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Biomedical subjects

B Rajan

Publications and source records attributed to B Rajan.

At least 19 recordsLinked to original sources
PubMed2003

Soft tissue sarcoma of the head and neck region in adults.

Soft tissue sarcomas (STS) are rare solid tumours accounting for less than 1% of all malignancies and are very unusual in the head and neck region. Histopathologically diagnosed cases of STS treated at Regional Cancer Centre (RCC). Trivandrum, India, between January 1989 and November 2000 were analyzed retrospectively. Survival analysis was carried out by Kaplan-Meier method and curves were compared using log rank test. A total of 22 cases were seen during the study period. The mean age of the patients was 36.4 years with male-to-female ratio of 2:1. The neck, lower jaw, tongue, cheek, scalp and maxilla were the commonest sites affected. None of the patients had palpable neck nodes or distant metastasis at presentation. All the patients were treated with primary surgical resection and this was followed by adjuvant treatment in 14 cases (63.6%). After a median follow-up of 14.5 months, two patients died, six developed local recurrence, four developed metastatic disease and another patient developed second primary sarcoma. The overall 5-year survival was 80% while the 5-year disease-free survival rate was 24.1%. The majority of the patients failed within first and second year. None of the parameters except grade of tumour (P=0.008) were found to have a significant effect on survival. The overall survival rate for patients with soft tissue sarcoma of the head and neck is good, however, disease-free survival is poor as the majority of these fail within 2 years of completing treatment.

Adolescent↗
PubMed2002

Cerebrovascular mortality in patients with pituitary adenoma.

OBJECTIVE: To assess cerebrovascular mortality in a UK cohort of patients with pituitary adenoma known to have increased incidence of cerebrovascular accidents (CVA). METHODS: A total of 334 patients treated at the Royal Marsden Hospital (RMH) between 1962 and 1986 with surgery and postoperative radiotherapy were followed up via the NHS Central Register (NHSCR) to identify deaths and emigrations. The causes of death were assessed by NHSCR-based death certificates and coded according to the 9th revision of ICD. Follow-up was censored at age 85, on emigration or cancellation of NHSCR. Thirteen patients could not be traced. A total of 4982 person-years was accumulated in the cohort. Expected numbers of deaths were computed from the national age-, sex- and period-specific mortality rates for England and Wales. RESULTS: In the pituitary adenoma cohort, 128 deaths were observed compared to 80.9 expected [relative risk (RR) of death 1.58 (95% CI: 1.32-1.90)]. There were 33 cerebrovascular deaths compared with 8.04 expected (RR 4.11, 95% CI 2.84-5.75). Three deaths were from subarachnoid haemorrhage compared to 0.54 expected (RR 5.51, 95% CI 1.14-16.09). There was an increased cerebrovascular mortality in women (RR 6.93, 95% CI 4.29-10.60) compared to men (RR 2.4, 95% CI 1.24-4.20; P = 0.002) and in patients having debulking surgery (RR 5.19, 95% CI 3.50-7.42) compared to biopsy/no surgery (RR 1.33, 95% CI 0.27-3.88; P = 0.02). The RR in patients with nonsecretory tumours was 3.65 (95% CI 2.26-5.58), compared with 5.23 (95% CI 2.25-10.30) in secretory tumours (P = 0.4). The effect of age at radiotherapy was not significant (P = 0.4). CONCLUSION: Patients with pituitary adenoma treated with surgery and radiotherapy have an increased risk of cerebrovascular mortality compared to the general population, which mirrors the increased incidence of CVA. The possible risk factors include hypopituitarism, radiotherapy and extent of surgery but none are at present proven causes. The evaluation of new treatment strategies should not only assess intermediate end-points of tumour and endocrine control but should concentrate on long-term survival with particular emphasis on CVA incidence and mortality.

Adenoma↗
PubMed2002

A review of assigned protection factors of various types and classes of respiratory protective equipment with reference to their measured breathing resistances.

