Intra-operative interstitial brachytherapy in a novel infra-zygomatic approach for partially resectable head and neck cancers around the base of skull: A technical note.

Purpose: To report an intra-operative catheter insertion technique into the base of skull tumor bed following surgical resection for maxillary tumors. Material and methods: A 42-year-old male patient diagnosed with carcinoma of the maxilla was treated with neoadjuvant chemotherapy followed by chemo-radiation using external beam technique combined with brachytherapy boost to post-operative bed. Brachytherapy was delivered via intra-operative catheter placement at the base of skull to residual disease, which was surgically unresectable. Initially, catheters were placed cranio-caudally. This was later changed into an infra-zygomatic approach to improve planning and dose coverage. High-risk clinical tumor volume (CTV) was generated with a 3 mm margin to residual gross tumor. Planning was done using Varian Eclipse brachytherapy planning system, and an optimal plan was generated. Conclusions: An innovative, beneficial, and safe brachytherapy approach is necessary in a difficult and critical area, such as the base of skull. Our novel method of implant insertion through infra-zygomatic approach resulted in a safe and successful procedure.

Outcomes of Cancer Surgery During the COVID-19 Pandemic: Preparedness to Practising Continuous Cancer Care.

The COVID-19 pandemic has placed unprecedented pressure on healthcare services. Deprioritisation of nonemergency clinical services and growing concerns of adverse outcomes of COVID-19 in cancer patients is having a deleterious impact across oncologic practice. We report cancer surgery outcomes taking into account the acuity of the COVID-19 situation. A prospectively maintained database of the Department of Surgical Oncology was analysed from 1st May to 30th June, 2020, to evaluate the perioperative outcomes, morbidity and mortality following major surgical procedures. A total of 359, preoperatively, tested negative for COVID-19 underwent surgery. Median age was 52 years with 26.7% (n = 96) above the age of 60 years. Sixty-one percent (n = 219) patients were American Society of Anaesthesiology grades II-III. As per surgical complexity grading, 36.8% (n = 132) cases were lower grades (I-III) and 63.2% (n = 227) were complex surgeries (IV-VI). 5.3% (n = 19) had ≥ grade III Clavien-Dindo complication, and the postoperative mortality rate was 0.27% (n = 1). Major complication rates in patients > 60 years were 9.3% in comparison to 4.1% in < 60 years (p = 0·63). The median hospital stay was 1-10 days across subspecialties. Postoperatively, repeat COVID 19 testing in 2 suspected patients were negative. Our study showed that after screening, triaging and prioritisation, asymptomatic cases may undergo cancer surgeries without increased morbidity during COVID-19 pandemic.

Salvage Surgery in Recurrent Oral Squamous Cell Carcinoma.

More than half of patients with oral cancer recur even after multimodality treatment and recurrent oral cancers carry a poorer prognosis when compared to other sites of head and neck. The best survival outcome in a recurrent setting is achieved by salvage surgery; however, objective criteria to select an ideal candidate for salvage surgery is difficult to frame, as the outcome depends on various treatment-, tumor-, and patient-related factors. The following is summarizes various tumor- and treatment-related factors that guide our decision-making to optimize oncologic and functional outcomes in surgical salvage for recurrent oral cancers. Short disease-free interval, advanced tumor stage (recurrent and primary), extracapsular spread and positive tumor margins in a recurrent tumor, regional recurrence, and multimodality treatment of primary tumor all portend worse outcomes after surgical salvage. Quality of life after surgical intervention has shown improvement over 1 year with a drastic drop in pain scores. Various trials are underway evaluating the combination of immunotherapy and surgical salvage in recurrent head and neck tumors, including oral cavity, which may widen our indications for salvage surgery with improved survival and preserved organ function.

Thyroid Hemiagenesis and Papillary Carcinoma: a Rare Association.

A 20-year-old female presented with a slowly growing solitary left thyroid nodule for 1 year. USG and CECT neck showed a 4 × 3 cm solid-cystic nodule in the left lobe of thyroid, with notable absence of the right lobe. FNAC from the nodule was Bethesda V. Operative findings confirmed right thyroid lobe agenesis with corresponding absence of right superior thyroid vessels. The right sided RLN, ESBLN, superior and inferior parathyroids, and inferior thyroid vasculature were in their anatomical positions. She underwent standard left hemithyroidectomy. Histopathological examination revealed follicular variant of papillary carcinoma.

