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The aim of post operative radiotherapy to chest wall and drainage areas in advanced breast cancer is to sterilize the possible microscopic disease. Fifty cases of post surgical breast cancers were evaluated in a prospective study of chest wall radiation therapy by electrons. Fifty women of histologically proved post operative invasive breast cancers underwent simple mastectomy with axillary dissection followed by post-operative radiotherapy (Electron) to chest wall +/- drainage area. The chest wall and IMC was treated by a direct electron beam (9/12 MeV and 12 MeV) at fixed angle. 6 MV X-ray beam was used to treat axillary apex and supraclavicular area. In some cases, supplement RT was given by 6 MV X-rays through small posterior axillary portal. The energy of electron beam was 9 MeV or 12 MeV depending on the thickness of treated area. The supraclavicular and axillary lymphatic regions were treated, by direct custom shaped anterior portal. The dose delivered was 50 Gy over 5 weeks at 2 Gy per fraction. Adjuvant chemotherapy was given to patients who were pre-menopausal with histologically proved axillary node involvement as Cyclophosphamide, Methotrexate and 5-Fluorouracil (CMF) after radiotherapy. Post menopausal patients received adjuvant tamoxifen 10 mg.bid. The overall time varied from 26 to 87 days with a median of 41.5 days (SD 11.7). The followup period varied from 4-32 months with a mean of 22 months (SD 6.4). All the fifty patients developed dense pigmentation towards the end of radiation therapy, along with patchy dry desquamation. Moist desquamation occurred in 6 patients. The median OTT in the patients who developed moist desquamation was 34.5 days. The moist reaction healed over 10-15 days after completion of radiotherapy. Lung Fibrosis (Apical lobe) occurred in four patients. The fibrosis was evident at a median of 12 months of follow up. Lymphoedema of the ipsilateral arm occurred in six patients. None of 50 patients developed late sequalae like Cardiac effects, Rib fracture, Brachial Plexopathy, Shoulder joint impairement and Soft tissue effects. Local control in this study was 96% (48 patients). The two year actuarial overall survival was 80%. In early stages survival was significantly better compared to late stages. The actuarial two year DFS was 72%. In early stages DFS was significantly better compared to late stages.

SUMMARY A retrospective analysis of 14 cases of sacral chordoma seen between 1984 and 1993 at the Kidwai Memorial Institute of Oncology is reported. The mean patient age was 54 years, with 13 males and one female. Seventy-one per cent of patients presented with symptoms related to a painful sacral mass. Eight patients underwent radical surgery and two had adjuvant radiotherapy. One patient had a partial tumour resection. Three patients received radical radiotherapy. Two patients were offered only pain relief medication. The median follow-up was 33 months. The actuarial overall survival (OS) at 5 years was 48%. In the 12 patients in whom curative therapy was attempted, the 5-year OS was 56% and progression-free survival was 36%. Four patients developed local recurrence and three developed distant metastasis.

Purpose: Based on the clinical evidence of mucosal protection by GM-CSF during cytotoxic chemotherapy, a pilotstudy was undertaken to determine the safety and mucosal reaction of patients receiving GM-CSF while undergoing definitive conventional fractionated radiotherapy in head and neck carcinoma. Methods and Materials: Patients were considered eligible if buccal mucosa and oropharynx were included in the teleradiation field. Ten adult patients with squamous cell carcinoma of head and neck (buccal mucosa-8 and posterior l/3 tongue-2) were entered into the trial. Radiation therapy was delivered with telecobalt machine at conventional 2 Gy fraction and 5 fractions/week. The radiation portals consisted of two parallel opposing lateral fields. GM-CSF was given subcutaneously at a dose of 1 pg/kg body weight, dally, after 20 Gy until the completion of radiation therapy. Patients were evaluated dally for mucosal reaction, pain, and functional impairment. Results: The median radiation dose was 66 Gy. Eight patients received 260 Gy. The tolerance to GM-CSF was good. All 10 patients completed the planned daily dose of GM-CSF without interruption. Mucosal toxicity was Grade I in four patients till the completion of radiotherapy (dose range 50-66 Gy ) . Six patients developed Grade II reaction, fibrinous mucosal lesions of maximum size 1.0-1.5 cm, during radiotherapy. None developed Grade III mucositis. The maximum mucosal pain was Grade I during GM-CSF therapy. In two patients after starting GM-CSF the pain reduced in intensity. Functional impairment was mild to moderate. All patients were able to maintain adequate oral intake during the treatment period. Total regression of mucosal reaction occured within 8 days following completion of radiotherapy. Conclusions: GM-CSF administration concurrently with conventional fractionated radiotherapy was feasible without sign&ant toxicity. The acute side effects of radiotherapy namely mucositis, pain, and functional impairment were nll to minimal. The results are suggestive of mucosal protection by GM-CSF during radiotherapy and warrants further study in randomized double blind trial. 0 1997 Elsevier Science Inc. Radiation mucositis, GM-CSF, Radiotherapy, Head and neck carcinoma, Oral carcinoma.

