Search

Inguinal skin flap necrosis (SFN) is a significant clinical problem associated with inguinal lymph node dissection (ILND). The aetiology of SFN is multifactorial, and its manifestations vary widely. Thermal damage caused by electrocautery during the elevation of the skin flap may contribute to this problem, which has not been studied previously. This prospective, observational study included patients undergoing ILND from January 2020 to July 2022. Based on the technique of raising the inguinal skin flaps, the patients were divided into two groups (cold knife or electrocautery). The remaining part of the procedure was the same. The inguinal wound was examined and photographed to assess the SFN. A total of 42 patients were included (21 in each group). Age, gender, body mass index (BMI), alcohol or tobacco consumption, immune compromised status, and serum albumin were comparable (p > 0.05). The average time required to elevate flaps was 13.14 vs. 11.47 min (p = 0.0231), and gauze soakage was 2.05 vs. 1.52 (p < 0.0001) with a cold knife compared to electrocautery. The incidence of SFN and surgical site infection (SSI) was significantly lower with the use of a cold knife [4.8% vs. 33.3% (p = 0.045) and 0% vs. 19% (p = 0.0378)]. Grade 3 necrosis was observed only with electrocautery use. Compared to conventional electrocautery, the cold knife technique lowers the incidence of SFN and SSI. Further research with a larger sample size and a standardized definition is needed to validate these results. [ABSTRACT FROM AUTHOR]

Gallbladder cancer (GBC) is a lethal disease. Incidentally detected gallbladder cancer (IGBC) presents a unique opportunity for early management and better outcomes. We present the institutional experience of a high-volume tertiary care center in northern India. Retrospective analysis of a prospectively maintained database was performed and data of all IGBC patients between January 2014 to December 2021 was analyzed. There were 125 patients of IGBC among the 750 patients of GBC seen during the study period. Of these 125 patients, 72 (57.6%) patients were not eligible for surgery. Successful completion radical cholecystectomy (CRC) was possible in 37 (69.8%) of the 53 patients who underwent surgery. On univariate analysis, thickness of gallbladder wall 10 mm or more (p < 0.001, OR 19.0, 95% CI 4.58–78.76), pathological stage (p < 0.001, OR 5.8, 95% CI 2.45–14.98) and median delay of 16 weeks or more (p < 0.001, OR 17.0, 95% CI = 4.08–70.76), were associated with inoperability. However, on multivariate analysis only gallbladder wall thickness of 10 mm or more (p < 0.001, AOR 17.9, 95% CI 3.24–98.78) and median delay of 16 weeks or more (p < 0.001, AOR 32.33, 95% CI 6.05–172.66) remained significant. Median time to recurrence (TTR) and overall survival (OS) was not reached after a median follow up of 30 months in patients undergoing successful CRC. Successful outcomes of IGBC are dependent on several factors. Diligent workup of suspicious thickening before simple cholecystectomy for gallstone disease and timely referral of IGBC to tertiary care are the keystones for good outcomes. [ABSTRACT FROM AUTHOR]

In this research, the Co precipitation method was utilized to synthesize a nanocomposite of vanadium oxide (V2O5) and graphene oxide (GO). Pure GO was synthesized by the modified hammers method. Using a 1:2 ratio of GO and V2O5 and heating in the oven at 70 °C leading to the formation of V2O5/GO nanocomposite. By grafting of GO on V2O5 surface, a high range of graphene oxidation in V2O5/GO allowed for better reduction with V2O5 metal-oxide. The scanning electron microscope (SEM) images and X-ray diffraction (XRD) spectra provide evidence of the distinct phase of graphene oxide formation. The antioxidant activity of V2O5/GO nanocomposite was conducted in two vitro assays, focusing on neutralization of 2, 2-diphenyl-1-picrylhydrazyl (DPPH) and H2O2 radicals. The uniqueness of the nanocomposite was evident from its concentration-dependent antioxidant activities. Interestingly, the V2O5/GO samples has showed 60% antioxidant performance in the H2O2 assays compared to its constituent. Highlights: Nanocomposite of V2O5/GO was synthesized by grafting of GO on V2O5 surface. The oxidation of graphene within the V2O5/GO system facilitated improved reduction when combined with V2O5 metal oxide. The distinctiveness of the nanocomposite became apparent through its antioxidant activities, which were dependent on its concentration. It is noteworthy that the V2O5/GO samples exhibited a 60% higher antioxidant performance in the H2O2 tests compared to their individual components. [ABSTRACT FROM AUTHOR]

