Practical consensus recommendatons for Paget's disease in breast cancer.

Paget's disease of the breast is a rare type of cancer of the nipple-areola complex and that is often associated with an underlying in situ or invasive carcinoma. Diagnosis and treatment of Paget's disease is controversial. Expert oncologists discuss on the update on the approaches of Paget's disease diagnosis and its treatment options. This expert group used data from published literature, practical experience and opinion of a large group of academic oncologists to arrive at this practical consensus recommendations for the benefit of community oncologists.

Prevalence, etiology, and management of neuropathic pain in an Indian cancer hospital.

Neuropathic pain is still an under-diagnosed and undertreated problem in third world countries. This retrospective study was undertaken to detect the prevalence, etiology and treatment profile of neuropathic pain in cancer. During January-December 2007, 716 new cancer pain patients were examined in Tata Memorial Hospital Pain Clinic. A total of 180 patients with a mean age of 47.14 yrs were found to have neuropathic pain characteristics on the basis of clinical impression, site of pain and the underlying cause i.e. due to tumor itself or cancer therapy. Head and neck cancer (32.2%) was found to be the most common cause of neuropathic pain, followed by breast (20.6%), thoracic (14.4%), genitourinary or gynecology (10.0% each), GI (9.4%), and medical oncology (2.8%). About 56% patients were post surgery, 44.4% post chemotherapy and 51.1% patients were post radiotherapy. The most common site of pain was thoracic (36.7%) due to primary or secondary metastatic disease. Pricking type of pain was the most characteristic feature (47.8%) followed by shooting pain (38.3%). The mean pain score was 5.96 +/- 1.5 (SD) and mean duration (months) of pain was 2.8 +/- 2.5. Neuropathic pain was found commonly associated with somatic pain (59.4%). The most common pharmacological agents prescribed were: tricyclic antidepressants (93.9%), anticonvulsants (66%), Opioids (85%), and nonsteroidal anti-inflammatory drugs (NSAIDs) (97.2%). Only 35% patients followed up more than once at the pain clinic. The most common and challenging patients were of orofacial pain. Nerve blocks techniques have a limited role in neuropathic pain.

Lack of precision in HbA(1c) values on variant II in cases of hemoglobin Q India.

This study was carried out to check the precision of HbA(1c) values on Bio-Rad Variant II in cases of a rare hemoglobin variant Q India. The study was carried out over a three month period on samples collected for HbA(1c) estimation. Seven out of eleven patients showed variable results of HbA(1c) with a very high and unacceptable intraday mean coefficient of variation (CV) of 9.93%. We conclude, that the results of HbA(1c) on Variant II can not be reported without adversely affecting HbA(1c) as a marker of long-term glycemic control in patients who have hemoglobin Q India. The HbA(1c) value of these patients needs to be assessed by a different instrument/method or the glycemic control be monitored by an alternate test like serum Fructosamine.

Neurolytic celiac plexus block: a better alternative to opioid treatment in upper abdominal malignancies: an Indian experience.

The majority of patients with advanced upper abdominal malignancies suffer from moderate to severe pain due to unavailability of morphine in developing world. This study was undertaken to evaluate the role of neurolytic celiac plexus block on pain and quality of life in this patient subpopulation. One hundred consecutive patients receiving opioids for their pain relief were divided in two groups. Group I (control) patients received oral morphine & NSAIDS and group II (study) patients underwent neurolytic celiac plexus block (NCPB) to compare their effects on pain relief, morphine consumption, quality of life (QOL), Karnofsky and performance scores up to one month. NCPB provided statistically significant better pain relief and reduced morphine consumption at one month (P = 0.000). Superior Karnofsky and performance scores also favored NCPB group (P = 0.000); however the difference in overall QOL was not statistically significant (P = 0.24). Patients in oral morphine group had more side effects (94% vs. 58%) as compared to NCPB (P = 0.000). NCPB is an effective tool to reduce opioid requirement and the drug-related adverse effects. It is a rewarding technique, especially when morphine availability and its easy accessibility to the deserving patient is poor.

Efficacy of intravenous ketoprofen for pre-emptive analgesia.

AIM: To determine whether intravenous ketoprofen is effective as pre-emptive analgesia for breast surgery. DESIGN: Randomised, controlled, double blind study. PATIENTS AND METHODS: 50 patients undergoing breast surgery under general anaesthesia randomised to receive either 100 mg intravenous ketoprofen 30 minutes before (Group I), or immediately after surgical incision (Group II). Postoperatively, pain scores (Visual Analogue Scale, VAS) and time to rescue analgesic were recorded by an independent, blinded observer. The study was terminated when rescue analgesic was required (VAS > or =4 or demand for analgesic). STATISTICAL ANALYSIS: Continuous variables were analysed by the unpaired 't' test, discrete variables with the chi square test, and survival curves by the log-rank test. RESULTS: Pain scores were significantly lower in Group I till 10 hours after surgery. The number of patients requiring analgesia at 4, 6, 8 and 10 hours was significantly lower in group I (0% vs. 47% [P <0.0001], 0% vs. 44% [P <0.003], 0% vs. 80% [P <0.0001], 0% vs. 100% [P <0.0001] respectively). The mean time for rescue analgesic was 15.47 -/+ 2.87 hours in group I versus 4.22 -/+ 2.55 hours in group II (P <0.0001). CONCLUSION: Pre-emptive analgesia with Intravenous ketoprofen (100mg) produces better postoperative pain-relief in patients undergoing breast surgery.

Costing of a cardiac catheterisation procedure.

An attempt has been made to identify the main factors involved in the costing of a Cardiac Catheterisation Procedure (CCP). The technique of historical costing was used. The cost of a CCP worked out to Rs. 4265.21. The direct costs contributed 62%, the indirect costs 2.6% and expenses contributed 35% to the total cost. All these factors were found to be sensitive to the volume and duration of CCP, hence administrators must assist the staff of cardiac catheterisation laboratory (CCL) in controlling these two factors for the cost-effectiveness and efficient utilisation of the CCL.

Developments in x-ray detectors and associated electronics: a review of the technology and possible future trends.

The detection of low-energy x rays in a precise and efficient manner is now routinely performed with a range of solid state detectors. These devices have been developed continuously over the past 30 years to the point where current performance closely matches theoretical predictions for resolution and efficiency. To achieve these goals parallel developments in field effect transistors and amplifiers were also required. To fully understand the problems associated with the development and use of these detectors it is necessary to discuss both the generation of x rays and the way in which x rays interact with the available detector materials. The energy range considered is 0-100 keV and a comparison between the successful lithium drifted silicon detector and the more recently re-developed high-purity germanium detectors for these low energy applications is given.

Fibreoptic intubation in cicatricial membranes of the pharynx.

Two patients presented with almost total obliteration of the pharynx. In one, a membrane developed after corrosive poisoning; in the other, the oropharynx was filled with a dense cicatrix in the sclerosing phase of rhinoscleroma. In both patients, a single opening in the membrane provided access to both the larynx and oesophagus. Fibreoptic intubation allowed both a thorough assessment of the pathology and subsequently the passage of a cuffed tracheal tube to secure the airway. To overcome the problem of respiratory obstruction while the fibrescope passed through the opening in the membrane, either rapid intubation, or a technique using pre-oxygenation and voluntary hyperventilation followed by breath-holding during bronchoscopy, was used. The thin calibre and manoeuvrability of the flexible fibreoptic bronchoscope makes fibreoptic intubation an excellent technique of airway management in cicatricial membranes of the pharynx.