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Free space optical (FSO) communication systems are gaining high popularity from the last decade due to its various advantages such as no license spectrum, low-cost implementation etc. In this work, 160 Gbps data is transmitted over 8 km FSO link by adopting alternate mark inversion (AMI), wavelength division multiplexing (WDM) and polarization division multiplexing (PDM) schemes. The results are reported in terms of Q factor, bit error rate, signal to noise ratio, total received power and eye diagrams.

In the current era of data communication everyone deals with the huge amount of data in form of text, audio, video and different other formats in which everyone want a secure and higher bandwidth channel to transmit and receive so, only the optical channel provides the solution of above said problem. The only difficulty with the existing model that the data from electrical domain first converted in form of light (optical domain) at the transmission end while after receiving the data at the receiver end it will be further converted in form of electrical signal for extracting the message. This type of conversion from one domain to other gives the energy loss. In the current research article, we proposed a model of optical processor which transmit and receive the data without conversion which provides an energy efficient optical technology. By adding reversibility, heat bender can be further reduced. In this manuscript, an arithmetical logic unit has been created, a photonic reversible complete subtractor and an irregular logic portal. SOA-MZI structure is the basic component of the architecture. The method is mainly carried out by the semiconductor Amplifier, using nonlinear properties such as cross-gain modulation and cross-phase modulation. The efficiency deciding factor for the whole system is 21.23 and 53.27 dB in the average extinction ratio. The cost of the arithmetic logic unit optically constructed is 9.

Microwave heating systems for industrial uses, notably for food and farm goods have been extensively developed. Microwave energy is now being used in many ways, with greater focus on consumption. If utilized for a consumer product as a power source, microwaves are typically employed in a totally shielded enclosure that does not allow access while the microwave source is running. The radio frequency (RF) leakage above 5mW (+ 10 dBm) is dangerous to humans, according to the World Health Organization (WHO) guideline. This manuscript focuses on the low cost hand held device for detection of microwave energy radiation because it is very hazardous for human body. This kind of device will be very helpful for clean and green society.

Air pollution is a serious public health problem in all over the world. Coal burning in the brick kilns is contributing significantly to the worst air quality in Uttar Pradesh. Five coal samples were collected from five different brick fields in Uttar Pradesh (Kursi Road - Lucknow, Sitapur Road - Lucknow, Diamond - Barabanki, Awadh – Barabanki and Suraj - Barabanki). Elemental composition (C, N, H and S) with CHN analyzer and trace metals (Na, K, Ca, Fe, Cr, Cd, Cu, Pb, and Ni) with atomic absorption spectrophotometer (AAS) were determined in the coal samples. Coal samples were grinded and extracted with distilled de-ionized water with temperature control water bath and sonicator. The average concentration of nitrogen, carbon, hydrogen and sulfur were 13.4 (wt%), 34.2 (wt%), 5.89 (wt%) and 4.59 (wt%), respectively. Carbon and sulfur are very important for the atmospheric pollution as they may undergo many primary and secondary chemical reactions. The average concentrations of the determined trace metals were 14.2±7.5 ppm for Sodium, 0.8±0.6 ppm for Potassium, 11.4±11.7 ppm for Calcium and 11.0 ± 12.7 ppm for Iron. Chromium, Cadmium, Cupper, Lead and Nickel concentrations were found below detection limit. The results showed that pollutants containing coals are the potential threat for human health especially for the worker those who are working in the brick industries. The management of pollutants emitted from brick kilns has to be high combustion efficiency coal particles during process of devolatisation, use of coal with particle size smaller than 3/ 4 inch and keep sufficiently long firing zone (coal feeding zone of at least 3-4 lines) so that the volatiles get sufficient space (high temperature zone) to mix and burn.

