Arathi Srinivasan

The Effect of Yttrium Addition on the Microstructure and Mechanical Properties of Mg Alloys

AbstractAutomotive and aerospace industries shall witness advancement to the next generation if magnesium (Mg) alloys become an integral part of their manufacturing unit primarily because of its light weight. The main limitation which hinders the progress in this direction is the inferior creep properties of Mg alloys. In order to transform this expectation into reality, rare earth (RE) elements are extensively used as alloying elements for improving the room temperature (RT) as well as high temperature (HT) properties. Yttrium (Y) is one of the most extensively used RE elements primarily because of its very high solubility in Mg. Many researchers have studied the influence of Y addition in Mg alloys because of its very high solubility in Mg. However, there is a need to consolidate the work that has been carried out so far which will help in interpolating the future prospects. This review consolidates the work that has been carried out so far in Y addition covering various aspects related to microstructural modifications and RT as well as HT mechanical properties.

Impact of cancer support groups on childhood cancer treatment and abandonment in a private pediatric oncology centre.

Aims: To analyze the impact of two cancer support groups in the treatment and abandonment of childhood cancer. Materials and Methods: This is a retrospective review of children with cancer funded and non-funded who were treated at Kanchi Kamakoti CHILDS Trust Hospital from 2010 to 2013. A total of 100 patients were funded, 57 by Ray of Light Foundation and 43 by Pediatric Lymphoma Project and 70 non-funded. Results: The total current survival of 80%, including those who have completed treatment and those currently undergoing treatment, is comparable in both the groups. Abandonment of treatment after initiating therapy was not seen in the financially supported group whereas abandonment of treatment after initiation was seen in one child in the non-funded group. Conclusions: Besides intensive treatment with good supportive care, financial support also has an important impact on compliance and abandonment in all socioeconomic strata of society. Financial support from private cancer support groups also has its impact beyond the patient and family, in reducing the burden on government institutions by non-governmental funding in private sector. Improvement in the delivery of pediatric oncology care in developing countries could be done by financial support from the private sector.

Pediatric Inflammatory Myofibroblastic Tumors of the Airway: Two Case Reports with Varying Clinical Presentation

Introduction: An inflammatory myofibroblastic tumor (IMT) is a rare tumor of intermediate malignant potential. It may occur in a wide range of anatomical locations. One-third are found in the respiratory tract. We report two cases of IMT of the airway diagnosed at our institution. Case Report: Case 1: A 6-year-old male child presented with a 1-month history of hoarseness of the voice. On evaluation, a polypoid nodule was noted in the right vocal cord which was excised through the endolaryngeal route. Histopathology was suggestive of anaplastic lymphoma kinase (ALK)-negative IMT. He presented with recurrence after 4 months, for which he underwent endolaryngeal reexcision and tracheostomy for airway protection. A third recurrence after 6 months was managed with laser excision, and the patient was started on oral celecoxib. After 1.5 years of follow up, endoscopic examination showed no recurrence, and celecoxib was continued. Case 2: A 7-year-old male child presented with cough and respiratory distress. Bronchoscopy and high resolution computed tomography showed a polypoidal lesion with calcification arising from the left anterolateral wall of the trachea with significant narrowing of the lumen. The patient underwent biopsy followed by endoscopic excision, and was diagnosed with IMT. Currently the patient is under follow up with no recurrence. Conclusion: IMT indicates a proliferative myofibroblastic growth. Surgical resection should be recommended for all lesions if not prohibited by anatomic location or morbidity. Patients should be followed up closely for recurrence. In most cases, complete surgical excision will suffice; however multiple recurrences can be managed with chemotherapy. These two cases highlight the importance of a multidisciplinary approach in rare tumors in difficult anatomical locations.

Profile and outcome of pediatric brain tumors – Experience from a tertiary care pediatric oncology unit in South India

Context: Tumors of the central nervous system (CNS) constitute the second most common pediatric cancers. Unlike leukemia, management of CNS tumors requires a good multidisciplinary team. Higher rates of treatment abandonment are documented in view of complexity of the treatment with long duration, involving neurosurgery, radiation, chemotherapy, and high cost of treatment. Morbidity associated with CNS tumors may be significant in terms of physical deficits as well as neuropsychological and neuroendocrine sequelae. Pediatric neurooncology is still at a very nascent stage in the developing countries. There are only a few reports on the multidisciplinary approach and outcomes of pediatric brain tumors in developing countries. Aims: The aim of this study is to identify the clinicopathological profile of Pediatric CNS tumors in a tertiary care center located in South India in comparison with reports from other low-and middle-income Countries. Settings and Design: A retrospective analysis of medical records of all children diagnosed with brain tumors from January 2012 to November 2016 at our institute was done. Subjects and Methods: A retrospective study of clinical, pathological profile, and outcomes of children <18 years diagnosed with brain tumors at our institute from January 2012 to November 2016 was done. Histopathological categorization was done as per the WHO classification 2007. The multidisciplinary treatment with respect to surgery, radiation, and chemotherapy was noted and the outcomes were recorded. Statistical Analysis Used: R for Statistical Computing (Version 3.0.2; 2013-09-25). Results: A total of 52 children were diagnosed with male preponderance of 66.6%. Highest incidence was noted in the age group of 0–4 years (50%). Majority of them were supratentorial (59.6%). CNS embryonal tumors contributed to 48% of all our brain tumors. 73% of them underwent either resection or biopsy. Eight (15.3%) of them died due to the progression of disease, but 44% abandoned treatment due to the progression/recurrence of disease. Those lost to follow-up were mostly among the high-risk groups with poor prognosis such as pontine glioma, medulloblastoma (high risk), and primitive neuroectodermal tumor. Conclusions: Although brain tumors constituted 30% of all our solid tumors, only 56% of them received appropriate treatment and 25% abandoned treatment. High rates of abandonment were a consequence of late diagnosis, complex multidisciplinary treatment involved, high treatment cost, lack of uniformity in management between different oncology centers and poor prognosis of the tumor subtype.

