Prospective Observational Comparative Study of Response and Toxicities in Early Glottic Cancer Using Telecobalt Versus 3D-CRT.

The study was performed with 50 patients, 24 patients in Arm A and 26 patients in Arm B. Arm A-Conventional Telecobalt RT 66 Gy/33 fraction in stage T1N0M0 and stage T2N0M0 and Arm B-3D-CRT 66 Gy/33 fraction in T1N0M0 and T2N0M0 used. At the end of RT, 6 weeks, 3 months acute and late toxicities were noted by RTOG/EORTC morbidity scoring criteria for skin reaction, dysphagia and laryngeal toxicity. Fiber optic Laryngoscopy clinical assessment criteria were used to assess response after 6 weeks, 3 months of treatment completion. At 6 weeks of follow-up-Both Arm A and B complete response rate were 83.3% and 88.5% respectively and at 3 months rate were 85.0% and 95.7% respectively. There was no superiority of results with 3D-CRT over 2DRT. At the end of RT dysphagia grade 3 toxicity seen 1 patient (4.2%) but in Arm B (total 26 patients) no grade 3 toxicity found. At the end of 6 week and 3 month, one patient (4.3%) had grade 3 toxicity on Arm B only at 3 month. All these results are comparable. At the end of RT, one patient (3.8%) had incidentally dermatitis grade 3 toxicity in Arm B only. But all the results are comparable. On follow up, 6 week and 3 months, no grade 3 toxicity noted. At the end of RT, grade 3 laryngeal toxicity noted in 3 (12.5%) in Arm A and 2 (7.7%) in Arm B, not statistically significant. At 6 week, grade 3 toxicity found in 3/24 (12.5%) in Arm A and 2/26 (7.7%) in Arm B, at 3 months, 1/26 (4.3%) patient had incidental grade 3 toxicity only in Arm B. As conformal radiotherapy is more time consuming, less available in India and more costly than 2DRT, we can consider Conventional 2D planning for patients in India where most of people belong to low economic profile. Due to limitation in sample size and long-term follow-up further randomized studies are needed to validate the results.

Choroidal melanoma of left eye with very early liver metastasis.

Uveal melanoma is a cancer (melanoma) of the eye involving the iris, ciliary body, or choroid (collectively referred to as the uvea). The liver is a frequent site for metastasis in patients with uveal melanoma. The interval between the diagnosis of the uveal melanoma and the diagnosis of the metastatic lesion can vary. Despite therapy, the median survival of those with liver metastasis is 5-7 months. We report here a rare case of choroidal melanoma in a 45-year-old male smoker presented with liver metastasis within just 8 months after completion of initial treatments consists of enucleation of eye and 3 Dimensional conformal radiation therapy (3D-CRT). The metastasis is an incidental finding on imaging after having some vague symptoms. This type of very early metastasis after completing initial treatment is very rare and proves the aggressiveness of the disease.

Pouch colon associated with anorectal malformations fails to show spontaneous contractions but responds to acetylcholine and histamine in vitro.

PURPOSE: Congenital pouch colon (CPC) associated with anorectal malformation (ARM) is most commonly reported from Northern India. So far, no physiologic study comparing the detailed contractile status of CPC with non-CPC conditions are available. The present article deals with the contractile study and histopathologic observations in CPC, which may be useful for better surgical management. METHODS: Freshly excised 12 neonatal CPC and similar number of non-CPC (control) specimens were transferred to ice-cold (4 degrees C-6 degrees C) Krebs-Ringer solution bubbled with 100% oxygen. Longitudinally prepared 2 to 4 colonic strips were obtained from central part of each specimen and subjected to the contraction recording after exposure to cumulative concentrations of acetylcholine (ACh) and histamine. Acetylcholine-induced contractions were evaluated after application of atropine (muscarinic blocker), and histaminergic contractions were recorded after pheniramine (H(1) blocker), lignocaine (neuronal blocker), and atropine. Histopathologic observations were made by using H&E and Masson trichrome stains. RESULTS: Control specimens showed spontaneous contractions, but CPC strips did not. Both control and CPC responded to ACh and histamine. The response to histamine was greater (P < .05) in CPC as compared to control, whereas the response to ACh was more (P < .05) in control. In CPC, response of histamine (100 micromol/L) was blocked by pheniramine (0.32 mmol/L) and lignocaine (4 mmol/L) by 97% and 80%, respectively, and enhanced by 57% after preapplication of atropine (10 micromol/L). Acetylcholine (100 micromol/L)-induced contractions were attenuated (86%) in presence of atropine. Histopathologic examination showed fewer mature ganglion cells with various changes in muscle layers including fibrosis, disruption, hypertrophy, atrophy, and constriction bands. CONCLUSION: Congenital pouch colon associated with ARM lacks normal spontaneous contractions but retains ACh and histamine-induced contractility. In view of the functional and histologic abnormalities, we propose that CPC associated with ARM is an abnormally functional and developed tissue. Therefore, resection of the pouch should be considered for better functional outcome of the remaining bowel.

In vivo and in vitro bradycardia induced by local anesthetics is potentiated by calcium channel blockers.

The present study examined the interactions of local anesthetics (LA) and calcium channel blockers (CCBs) on rhythmicity of heart using in vivo and in vitro experiments. ECG recordings were made from the anesthetized rats for in vivo preparations and spontaneously beating isolated rat right atrial potential for the in vitro experiments. The in vivo experiments with LA showed dose-dependent bradycardia with lignocaine (LIG, 100-500 microg/kg) and bupivacaine (BUP, 10-100 microg/kg). BUP was 4-5 times more potent than LIG. Verapamil (VML) and diltiazem (DTZ), CCBs also produced dose (10-100 microg/kg) -dependent bradycardia. However, none of them affected the PR/QT interval or QRS complex. Further, LA-induced bradycardia was potentiated by CCBs. In addition, flattening of P-wave in ECG was observed with doses (10-25 microg/kg) of LA in the presence of CCBs. Similarly, the in vitro experiments demonstrated a concentration-dependent decrease in atrial rate by BUP or VML. The BUP-induced decrease was potentiated in the presence of VML. Thus, the results suggest that CCBs potentiate the LA-induced bradycardia by involving pacemaker activity. Further, the flattening of P-wave in ECG serves as an early indicator of the cardiotoxicity produced by these drugs.