The standard molar heat capacity measurements on compounds Rb2TeO3 (s), Rb2Te2O5 (s) and Rb2Te4O9 (s) in the Rb–Te(IV)–O system were taken using differential scanning calorimeter in the temperature range 325–675 K. The compounds were synthesized by solid-state route and characterized using X-ray diffraction technique. The molar heat capacity values were least squares analyzed, and the dependence of the molar heat capacity with temperature can be given as, $$ \begin{aligned} C^{\text{o}}_{\text{p,m}} \left( {{\text{Rb}}_{2} {\text{TeO}}_{3} , \, s,T} \right) \, /{\text{J K}}^{ - 1} {\text{mol}}^{ - 1} & = 156.00 + 0.02 \, \left( {T/{\text{ K}}} \right){-}4.12 \times 10^{6} \left( {T \, /{\text{K}}} \right)^{ - 2} \\ C^{\text{o}}_{\text{p,m}} \left( {{\text{Rb}}_{2} {\text{Te}}_{2} {\text{O}}_{5} , \, s,T} \right) \, /{\text{J K}}^{ - 1} {\text{mol}}^{ - 1} &= 216.50 + 0.03 \, \left( {T/{\text{ K}}} \right){-}2.52 \times 10^{6} \left( {T \, /{\text{K}}} \right)^{ - 2} \\ C^{\text{o}}_{\text{p,m}} \left( {{\text{Rb}}_{2} {\text{Te}}_{4} {\text{O}}_{9} , \, s,T} \right) \, /{\text{J K}}^{ - 1} {\text{mol}}^{ - 1} &= 351.80 + 0.04 \, \left( {T/{\text{ K}}} \right){-}3.52 \times 10^{6} \left( {T \, /{\text{K}}} \right)^{ - 2} \\ \end{aligned} $$ From these data, thermodynamic functions such as enthalpy increment (H T o − H 298.15 o ), entropy (S T o ) and Gibbs energy functions (fef) were evaluated.

Rb2CeO3 compound was prepared by conventional solid-state reaction route. The Gibbs energy formation of the compound was determined by measuring the partial pressure of CO2 over the equilibrium phase mixture {Rb2CO3(s) + CeO2(s) + Rb2CeO3(s)} using Knudsen effusion quadrupole mass spectrometry. Gibbs energy formation of the compound, $$\Delta_{\text{f}} G_{\text{m}}^{o}$$ , as a function of temperature is obtained as: $$\Delta_{\text{f}} G_{\text{m}}^{\rm o} \left( {{\text{Rb}}_{2} {\text{CeO}}_{3} ,{\text{s}},T} \right)({\text{kJ}}\;{\text{mol}}^{ - 1} ) \, \left( { \pm 7} \right)\; = \; - 1601 + 0.41 \times \left( {T/K} \right)(991 \le T/K \le 1124)$$ The molar heat capacity of the compound, $$C^{\text o}_{\text{p,m}}$$ , was measured from 390 to 1100 K using a differential scanning calorimeter and is given as: $$C^{\rm o}_{\text{p,m}} \left( {{\text{Rb}}_{2} {\text{CeO}}_{3} ,{\text{s}},T} \right) \, ({\text{J}}\;{\text{mol}}^{ - 1} \;{\text{K}}^{ - 1} ) = 210.8 + 0.0061 \times \left( {T/K} \right){-}6348435/\left( {T/K} \right)^{2}$$ Based on these experimental data, thermodynamic table of the compound was also generated from 298.15 to 1000 K. Standard molar enthalpy of formation $$\Delta_{\text{f}} H_{\text{m}}^{\rm o}$$ (298.15 K) and standard molar entropy $$S_{\text{m}}^{\text o}$$ (298.15 K) of Rb2CeO3 are −1643 kJ mol−1 and 61.5 J K−1 mol−1, respectively.

The Li2TeO3 (s) and Li2TeO4 (s) were synthesized using solid-state reaction route and characterized using X-ray powder diffraction techniques. Molar heat capacity measurement on Li2TeO3 (s) and Li2TeO4 (s) were carried out using differential scanning calorimeter. The molar heat capacity values were least squares analyzed, and the dependence of molar heat capacity with temperature for Li2TeO3 (s) and Li2TeO4 (s) can be given as, $$\begin{aligned} C^{\text{o}}_{\text{p,m}} \left( T \right)\left( {{\text{Li}}_{ 2} {\text{TeO}}_{ 3} , {\text{ s}},\;T} \right) \, /{\text{J K}}^{ - 1} {\text{mol}}^{ - 1} = \, 107.56 \, + \, 0.05\;T\left( {\text{K}} \right) \, {-} \, 2.21 \, \times \, 10^{6} \;T^{ - 2} \left( {\text{K}} \right) \left( {325 \, \le \;T\left( {\text{K}} \right) \, \le \, 675} \right). \hfill \\ C^{\text{o}}_{\text{p,m}} \left( T \right)\left( {{\text{Li}}_{ 2} {\text{TeO}}_{ 4} , {\text{ s,}}T} \right) \, /{\text{J K}}^{ - 1} {\text{mol}}^{ - 1} = 121.59 \, + \, 0.06\;T\left( {\text{K}} \right) \, {-} \, 1.92 \, \times \, 10^{6} \;T^{ - 2} \left( {\text{K}} \right) \left( {325 \, \le \;T\left( {\text{K}} \right) \, \le \, 675} \right). \hfill \\ \end{aligned}$$ From these data, other thermodynamic functions such as enthalpy increment ( $$H^{\text{o}}_{\text{T}} - H^{\text{o}}_{298.15}$$ ), entropy ( $$S^{\text{o}}_{\text{T}}$$ ) and Gibbs energy functions {−( $$G^{\text{o}}_{\text{T}} - H^{\text{o}}_{298.15}$$ ) T −1} were computed.