Background: Locoregional recurrence of oral cancer causes significant morbidity. This study aims at assessing the functional outcomes of patients undergoing treatment for recurrent oral squamous cell carcinoma. Methods: This study was done in a tertiary care center in North India and includes prospective cohort of 179 recurrent oral carcinoma patients, from September 2017 to September 2018. Patients undergoing treatment of recurrent oral carcinoma were assessed for quality-of-life score at baseline before starting treatment and two months after the completion of the treatment. For the assessment, EORTC QLQH&N35 questionnaire was used. Results: Of 179 patients included, 71 (39.66%) patients underwent salvage surgery and 104 patients (58.10%) received palliative chemotherapy. One hundred and thirty patients could complete the "EORTC-QOL-H&N-35" questionnaire on required two occasions. Forty-nine patients died before completing second questionnaire. More than half (55.6%) of patients who underwent salvage surgery had improved quality of life after the procedures. They have little or no pain in oral cavity, improved swallowing, less odynophagia, improvement in neck and shoulder pain, less problems with the external appearance and socialization, and enjoyed better sexual life. In patients receiving palliative chemotherapy, the quality of life declined in majority (88.1%) of the patients. Conclusions: Although salvage surgery is the best modality of treatment for recurrent oral carcinoma, only about one-third of patients qualify for surgery and enjoy improved quality of life following surgery. On the other hand, in majority of the patients receiving palliative chemotherapy, the quality of life worsened with time and treatment. [ABSTRACT FROM AUTHOR]

Nb-Si based alloys are considered as a potential candidates to substitute for Ni-based super alloys. However, its poor mechanical properties and high temperature oxidation resistance greatly limit its development and application. Alloying can effectively improve the mechanical properties and oxidation resistance of Nb-Si based alloy. In this work, the effects of Al, Cr, B elements addition on the mechanical properties and oxidation resistance of niobium-silicon ternary alloys are summarized. The microstructure, oxidation behavior and mechanical properties of various alloys were analyzed and compared. Moreover, the fracture and oxidation failure mechanism of the alloys are also summarized. Finally, the development trend of ternary Nb-Si based oxidation-resistant alloys in the future has been prospected. [ABSTRACT FROM AUTHOR]

Eccrine spiroadenoma arises from adnexal tissue of skin and is usually benign, slow growing and may remain static for decades [1]. Dabska et al. first defined the term malignant eccrine spiroadenoma (MES) in 1972, since then around 100 cases of MES have been found (Alejandra de Andrés Gómez. Malignant eccrine breast spiroadenoma. A case report and literature review [2]). Its very rare kind of tumor can arise either from transformation in benign lesion or can arise de novo. Here we are reporting a case of malignant spiroadenoma arising from transformation of benign lesion, its pathology and treatment. [ABSTRACT FROM AUTHOR]

The current COVID 19 pandemic has a major impact on healthcare delivery globally. Oral cancer involving anterior arch of mandible is difficult to reconstruct and ideally, requires free fibular osteomyocutaneous flap. During this time of resource constraint situation, these free flaps are not a great choice, as it increases exposure of both patient and surgical team to the deadly virus. We are describing a novel method of reconstruction after resection of oral cancer involving anterior arch of mandible. In this new technique, we have reconstructed central arch defect by hanging bipaddle pectoralis major myocutaneous flap with orbicularis oris muscle using ethylene terephthalate suture. Operative time, early postoperative complications and early cosmetic and functional outcome were assessed. We have used this novel technique in eight patients of T4a oral cancer involving anterior arch of mandible and skin over chin. Mean operative time was 180 min. One patient had minor flap loss with surgical site infection (Clavien-Dindo grade I). In all patients, we were able to discharge all patients on eighth postoperative day. Cosmetic outcome and functional outcomes were mostly satisfactory. All patients were able to oppose their lips without any oral incompetence and drooling. Tongue mobility was good. There was no incidence of 'Andy Gump deformity'. This is a feasible option for reconstructing anterior arch defect in resource- and time-limited setting of COVID 19 pandemic. This technique can also be used in comorbid conditions where it is not advisable to do very long surgery. [ABSTRACT FROM AUTHOR]