PMMC Patch Pharyngoplasty Reconstruction After Laryngectomy: Our Experience at a Regional Cancer Institute.

To evaluate our results of post laryngectomy pharyngeal defect reconstruction by pectoralis major myocutaneous (PMMC) flap. Retrospective analysis of 48 patients who underwent laryngectomy and PMMC patch pharyngeal reconstruction from year 2009 to 2013 was done. Patient and tumor characteristics were noted, CT scan and histopathology reports were reviewed. 46 (95.8 %) patients were male and 2 (4.2 %) were female. Mean age was 57.2 ± 8.5 years and mean postoperative stay was 22.6 ± 12.0 days. Most common complication was pharyngocutaneous fistula, seen in 13 (27.1 %) cases. Postoperative mortality was low (2.1 %). Post surgery rehabilitation in respect to swallowing and tolerance to radiotherapy was satisfactory in most patients. PMMC patch pharnygoplasty is a reliable option for pharyngeal reconstruction with acceptable complication.

Pharyngocutaneous Fistula Incidence After PMMC Patch Pharnygoplasty for Post Laryngectomy Defect Reconstruction - Predictive Factors, Our Experience at KMIO.

To analyse pharyngocutaneous fistula, post Pectoralis major myocutaneous patch pharnygoplasty, and its association with various tumor, patient and treatment related factors. It is a retrospective study that included 48 patients who underwent laryngectomy and PMMC patch pharyngeal reconstruction from year 2009 to 2013. We studied the previously reported factors that could influence fistula formation such as age, gender, previous radiotherapy, previous tracheostomy, location of tumor, extent of tumor, tumor volume, tumor stage and surgical margins. Pharyngocutaneous fistula was observed in 13(27.1 %) cases. In 84.6 % (n = 11) patients, fistula closure was achieved by conservative measures. No statistically significant association was found between tumor location, extent and size. There was no association between history of previous tracheostomy and postoperative microscopic margin status. Patients with T4 disease showed increased association (36.7 %) compare to T3 stage (11 %) (p value-0.0362). Postoperatively 6 patients presented with dysphagia out of which 4 patients (66.7 %) had history of leak. It also showed significant increase in post operative stay and delay in oral feeding in fistula patients. There is still no consensus regarding the most significant risk factors, our data showed that, most disease and treatment related parameters were not predictive for fistula occurence. Prabably a larger number of patient cohart need to be analysed for additional information.

La(III) complex involving the O,N-donor environment of quinazoline-4(3H)-one Schiff's base and their antimicrobial attributes against methicillin-resistant Staphylococcus aureus (MRSA).

The incidence of methicillin-resistant Staphylococcus aureus increased during the past few decades, so there is an urgent need of new antimicrobial agents if public health is concerned. Though the Schiff's bases and La(III) complex have enormous biological activity, but less attention was given in their synthesis. In the present investigation, we synthesized a new (E)-3-((2-hydroxynaphthalen-1-yl) methyleneamino)-2-methylquinazoline-4(3H)-one HNMAMQ Schiff's base by the condensation of 3-(2-aminophenyl) quinazolin-2-methyl-4(3H)-one and 2-hydroxy-1-naphthaldehyde. The Schiff's base HNMAMQ and its La(III) complex were characterized by elemental analyses, IR, NMR, mass spectra, and thermal studies. The newly synthesized Schiff's base HNMAMQ and its La(III) complex were evaluated for their antimicrobial activity against methicillin-resistant Staphylococcus aureus isolated from the Gulbarga region in India. The Schiff's base HNMAMQ and its La(III) complex showed good antimicrobial activity and thus represents a potential new drug of choice.

(E)3-2-(1-(2,4-Dihydroxyphenyl)ethyldeneamino)phenyl)-2-methylquinazoline-4(3H)-one Schiff Base and Its Metal Complexes: A New Drug of Choice against Methicillin-Resistant Staphylococcus aureus.