The British Standards Institution 'Guide to implementing an effective respiratory protective device programme' (BS 4275) lists assigned protection factors (APFs) for various types of respiratory protective equipment (RPE). The APFs were allocated either on the basis of available workplace studies data which met set criteria or on the basis of professional judgement that there is equivalence between its operation and that of a device for which an APF is derived from workplace data. However, in many cases no workplace study information exists to support this professional judgement. As an interim measure, pending information based on workplace measurements, the breathing resistance of a range of tight-fitting RPE from negative pressure filtering devices through to self-contained positive pressure breathing apparatus was measured at various breathing rates. The relative inhalation resistances were then compared on the assumption that similar breathing resistance performance is likely to give similar inward leakage on a facepiece and hence similar protection if all other factors, such as fit, etc., are equal. This work indicates that for most devices the allocation of APFs by analogy to other devices seems to be acceptable. However, there appears to be no justification for the allocation of an APF value of 100 to continuous flow compressed air line breathing apparatus. It is recommended that it should be lowered to 40 until there is valid workplace study data to support the current APF of 100. The work provides an informative insight into the relative performance of devices.

Humans↗
PubMed2002

Seminoma arising in cryptorchid testis 25 years after orchiopexy: case report.

A 33-year-old man who underwent right orchiopexy at age 8 for undescended testis had a swelling develop at the same site 25 years later. He underwent right high orchiectomy. Histopathologic examination of the resected specimen suggested seminoma, and he was treated with chemotherapy (cisplatinum, etoposide, and bleomycin.) Even though the ideal age at orchiopexy is unknown, early intervention is advocated to preserve fertility and prevent malignant transformation. The management of cryptorchid testis is controversial. In view of the persistent malignant potential of this condition, early orchiopexy and lifelong follow-up are recommended.

Adult↗
PubMed2002

Oligodendroglioma: clinical profile and treatment results.

Oligodendrogliomas are rare glial tumors with a long natural history. Radical surgery, postoperative radiotherapy, chemotherapy and observation have been suggested as part of primary management. This series reports the presentation and outcome in 34 patients with histologically verified pure oligodendrogliomas treated between 1983 and 1993. All patients were treated at the time of initial diagnosis with surgery, with or without additional radiotherapy. The overall survival and progression free survival rates at five years were 69.8% and 55% respectively. There was no tumor or treatment related factor influencing survival significantly.

Adolescent↗
PubMed2000

Poorly differentiated carcinoma of the lung presenting with Lambert--Eaton myasthenic syndrome.

Lambert-Eaton myasthenic syndrome commonly seen in small-cell lung cancer represents an autoimmune reaction against antigens coexpressed by tumor and neurons. It is rarely seen with other histologic subtypes. Symptoms antedate the appearance of the neoplasm by weeks to years. Therapeutic options range from immunosuppression, plasmapheresis, pharmacologic facilitation of neuromuscular transmission, and definitive therapy of the primary tumor. This case report describes the rare association of Lambert-Eaton myasthenic syndrome with non-small-cell lung cancer.

Carcinoma, Non-Small-Cell Lung↗
PubMed1999

Modifying radical radiotherapy in high grade gliomas; shortening the treatment time through acceleration.

PURPOSE: To evaluate the efficacy and toxicity of accelerated radiotherapy in patients with primary high grade glioma, where acceleration is used as a means of delivering a shortened course of radical radiotherapy. PATIENTS AND METHODS: Two-hundred and eleven patients with primary high grade glioma were treated at the Royal Marsden NHS Trust between 1987 and 1997 with accelerated radiotherapy (55 Gy in 34 fractions twice daily), to planning target volume (PTV) defined as enhancing tumour and a 3 cm margin. All had histologically confirmed high grade glioma (53 anaplastic astrocytoma, 137 glioblastoma multiforme, 4 gliosarcoma, 5 gemistocytic astrocytoma, 12 high grade astrocytoma not otherwise specified). The mean Karnofsky performance status (KPS) was 90 and median age was 54 years (range 19-77). RESULTS: Of 211 patients entered, 201 were able to complete radiotherapy; 39 patients (19%) had deterioration in KPS during radiotherapy and this was transient in 11. Median survival of 211 patients was 10 months with 1 year, 2 year, and 3 year survival probabilities of 38%, 14%, and 8% respectively. Age and extent of excision were independent prognostic factors for survival. Previous comparison to matched cohort receiving 60 Gy in 30 daily fractions did not demonstrate significant survival difference. CONCLUSION: Accelerated radiotherapy is a feasible treatment approach for patients with high grade glioma. The survival and functional outcome are comparable to conventional radiotherapy and the treatment is without serious acute toxicity. While acceleration of conventional dose irradiation could be tested in randomised studies, it is unlikely this approach would result in a clinically meaningful survival benefit. Accelerated radiotherapy therefore remains one of the ways of delivering radical irradiation in patients with high grade glioma. However, it adds complexity to what is a palliative treatment regimen and the rationale and advisability should be re-examined, particularly in terms of impact on quality of life, true patient preference, and health economic considerations.

