H. S. Shukla

A comparative study of scalpel and surgical diathermy incision in elective operations of head and neck cancer

OBJECTIVE The aim of the study was to assess the outcome of patients following use of scalpel or surgical diathermy in elective skin incision of head and neck cancer. MATERIALS AND METHODS 80 patients undergoing surgery for various head and neck cancers were analyzed retrospectively from Jan 2002 to May 2005 and divided into two groups, matched for age, sex, stage and histopathology according to the method used to perform incision, i.e., scalpel or surgical diathermy. Blood loss, total operative time, blood transfusions, wound related complications and cosmetic assessments of the scar were compared. RESULTS The two groups did not differ significantly in relation to patients or wound characteristics in terms of total operative time and quantity of blood transfusions. There was significantly less blood loss in the diathermy group compared with the scalpel group. There was no difference between the groups in wound complications and cosmetic results before discharge and at 1-month follow-up. CONCLUSIONS There is no change in wound complication rate and scar formation even after application of heat during use of surgical diathermy. Therefore, surgical diathermy is safe and as effective as scalpel during elective skin incision of head and neck cancer.

Significance of Her-2/neu protein over expression in Indian breast cancer patients

BackgroundRacial disparity in presentation and outcome of breast cancer is established but cause is unexplained. Many studies show various molecular markers for racial differences in the prognosis of breast cancer. There is scarcity of data on prognostic significance of HER-2/neu in Indian breast cancer.Aims and ObjectiveTo know incidence and prognostic significance of HER-2/neu expression in Indian patients. To correlate HER-2/neu Expression with other prognostic markers and ER/PR Receptor status.Material and Methods112 consecutive patients with breast cancer attending the Department of Surgical Oncology from March 1997 to March 2000 were included in this study. The clinical data along with ER/PR status, follow up data and HER-2/neu expression examined by immuno-histochemical method was recorded.Statistical AnalysisData was analyzed by univariate and multivariate analysis for all prognostic factors. Significance was calculated by using Chi square test and survival analysis by using Kaplan Meier survival curve.ResultsThe median age of 112 patients was 46.56 (±9.55) years. HER-2/neu over expression was present in 46.37%. Significant correlation was found between HER-2/neu over expression and lymph node status, grade of tumor and ER/PR receptor status. Median follow up period of 23 months. There was significant tumour free survival advantage (p < 0.01) and overall survival advantage (p < 0.001) in patients with HER-2/neu negative expression.ConclusionHER-2/neu oncogene over expression is higher (46.37%) among Indian patients in comparison to 25–30% shown in most western literature. HER-2/neu oncogene over expression significantly correlates with grade, lymph node involvement, ER/PR status and also affects survival.

What Causes Cancer Gallbladder?" A Review

Gallbladder cancer is a common malignancy of the biliary tract. It is the fifth common malignancy of the gastrointestinal tract in United States [1] and third in Northern India [2]. Despite such high prevalence, there is scanty published literature about this disease in indexed journals. Therefore, this article is intended to provide a brief overview of gallbladder cancer risk factors, based mainly on published evidence from analytical epidemiology and recent research findings of biologists and practising oncologists. Furthermore, an attempt has been made to establish an association between different causative factors and the occurrence of the disease.

An evolution of clinical application of inferior pedicle based rectus abdominis myocutaneous flap for repair of perineal defects after radical surgery for cancer.

The inferior epigastric artery based rectus abdominis myocutaneous flap (RAMF) is one of the most versatile flaps used to bridge gaps in the perineum and groin, in the reconstruction of vagina after radical resections for cancer and in selected patients with benign and non‐healing perineal lesions. Its use for reconstruction after Abdomino‐perineal resection was first described in 1984. This review attempts to summarize the anatomic‐technical aspects of inferiorly based RAMF and its applications. J. Surg. Oncol. 2010;102:287–294.

Tuberculosis of the Gallbladder

Analysis of 5 patients with gallbladder tuberculosis who had open cholecystectomy and review of literature have shown that, although still rare it presents as a part of systemic miliary tuberculosis, abdominal tuberculosis, isolated gallbladder tuberculosis and as acalculus cholecystitis in anergic patients. There are no pathognomonic signs, the diagnosis depends on suspicion of tuberculosis, peroperative findings and histological examination.