For addressing needs of modern day communication needs, new type of networks are required to be evolved to cater the demand of high data rates. Use of survivable elastic-optical-network (EON) with existing passive-optical-networks (PON) may provide the solution for this. The present work focus on employing EON–PON based wave-length-division multiplexing enabled communication system comprises of 2×5 Gbps for downlink and 2×1 Gbps for uplink over a single-mode-fibre of length 100 km. The results are the evaluated via bit-error-rate analyser, q factor and eye diagrams.

Robotics always used to have an extraordinary contribution into multiple parts of operations in process industries such as oil and gas industries, the one presently discussed in this research paper deals with the mathematical analysis and real-time replication model of out pipe crawler robot used for thickness measurement of ferromagnetic pipelines in petrochemical plants and refineries. The aim of this paper is to evaluate and simulate the movement of the robot in a 2-dimensional plane over a black track motif as a pipeline line which infers the effect of real-time simulation prototype model. The analysis presented in this paper is very useful in developing a mathematical model and crafting a prototype of wheelbase mobile robot to traverse over an uneven surface of ferromagnetic pipelines with the help of an array of IR sensors used for estimation of the thickness of pipes.

The common histological abnormalities on testicular histology in 79 infertile virile men were hypospermatogenesis (35%), severe testicular atrophy (29%) and maturation arrest (19%). Sperm counts showed no correlation with testicular size, gonadotropin levels and histological classification. There was elevation of mean follicle stimulating hormone levels in males with maturation arrest (5.8±3.8 lUlL) and Sertoli-cell only syndrome (21.7±3.4 lUlL). Patients with severe testicular atrophy had elevated luteinizing hormone (15.1±11.8 lUlL) as well as follicle stimulating hormone (49.8±11.4 lUlL) levels. Patients with hypospermatogenesis and focal atrophy had normal luteinizing hormone and follicle stimulating hormone levels and all of them had normal testosterone and prolactin levels. Treatment with gonadotropins or clomiphene citrate was ineffective.

In this article, first the model of 2×2 reversible logic gate is proposed after then the performance of the proposed designed is evaluated. With the increasing flow of information, data rate is increasing very rapidly. This has resulted in increased amount of heat dissipation from the processing nodes. Generally, electronic processors dissipate heat if the data rate is very high. Hence, this model will be very helpful for solving this problem. Evaluated performance of this model is based on the value of quality factor and extinction ratio. The quality factor and extinction ratio are evaluated under different conditions. The average extinction ratio of the design is 19.58 dB and the average quality factor is 53.03 dB. The optical cost of the proposed circuit is 1.

In this paper firstly the model of 2 × 2 reversible logic XOR gate is proposed after that the performance of proposed designed is evaluated. With the increasing flow of information, the data rate is also increasing rapidly. It increases the heat dissipation in the circuit due to loss of data information. Usually data rate is very high in the electronic processor, it dissipate more heat. Hence this model will be very helpful for solving this problem. Evaluated performance of this model is based on the value of quality factor and extinction ratio. The quality factor and extinction ratio is evaluated under different condition. The average extinction ratio of the design is 19.58dB and the average Quality factor is 53.03dB. The optical cost of the proposed circuit is 1.

Background: Breast cancer is the most frequently diagnosed cancer in females worldwide. The Population Based Cancer Registry data of Delhi were here used to describe the epidemiology and trends in breast cancer incidence in Delhi. Methods: Crude rate, age-standardized incidence rates (ASR) and age-specific incidence rates were calculated using the data collected by Delhi PBCR for the year 2012. The time trend of breast cancer incidence was evaluated by joinpoint regression using the PBCR data from 1988-2012. Results: A total of 19,746 cancer cases were registered in 2012, 10,148 in males and 9,598 in females. Breast cancer was the leading site of cancer in females accounting for 2,744 (28.6%) of cases with a median age of 50 years. The crude and age standardized incidence rates for breast cancer were 34.8 and 41.0 per 100,000 females, respectively. Age specific incidence rates increased with age and attained a peak in the 70-74 years age group.. A statistically significant increase in ASR with an annual percentage change (APC) of 1.44% was observed. Conclusions: The breast, which was the second most common cancer site in Delhi in 1988, has now surpassed cancer of cervix to become the leading site over the years. A similar trend has also been noted for other metropolitan cities viz. Bangalore, Bhopal and Chennai. Though the ASRs in these are comparable, they are still low compared to Western countries. Changing life styles in metropolitan cities like delayed marriage, late age at first child birth, lower parity and higher socio-economic status, may be some of the probable primary cause for higher incidences of breast cancer in urban as opposed to rural areas.