Adult↗
PubMed1999

Plasma cell neoplasms in the young.

Multiple myeloma, a disease of the elderly, is extremely rare in those below 30 years of age. Two patients with multiple myeloma diagnosed at 20 years and 18 years are described. Both presented with extradural cord compression, lytic bone lesions and bone marrow plasmacytosis. One patient received combination chemotherapy and radiotherapy and survived for 14 years. A literature review is presented.

Adolescent↗
PubMed1998

Haematological toxicity of cranio-spinal irradiation.

BACKGROUND: To assess the frequency and severity of myelosuppression due to cranio-spinal irradiation either alone or in combination with chemotherapy and to identify patients at high risk of haematological toxicity who may require supportive therapy. MATERIALS AND METHODS: Between 1965 and 1994, 210 patients received cranio-spinal axis (CSA) radiotherapy as a component of treatment for primary CNS tumours at the Royal Marsden Hospital. Full blood counts (FBC) were obtained before, during and after radiotherapy in 200 patients. Haematological toxicity was graded according to the WHO criteria and duration was measured from the onset of grades 3 and 4 toxicity until recovery to grade 2. RESULTS: Sixty-six (33%) patients developed grades 3 and 4 haematological toxicity. Nadir occurred during radiotherapy and was most frequent during the second week of spinal radiotherapy. Low haemoglobin and white cell counts prior to radiotherapy increased the likelihood of myelosuppression. Nine patients had febrile episodes requiring antibiotic therapy. Treatment was interrupted in 49 patients but treatment time was extended beyond 12 weeks in only 17 (8%) patients of which nine were due to haematological toxicity. Chemotherapy (vincristine) during radiotherapy did not impact on haematological toxicity. Age and prior chemotherapy were independent predictive factors for haematological toxicity. The relative risk of leukopaenia in children compared to adults was 7.9 (95% CI 3.4-18.6%). Patients who received prior chemotherapy had a relative risk of toxicity of 6.1 (95% CI 2.9-12.8%). CONCLUSION: One-third of patients undergoing CSA radiotherapy develop grades 3 and 4 haematological toxicity. The risk is higher in children and in patients who receive chemotherapy prior to radiation. There was no treatment-related mortality and only nine of 200 patients (9/60 of those with toxicity) required supportive treatment for neutropaenic sepsis. The low incidence severe haematological toxicity does not warrant routine use of haemopoietic growth factors during CSA irradiation and future studies should target high risk subgroups.

Adolescent↗
PubMed1998

Renal metastasis from squamous cell carcinoma of the lung.

Symptomatic renal metastases from primary malignancy elsewhere in the body is an uncommon feature in disseminated cancer. Postmortem diagnosis is more frequent. A case is reported here of a patient with renal metastasis from lung carcinoma who presented with haematuria.

Carcinoma, Squamous Cell↗
PubMed1997

Craniopharyngioma: improving outcome by early recognition and treatment of acute complications.

PURPOSE: To assess the frequency, mode of presentation, treatment, and outcome of acute complications in patients with craniopharyngioma around the time of radiotherapy. METHODS AND MATERIALS: A review was made of 188 patients with craniopharyngioma treated with conservative surgery and external beam radiotherapy at the Royal Marsden Hospital between 1950 and 1992. RESULTS: Twenty six (14%) (95% confidence interval: 9-19%) patients with craniopharyngioma developed acute deterioration immediately before, during and 2 months after radiotherapy with visual deterioration (19 patients), hydrocephalus (7 patients), and global deficit (7 patients). Cystic enlargement with or without hydrocephalus was the most common cause of deterioration. No patient or disease characteristics were predictive of deterioration on univariate or multivariate analysis. Eighteen patients had surgical intervention at the time of deterioration and survived the immediate period. Six of seven patients who did not have surgical intervention died. All patients who survived the postcomplication period completed the full course of external beam radiotherapy. The 10-year progression-free survival of 162 patients without deterioration was 86%, and of 18 patients with acute deterioration who recovered after surgery, 77%. CONCLUSION: Patients with craniopharyngioma develop acute deterioration around the time of radiotherapy owing to cystic enlargement and/or hydrocephalus which does not represent tumor progression. Early recognition and appropriate surgical treatment followed by conventional full-dose radiotherapy are associated with good long-term outcome.

