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.

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.

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.

A new natural background radiation area on the southwest coast of India.

The systematic study of background radiation and the distribution of radionuclides in the environment of coastal Karnataka, South India, has been initiated with an objective of establishing reliable baseline data on the background radiation level of the region for future assessment of the impact of nuclear and thermal power stations that are being set up in the region. The ambient gamma radiation survey in the environment of Mangalore, a major industrial city of coastal Karnataka, revealed significantly high gamma dose in air in certain locations of the Mangalore beach area. Thermoluminescent dosimetric studies indicated conspicuously high gamma dose in air in these places. Gamma spectrometric analyses of the soil and sand samples of this high background area have been carried out. The measured gamma dose in air in high background area is in the range 44-2102 nGy h-1. The average activity of 232Th, 238U, and 40K in soil samples is 2,971 Bq kg-1, 546 Bq kg-1, and 268 Bq kg-1, respectively. In sand samples, the respective activities are 1,842 Bq kg-1, 374 Bq kg-1, and 158 Bq kg-1. Results of these systematic investigations which establish the existence of new patches of monazite in the Mangalore beach area, on the southwest coast of India, are presented in this paper.

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.

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.

Distribution and enrichment of radionuclides in the newly discovered high background area in Ullal on the southwest coast of India.

In order to understand the distribution of radionuclides in the newly discovered high background area in Ullal near Mangalore, soil and sand samples collected from different depths were analyzed for the concentration of primordial radionuclides by gamma spectrometry. The activity of 232Th and 238U in soil and sand was observed to be maximum in the 0-10 cm layer. The activity of primordial radionuclides was determined for the different size fractions of soil and sand to study the enrichment pattern. The highest activity was found in the 250-125 mu fraction in both soil and sand. The concentration of primordial radionuclides in riverine and marine sediments in the vicinity of the high background area was measured to understand the transportation of radionuclides in riverine and marine environments and to throw light on the formation of the new patches of monazite deposit. The results of these systematic investigations are discussed in this paper.

Natural radioactivity in the soil samples of Coastal Karnataka of South India.

Studies on radiation level and radionuclide distribution in the region of Coastal Karnataka, India, were undertaken. The purpose of this study is to provide baseline data on radiation level and radionuclide distribution in the region for the future assessment of the impact of the nuclear and thermal power stations that are being set up in the region. Further, this study may reveal information on the transportation of radionuclides in the environment. The external gamma dose rates in air have been measured throughout Coastal Karnataka using a sensitive plastic scintillometer. The measured dose rates include both terrestrial and cosmic ray components. The gamma dose rates in air range from 26 to 174 nGy h(-1) with a median value of 74 nGy h(-1). The activities of naturally occurring radionuclides in the soil samples of the region were measured using HPGe gamma ray spectrometry, and the resulting doses in air were calculated. The activity of 40K varies from 61.0 to 316.7 Bq kg(-1) with a median of 117.5 Bq kg(-1); the activity of 226Ra varies from 20.1 to 62.3 Bq kg(-1) with a median value 35.0 Bq kg(-1) and that of 232Th from 14.3 to 48.6 Bq kg(-1) with a median value of 29.8 Bq kg(-1). The mean absorbed dose rate in air due to naturally occurring radionuclides is found to be 41.5 nGy h(-1). In addition to this, the correlations between 226Ra and 40K, 232Th and 40K, and 226Ra and 232Th were computed from the results of the concentration of these naturally occurring radionuclides. A weak correlation was observed between 226Ra and 40K and between 232Th and 40K while a moderately good correlation was observed between 226Ra and 232Th. The results of these systematic investigations are presented and discussed in this paper.

Radium-226, 232Th, and 40K distribution in the environment of Kaiga of south west coast of India.

Systematic studies on gamma radiation level and the distribution of natural radionuclides were carried out under a pre-operational survey for the establishment of baseline data on background radiation level and the distribution of radio-nuclides in the environment of Kaiga, in the south west coast of India, where a nuclear power reactor of 235 MWe has just been commissioned. The external gamma absorbed dose rates prevailing in the region were measured using a portable plastic scintillometer. Soil samples from 18 stations were collected from depth intervals of 0-5, 5-10, and 10-25 cm and analyzed for their 226Ra, 232Th, and 40K activity concentrations by gamma spectrometry employing a 90 cc PGT HpGe detector coupled to an EG&G ORTEC 8K multichannel analyzer. The activity of 226Ra was found to vary between 15.5-61.2 Bq kg(-1) with a mean value of 31.3 Bq kg(-1), that of 232Th varies between 11.4-41.9 Bq kg(-1) with a mean value of 27.5 Bq kg(-1) and of 40K between 78.3-254.8 Bq kg(-1) with a mean value of 159.9 Bq kg(-1) in 0-5 cm soil profiles of the region. The contributions of 238U, 232Th, and 40K to the total gamma absorbed dose rate were 39.9%, 40.7%, and 16.0%, respectively. The gamma absorbed dose rate in air estimated using the results of activity concentration of 226Ra, 232Th, and 40K are found to compare well with that of the direct measurement. The results of the study were compared with the literature values reported for other environs of the country as well as the world, and conclusions are drawn.

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.

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.

Correlation of clinical and histopathologic features in untreated macular lesions of leprosy--a study of 100 cases.

Clinical and histopathological correlative studies carried out in 100 cases of leprosy with macular lesions revealed an overall parity in 47% of the cases. Disparity was observed in TT, BT, BB, BL and IL series but not in LL series. The variable tissue response in the disease spectrum due to the variability of CMI is responsible for the disparity in various types of leprosy, irrespective of the type of lesions, whether macular or elevated.

Calcification of ulnar nerve in a patient with tuberculoid leprosy--a case report.

A case of Tuberculoid Leprosy who showed Evidence of Calcification of Right Ulnar Nerve at Elbow on Radiological Examination is reported.

Steatocystoma multiplex.

A case of steatocystoma multiplex in a 45-year-old male is reported. The diagnosis was based on clinical as well as histopathological findings.