The enthalpies of formations of Ce2(MoO4)3(s) and Sm2(MoO4)3(s) have been measured at 298.15 K using semi adiabatic solution calorimetry. The precipitation reaction between RE(NO3)3·6H2O(s) (R= Ce, Sm) and ammonical solution of Na2MoO4(s) was studied. From the enthalpy of precipitation and other required auxiliary data, $$ \Updelta_{\text{f}} H_{\text{m}}^{ \circ } \left( { 2 9 8. 1 5 {\text{ K}}} \right) $$ of Ce2(MoO4)3(s) and Sm2(MoO4)3(s) have been calculated for the first time as −4388.7 ± 3.6 and −4363.4 ± 4.1 kJ mol−1, respectively. The enthalpy of hydration of anhydrous Ce(NO3)3(s) to Ce(NO3)3·6H2O(s) has been calculated. $$ \Updelta_{\text{f}} H_{\text{m}}^{ \circ } \left( {{\text{MoO4}}^{ 2- } ,\,{\text{aq}},\, 2 9 8. 1 5 \,{\text{K}}} \right) $$ has also been measured and calculated as −995.1 kJ mol−1 from required literature data.

Data on patients with localized Ewing sarcoma family of tumors (ESFT) who have received a uniform chemotherapy protocol are minimal.This is a single institutional review of patients with ESFT treated between June 2003 and November 2011.224/374 (60%) patients with ESFT presented with localized disease; median age was 15 years (range: 0.1-55). Ninety-nine patients underwent surgery of which 50 received adjuvant radiotherapy; 80 patients received radical radiotherapy following neoadjuvant chemotherapy. At median follow-up of 40.2 months (range: 1.3-129), 5-year EFS, OS, and local-control-rate, were 36.8 ± 3.6%, 52.4 ± 4.3%, and 63 ± 4.3%, respectively. In multivariate analysis, tumor diameter8 cm (P = 0.03), symptom duration4 months (P = 0.04), and WBC11 × 10(9) /L (P = 0.003) predicted inferior EFS; spine/abdomino-pelvic primary (P = 0.009) and WBC11 × 10(9) /L (P = 0.003) predicted inferior OS. Tumor size8 cm (P = 0.03) and radical radiotherapy as local treatment (P = 0.01) predicted inferior local-control-rate.Prognostic hazard models for EFS and OS based on significant prognostic factors suggested that patients with combination of ESFT of spine/abdomino-pelvic region and baseline WBC11 × 10(9) /L had inferior OS (hazard ratio 4.44, P0.001) while patients with combination of ESFT with symptom duration4 months, tumor diameter8 m and baseline WBC11 × 10(9) /L had inferior EFS (hazard ratio 3.89, P = 0.002).

Data on extraosseous Ewing sarcoma (EES) with uniform chemotherapy protocol are minimal. We aimed to examine this aspect in our patients, identify prognostic factors and compare the same with osseous Ewing sarcoma.A single institutional data review of patients with EES treated between June 2003 and November 2011 with uniform chemotherapy and evaluated on intent-to-treat analysis was done.Of 374 patients with Ewing sarcoma, 60 (16%) were EES with median age 16 years; 20 (33%) had metastases. After median follow-up of 25 months (range: 1.7-104.4), 5-year event free survival (EFS), OS, and local-control-rate were 47.1 ± 7.9%, 61.6 ± 7.8%, and 77.9 ± 8.6%, respectively for entire EES cohort. In multivariate analysis, hemoglobin ≤ 10 g/dl (P = 0.03), and white blood cell count (WBC)11 × 10(9) /L (P = 0.009) predicted inferior EFS for the entire EES cohort. Low hemoglobin (P = 0.05) and high LDH (P = 0.01) predicted inferior OS for the entire EES cohort on multivariate analysis. As compared to the cohort of skeletal primary (n = 314), higher proportion of patients underwent surgery in the cohort of EES (P = .003); EFS (P = 0.004) and OS (P = 0.08) were superior for patients with EES than patients with skeletal Ewing sarcoma.These data of EES suggests that low hemoglobin and high WBC count adversely affect EFS. Overall outcome was significantly better for EES than skeletal primary tumors.

