Toxicity and side-effects of combination chemohormonal therapy of advanced breast cancer.

Seventy-five female patients suffering from advanced breast cancer were treated with toilet mastectomy, radiotherapy and oophorectomy (if premenopausal) or tamoxifen therapy (if postmenopausal) as well as chemotherapy with cyclophosphamide, methotrexate, 5-fluorouracil and prednisone. The most common side-effects of combined chemohormonal therapy were gastro-intestinal (nausea, vomiting, rarely diarrhoea) in 43 patients (57.3%), followed by alopecia in 23 patients (30.6%), myelosuppression in 12 patients (16%), extravasation and thrombophlebitis in 7 patients (9.3%), and mucositis and oral erythema in 3 patients (4%). Side-effects of tamoxifen therapy such as vaginal discharge, bleeding, hot flushes were encountered in 10 patients (13.3%). Hypercalcaemia, tumour flare and hepatic, renal, cardiac, pulmonary and neurological toxicities were not encountered. Improvement of 10-30% in Karnofsky performance status was noted in responders while 20-30% deterioration was observed in non-responders. Combination therapy was mostly well tolerated, side-effects were few and toxicities were temporary and reversible.

Filarial lymphoedema and elephantiasis of lower limb: a review of 44 cases.

Twenty patients with early lymphoedema due to filariasis and twenty-four patients with elephantiasis of the lower limb were subjected to lymph nodovenous shunt (LNVS) and Charles' operation respectively. In 62 per cent of cases subjected to LNVS operation, there was a rapid relief of lymphoedema followed by slow reduction, 24 per cent had slow and gradual reduction and 14 per cent had very slight reduction in volume and circumference. Patients subjected to Charles' operation had immediate volume and circumference reduction and skin graft 'take' was 88 per cent. There were no operative and a few minor postoperative complications in both the procedures, infection being most notable in those who had undergone Charles' operation. The hospital stay was 7-10 days in LNVS and 21-36 days in Charles' operation. There was no mortality. The long-term results of the present study in terms of volume and circumference reduction, skin condition and freeness of joint movement were encouraging. It is concluded that, while excisional surgery such as Charles' operation becomes necessary for late states of lymphoedema which have progressed to elephantiasis, nodovenous shunt alone is sufficient to relieve early stages of lymphoedema due to filariasis.

The incidence of Filaria as an aetiological factor for testicular hydrocele.

Five hundred cases of hydrocele of the tunica vaginalis testis (TVT) have been studied in detail in order to ascertain their aetiology. In 43 per cent of cases hydrocele was found to be definitely due to filariasis, in 14 per cent it was highly likely that filariasis was responsible and in 16 per cent filariasis was suspected to be the aetiological factor. The remaining 27 per cent of cases were found to be non-filarial.

Elephantiasis of the penis and scrotum. A review of 350 cases.

Three hundred fifty patients with elephantiasis of the penis and scrotum were surgically treated by excision of all elephantoid skin and subcutaneous tissues. Before attempting to excise the extensive elephantoid tissues, the spermatic cord and testes with their coverings were taken out by two small lateral incisions, which made the operation easier and less time-consuming and minimized the complications. The skin of the scrotal neck was found to be the best for reconstruction of the scrotum to accommodate the two testes. The fascial penis is an ideal bed for intermediate split-thickness skin grafts. There was mechanical improvement in the physical disability, restoration of potency and sexual habits, and reduction of mental anguish.

Surgery for large hydrocele.

Nine hundred fifty cases of moderate to large hydrocele were surgically treated by excising the skin, dartos, spermatic fascia, sac, and the median septum, leaving sufficient scrotal skin to construct a new scrotum--just enough to accommodate both the testes. The cure was complete, and the postoperative complications were minimal. The redundant skin and subcutaneous tissues were removed because they would otherwise hang and flop against the inner aspect of the patient's thighs, resulting in great difficulty and dissatisfaction in walking. This method of skin excision can also be applied to a huge inguinoscrotal hernia after its repair.