The 3-(2-aminophenyl) quinazolin-2-methyl-4(3H)-one and 2,4-dihydroxyacetophenone undergo condensation to afford (E)3-2-(1-(2,4-dihydroxyphenyl)ethyldeneamino)phenyl)-2-methylquinazoline-4(3H)-one Schiff base (DHPEAPMQ). The newly synthesized Schiff base (DHPEAPMQ) and its metal complexes were evaluated for their antimicrobial activity against methicillin-resistant Staphylococcus aureus isolated from the Gulbarga region in India. The Cu(II), Ni(II), and Zn(II) complexes of Schiff base (DHPEAPMQ) showed good antimicrobial activity. So, this could be a new drug of choice.

Modified technique of stapled esophagojejunostomy without a purse-string suture.

Placement of a purse-string suture during a stapled esophagojejunostomy following total gastrectomy is a technically demanding and time consuming procedure. Improper placement of the purse-string suture can lead to anastamotic breakdown with its associated complications. We describe a technique of stapled esophagojejunostomy without using a purse-string suture. We used this technique in 35 patients including 4 patients who underwent an extended total gastrectomy. We encountered a difficulty only in one patient due to malfunction of the stapler. None of the patients had an anastamotic leak. The modified technique of stapled esophagojejunostomy without a purse-string suture makes the procedure more easy, safe and simple.

The effect of electron and gamma irradiation on the induction of micronuclei in cytokinesis-blocked human blood lymphocytes.

The effect of electrons and gamma irradiation on the induction of micronuclei in cytokinesis-blocked human peripheral blood lymphocytes was investigated to understand the relative biological effectiveness (RBE) of electrons compared with gamma rays. Blood samples were irradiated with an 8 MeV pulsed electron beam, at a mean instantaneous dose rate of 2.6 x 10(5) Gy s(-1). Gamma irradiation was carried out at a dose rate of 1.98 Gy min(-1) using (60)Co gamma source. A dose-dependent increase in micronuclei yield was observed. The dose-response relationships for induction of micronuclei fitted well to a linear-quadratic relationship and the coefficients alpha and beta of the dose-response curve were estimated by fitting the data using error-weighted minimum chi (2) method. The RBE of 8 MeV electrons were found to be near unity as compared with gamma rays.

Natural radioactivity in some major rivers of coastal Karnataka on the southwest coast of India.

Systematic studies on radiation level and distribution of radionuclides have been carried out in riverine environs of three major rivers of coastal Karnataka, viz. Kali, Sharavathi and Netravathi. The ambient gamma radiation levels along three rivers were measured using a portable plastic scintillometer. Activity concentrations of (226)Ra, (232)Th and (40)K in soil, sediment and rock were measured using a NaI(Tl) gamma-ray spectrometer. In the Kali, Sharavathi and Netravathi riverbanks, the median values of absorbed gamma dose rates in air were found to be 44 nGy h(-1), 35 nGy h(-1) and 57 nGy h(-1), respectively. The highest activity of (226)Ra was found in riverbank soil samples of Sharavathi River. The highest activities of (232)Th and (40)K were found in riverbank soil and sediment samples of Netravathi River. In Kali River, the highest (226)Ra activity was recorded for rock samples. To assess the radiological hazard of natural radioactivity in the samples, absorbed gamma dose rates in air, radium equivalent activity, representative level index, external hazard index and internal hazard index associated with the radionuclides were calculated and compared with internationally recommended values. The representative level index (I(gammar)) values are high in sediment samples of Netravathi River. The radium equivalent activity (Ra(eq)), external hazard index (H(ex)) and internal hazard index (H(in)) values are high in rock samples of Kali River. The results of these investigations are presented and discussed in this paper.

Behavior of 210Po and 210Pb in high background areas of coastal Kerala on the south west coast of India.