A case control study was conducted on 170 patients with oesophageal cancer. An equal number of healthy persons (attendants of patients) were included in the study as controls to identify nutritional risk factors for oesophageal cancer. The majority (55%) of the patients were of low socio-economic status and from Northern parts of India. They were predominantly male (66%). Increase in risk was associated with low consumption of green leafy vegetables, other vegetables and fresh fruits, milk and milk products. Heavy use of spices and use of very hot tea or food were also associated with increased risk. Differences in the past dietary consumption patterns of oesophageal cancer patients and controls suggest a role for nutritional factors in oesophageal cancer pathogenesis. At the same time substance abuse by cigarette or bidi smoking, alcohol consumption, paan and tobacco chewing also increased risk. After multivariate analysis, green leafy vegetables, other vegetables spices, bidi usage and fresh fruits provided protection against oesophageal cancer.

Cellulose acetate supported dl -α-tocopherol liquid surfactant membrane has been characterised by measuring membrane potentials, using sodium chloride solutions of different mean concentrations. Fixed charge density, f X , permselectivity, P s , have been estimated from ionic transport numbers. Variation of membrane potential with pH and concentration of sodium chloride solution has also been examined. The data obtained have also been discussed in the light of the biological actions of dl -α-tocopherol.

Little is known about mortality statistics of hospitalised cancer patients from developing countries. This paper describes the distribution of causes of death in various malignancies, status of malignancy at the time of death, type and intent of therapy received by the cancer patient prior to death and nature of infections in terminal cancer patients who died in hospital. We also aimed to study discrepancies in mortality reporting in terms of death certificate at our center and tried to analyse possible causes.Data for 259 consecutive deaths in hospitalized cancer patients in a calendar year were analysed. Of all these, 147 (57%) were cases of solid tumors, 107 (41%) were cases of hematological malignancies and 5 (2%) were other or undiagnosed cases. Median duration of hospital stay prior to death was 7 (1-106) days. Sepsis/multi organ dysfunction syndrome (MODS) was commonest immediate cause of death 118/259 (45.2%) followed by progressive malignancy in 64/259 (24.7%) cases. Only 13/267 (5%) patients died with controlled cancer. Some 184 (71.3%) deaths occurred within 90 days of any form of anticancer treatment of which more than three fourths (77.2%) occurred after chemotherapy. Among these chemotherapy related deaths, 63 were febrile neutropenic deaths, with the commonest site of infection in the lungs, and positive blood culture was found in 18 (28%) cases. There were discrepancies in information derived from death certificates and from case records in 84 (32%) cases. Most of these were due to the use of ambiguous terms like cardio-respiratory arrest as a cause of death in the death certificate.It is important to audit mortality data on a regular basis as this can provide valuable insight into hospital practice and may help to identify preventable causes of mortality. Mortality record keeping is another important aspect as variable practices in this area may have implications for cancer mortality reporting and this may ultimately lead to erroneous cancer epidemiology.

The study of advanced modulation formats for high speed internet services using potentially the bandwidth of single mode embedded fiber is very important. Basically, the use of RZ format is considered in order to reduce the inter-symbol interference (ISI) caused mainly by effects such as Chromatic Dispersion (CD), Polarization Mode Dispersion (PMD) and Nonlinear effects. The comparative analysis among the RZ and NRZ formats is carried out by means of the obtaining different spectrums.

In search of novel molecular markers for oral cancer, we reported increased levels of TC21/R-Ras2 transcripts in oral squamous cell carcinoma by differential display. The aim of this study was to determine the clinical significance of TC21 in oral cancer.Immunohistochemical analysis of TC21 protein expression was carried out in 120 leukoplakias, 83 OSCCs and 30 non-malignant tissues, confirmed by immunoblotting, and correlated with clinicopathological parameters as well as disease prognosis. Co-immunoprecipitation assays were carried out to identify the interaction partners of TC21 protein in oral cancer cells and tissues.TC21 nuclear expression increased from normal oral tissues to leukoplakia and frank malignancy (P0.001). TC21 overexpression was observed in 74.2% leukoplakia with no dysplasia, 75.9% dysplasias and 79.5% OSCCs in comparison with normal oral tissues. Receiver operating characteristic analysis showed that the area-under-the curve values were 0.895, 0.885, and 0.919, while the positive predictive values were 95.8%, 95.6%, and 97.1%, for nuclear immunostaining for normal versus leukoplakia with no dysplasia, leukoplakic lesions with dysplasia, and OSCCs, respectively. Immunoblotting confirmed overexpression of TC21 in oral lesions. Using co-immunoprecipitation assays, we showed interactions of TC21 with Erk2, PI3-K, 14-3-3zeta and 14-3-3sigma proteins in oral cancer cells.Our findings suggested that alteration in TC21 expression is an early event in oral cancer and correlates with poor prognosis of OSCCs. TC21 interactions with Erk2, PI3-K, 14-3-3zeta and 14-3-3sigma proteins in oral cancer cells and tissues suggests the involvement of TC21 in signaling pathways in oral cancer.