Isolated central nervous metastasis is rare in patients with Ewing's sarcoma. Here we report two cases with CNS metastasis as the sole manifestation of relapse with a brief review of the literature.

The Bethesda System categorizes atypical parakeratosis (APK) as "ASCUS or SIL depending on the degree of cellular abnormalities." APK, however, is not well-defined. We retrospectively reviewed 68 cervicovaginal specimens with follow-up material to identify specific criteria and clinical significance of APK. APK cells were small cells, 2-3 times the diameter of neutrophil, with dense, orangeophilic cytoplasm, high nuclear cytoplasmic ratio, dense, often uneven chromatin, and irregular nuclear contour. Of 62 cases with APK, 37 had accompanying dysplastic cells. Of 25 cases with APK alone, follow-up revealed 12 with squamous intraepithelial lesion (5 HSIL and 7 LSIL) and 13 with benign changes. A major diagnostic pitfall of APK was inflammation with degeneration. Abundant APK cells, minimal inflammation and degeneration, and previous history of dysplasia frequently were associated with follow-up SIL. The findings of this study identify APK as an important marker for dysplasia that warrants careful evaluation and follow-up.

Granulocytic sarcoma is an extramedullary tumor of malignant granulocytic progenitor cells, that may precede the onset of acute myeloid leukemia or appear during the leukemic manifestation or blastic crisis of chronic myeloproliferative disorders. We describe a case of granulocytic sarcoma of vagina in a 27 year old woman treated with local radiotherapy. After seven months of follow up she developed acute myeloid leukemia. The case has been presented in view of its rarity and discussed in light of the available literature.

An analysis of head and neck cancer patients treated by radiotherapy (RT) alone (114 patients) and by chemo-radiotherapy (RT + CT) (115 patients) was carried out; the doses varied from 40-77 Gy and 35-71 Gy in RT and RT + CT groups respectively. The chemotherapy (CT) (induction/concurrent) drugs used were 5-FU, cisplatin, methotrexate either single or in combination. Extrapolated response dose values were evaluated with alpha/beta values of 10, 2.5 and 6 Gy for acute, late complications and tumour response, respectively. Dose enhancement factor (DEF) and Therapeutic gain factor (TGF) values were evaluated on the basis of ERD for patients receiving 5-FU RTCT (72 patients). ERD vs late complication rate and response rate curves were drawn for RT, RT + CT (7 cycles), RT + CT (6 cycles) and RT + CT (cumulative). DEF values for response rate were 0.95, 0.95 and 0.82 for the three RT + CT groups respectively. Similarly DEF values for late complication rate were evaluated as 0.87, 0.93 and 0.88. TGF values for RT + CT were 1.09, 1.02 and 0.93. TGF values indicated lack of significant influence of CT on clinical outcome. The correlation of ERD with late complication, response and status at last follow up (NED) was statistically significant for both groups (P0.01). ERD did not correlated with acute complication in RT group (P0.01). From the present analysis, in RT + CT treatments of head and neck cancers, an ERD value of 69 Gy is suggested as the limit for an acceptable 5% late complication rate.