Adolescent↗
PubMed1997

Spinal cord compression in prostate cancer: treatment outcome and prognostic factors.

BACKGROUND AND PURPOSE: Spinal cord compression (SCC) is an important complication of metastatic prostate cancer. We have analysed patients treated at the Royal Marsden Hospital to assess treatment outcome and prognostic factors in this patients group. MATERIALS AND METHODS: We performed retrospective analysis of 69 patients with spinal cord compression and prostate cancer treated at the Royal Marsden Hospital. RESULTS: At presentation 40 (58%) patients were non-ambulant and 52% were catheterised. Diagnosis was established by myelography in 42% and magnetic resonance imaging (MRI) in 47% of patients. MRI detected significantly more patients with multiple sites of compression (51 versus 7%, P < 0.001). SCC was present at the initial diagnosis of prostatic cancer in 13 patients and 17 patients had received no hormone treatment prior to diagnosis. Following treatment 36 (52%) patients had a functional improvement of motor power with 25/40 (63%) non-ambulant patients becoming ambulant. Seventy-seven percent of patients who had eventual improvement had some improvement in power within 7 days. On multivariate analysis a single level of compression, no previous hormone therapy and a young age (<65 years) predicted for better outcome. When these factors were included an increased radiation dose (>30 Gy) or the addition of surgery did not improve the functional outcome. Following initial recovery; there was a 45% risk of developing a further episode of cord compression at the same or new site by 2 years with a median time to progression of 236 days (range 47-1215 days). The median survival was 115 days (range 5-2016 days) with 25% of patients surviving for 2 years. Patients with no prior hormone therapy had a median survival of 627 days (range 46-1516 days). Other predictors of improved survival on multivariate analysis were a single site of compression and a haemoglobin over 12 g. CONCLUSIONS: Treatment of SCC in prostate cancer results in improved motor function in the majority of patients. Long-term survival is possible, especially in good performance status patients with no prior hormone treatment. Survivors remain at high risk of subsequent neurological relapse. An early improvement in motor power is a strong predictor of subsequent functional improvement. MRI detects additional sites of asymptomatic SCC which makes it the investigation of choice.

Aged↗
PubMed1997

Conservative surgery and radiotherapy in the treatment of spinal cord astrocytoma.

Spinal cord astrocytomas are rare neoplasms, and optimal treatment guidelines are undefined, 23 patients with spinal cord astrocytomas were treated between 1984 and 1993 with conservative surgery and postoperative radiotherapy. The mean age was 31 years. Twelve patients were male and eleven female. All patients presented with neurologic deficit. Cervical cord was involved in five patients, cervicothoracic in four, thoracic in eight and thoracolumbar in six. Five patients had intramedullary cysts. Fifteen patients had low grade tumors and six high grade. Surgery was near total excision in three patients, partial excision in ten and biopsy in ten patients. All patients received postoperative radiotherapy to a median dose of 45 Gy in 25 fractions over 5 weeks. The median followup was 51 months (range 7-143 months). At 6 months post radiotherapy, twelve patients had improvement of neurologic status, nine had stable status, and two deteriorated. The actuarial overall survival was 55% at 5 years and 39% at 10 years. The actuarial progression free survival probability was 75% at 5 years and 55% at 10 years. Five patients had local failure and two failed at distant sites. Twelve patients died, six due to progressive disease, five due to complications of paraplegia and one patient of unrelated causes. Tumor grade was a significant prognostic factor for overall survival. 5 year overall survival was 79% for low grade tumors. No patient with high grade tumor survived more than 2 years and the median survival was 10 months. Low grade, female sex and presence of intramedullary cysts were associated with significantly improved progression free survival. Conservative surgery followed by radiotherapy appears to have a role in achieving tumor control and neurologic recovery in patients with low grade astrocytomas of the spinal cord. Treatment results of high grade tumors remain poor and new therapeutic strategies need to be studied.