This paper deals with the distribution and behavior of (210)Po and (210)Pb in beach sand and surface soil samples from the Quilon district of Kerala. Beach sand and soil samples were collected and analyzed for (210)Po and (210)Pb radionuclides using standard radiochemical analytical techniques. Mean activities of (210)Po and (210)Pb were found to be maximum in the samples collected at 20 m away from waterline. Among the beach sand samples, the activities of radionuclide were found to be maximum for samples from most of the regions of Chavara and few regions of Neendakara. The activity of (210)Po was found to vary from 2.4 to 20.5 Bq kg(-1) with a mean value of 8.3 Bq kg(-1) at the water line, 2.5-19.9 Bq kg(-1) with a mean value of 10.2 Bq kg(-1) at 20 m away from the waterline, and 2.1-6.7 Bq kg(-1) with a mean value of 3.5 Bq kg(-1) at 40 m away from waterline. The respective values found for (210)Pb were from 1.2 to 48.2 Bq kg(-1) with a mean value of 14.9, 11.3-34.2 Bq kg(-1) with a mean value of 19.8 Bq kg(-1) and 2.3 to 18.3 Bq kg(-1) with a mean value of 8.7 Bq kg(-1). The depth profile study indicated the mean activity of (210)Po to decrease with depth for samples collected 20 m away from waterline whereas the activity slightly increases with depth 40 m away from sea. The activity concentration of (210)Po and (210)Pb in surface beach sand shows good correlation, with a correlation coefficient 0.81.

Vertical profiles and enrichment pattern of natural radionuclides in monazite areas of coastal Kerala.

Detailed studies on radionuclides concentration in different environmental matrices of high background areas were undertaken in the coastal areas of Karunagapalli, Chavara, Neendakara and Kollam to study the distribution and enrichment of the radionuclides in the region. The sand samples collected at different distances from sea waterline and at different depths, were analysed for primordial radionuclides by gamma spectrometry. The activity of primordial radionuclides was determined for the different size fractions of sand to study the enrichment pattern. The highest activity was found confined in 125-63 microm particle size fraction in sand. The minimum (232)Th activity was 9.4 Bq kg(-1), found in Kollam at a depth of 10-20 cm, 40 m away from waterline in 500-250 microm particle size fraction and maximum activity of 136,811.2 Bq kg(-1) was observed in Chavara in grains of size 125-63 microm at a depth of 0-10 cm for a sample collected 20 m away from waterline. The lowest (226)Ra activity observed was 29.6 Bq kg(-1) at Kollam beach for a sample 40 m away from waterline in grains of size 1000-500 microm and at a depth of 20-30 cm and the highest activity observed was 10,309 Bq kg(-1) in grains of size 125-63 microm for a sample collected at a distance 20 m away from waterline and at a depth of 0-10 cm. The activity of (40)K was below detectable level in most of the samples collected from the high background monazite area. The (232)Th, (226)Ra activities decrease with depth for the samples collected 20 m away from the waterline and increase with depth for the samples collected 40 m away from the waterline at Chavara and Kollam beaches. No definite correlation was found between variation of the concentrations of (232)Th and (226)Ra with depth at Karunagapalli and Neendakara beach sands. There exists a strong correlation between (226)Ra and (232)Th activities in the region. The results of these investigations are presented and discussed in this paper.

226Ra, 40K and 7Be activity concentrations in plants in the environment of Kaiga, India.

Leaves, stem and bark samples from several plant species were collected from tropical forest of Kaiga, in the west coast of India where two nuclear power reactors of 220 MW each have just been commissioned and another two are under construction, and analysed for their (226)Ra, (40)K and (7)Be concentrations. The activities of (226)Ra and (40)K in plants were found to vary in the range BDL-13.2 and 12.0-797.3 Bq kg(-1), respectively. Plants show significant (7)Be activity in leaves, the activity varies in 72.5-1,060.8 Bq kg(-1). Stem and bark of plants show higher levels of (226)Ra and (40)K when compared to leaves. Soil-to-plant transfer factor for (226)Ra and (40)K were found to vary in the range BDL-0.37 and 0.09-5.61, respectively for different plants. The concentration of (226)Ra and (40)K in leaves depends on the age of the leaves.

Trichotillomania.

Trichotillomania is one of the types of traumatic alopecia and is defined as the irresistible urge to pull out the hair, accompanied by a sense of relief after the hair has been plucked. In trichotillomania alopecia results from deliberate efforts of the patients who is under tension or is psychologically disturbed. The condition maybe episodic and the chronic type is difficult to treat. The prevalence of the condition appears to be more common than previously believed. The purpose of this article is to discuss the various aspects of the condition including the available treatments.

Dry skin conditions, eczema and emollients in their management.

