Browsing by Author "Shukla, N K"
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Item Adenocarcinoma esophagus with choroid metastasis.(2004-05-15) Singh, Devinder; Sharma, Atul; Arora, Brijesh; Shukla, N K; Mohanti, B KMetastases 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.Item An analysis of long-term venous access catheters in cancer patients:experience from a tertiary care centre in India.(2002-01-26) Shukla, N K; Das, D K; Deo, S V S; Raina, VBACKGROUND: Venous access is crucial for cancer management for administration of drugs blood products, antibiotics and periodic sampling. AIMS: 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. Setting and Design: A retrospective analysis of data in a tertiary care Regional cancer centre. PATIENTS AND METHODS: 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. RESULTS: 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). CONCLUSIONS: 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.Item Association of vitamin A, vitamin C and zinc with laryngeal cancer.(2003-04-13) Kapil, U; Singh, P; Bahadur, S; Shukla, N K; Dwivedi, S; Pathak, P; Singh, RBACKGROUND: 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. AIMS: To assess the levels of vitamin A, vitamin C and zinc in laryngeal cancer patients and healthy controls. SETTING AND DESIGN: A hospital based case- control study. MATERIAL AND METHODS: 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. STATISTICAL ANALYSIS USED: 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. RESULTS: The mean serum vitamin A, zinc and plasma vitamin C levels were significantly lower in laryngeal cancer patients as compared to the controls. CONCLUSIONS: The findings of the present study indicated a strong association of these micronutrients with laryngeal cancer in the Indian population.Item Association of vitamin A, zinc, selenium and magnesium with oesophageal cancer.(1998-10-06) Nayar, D; Kapil, U; Joshi, Y K; Sundaram, K R; Srivastava, S P; Shukla, N K; Tandon, R KItem Bacteriological water quality and incidence of water borne diseases in a rural population.(1971-11-01) Trivedi, B K; Gandhi, H S; Shukla, N KItem Biliary tract neoplasms.(1998-04-30) Sharma, D N; Chawla, S; Gairola, M; Mohanti, B K; Deo, S V; Shukla, N K; Rath, G KFrom January 1993 to December 1995, complete records of patients with biliary neoplasms were analysed. A total of 124 patients were registered. Majority of patients were in the age range of 40-60 years (median 54 years). There were 38 males and 86 females. Histopathologically, adenocarcinoma was the commonest type (59%). Pain, jaundice and lump were noticed in 119, 54 and 77 patients respectively. Fifty six patients had associated gall stones. Ninety patients had metastatic disease at presentation. Majority of them (110/124) had advanced, inoperable disease and therefore were considered for palliative treatment. Only 14 patients (12%) were considered for curative treatment. Of these 14 patients, all the cases underwent surgery, 10 received radiotherapy and 10 received chemotherapy. Follow up was very poor. The survival of 14 patients, who received curative treatment, ranged from 2 months to 44 months with mean of 16 months.Item Breast cancer presentation at a regional cancer centre.(1995-01-01) Goel, A K; Seenu, V; Shukla, N K; Raina, VBACKGROUND. Breast cancer accounts for 20% of all female cancers in India and most patients present with advanced disease. Many factors may be responsible for the late presentation including the prehospital diagnostic and therapeutic approach towards breast lumps which may be malignant. To evaluate these factors we carried out a prospective investigation at the Institute Rotary Cancer Hospital of the All India Institute of Medical Sciences. METHODS. We studied 100 new patients with breast cancer seen in a special clinic over a 12-week period, excluding patients who did not have a palpable lump and those who had had an operation in another hospital more than six months previously. RESULTS. Fifty-seven of the patients were from urban and 43 from rural areas. Only 20 patients were aware of breast cancer before the onset of their illness. They were mainly from an urban background, educated and had a family history of breast and other malignancies. The total duration of illness ranged from 1 week to 10 years (mean 11.3 months) and the time to first visit ranged from 1 day to 9.5 years (mean 6.7 months). The delay between the first contact with a doctor to the date seen in the Institute Rotary Cancer Hospital thus amounted to a mean of 4.6 months. The duration of illness as well as time to first visit was also significantly shorter in urban patients, those who were educated and