India has one of the highest incidences of oral squamous cell carcinoma (OSCC), with 75,000–80,000 new cases a year. The outcome in early oral cancer is better, but a significant proportion (12–14%) of these patients still relapses and dies due to locoregional or distant recurrences. Several clinicopathological and molecular factors have been used to prognosticate and predict outcomes in these patients of OSCC. The present study aims to validate Brandwein Gensler (BG) risk predictive model in surgically treated OSCC patients in a tertiary care centre in North India. All oral cavity cancer patients, treated in the Department of Surgical Oncology, King George's Medical University, between 2013 and 2017, were reviewed. Patients with histologically diagnosed OSCC, aged > 18 years undergoing primary surgical resection were included in the study. The final histopathological evaluation was done by a dedicated pathologist to categorize patients according to BG model risk categories. This model comprises of three factors, lymphocytic host response, perineural invasion and worst pattern of invasion, scored by the method described by Brandwein Gensler et al. The sum of these scores is used to define low, moderate and high risk categories. The study, conducted during 2013–2017, included 149 patients. Median age was 45 years (range 25–75 years). Tobacco use was noted in 143 patients. Buccal mucosa was the most common site (51%). Surgical margins were clear (> 5 mm) in 97.9% cases. Postoperative radiotherapy was given in 47.7% patients. Locoregional recurrences (LRR) (primary site and neck) were documented in 17 of the 149 patients (11.4%). There was no synchronous or metachronous distant metastasis noted in any of the study patients. Six patients had disease specific mortality. Among the 17 patients with LRR, majority (11) belonged to the high risk category of the BG risk model. Adjuvant radiotherapy had been administered in 10 of these 11 recurrent patients belonging to the high risk category. The Brandwein Gensler risk model is predictive of locoregional recurrences (p = 0.02) for OSCC undergoing primary surgery. It can be used to devise strategies to prevent recurrences or identification of recurrences at an earlier point for salvage. The benefit of further escalation of adjuvant therapy in the high risk category needs further studies, as 90% patients in this group recurred despite complete adjuvant treatment. [ABSTRACT FROM AUTHOR]

Background: Differentiating malignancy from benign diseases is the key to successful management of adnexal masses. Risk of malignancy algorithm (ROMA) has been used for this purpose. We have prospectively studied the diagnostic value of ROMA in patients presented with adnexal masses. Methods: We prospective calculated ROMA values prior to surgery for adnexal masses. The risk calculated was then correlated with the histological findings, and results were analyzed according to menopausal status. ROMA cutoff value was determined using ROC curve, and sensitivity, specificity and predictive values were calculated. Statistics were performed on SPSS software (version 20.0). Results: There were 94 patients with adnexal masses included in the study, 65 (69.1%) had epithelial ovarian cancer and 29 (30.9%) were diagnosed benign on histopathology. In both pre- and postmenopausal patients, ROMA values were significantly higher in patients with malignancy compared to those with benign disease (p < 0.05). ROMA score was of a significant diagnostic value in both premenopausal (AUC = 0.914, Z = 10.81, p < 0.001) and postmenopausal patients (AUC = 0.975, Z = 21.51, p < 0.001). In premenopausal females, ROMA > 13.3% was able to discriminate malignant from benign patients with 97.06% sensitivity and 85.00% specificity. The positive and negative predictive values were 91.7% and 94.4%. Similarly, in postmenopausal females, ROMA value of > 76% achieved 87.10% sensitivity and 100.00% specificity in discriminating malignant from benign patients with 100% positive and 69.2% negative predictive value. The overall accuracy of ROMA in pre- and postmenopausal patients was 87.0% and 85%, respectively. Conclusions: ROMA is a useful and accurate test for differentiating epithelial ovarian cancer from benign ovarian masses. Further studies are needed to compare performance of ROMA with the Risk of Malignancy Index (RMI), CA 125 and HE4. Such comparative studies will be helpful to the clinician in deciding the best diagnostic tool for women with adnexal masses. [ABSTRACT FROM AUTHOR]