Breast cancer is the commonest cancer among women worldwide. Surgery plays an important role in its management. Axillary lymph node dissection has been the standard of care for staging, prognostication and control of axillary disease for almost a century. However, this time-tested paradigm is shifting gradually in the western world, because of the increasing use of screening mammography resulting in the detection of a large proportion of node-negative early breast cancers and a significant incidence of axillary lymph node dissection-related arm morbidity. Minimally invasive and less morbid procedures such as sentinel lymph node biopsy are being used more commonly in the West. However, the western experience cannot be directly extrapolated to the Indian scenario because of the differences in patient profile, treatment standards and expertise available. There is a need to critically analyse these issues before the Indian medical community advocates sentinel lymph node biopsy as a routine procedure for managing patients with breast cancer.

To study the efficacy of an organ-preserving, sequential chemoradiation therapy for squamous cell carcinoma of the anal canal, and of salvage surgery in those in whom this treatment fails.Forty biopsy-proven untreated patients (28 men) with squamous cell carcinoma of the anal canal received two cycles of chemotherapy using cisplatin and methotrexate, followed by 45 to 60 (median 50) Gy external beam radiotherapy. Salvage surgery was offered to those in whom this treatment failed. Overall survival, disease-free survival and colostomy-free survival were analyzed.Most patients (n=35; 87%) had T3 or T4 lesions and 5 (12.5%) had involvement of inguinal nodes. Thirty-one patients (77.5%) had complete response after chemoradiation. Only three patients (7.5%) developed chemotherapy-related grade 3 mucositis and myelosuppression. Radiotherapy-related toxicity included grade III cystitis in one patient and grade III proctitis in three patients. Three patients had post-treatment anal stenosis requiring repeated dilatation and two had chronic non-healing ulcers at the anal verge. Nine patients had failure of chemoradiation or disease recurrence; of these, only 5 could undergo salvage surgery. After a median follow up of 60 months, overall survival, disease-free survival and colostomy-free survival were 80%, 77.5% and 72.5%, respectively.Chemoradiation is effective in the treatment of squamous cell anal cancer and has acceptable toxicity. Surgical salvage may be useful in those with failure of this treatment.

Breast conservation therapy is a well-established treatment modality for early breast cancer. It is not widely practised in developing countries because of a lack of awareness and treatment facilities, and physician and patient bias. We analysed our experience of breast conservation therapy.We retrospectively reviewed 102 patients who had undergone breast conservation surgery and axillary dissection for breast cancer. Surgery was followed by 45 Gy of radiation to the whole breast and 15-20 Gy of tumour bed boost. All high risk patients received adjuvant systemic therapy. The disease profile, morbidity and treatment outcome were analysed.Out of 902 patients, 102 underwent breast conservation therapy (90 had early breast cancer and 12 had locally advanced breast cancer). Only 19.6% of patients with early breast cancer received breast conservation therapy. One-third of the patients had had a prior surgical intervention. The mean tumour size was 2.8 cm, 44% had nodal involvement and 29% were oestrogen- and progesterone-receptor negative. At a mean follow up of 32 months, only 1 patient had local recurrence, and the 5-year projected disease-free and overall survival were 82% and 88%, respectively.Breast conservation therapy should be offered to suitable breast cancer patients. Strict adherence to protocol-based therapy and active multidisciplinary coordination are crucial for a successful breast conservation therapy programme. Education of the patient as well as the physician population is necessary for increasing the breast conservation therapy rates in India.

Postoperative fistula involving upper gastrointestinal tract surgery is a rare but troublesome occurrence. Reoperation on these patients is challenging and needs to be individualised. Various methods are described including primary closure, bypass procedures, serosal patch repair and Roux-en-Y repair. We present a new technique of repair using afferent loop that provided a vascularized bowel segment, which used in an anatomical fashion for closure of fistula.

Metastases to the eye are rare and those from carcinoma esophagus are very rare, with only one report in the English literature. We report a 46-year-old man with adenocarcinoma of esophagus who developed isolated choroid metastasis after definitive treatment of the primary tumor.