those who were aware of the disease. Fine needle aspiration cytology was used in 50 patients and was diagnostic in 39. Thirty of the 100 patients had no diagnostic investigations. Of the 43 patients treated elsewhere, the operation had been inadequate in 17 and 27 of the 43 patients were found to have had faulty adjuvant therapy. Many patients did not carry their operation notes and histopathology reports and when these were available, they were often of poor quality. The use of staging investigations was incomplete so much so that in 22 patients the disease could not be staged at all because of poor records. CONCLUSION. Breast cancer is seen in our hospital in an advanced stage because most patients are unaware of the disease. However, the treating physician also contributes to delay in the diagnosis, uses the diagnostic and staging investigations improperly, performs inadequate surgery and prescribes inappropriate adjuvant treatment. Record keeping is also of a poor quality. We need to provide more information to both patients and doctors about breast cancer.Item Breast conservation therapy for breast cancer: patient profile and treatment outcome at a tertiary care cancer centre.(2005-07-29) Deo, S V S; Samaiya, A; Shukla, N K; Mohanti, B K; Raina, V; Purkayastha, J; Bhutani, M; Kar, M; Hazarika, S; Rath, G KBACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.Item Carcinoma of buccal mucosa: incidence of regional lymph node involvement.(1993-12-01) Dhawan, I K; Verma, K; Khazanchi, R K; Madan, N C; Shukla, N K; Saxena, RHistopathological findings in 57 surgical specimens of T3 and T4 buccal mucosa cancers are reviewed. The incidence of the well-differentiated tumours (including verrucous carcinoma) was 61%. A moderate degree of lymphocytic infiltration of the tumour was present in 37% of patients. Histologically proven cervical lymph node deposits were present in only 16% of the patients. Amongst the group of patients with clinically enlarged lymph nodes, metastatic disease was histologically demonstrated in 17.5% at level I and 14% at level II of neck nodes. Amongst group of patients with no palpable nodes in the neck, metastatic disease was histologically demonstrated in 11.7% at level I and 9% at level II of neck nodes. These findings contra-indicate an elective neck dissection and indicate the need to confirm histologically the presence of lymph node deposits doing a radical neck dissection in patients with buccal mucosa cancer. This well-differentiated tumour has a much lower tendency to metastasize than cancers in other sites of the oral cavity.Item Clinical and pathological response rates of docetaxel-based neoadjuvant chemotherapy in locally advanced breast cancer and comparison with anthracycline-based chemotherapies: Eight-year experience from single centre.(2011-07) Gupta, D; Raina, V; Rath, G K; Shukla, N K; Mohanti, B K; Sharma, D NIntroduction: The administration of neoadjuvant chemotherapy (NACT) prior to local therapy is advantageous for women with locally advanced breast cancer (LABC), since it can render inoperable tumors resectable and can increase rates of breast conservative surgeries. Materials and Methods: We retrospectively analyzed LABC patients who received NACT from January 2000 to December 2007. Out of 3000 case records screened, 570 (19%) were LABC and 110/570 (19%) treatment-naïve patients started on NACT were analyzed. Ninety-one (37 docetaxel [D], 54 anthracycline [A]) patients were eligible for response and survival analysis. Pathological complete remission (pCR) was defined as no evidence of malignancy in both breast and axilla. Results: Median age of the whole cohort was 45 years (range 25-68 years). Premenopausal were 42% and estrogen receptor + 49.5%. Most (90%) were T4 tumors and 70% were Stage IIIB. Median numbers of preoperative cycles were six and three in the D and A group respectively. Overall clinical response rates for breast primary were 74.3% and 53.7% (CR 28.6% vs. 16.7%, P=0.58) while for axilla ORR were 75.7% vs. 54.8% (51.4% vs. 40.4% CR, P=0.77) respectively for D and A. Corresponding pCR rates were 19% vs. 13% respectively. There was no significant difference in disease-free (three-year 56.84% vs. 61.16%, P=0.80) and overall survival (three-year 70% vs. 78.5%, P=0.86) between the two groups. Conclusions: Although pCR rates were higher with docetaxel-based NACT, it did not translate into superior disease-free survival / overall survival compared to anthracycline-based chemotherapies.Item Colorectal cancers--experience at a regional cancer centre in India.