To collect information on the status of cytopathology training in the United States.Questionnaire survey mailed in June 1994.Pathology residency training programs in the United States.Pathology residency directors.Training length, numbers of cytology specimens, teaching methods and topics, and graduated responsibility.Of the 196 surveys mailed, 101 (52%) programs responded. The average length of required training was 3 months. The perceived optimal training time averaged 4.5 months, however, with 80% of programs requiring less than their stated optimum. The median numbers of gynecologic, nongynecologic, and fine-needle aspiration biopsy specimens examined per resident were 1100, 500, and 200, respectively. Cytopreparatory techniques, laboratory management, computer systems, and immunocytochemistry were included in over 75% of cytopathology training programs. Teaching at the microscope was rated as the most important teaching method by 90% of respondents. The majority of senior residents performed fine-needle aspiration biopsy procedures and screened and signed out cases with direct faculty supervision, but fewer than 20% of programs allowed senior residents to independently sign out specimens.Recommendations based on this review include a minimum training time of 3 months, improved training in both fine-needle aspiration biopsy techniques and gynecologic cytology, continuous exposure to cytopathologic techniques, and increased graded responsibility for senior residents.

In this paper, we present nickel oxide (NiO) thin film bipolar non-volatile resistive memory device with multi-level conduction prepared by solution route at room temperature. The fabricated device with structure Al/NiO/ITO exhibits excellent switching parameters, such as a stable resistance value in both ON and OFF states for over 10 000 s (retention) and 105 switching cycles of memory operation (endurance). Stable multi-level conductance states are observed in the memory device, which could be exploited for a multilevel-cell programming scheme. The switching mechanism in the resistive memory device is discussed based on the formation/dissolution of conductive filaments.

In this paper we report Al/CdSe-ZnS core-shell quantum dot/AlOx/CdSe-ZnS core-shell quantum dot/ITO based non-volatile resistive memory devices with an ON/OFF ratio of ~1000. The facile solution processed device exhibited excellent endurance characteristics for 200,000 switching cycles. Retention tests showed good stability for over 20,000 s and the devices are reproducible. A memory operating mechanism is proposed based on charge trapping-detrapping in core-shell quantum dots with AlOx acting as a barrier leading to Coulomb blockade. I-V characteristics of a three terminal device fabricated with the additional terminal wired-out from the middle AlOx layer supports the proposed charge trapping mechanism.

Although rhabdomyosarcoma (RMS) has a predilection for the head and neck region its occurrence in the tongue is uncommon. We report 2 cases of RMS of the tongue, 1 paediatric and 1 adult patient. The child who had RMS of the alveolar type involving anterior two-thirds of the tongue was treated with surgery and chemotherapy and is disease-free at 84 months of follow-up. The adult patient had locally extensive embryonal RMS of posterior third of the tongue, received chemotherapy and radiotherapy but died with progressive disease at 24 months of follow-up.

At the Kidwai Memorial Institute of Oncology, advanced laryngeal cancers are subjected routinely to primary surgery and/or post-operative radiotherapy (RT). The surgery consists of wide field laryngectomy which entails total laryngectomy, ipsilateral/bilateral thyroid lobectomy, bilateral paratracheal clearance, and bilateral clearance of levels 2, 3 and 4 lymphatics. Post-operative RT is indicated in event of the following histopathological (HPE) situations to consolidate local-regional control: (1) T4 primary; (2) significant subglottic extension; and (3) jugular/paratracheal metastatic deposits. This prospective study highlights the therapeutic efficacy of this protocol at our centre in 45 consecutive T4/T3 glottic cancers and specifically evaluates the role of interjugular dissection and/or post-operative RT in prevention of regional recurrence. Fifty-two per cent of primary lesions needed a post-surgical upstaging as against 14 per cent of the neck lesions. Accordingly 91 per cent of the cases (41/45) qualified for post-operative RT and 82 per cent (37/41) complied with the prescribedschedule. Recurrent disease in the lateral neck was noted in 2/37 who received the prescribed schedule and 1/4 non-compliant cases; while a recurrent central neck disease was noted in 1/37 and 1/4 of these cases respectively. All cases were followed-up for a period of two years and 66 per cent of the evaluable cases for a period of five years. This study confirms conclusively that our treatment schedule yields extremely gratifying two-year local-regional control rates of 89 per cent which translates into a two and five-year actuarial survival rate of 92 and 70 per cent respectively.