Expression of procaspase 3 and activated caspase 3 and its relevance in hormone-responsive gallbladder carcinoma chemotherapy

Background/Aims The higher incidence of gallbladder cancer (GBC) in females has been accredited to the involvement of hormones. The clinical implications of sex hormone receptors in GBC are well established. Cysteine proteases (such as caspase-3-9, etc.) are known to play a central role in the apoptotic pathway. Of these, the downstream enzyme caspase-3 is often activated in the apoptotic pathway. The aim of this work was to examine the status of apoptosis (which directly correlated with the level of active caspase-3) in hormone-responsive GBC. Methods We used 10 androgen receptor (AR)-positive, 14 estrogen receptor (ER)-positive, 12 HER/neu-positive, eight triple positive, and 10 triple negative malignant GBC human tissue samples. We isolated the total cellular protein from tumor tissues and carried out Western blotting using antipro-caspase-3 and anti-activated caspase-3 antibodies. Results ER and HER/neu-positive GBC exhibited high caspase-3 activity and low procaspase-3 activity, whereas AR-positive GBC showed no significant level of apoptosis. We also evaluated the apoptosis status of triple positive GBC and triple negative GBC, and found significant apoptosis in triple positive GBC. Conclusions The results indicate that ER and HER/neu-positive GBCs had active apoptosis, whereas AR-positive GBC was highly resistant to apoptosis.

Expression of MUC5B Protein and mRNA in Gallbladder Membrane Directly Correlated with Gallstone Nucleation

The presence of gallstones in the gallbladder (Cholecystolithiasis) is a common disease in Northern part of India and some other countries like japan, China and Indo-American population. Nucleation is first event for the formation of gallstone in gallbladder sac environment. It was suspected that mucin family gene play role in nucleation process. Out of 20 mucin family members it is still unclear which one playing crucial role in gallstone nucleation process. Our objective was to investigate secretary/jell forming mucins in gallstone formation. Mucin family genes [MUC1, MUC5AC, MUC5B, MUC6, MUC7, MUC9 and MUC11] were evaluated through western blotting and semiquantitative PCR. MUC5B mRNA level was most prominent in expression followed by MUC9 and MUC5AC. MUC5B expression was much significantly higher in cancerous gallbladder than non-cancerous gallbladder (p<0.001, CI95%). MUC5B expression was directly correlated with number of stone. Whereas size of stone was not having any impact on MUC5B upregulation. Above result indicate that MUC5B protein may crucially involve in nucleation process during gallstone formation.

Analysis of wedge resection of gallbladder bed and lymphadenectomy on adequate oncologic clearance for gallbladder cancer

BACKGROUND Surgery (R0 resection) is the mainstay of treatment of gallbladder cancer (GBC) as GBC is relatively resistant to currently known chemotherapy and radiotherapy regimens. AIM to assess if wedge resection of the gallbladder bed achieves an adequate oncological clearance in GBC (namely T1 and T2) and some T3 GBC with minimal liver infiltration. PATIENTS AND METHODS Patients with GBC who underwent radical cholecystectomy (en bloc cholecystectomy, wedge resection of the gallbladder fossa with a ≥2 cm rim of nonneoplastic liver tissue, and regional lymph node dissection) between October 2012 and June 2015 after obtaining informed consent. RESULTS Of thirty patients, mean age of 52 years, 5 had T1b, 13 T2, and 12 T3 GBC. R0 resection was achieved in all thirty GBC patients. Hepatic invasion was found in seven patients. The depth of hepatic invasion ranged from 0 to 9 mm. Follow-up ranged from a minimum of 12 to 43 months. Nineteen (63%) patients had N0 and 11 (37%) had N1 GBC. Total lymph node (TLND) count ranged from 1 to 12/patient with a median of 3. There was no local recurrence or systemic relapse of the disease. CONCLUSION Wedge resection of the gallbladder bed achieves an adequate oncological clearance in early GBC. TLND counts remain poor even after a thorough standard lymph node dissection for resectable GBC.

Familial childhood parathyroid adenoma

Abstract A family in which both the father and son had parathyroid adenoma in childhood is presented, along with a brief review of the literature.