomen was done in all the cases. After appropriate pre operative work up all the patients underwent type III radical hysterectomy with bilateral pelvic lymph node dissection. Para aortic lymph node sampling was done in 27 cases. The clinical stage was then compared with the pathological TNM stage post operatively. A comparison was also made between the ultrasonography findings and histopathology. The pre operative histology from punch biopsy was compared to the final histology. 28 patients (45%) received adjuvant radiation therapy. All the patients were followed up regularly as per guidelines with a median follow up of 12 months (Range 3-42m).On comparison of FIGO & TNM Stage, there was a discrepancy between the two in 18 patients (29%). 10 (16%) patients got upstaged whereas in 8 (13%) patients the disease was down staged. In 3 patients the disease got up staged because of metastasis in pelvic lymph node. 5 patients got up staged due to microscopic vaginal involvement. Tumor size led to upstaging in 2 patients. All upstaged patients required Adjuvant Radiotherapy.Clinical staging being observer dependent is not an objective method of staging and significant discrepancies have been observed between the two staging systems. No significant financial relationships to disclose.

PubMed | Mahavir Cancer Sansthan
Type: Journal Article | Journal: Journal of clinical oncology : official journal of the American Society of Clinical Oncology | Year: 2016

15032 Background: Studies have described decreased pelvic control & survival rates in invasive ca cervix when overall time in definitive RT is prolonged. We evaluated impact of timing of brachytherapy on outcome.Retrospective analysis of 338 patients of ca cervix treated with radical RT from Jan 2002 to Dec 2002 at Mahavir Cancer Sansthan Patna. The median age was 50 yrs (23-80 yrs). 73% patients were postmenopausal. Histopathology was Squamous Cell in 97% patients. Most common presenting complaints were bleeding P/V (92%) & discharge P/V (82%); with stage I (3%), II (35%), III (43%), IV (5%), unknown stage in 14% cases.Records of 338 patients (Stage IB to III) treated with definitive irradiation (combination of EBRT & ICRT) were reviewed with reference to loco regional control, distant failure and its correlation with patient and tumor variables including OTT. Out of 302 patients who received complete RT, 24 received 60 Gy in 30 fractions as they were found to be unsuitable or were unwilling for ICRT. The rest received a dose of 50 Gy/25 Fr to 50.4 Gy/28 Fr over a median duration of 37 days. 30 patients received concomitant chemo radiation (cisplatin 40 mg/mLonger radiotherapy completion time was found to be associated with diminished survival outcomes for patients treated radically for carcinoma cervix. The significance of this observed association requires further investigation & correction to keep OTT as short as possible. No significant financial relationships to disclose.

PubMed | Mahavir Cancer Sansthan
Type: Journal Article | Journal: The Indian journal of surgery | Year: 2012

Lipomas are one of the most common benign mesenchymal tumors in the body. Usually asymptomatic, they rarely warrant treatment unless they attain enormous size causing cosmetic deformity or pressure effects. Head and neck region is an uncommon site, retropharyngeal space being one of the rarest. Lipomas in this region can produce pressure symptoms demanding surgical excision.This is a case report of retropharyngeal lipoma, extending from skull base to the clavicle. Though tumor was present for 20 yrs it exhibited rapid growth over a period of 2-3 yrs causing respiratory obstruction, dysphagia & dysphonia. Clinically the entire laryngopharynx, trachea and carotid sheath were pushed anteriorly. On imaging, it showed classical features of a lipomatous mass. Patient underwent complete excision which presented a surgical challenge to surgeon and the anaesthetist from intubation to extubation.

PubMed | Mahavir Cancer Sansthan
Type: Journal Article | Journal: Indian journal of cancer | Year: 2017

To identify prognostic factors in carcinoma penis with its impact on survival.To find out the relation of various prognostic factors of carcinoma penis with the various outcomes.Retrospective cohort study.Each patient diagnosed as having carcinoma of penis by incision biopsy and operated from January 2004 to May 2009 at the institute was included in the study (n = 117). Data were collected and analyzed.The Chi-square (2) test was used to test for the significance of association between the independent (predictor) and dependent (outcome) variables. Multivariate logistic regression analysis was used to determine predictor variables that predicted the outcome. Five year disease-free survival (DFS) and overall survival (OS) were calculated using the Kaplan-Meier method.Of the total 117 patients studied, 30 patients died within 5 years (median = 25 months). Recurrences (local or systemic) were seen in 23 patients (median = 14 months). Five-year DFS was 80.34% and OS was 72.22%. Kaplan-Meier analysis showed that well to moderately differentiated grade, lymph node negative disease and low stage have higher survivals than poorly differentiated grade, lymph node positive disease and higher stage, respectively. Multiple logistic regression analysis revealed that inguinal lymph node positivity and grade were significantly associated with local or systemic recurrence.Penile cancer patients with advanced disease had poor survival. Tumor grade and inguinal lymph node metastasis are factors affecting DFS. Lymphadenectomy remains an integral part of the management of patients with penile cancer.

PubMed | Mahavir Cancer Sansthan
Type: Journal Article | Journal: Journal of clinical oncology : official journal of the American Society of Clinical Oncology | Year: 2016

4272 Background: Carcinoma gall bladder is one of the most aggressive malignancies, with very poor outcome. At the time of presentation, most of the cases are either locally advanced or are metastatic. Surgery is the only modalitywith a curative and also a useful palliation.Patterns of presentation and management differ significantly in different regions of the world.In this era of laparascopic surgery, for gall stones.quite a few cases of incidently diagnosed carcinoma gall bladder present asymptomatically or with minimal symptoms. Majority of patients with symptomatic disease are in an advanced stage.To analyse the clinical presentation and surgical outcomeof gall bladder cancer in patients with or without prior surgery.A total of 496 patients of carcinoma gall bladder were seen in our out-patient department during the period Jan.2002 - Jan 2004.Disease profile and treatment outcomeof 27 patients operated at MCS were analysed retrospectively.17 patients (62%) presented as primary cases while 10 patients (37.03%) came after prior surgery. Among the patients with prior surgery, seven (70%) had laparoscopic cholecystectomy while in 3 (30%) open surgery was performed. Most patients were throughly worked up before being taken up for surgery. Radical surgery was possible in 17 patients (62.9%) while in 10 patients (37.03%) palliative surgery was done due to local advacment or advanced disease state. Nine patients (33.3%) without prior surgery could undergo radical surgery. In the prior surgery group, in all seven (100%) laparoscopic surgery patients, Curative resection was possiblewhile in oneof the three (33%) open surgery group, radical resection could be achieved. Reasons for their inoperability was probably local advancement or advanced disease with post operative dense fibrotic lesions.Incidentally diagnosed (asymptomatic ) gall bladder cancer has a better resectability rate as compared to compared to those with symptoms and radical surgery can be better achieved in patients with prior surgery. No significant financial relationships to disclose.

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