A simple derivatization RP-HPLC method for the simultaneous determination of zineb and hexaconazole in pesticide formulation using a PDA detector.

A simple derivatization reverse-phase high performance liquid chromatographic method for the simultaneous analysis (separation and quantification) of zineb and hexaconazole has been optimized and validated. The method was carried out on an Agilent Eclipse plus C18 column (150 × 4.6 mm; 5 µm), with a mobile phase comprising acetonitrile + methanol (80 + 20 v/v): water (0.1% v/v trifluoroacetic acid) (60 : 40 v/v) at a flow rate of 1.0 mL minute-1, and the quantification was achieved at 272 nm and 205 nm. The retention times of zineb and hexaconazole were found to be 6.4 min and 7.6 min, respectively. The performance of the method was validated according to the SANCO, CIPAC and ICH guidelines for specificity, selectivity, linearity, precision, accuracy, limit of detection, limit of quantification and robustness. The developed method was successfully applied for the estimation of zineb and hexaconazole in a pesticide dosage form.

Oxidative stress in relation to obesity in breast cancer.

PURPOSE: Breast carcinoma is one of the most common neoplasms in women and is a leading cause of cancer-related deaths worldwide. Obesity-induced chronic inflammation promoted by adipose tissue dysfunction is a key feature, which is thought to be an important link between obesity and cancer. Oxidative stress (OS) has been suggested to play an important role in carcinogenesis. Obese women have been shown to have higher levels of OS markers. The study was performed to know the influence of obesity on OS to be replaced with OS markers in patients with breast cancer. MATERIALS AND METHODS: Thirty women attending the outpatient Department of Surgical Oncology and Surgery at Sri Venkateswara Institute of Medical Science, Tirupati, who were clinically diagnosed and histologically confirmed with breast cancer were considered as the patients and 30 healthy women were included as controls. Malondialdehyde (MDA), protein carbonyls (PCC), and advanced oxidation protein products (AOPP) as oxidative markers along with protein thiols and ferric-reducing ability of plasma (FRAP) were studied as markers of antioxidant status. RESULTS: Patients with breast cancer had significantly higher levels of MDA (P = 0.005), PCC, and AOPP compared to controls (P = 0.001) and significantly lower levels of thiols and FRAP compared to controls (P = 0.001). No significant correlation was found between OS markers and indices of obesity. A significant association was found between OS markers (P = 0.005), PCC (P = 0.002), AOPP (P = 0.002), and breast cancer. CONCLUSIONS: Patients with breast cancer have increased OS as evidenced by an increase in oxidant markers and a decrease in antioxidant markers. OS is not related to their adiposity but is related to the presence of breast cancer.

An analysis of response to neo-adjuvant chemotherapy in patients with locally advanced breast cancer with emphasis on pathological complete response.

CONTEXT: In India, most breast cancer women present at a locally advanced stage. Routine practice in majority of the cancer centers is to administer neo-adjuvant chemotherapy (NACT) followed by loco-regional treatment. Surgery is scheduled after 3 or 4 cycles. The patients who achieve pathological complete response (pCR) are expected do well. AIMS: The present study was conducted to analyze our results with NACT, to know pCR rate, to compare pCR rates among various subgroups and to determine the factors which predict pCR. SETTINGS AND DESIGN: The study was conducted in a tertiary care university affiliated cancer hospital in South India. SUBJECTS AND METHODS: All patients with non-metastatic locally advanced breast cancer and agreed by the hospital tumor board to receive NACT were included. At each visit, response was assessed according to RECIST criteria. Re-staging work up and mammography was done prior to surgery. STATISTICAL ANALYSIS USED: Chi square test was used to analyze categorical variables and uni and multivariate analysis were performed to determine the factors predicting pCR rates. RESULTS: A total of 84 patients received NACT. Median age was 46 years (ranged from 28 to 66), 46 patients were premenopausal. Totally 72 patients completed the full course before surgery. Clinical response was complete in 26, partial in 52 and 3 had local progression, one stable and two patient developed distant metastasis. Forty-eight patients underwent modified radical mastectomy and breast could be conserved in 34 patients, pCR rate was 36%. CONCLUSIONS: Compared with historical controls particularly from India, we could achieve higher pCR rates.

Optimizing managed care peer reviews: turning a "Doc to Doc" talk into better advocacy for psychiatric inpatients.

Clinicians often resent behavioral health managed care peer reviews. However, such reviews need not be onerous. This Open Forum, written by managed care physician reviewers, attempts to help attending psychiatrists, specifically those on inpatient units, achieve more satisfying outcomes for patients by adhering to a few basic principles. Beyond the level-of-care guidelines, attending psychiatrists are advised to focus on immediate acuity, along with specific life events that may have immediate impact on the patient's well-being. A clear diagnosis, relevant treatment plan, salient updates, and strategies for preventing readmission can justify additional treatment time. By contrast, "time-based treatments," dispositional issues, or a patient's lack of acceptance or effective use of treatment are harder to justify.

Incidental intraoperative discovery of colonic growth in a patient with esophageal carcinoma- lessons learnt!

Presentation of more than one malignancy at the intial time of diagnosis is rare. Recently we encountered a patient who was diagnosed with carcinoma esophagus found to have another incidental growth in his right colon at the time of surgery. When managed appropriately such patients do well depending on the stage of their malignancy. Here in this article we have reviewed the literature pertaining to multiple primary malignancy.

Breast conserving surgery for breast cancer: single institutional experience from Southern India.