Early detection and multimodality therapy has resulted in an overall improvement of survival among breast cancer patients. Despite a significant shift in the treatment approach from radical mastectomy to breast conservation a significant number of patients develop lymphedema. This study was conducted to evaluate the prevalence and risk factors for development of lymphedema.Retrospective analysis for prevalence of lymphedema in a tertiary care regional cancer centre.Three hundred treated breast cancer patients with a minimum follow up of one year were evaluated for the prevalence and risk factors for lymphedema. Lymphedema was assessed using a serial circumferential measurement method. More than 3 cm difference in circumference is considered as clinical significant lymphedema. Univariate and multivariate analysis were performed for evaluating the risk factors by using the Chi square test and Cox logistic regression analysis.The prevalence of clinically significant lymphedema was 33.5 % and 17.2 % had severe lymphedema. The prevalence of lymphedema was 13.4 % in patients treated with surgery only where as the prevalence was 42.4% in patients treated with surgery and radiotherapy. Stage of the disease, body surface area1. 5 m2, presence of co-morbid conditions, post operative radiotherapy and anthracycline based chemotherapy were significant risk factors in univariate analysis where as axillary irradiation and presence of co-morbid conditions have emerged as independent risk factors in multivariate analysis (P0.001).Post treatment lymphedema continues to be a significant problem following breast cancer therapy. Presence of co-morbid conditions and axillary radiation significantly increases the risk of lymphedema. A combination of axillary dissection and axillary radiation should be avoided whenever feasible to avoid lymphedema.

The incidence of the cancers of the oral cavity, pharynx, esophagus and larynx in different population groups of India is amongst the highest reported in Asian countries. There is evidence that high dietary carotenoids and vitamin C may possibly decrease the risk of laryngeal cancer. Limited data is available from India on the association between these micronutrients and the risk of laryngeal cancer.To assess the levels of vitamin A, vitamin C and zinc in laryngeal cancer patients and healthy controls.A hospital based case- control study.One hundred and fifty five laryngeal cancer patients and a control group of 155 healthy individuals constituted the study population. Individuals in the control group were individually matched with the patients for their age +/- 2 years, sex and place of residence. Venous blood was drawn from the cases and controls and estimations of vitamin A, zinc and vitamin C was done utilizing the standard procedures.Paired 't' test to compare the mean serum levels of vitamin A and zinc and plasma vitamin C between laryngeal cancer patients and controls. Univariate logistic regression analysis to calculate the odds ratios and the confidence intervals.The mean serum vitamin A, zinc and plasma vitamin C levels were significantly lower in laryngeal cancer patients as compared to the controls.The findings of the present study indicated a strong association of these micronutrients with laryngeal cancer in the Indian population.

Isolated ipsilateral supraclavicular lymph nodal (IISCLN) metastasis was considered part of locally advanced breast cancer (LABC) previously but the recent staging system categorised this group to metastatic disease (stage IV). There is no clear consensus on intent of therapy in patients with IISCLN. A retrospective comparative analysis of IISCLN and LABC patients treated with a curative multimodality approach was performed to evolve guidelines on treatment approach in patients with IISCLN spread.A total number of 670 patients with breast cancer treated in the Department of Surgical Oncology, IRCH, AIIMS, during the period between January, 1993 to December, 2000 were studied retrospectively. Out of these 16 (2.4%) patients with cytology proven isolated metastasis to ipsilateral SCLN without any other distant disease and 299 LABC patients were analysed. All patients received neoadjuvant anthracycline based chemotherapy, surgery, postoperative radiotherapy (50 Gy) including supraclavicular fossa. The relapse patterns and survival in both the groups were compared.At a median follow up of 36 months (range 9-72 months) the total recurrence in the IISCLN group was 31% and in the LABC group was 26%, the systemic recurrence was equal at 25% in each group while the locoregional recurrence was 12% and 7% in the IISCLN and LABC groups respectively. The overall survival (OS) was 81% and 91% whereas the disease-free survival (DFS) was 12% and 7% in the IISCLN and LABC groups, respectively.Intent of therapy in metastatic breast cancer is palliative. However, patients with IISCLN metastasis have a relatively less aggressive biologic behaviour as compared to patients with spread to other distant sites. Results of the current study shows that the relapse patterns and survival of IISCLN group and LABC are comparable. Hence, despite being staged as metastatic disease, patients with IISCLN spread should be treated with combined modality approach for prolonged survival.