Adolescent↗
PubMed1997

Radiotherapy in the treatment of solitary plasmacytoma.

Solitary plasmacytoma of bone (SPB) and extramedullary plasmacytoma (EMP) are rare. High local control rates are reported with radiotherapy, although the optimal dose and extent of radiotherapy portals remains controversial. Between 1983 and 1993, 30 patients with solitary plasmacytoma were seen at the Regional Cancer Centre, Trivandrum, India. 23 patients had SPB and seven EMP. The mean age was 52 years and the male to female ratio 3.2:1. Diagnosis of SPB was confirmed by biopsy in 16 patients and tumour excision in seven. 20 patients received megavoltage radiotherapy to the bone lesion with limited margins, and one received chemotherapy. Two patients who underwent complete tumour excision received no further treatment. All seven patients with EMP received megavoltage radiotherapy, four following biopsy and three after tumour excision. Local control was achieved in all patients with SPB. Nine progressed to multiple myeloma and one developed a solitary plasmacytoma in another bone. Six patients with EMP achieved local control. Three later progressed to multiple myeloma and one had local relapse. Median time to relapse was 28 months in SPB and 30 months in EMP. 5-year overall survival rates were 82% and 57% for patients with SPB and EMP, respectively. The corresponding progression free survival rates were 55% and 50%, respectively. Age, sex, site of tumour, serum M protein and haemoglobin levels did not significantly influence progression free survival. The extent of surgery, radiotherapy dose or time to relapse were not significant prognostic factors. Radiotherapy appears to be an effective modality of treatment of solitary plasmacytoma. No dose-response relationship is observed, and high local control rates are achieved with limited portals. Progression to multiple myeloma is the commonest pattern of failure, although no prognostic factors for progression are identified. The role of chemotherapy in preventing disease progression needs further evaluation.

Adult↗
PubMed1997

Localized thymic Langerhans' cell histiocytosis and its relationship with myasthenia gravis. Immunohistochemical, ultrastructural, and cytometric studies.

OBJECTIVE: It has been suggested that localized Langerhans cell histiocytosis may represent an exaggerated form of a proliferative process that has been reported in a few patients with myasthenia gravis. To evaluate the relationship between thymic Langerhans' cell proliferation and myasthenia gravis, we analyzed a rare case of localized thymic Langerhans' cell histiocytosis and examined thymic Langerhans' cell distribution in myasthenic and control patients. DESIGN: Immunohistochemical, ultrastructural, and image cytometric DNA analyses were performed on the index case. Immunostaining for S100 was performed on 20 additional thymuses, 10 from patients with myasthenia gravis and 10 from control patients. RESULTS: Immunohistochemical studies revealed no increase in Langerhans' cells in the surrounding thymic tissue of the index case. No difference was found between the number of Langerhans' cells in the remaining thymuses of myasthenia patients compared with the control group, and no micronodular proliferations were identified in either group. CONCLUSIONS: Localized thymic Langerhans' cell histiocytosis is an unusual lesion that is associated with myasthenia gravis in some patients. In the few cases reported at present, however, the lesion does not appear to be related pathogenetically to myasthenia gravis.

Adult↗
PubMed1996

The selected ion flow tube (SIFT)--a novel technique for biological monitoring.

We describe the use of our selected ion flow tube (SIFT) technique for the rapid detection and quantification of trace gases in atmospheric air, with special reference to the analysis of human breath. It is based on the chemical ionization of the breath trace gases to the exclusion of the major breath gases, using 'soft' proton transfer from H3O+ ions. Breath samples can either be introduced into the SIFT from bags or by direct breathing into the apparatus, the advantage of the latter approach being that surface active gases such as ammonia and many organic vapours which adsorb onto bag surfaces can be more accurately quantified. We present examples of the analysis of laboratory air, the breath of a non-smoker and of a smoker taken from bag samples, and illustrate the rapid time response of the technique by showing the time profile of acetone on breath during direct breathing into the apparatus. The current partial pressure sensitivity of our SIFT method is within the range 30 ppb to in excess of 100 ppm, but with further development the device could be made more sensitive, 1 ppb being well within reach. A transportable SIFT device is under development which will have applications in environmental, medical and biological research, health and safety monitoring, and in clinical diagnosis.

Breath Tests↗