Introduction: Abundant blood supply of tongue permits various flap designs and makes it a good choice for reconstructing defects following resection of oral cancer. Aim: We aim to evaluate the reliability of tongue flap for small- and medium-size defects after resection of oral cancer in terms of viability, complications, and functional outcome. Methods: In this retrospective analysis, patients reconstructed with lateral tongue flaps after resection of oral cavity carcinoma from May 2011 to December 2017 were included. Results: Forty-two patients underwent tongue flap reconstruction during the study period. Median size of defect was 3.5 cm. Out of 42 patients, 27 had carcinoma of buccal mucosa and 8 had carcinoma of lower alveolus. Mandibular resection was performed in 30 patients. Neck was addressed in all 42 patients. Supraomohyoid neck dissection was done in 12 patients, while others had comprehensive neck dissection. Average time to harvest flap was 25 min. There was no flap loss in the postoperative period. Three patients each developed flap tip necrosis and minor orocutaneous fistula that were managed conservatively. Subjective functional outcome was good to satisfactory in most patients (88%). Conclusion: Lateral tongue flap is a simple reliable flap for reconstruction of small- and medium-sized defects following resection of oral cavity cancers in terms of low morbidity and satisfactory functional outcomes. It obviates the need of distant tissue transfer. [ABSTRACT FROM AUTHOR]

Malignant germ cell tumors (GCT) of the ovary account for 2-3% of all ovarian neoplasms and occur mostly in the second and third decade of life. Over the past three decades, survival rates for germ cell tumors have dramatically improved, coincident with more aggressive surgical staging and combination chemotherapy. Although there are several studies describing ovarian GCT and fertility-preserving surgery in the western population, there is very little Indian data. We present our experience of germ cell tumor ovary in the Department of Surgical Oncology, King George’s Medical University over the last 5 years with special emphasis on treatment outcome and role of fertility preservation surgery. A retrospective review of medical records of patients with ovarian germ cell tumors, treated at our center from January 2012 to December 2016, was performed. Epidemiological and clinical profile of patients was reviewed. Clinical stage of presentation, neoadjuvant treatment, surgical treatment, and adjuvant treatment data were analyzed, and treatment outcome data was recorded. Patient follow-up was done to ascertain disease-free interval, treatment outcome, ability to conceive following fertility-preserving surgery, and quality of life. A total of 39 patients with ovarian germ cell tumor were treated during this period. Their median age at diagnosis was 22 years (range 11-65 years) and most common mode of presentation was abdominal lump without ascites. Around 36.8% (n = 14) patients had conservative surgery with preservation of opposite ovary and uterus. Most patients (71.1% n = 27) received neoadjuvant chemotherapy due to advanced disease in form of ascites or large mass, and five of these patients were amenable to fertility-preserving surgery after chemotherapy. Nine out of the fourteen patients have had return of menstrual function after a mean period of 3.5 + 0.5 months. One patient who underwent fertility-preserving surgery has delivered healthy children after treatment. Stage distribution for stage I to IV was as follows: 15.4% (n = 6), 35.9% (n = 14), 46.2% (n = 18), and 2.6% (n = 1), respectively. Dysgerminoma was the commonest histology (37.1% n = 13) followed by teratoma (22.9% n = 8). 17.1% (n = 6) patients had recurrence, with a median time to recurrence 16 months (range 5.5 to 37 months) and they were treated with second-line chemotherapy. Germ cell tumor of the ovary is an eminently treatable disease and selected patients can be managed with fertility-preserving surgery. BEP is the most effective chemotherapy regimen. Disease-free survival rates in these patients are quite high and recurrences can be managed with second-line chemotherapy. [ABSTRACT FROM AUTHOR]