Adenocarcinoma of the stomach is usually advanced at presentation, and local or distant spread may preclude the option of primary curative resection. Neoadjuvant chemotherapy (NAC) has shown promise in downstaging initially unresectable disease. This pilot study was planned to assess the utility of NAC using Cisplatin and 5-Fluoro uracil in the management of initially unresectable gastric cancer.Ten patients with unresectable gastric adnocarcinoma were included. They received two cycles of cisplatin, 30 mg/m2 intravenously in combination with 5-Fluoro Uracil, 1000 mg/m2. They were restaged using Endoscopy and CT scan and taken up for exploratory laparotomy.Eight of 10 patients (80%) had an objective response to chemotherapy. Six patients (60%) with initially unresectable disease could be offered curative surgery. The median survival was 10 months (range 1-60 months). There were two long term survivors (48 and 60 months respectively).Neoadjuvant chemotherapy (NAC) is an effective option in downstaging initially unresectable gastric carcinoma. Complete response to chemotherapy also predicts long term survival.

Radiation is well known to increase the risk of cancer. Leukemias, skin cancers, osteosarcomas, thyroid cancers are some examples of radiation-induced malignancies. Radiation-induced carcinoma of the esophagus is extremely rare. We present a case of 42 year old patient who received radiotherapy for breast cancer and subsequently developed esophageal carcinoma.

The harmonic scalpel is recently emerging as an alternative surgical tool for dissection and haemostasis and has been extensively used in the field of minimally invasive surgery. We studied the utility and advantages of this instrument over electrocautery for performing modified radical mastectomy.The operative and morbidity details of twenty-three breast cancer patients who underwent modified radical mastectomy using the harmonic scalpel were compared with 23 matched controls operated with electrocautery by the same surgical team.There was no significant difference in the operating time between the harmonic scalpel and electrocautery group (104 and 100 mins, p0.05). The blood loss (60 +/- 35 ml and 294 +/- 155, p0.001) and drainage volume (590 +/- 430 ml and 1,085 +/- 690 ml, p0.001) were significantly lower in the harmonic scalpel group. There was a significant reduction of drain days in harmonic scalpel group (mean five and nine days, p0.05). There was no significant difference in the seroma rate between two groups (16% and 22%).Modified radical mastectomy using harmonic scalpel is feasible and learning curve is short. Harmonic scalpel significantly reduces the blood loss and duration of drainage as compared to electrocautery.

Venous access is crucial for cancer management for administration of drugs blood products, antibiotics and periodic sampling.To review our experience of long-term venous access devices used over a ten-year period and to analyse the outcome in cancer patients in Indian setting.A retrospective analysis of data in a tertiary care Regional cancer centre.A total of 110 patients with various malignancies requiring long-term venous access were included in the study. A uniform open cut down procedure under local anaesthesia was used and silastic Hickman catheters were inserted in the cephalic or external jugular or internal jugular veins. A record of all complications and catheter loss and final out come were analysed.A total of 111 catheters were used in 110 patients. Sixty-nine catheters were placed in cephalic, 40 in external jugular, and 2 in internal jugular vein. Duration of catheter indwelling period ranged from 7 to 365 days with a median of 120 days. In 90% of the cases the catheter tip was located either in superior vena cava or in right atrium. Total catheter related complications were observed in 37 (34.54%) patients and catheter loss rate due to complications was 15.4% (17/111).Long-term venous access using Hickman catheter insertion by open cut down method is a simple, safe and reliable method for administration of chemotherapeutic agents, antibiotics and blood products. The incidence of various complications and catheter loss was acceptable and overall patient satisfaction was good.

The incidence of colorectal cancer (CRC) shows a wide geographic variation and India along with other Asian and African countries has a low incidence. Most patients present with advanced disease and no uniform treatment guidelines are followed at present.An audit of 91 patients treated as per IRCH protocol between June 1994 and Jun 2000 in a single surgical unit was performed.The mean age of patients was 45.3 years (18-90 years) and there was a predominance of rectal cancer patients (Rectal vs Colon = 76% vs 24%). Majority of the rectal cancers were low rectal cancers (67%) and abdominoperineal resection was the commonest surgical procedure performed(40). The inoperability rate was 24% and sphincter salvage rate was 13%. Seventy nine percent of patients had adenocarcinoma and 90% of CRC patients belonged to Astler-Collers stage B2 and C. A total of 37 patients also received adjuvant radiotherapy and only 39 out of 60 patients planned for adjuvant chemotherapy could complete the treatment. The operative mortality was 2.2% and morbidity was 18%. A total of 13 (14%) patients had relapse of disease (local 5, regional 3, distant 5).A significant number of CRC patients in India present with advanced stage of disease and probably due to referral bias majority had low rectal cancers. By advocating multimodality protocols a good locoregional and systemic control can be achieved despite the advanced stage of presentation.