CONTEXT: In India, breast conservation rates vary anywhere from 11 to 34%. This is in contrast to western world where breast conservation rates exceed 70% for early breast cancer. AIMS: The present study was conducted to analyze the results of breast conservation surgery (BCS) at our institute and compare with that of other facilities in world. SETTINGS AND DESIGN: The study was a prospective, outcome analysis study. All patients who underwent BCS were included. Data pertaining to clinical, pathological characteristics and treatment related outcomes were recorded. MATERIALS AND METHODS: The study comprised of retrospective collection of prospective data of 88 patients who underwent breast conservation treatment (BCT) till December 2009. STATISTICAL ANALYSIS USED: The statistical analysis included Kaplan-Meier survival analysis for disease-free (DFS) and overall survivals (OS), and univariate analyses to assess each prognostic factor separately using SPSS 16.0 for windows. RESULTS: Most common tumor location was upper outer quadrant and most common histology was infiltrating duct carcinoma. Median age was 45 years. Eighteen patients received preoperative chemotherapy to conserve the breast. Pathological complete response (pCR) in this subgroup was 39%. Majority had node negative disease and 42 tumors were hormone receptor positive. Median follow-up was 49 months. Two patients developed isolated local recurrences which were salvaged surgically. Seven patients had systemic disease of which 5 had simultaneously failed locally. Overall 5-year DFS was 89 %. CONCLUSIONS: When given an option, patients with breast cancer do desire to conserve their breast.

Prevalence and pattern of nodal metastasis in pT4 gingivobuccal cancers and its implications for treatment.

CONTEXT: The pattern of nodal spread in oral cancers is largely predictable and treatment of neck can be tailored with this knowledge. Most studies available on the pattern are from the western world and for early cancers of the tongue and floor of the mouth. AIMS: The present study was aimed to evaluate the prevalence and pattern of nodal metastasis in patients with pathologic T4 (pT4) buccal/alveolar cancers. SETTINGS AND DESIGN: Medical records of the patients with pT4 primary buccal and alveolar squamous cell carcinomas treated by single-stage resection of primary tumor and neck dissection at Gujarat Cancer and Research Institute (GCRI), Ahmedabad, a regional cancer center in India, during September 2004 to August 2006, were analyzed for nodal involvement. MATERIALS AND METHODS: The study included 127 patients with pT4 buccal/alveolar cancer. Data pertaining to clinical nodal status, histologic grade, pT and pN status (TNM classification of malignant tumors, UICC, 6th edition, 2002), total number of nodes removed, and those involved by tumor, and levels of nodal involvement were recorded. Statistical analysis was performed using the Chi-square test. RESULTS: Fifty percent of the patients did not have nodal metastasis on final histopathology. Occult metastasis rate was 23%. All of these occurred in levels I to III. Among those with clinically palpable nodes, level V involvement was seen only in 4% of the patients with pT4 buccal cancer and 3% of the patients with alveolar cancer. CONCLUSIONS: Elective treatment of the neck in the form of selective neck dissection of levels I to III is needed for T4 cancers of gingivobuccal complex due to a high rate of occult metastasis. Selected patients with clinically involved nodes could be well served by a selective neck dissection incorporating levels I to III or IV.

Malignant extrarenal rhabdoid tumor of the vulva in an adult.

Sarcomas of the vulva account for only 1-3% of all vulvar malignancies. Most common vulvar sarcomas are leiomyosarcomas, malignant fibrohistiocytomas, and aggressive angiomyxomas. Malignant rhabdoid tumor (MRT) of the kidney is a distinctive clinicopathological entity that is recognized as a highly aggressive renal tumor of childhood. Extrarenal malignant rhabdoid tumors have been proposed to exist at several sites, including soft parts. MRT of the vulva is a rare and very aggressive neoplasm. Median survival reported in other studies is 9 months. Only 10 cases have been reported thus far in the English literature. We are reporting the 11 th case who remains disease free 30 months following surgery and radiotherapy till the time of reporting.

Numb chin syndrome as a manifestation of metastatic squamous cell carcinoma of esophagus.

Numb chin syndrome (NCS) is a sensory neuropathy presenting with numbness of the chin in the distribution of the mental nerve and the branches of the mandibular division of the trigeminal nerve. Though it can be caused by a benign process, NCS should be regarded as being due to malignancy until proven otherwise. Among the malignancies that cause NCS the most common are breast cancer, prostate cancer, and lymphoreticular malignancy. In squamous cell carcinoma (SCC) of the esophagus, spread to the mandible is a rare and often late event. An often overlooked clinical sign in mandibular metastases is hypoesthesia or paresthesia over the peripheral distribution of the inferior alveolar nerve/mental nerve; this sign has been referred to in the literature as NCS or numb lip syndrome or mental nerve neuropathy. Rarely, this may be the first presentation of a disseminated malignancy. Prognosis is usually poor. The discovery of this symptom should alert the clinician to the possibility of disseminated disease. In this article we report a rare case of metastatic SCC of the esophagus in a 40-year-old male patient who presented with NCS. We also review the mechanism, causes, and evaluation of NCS.

Carcinoid of ampulla of Vater.

Carcinoid tumors of ampulla are rare clinical entities. They form 0.35% of all the gastrointestinal carcinoids. So far, only 109 cases have been reported in the literature, mostly as individual case reports. Since the metastatic potential and the tumor size have no correlation, unlike in duodenal carcinoids, pancreatoduodenectomy is considered the treatment of choice. Here we present a case of carcinoid of ampulla presenting to our department.