Background and Objectives: The selection of suitable functional excipients with low toxicity index and having P-glycoprotein inhibitory characteristics represents a major innovative step in designing a promising formulation for oral chemotherapy. This study was aimed at investigating the chemosensitizing effect of selected pharmaceutical excipients to improve the in vivo pharmacokinetic performance of VP-16. Methods: The pharmaceutical excipients having P-glycoprotein inhibitory activity were screened by shake flask method for their VP-16 solubilization capacity. The cumulative amount of VP-16 was determined with or without the selected pharmaceutical excipients at three different concentrations (0.1 % w/v, 0.5 % w/v and 1 % w/v) by an everted gut sac technique. Moreover, pharmacokinetic studies were also performed to determine the oral bioavailability assessment of VP-16 in albino male Wistar rats. Results: The absorptive transport from mucosal-to-serosal ( M → S) and secretory transport from serosal-to-mucosal ( S → M) for VP-16 solution over 90 min were found to be (3.58 ± 0.32) × 10 and (14.63 ± 3.11) × 10 cm/s, respectively, with a net efflux of 4.08. Addition of verapamil (200 µM), a P-glycoprotein inhibitor, elevated the transport from M → S [P app from (3.58 ± 0.32) to (9.66 ± 1.55) × 10 cm/s, p < 0.05] and lowered the S → M [P app from (14.63 ± 3.11) to (13.35 ± 2.01) × 10 cm/s, p < 0.01], with a net efflux of 1.38. The relative bioavailability of VP-16 following oral administration (4.5 mg/kg) in rats was increased significantly ( p < 0.01) in presence of Labrasol micellar solution at a concentration of 5 % (w/v) when compared with VP-16 solution alone. Conclusion: The findings suggest that pharmaceutical excipients may be employed in the development of drug delivery systems to improve the oral bioavailability of drugs having low solubility and/or less permeability as a result of substantial P-glycoprotein mediated efflux. [ABSTRACT FROM AUTHOR]

Purpose: Gallbladder carcinoma (GBC) is characterized by a dismal prognosis owing to the paucity of early signs and symptoms. North India reports high incidence of GBC possibly due to environmental, dietary and reproductive factors. Understanding the epidemiology of gallbladder cancer has and will continue to provide valuable insights into determining causes and risk factors for gallbladder cancer. Methods: Prospective study of gallbladder carcinoma patients, presenting in our department, was undertaken over three year period to evaluate the epidemiological profile of gallbladder carcinoma patients from our region. Results: The peak incidence of GBC was in 31-50 years age group (58 %). Male to female ratio was 1:4.83, with mean age for females (mean 49.1 years) significantly lower than male counterpart (mean 54.9 years) ( p value = 0.000423). Majority of patients were non-vegetarians (67 %) and 84 % of them consumed mustard oil (home made/loose packed) as predominant cooking medium. Majority of the patients of GBC in our study were from low socioeconomic strata (68 %) (Kuppuswamy classes IV, V (lower class)). GBC was more commonly seen in females with the age of menarche less than 14 years (83 %) and the age of the first child birth less than 20 years (56 %). Females with more than two children had higher incidence (57 %). Majority of the female patients (71 %) were postmenopausal. Gallstones were present in 390 out of 490 patients (80 %). Incidental gallbladder carcinoma was detected in 158 out of 490 patients (32 %). Pain abdomen was the most common presenting complaint (98 %). Significant proportion of the patients with GBC presented with distant metastasis (stage IVB) (52 %). The most common histological subtype was adenocarcinoma (78 %). Conclusion: Current data suggest that the epidemiology of gallbladder cancer is constantly evolving, with much of this change caused by lifestyle, cultural and dietary factors. Balanced diet, prevention of malnutrition/adulteration, tobacco prevention and early intervention for cholelithiasis may help in decreasing the incidence of this dreaded disease. More structured studies need to be carried out to ascertain risk factors for GBC in our population subgroup. [ABSTRACT FROM AUTHOR]