(2001-04-13) Deo, S V; Shukla, N K; Srinivas, G; Mohanti, B K; Raina, V; Sharma, A; Rath, G KBACKGROUND: 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. PATIENTS AND METHODS: An audit of 91 patients treated as per IRCH protocol between June 1994 and Jun 2000 in a single surgical unit was performed. RESULTS: 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). CONCLUSIONS: 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.Item Development of carcinoma of esophagus in a treated case of breast carcinoma: possibly related to radiation therapy.(2002-08-08) Sharma, D N; Shukla, N K; Rath, G KRadiation 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.Item Diffuse papillomatosis of gall bladder.(1988-03-01) Arunabh,; Sharma, A; Shukla, N K; Mathur, M; Kapur, M MItem Double primary-Lymphoepithelioma-like carcinoma of the parotid and papillary carcinoma of the thyroid.(2010-10) Bishnoi, R; Kaushal, S; Varma, M C; Shukla, N K; Ray, RItem Electron beam irradiation in treatment of skin carcinoma.(1989-03-01) Shahi, U P; Fernandes, P; Shukla, N K; Chander, S; Rath, G KThirty seven cases of carcinoma of skin treated with electron-beam irradiation over a period of three years have been analysed retrospectively. Majority of lesions were in head and neck and basal-cell carcinoma was the commonest histological type. Of twenty-one patients followed, seventeen (81%) achieved complete remission and remained disease free for a period of one to three years. Cosmetic results were excellent. Role of electron-beam in the management of these superficial cancers and its advantage over the conventional radiation therapy methods have been highlighted. Radiation therapy utilising electron-beams form a very useful modality in the management of skin cancers, especially those arising in head and neck.Item Esophageal bezoar: a rare but distinct clinical entity.(1995-01-01) Goel, A K; Seenu, V; Srikrishna, N V; Goyal, S; Thakur, K K; Shukla, N KA 89 year old female patient presented with severe dysphagia and was suspected to have carcinoma of the esophagus. Endoscopy revealed an esophageal phytobezoar which passed down spontaneously after unsuccessful endoscopic extraction attempt. Barium swallow study revealed diffuse spasm of the esophagus. A review of English literature revealed only 17 previous cases of esophageal bezoar. Salient features of esophageal bezoars are discussed based on previous reports and the current case.Item Experience with intraluminal radiotherapy in advanced oesophageal cancer.(1995-01-01) Mohanti, B K; Shukla, N K; Chawla, S; Ganesh, T; Deo, S V; Thakur, K K; Raina, V; Mohanta, P K; Rath, G KDespite improvement in the diagnostic modalities, surgical technique, chemotherapy and radiotherapy, mortality and morbidity due to carcinoma esophagus continues to be dismal. Combination of external and intraluminal radio therapy (ILRT) has emerged as a powerful and promising palliative therapy in this disease. Thirty four patients with inoperable cancer esophagus treated with ILRT during June 1991 to December 1993 were evaluated to assess its palliative effects. Seventeen of these patients had received additional chemotherapy and external radiotherapy. Thirteen patients received only radiotherapy (both external radiotherapy + ILRT) and the remaining 4 received only ILRT. They were followed up for a mean period of 8.3 months (range 2 to 28 months) during which one patient was lost to follow up. Eight had a follow up of less than 6 months. Eight (33%) amongst the remaining 25 patients were considered disease free, 15 had recurrent and progressive disease, one developed metastasis and one patient died. In 21 (66%) dysphagia markedly improved. Nine (26%) patients survived beyond 1 year and the median survival for all patients was 8 months. Associated radiation morbidity was documented in 13 (38%) patients. We conclude that combination of external radiotherapy and ILRT is an effective and safe therapy for inoperable esophageal malignancies.Item Gall bladder cancer: Usual presentation, unusual outcome.(2010-04) Sharma, Atul; Dwary, Amit Dutt; Vaithiswaran, V; Pal, Sujoy; Gupta, S Dutta; Shukla, N K; Raina, Vinod; Thulkar, S; Mohanti, Bidhu KItem Hepatic metastases from colorectal cancer: an overview of surgical management.(1994-07-01) Goel, A K; Seenu, V; Bal, S; Shukla, N KItem Hodgkin's lymphoma of colon: an unusual cause of isolated splenic vein obstruction.(1994-04-01) Seenu, V; Goel, A K; Shukla, N K; Dawar, R; Sood, SA case of splenic vein obstruction due to infiltration by Hodgkin's lymphoma of the colon is reported. The patient presented with massive upper gastrointestinal hemorrhage and a lump in the abdomen. Laparotomy revealed a colonic tumor infiltrating the splenic vein, causing left sided portal hypertension.
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