In this letter, we report a facile quantum dot based non-volatile resistive memory device with a switching speed of 10 ns and ON/OFF ratio of 10 000. The device showed excellent endurance characteristics for 100 000 switching cycles. Retention tests showed good stability and the devices are reproducible. Memory operating mechanism is proposed based on charge trapping in quantum dots with AlOx acting as barrier. This mechanism is supported by marked variation in capacitance value in ON and OFF states.

We report a Ti-TiOx/quantum dot based bipolar nonvolatile resistive memory device. The device has ON/OFF ratio 100 and is reproducible. The memory device showed good retention characteristics under stress and excellent stability even after 100 000 cycles of switching operation. The memory devices are solution processed at room temperature in ambient atmosphere. The operating mechanism is discussed based on charge trapping in quantum dots resulting in Coulomb blockade effect with the metal-oxide layer acting as the barrier to confine the trapped charges. The mechanism is supported by negative differential resistance (NDR) observed exclusively in the ON state.

We introduce an all-inorganic solution processed bipolar nonvolatile resistive memory device with quantum dot/metal-metal oxide/quantum dot structure. The two terminal device exhibits excellent switching characteristics with ON/OFF ratio >103. The device maintained its state even after removal of the bias voltage. The switching time is faster than 50 ns. Device did not show degradation after 1-h retention test at 150 °C. The memory functionality was consistent even after multiple cycles of operation and the device is reproducible. The switching mechanism is discussed on the basis of charge trapping in quantum dots with metal oxide serving as the barrier.

This was a retrospective study of 46 cases of urine specimens to distinguish low grade transitional cell carcinoma (TCC) and instrument artifact. The cytomorphologic features of 46 urinary specimens showing papillary fragments were studied. Urine from TCC showed papillary and irregular groups of cells with ragged borders and subtle nuclear changes. Urine after instrumentation showed cellular specimens with cohesive, ball-shaped and papillary clusters with smooth borders lined with a denser-staining cytoplasmic collar. The evenness of the border and presence of the cytoplasmic collar were distinguishing features of instrument artifact.

Multi-layer heterostructure negative differential resistance devices based on poly-[2-methoxy-5-(2'-ethyl-hexyloxy)-1,4-phenylenevinylene] (MEH-PPV) conducting polymer and CdSe quantum dots is reported. The conducting polymer MEH-PPV acts as a barrier while CdSe quantum dots form the well layer. The devices exhibit negative differential resistance (NDR) at low voltages. For these devices, strong negative differential resistance is observed at room temperature. A maximum value of 51 for the peak-to-valley ratio of current is reported. Tunneling of electrons through the discrete quantum confined states in the CdSe quantum dots is believed to be responsible for the multiple peaks observed in the I-V measurement. Depending on the observed NDR signature, operating mechanisms are explored based on resonant tunneling and Coulomb blockade effects.

This study highlights our treatment policy in 26 cases of epidermoid metastatic carcinoma in the neck from a primary deemed occult after exhaustive examination of the Upper Aero-digestive Tract (UADT). Planned Radical Neck Dissection (RND) and post-operative radiotherapy (RT) has been the favoured approach in all neck nodes deemed resectable and a loco-regional control rate of 64% was obtaining using this combined modality approach. Pre-operative RT was utilised in three cases with nodal disease of borderline resectability and loco-regional control was achieved in one case. Three cases of massive neck metastasis initially deemed unrectable became amenable to surgical salvage after Radical RT with concurrently administered chemotherapy. Only one of these remained disease free. Overall loco-regional control rate of 55 per cent could be achieved in 20 evaluable patients followed up for two years--three years (mean 30.5 months). Regional failures were noted in 25 per cent of patients while distant spread occurred in 15 per cent, thus accounting for an overall failure rate of 40 per cent. Manifest primaries were documented in 20 per cent, half of which could be salvaged and successfully controlled.

Hepatocellular carcinoma (HCC) presenting initially as a bony metastasis is rare. Involvement of maxillofacial bones is even more rare and only 20 cases have been reported. A case of a 65-year-old male patient presenting with metastasis to the mandible from a primary HCC is described.