A Rare Case of Perinatal Intrarenal Neuroblastoma

Perinatal neuroblastoma is the most common solid malignant tumor in infancy which comprises one fifth of all neuroblastomas. Most of them are of adrenal origin and extra-adrenal neuroblastoma is uncommon. We present a rare case of perinatal intrarenal neuroblastoma in a neonate who presented with an incidentally detected abdominal mass. These tumors cause diagnostic and therapeutic dilemma because of its uncommon location. Although very rare, neuroblastoma should be considered in the differential diagnosis of perinatally detected renal tumors.

Two Uncommon Paraneoplastic Neurological Syndromes in a Child With Hodgkin Lymphoma.

Paraneoplastic neurological syndromes (PNS) are rare, remote effects of cancer that are usually caused by an altered immune response to the tumor and not due to the tumor mass, metastasis, infection, ischemia, or metabolic derangements. PNSs can affect any area of the central, the peripheral, and the autonomic nervous systems. These are rare in lymphomas compared with solid tumors attributed to their presentation even in late stages and the absence of onconeural antibodies. We present a child with stage IIB Hodgkin lymphoma who presented with dual PNS, achalasia cardia, and Holmes Adie pupil occurring synchronously with the cancer.

Anaplastic large cell lymphoma: a rare cause of extreme neutrophilia in a child

Anaplastic large cell lymphoma (ALCL) in children can present with a broad spectrum of clinical manifestations which apart from nodal and extra nodal disease include paraneoplastic phenomena that can mimic an infection or inflammatory illness leading to delayed diagnosis. The following case report describes a child with prolonged fever, hepatosplenomegaly, polyserositis and extreme neutrophilia masquerading as an infection or inflammatory disorder for long before the definitive diagnosis of ALCL was made. This case highlights the rare paraneoplastic phenomena in ALCL and the heightened need to suspect this disorder when the search for underlying infections and connective tissue disorders are not conclusive.

ABVE-PC and modified BEACOPP regimen in Indian children with Hodgkin lymphoma: Feasibility and efficacy

Aims: To study the toxicity of ABVE-PC (doxorubicin, bleomycin, vincristine, etoposide, prednisone and cyclophosphamide) and modified-BEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide,vincristine, procarbazine, prednisone) in intermediate-risk and high-risk Hodgkin lymphoma patients. Methods: High-risk patients received 4 cycles of modified-BEACOPP (m-BEACOPP) plus 4 cycles of ABVD. Intermediate-risk patients received 4 cycles of ABVE-PC plus 2 cycles of ABVD. Results: From 2010 to 2014, 17 patients received 66 cycles of m-BEACOPP and 9 patients received 40 cycles of ABVE-PC. In the m-BEACOPP and ABVE-PC courses, respectively, significant thrombocytopenia (<50,000/mm3) occurred in 10.6% vs 0% of courses; anemia (Hb. <8 gm/dl) in 27.3% vs 15%; neutropenia (ANC<500/mm3) in 46.9% vs 32.5%; and febrile neutropenia in 33.3% vs. 22.5%. Only episode of documented infection (hepatic abscess) occurred in ABVE-PC. There were no episodes of sepsis, typhlitis or pneumonia in either group. All 26 patients are in remission with a median follow-up of 35 months (range, 17-61); and there have been no relapses. Two of 26 (7.7%) patients failed to achieve rapid early response after 2 cycles and complete remission after 4 cycles of chemotherapy; both achieved remission with more intensive regimens followed by radiation. The remaining 24 patients did not receive radiation therapy. Conclusions: Both m-BEACOPP and ABVE-PC regimens have acceptable toxicity; and thus can be used in most centres with optimum supportive care facilities. They offer promising response rate and relapse free survival without the need for radiation therapy in most patients; and thus may be considered for children with high-risk and intermediate-risk Hodgkin lymphoma.