Dry skin, which refers to roughened, flaky, or scaly skin that is less flexible than normal and dry to feel, is relatively common problem in all age groups, but is more common in elderly individuals. The water content of the stratum corneum is of paramount importance in maintaining the normal appearance and texture of human skin. The relative hydration of the stratum corneum is a composite of 3 factors viz. the rate of water transport from dermis to stratum corneum, the rate of surface loss of water and the rate of water binding ability of stratum corneum. Loss of integrity of the barrier function is a central factor in the development of dry skin conditions and eczema. The various factors involved in producing dry skin, various causes of dry skin and the role of emollients in the management of these conditions are discussed.

Cutaneous and mucosal pain syndromes.

The cutaneous and mucosal pain syndromes are characterized by pain, burning sensation, numbness or paraesthesia of a particular part of the skin or mucosal surface without any visible signs. They are usually sensory disorders, sometimes with a great deal of psychologic overlay. In this article various conditions have been listed and are described. The possible causative mechanisms are discussed when they are applicable and the outline of their management is described.

222Rn concentration in ground waters of coastal Karnataka and Kaiga of south west coast of India.

Groundwater (open well and bore well) samples from various locations of coastal Karnataka and Kaiga have been investigated for their 222Rn concentrations by emanometry method. The concentration of 222Rn in open well water was found to vary in the range 0.14-25.4 Bq L(-1) with a median value of 3.74 Bq L(-1) and that in bore well water in the range of 0.22-197.0 Bq L(-1) with a median value of 5.75 Bq L(-1). From the measured concentrations the effective doses for the population of the region were estimated. The effective dose was found to vary from 0.09 microSv y(-1) to 204.2 microSv y(-1) for open well water consumers and from 0.2 microSv y(-1) to 1586.9 microSv y(-1) for bore well water consumers. The results of the present study are also compared with the literature values and discussed.

Dietary intake of 210Po and 210Pb in the environment of Goa of south-west Coast of India.

This paper deals with the distribution and activity intake of 210Po and 210Pb in food, diet, and potable water samples of the Goa region and the estimated committed effective dose due to ingestion of these radionuclides. The activity concentrations of 210Po and 210Pb were determined in about 30 food and diet samples from different places of Goa in order to know the distribution and intake of these radionuclides. The activity concentration of 210Po in fish and prawn samples were significantly higher than concentrations found in vegetable and rice samples. Higher concentrations of 210Po and 210Pb were observed in leafy vegetables than in non-leafy vegetables. Among the diet samples the activity concentrations of 210Po and 210Pb in non-vegetarian meal samples were relatively higher than in vegetarian meal and breakfast samples. The committed effective dose due to annual intake of 210Po was found to be 94.6 microSv, 49.1 microSv, 10.5 microSv, and 2.2 microSv and that of 210Pb found to be 81.6 microSv, 59.9 microSv, 14.6 microSv, and 2.0 microSv for the ingestion of non-vegetarian meal, vegetarian meal, breakfast, and potable water, respectively.

137Cs concentration in the environment of Kaiga of south west coast of India.

This paper presents the results of 137Cs activity in soil and vegetation obtained through a carefully planned pre-operational survey for the establishment of baseline data on background radiation level and distribution of radionuclides in the environment of Kaiga, in the south west coast of India, where two nuclear power reactors of 235 MWe each are under construction. The vertical profile in soil and the seasonal variation in the activity have been studied. Nine commonly available vegetation species of Kaiga region were analyzed for their 137Cs activity, and the soil-to-plant transfer coefficients were evaluated. Measurements were made by gamma spectrometry method employing a 90 cc HpGe detector and a 3 x 3-inch well type NaI(Tl) detector. Results show significant levels of 137Cs activity in soil samples--ranging from below detection limit (BDL) to 65.4 Bq kg(-1). The mean value of activity observed in 0-5 cm soil profiles of Kaiga environs is significantly higher when compared to the reported values for other environs of India. Depth profile studies show that the 137Cs activity decreases with the increasing soil depth, and it is below detection limit for depths more than 25 cm. The mean value of effective dose commitment due to the presence of 137Cs in soil was 167.2 microSv. Vegetation samples of the region show elevated levels of 137Cs concentration. Epiphytic plants Cymbidium aloifolium (Lo.) Swartz. and Petrobryopsis tumida (Hook.) Dix. have been identified as bio-indicators to monitor the fallout of this radionuclide in the environment of Kaiga. Seasonal variation studies indicate higher fallout of this radionuclide along with rain.