Purpose: To investigate the viability and use of multiple MOSFET (Thomsan/Nelsion Canada) sensors as an alternate methodology for routine verification of IMRT plans. Method and Material: XWU‐IMRT Phantom (Thomsan/Nelsion Canada) is used for three dimensional IMRT QA. Phantom has dimension of 20cm × 20cm and predefined grooves to fix nine MOSFETdosimeters in three planes. Center planes, contains five MOSFET detection points, one at center and two each on either side separated by 2cm. One of two MOSFETs of either side is; 3.52 cm superior and other one is 2.48 cm inferior to center. Two MOSFETs are 1 cm above and two are 2 cm below center plane separated by 4cm. Total volume covered is 144 cm3. Thus geometry of these dosimeters represents point dose measurements in three dimensions. The CTimages of phantom were acquired and transferred to Brainscan planning system. IMRT plan was then transferred to phantom with pre‐determined isocenter. Point doses of nine dosimeters were recorded. Some of point doses were in low dose region also. The phantom was then irradiated as per IMRT plan. The absolute doses of nine dosimeters were analyzed and compared to data generated by RTP system. All MOSFETs are calibrated to known dose.Results: The average deviation of measured doses by MOSFET and dose calculated for 10 IMRT plans having a total of 90 measurements points was found to be 2.2% (std .53). Out of 90 measurements points, 26 points were found to be in low dose region where average variation was 2.8%.This is within acceptable level of ±3%. Conclusion:MOSFETs are well suited for QA of IMRT. The labor‐intensive procedures for verification of IMRT plans could be well managed with the three dimensional measurements using MOSFET and XWU‐IMRT Phantom. This methodology can be performed effectively in a busy radiation therapy centers

A nanoresolution translation setup for Bridgman technique was designed and employed for the growth of organic crystal meta-nitroaniline using stepper motor. Ultrasmooth and vibration-free translation was accomplished in microstepping mode. Linear translation of 40nm per microstep has been achieved. A potential molecular organic crystal meta-nitroaniline of 18mm diameter and 80mm length has been successfully grown with good optical quality. Ultraviolet-visible-near-infrared spectra showed excellent transmission from 1100to520nm. Etching studies reveal lower defect density.

Group invariants such as homotopy groups, and cardinal invariants such as weights and density character are very often used in the problem of classifying topological spaces. Some interesting and useful ordinal invariants introduced and investigated in the recent past have proved equally significant in this direction. The k-order and sequential order are two of them. In this paper, two natural open questions concerning them are answered fully. The main result of the paper is the theorem which assetts, for each ordinal α, the existence of a nice k-space of k-order α.

Studies of 226Ra and 228Ra concentrations in ocean waters provide a means of estimating ocean mixing rates, as has been demonstrated by a number of investigators. In this context, there is a considerable paucity of such data in coastal waters, whose radium concentrations are expected to vary significantly, relative to oceanic waters, due to terrigenous influences. The present study was carried out in the nearshore coastal waters of Kalpakkam (12° 33′N, 80° 11′E), which is the site of a major nuclear complex in Southern India. The results of this study show that dissolved 226Ra and 228Ra concentrations in nearshore seawaters range from 1·06 to 2·64 mBq litre−1 (mean 1·75 mBq litre−1) and from 4·15 to 7·8 mBq litre−1 (mean 5·94 mBq litre−1) respectively, with 228Ra/226Ra activity ratios of 2·3 to 4·9 (mean 3·4). However, the backwaters tend to show somewhat elevated dissolved 226Ra and 228Ra levels, ranging from 1·8 to 5·7 mBq litre−1 (mean 3·56 mBq litre−1) and from 14·3 to 71·7 mBq litre−1 (mean 44·6 mBq litre−1 respectively, with radium activity ratios from 7·9 to 15·3 (mean 12·5). This paper presents the results of a comprehensive study aimed at investigating 226Ra and 228Ra associated with the dissolved and particulate phases in the nearshore marine environment of Kalpakkam. Our earlier studies at the site have shown the presence in the area of the mineral monazite and this could be of significance in generating the observed high 228Ra/226Ra ratios in the dissolved and particulate phases along the Kalpakkam coast.