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C Varghese

Publications and source records attributed to C Varghese.

34 records · Page 2Linked to original sources
PubMed1994

A case-control study of diet and lung cancer in Kerala, south India.

A total of 281 male lung-cancer patients were identified from the hospital cancer registry in the Regional Cancer Centre in Trivandrum. The controls were selected from the visitors and patients' bystanders in the hospital. The recruitment of cases and controls started in 1990, and the present study used the cases registered in the first year. The questionnaire administered to cases and controls collected information on tobacco smoking and alcohol habits. Dietary data were collected using a food frequency questionnaire and were analyzed by multiple logistic regression producing odds ratio estimates of the relative risk and deviance chi-squared tests of significance. Analysis was done on the computer package, EGRET. All models included age, education, religion and smoking to adjust for the effect of confounding. Green vegetables and bananas were found to have a protective association with lung cancer. The odds ratio associated with the highest quartile of vegetable consumption compared with the lowest was 0.32 (95% confidence interval 0.13, 0.78). Forward stepwise regression analysis indicated pumpkins and onions as the most consistently significant protective factors. Animal protein foods and dairy products were found to have a predisposing effect on lung cancer in this study. The expected influence of smoking on lung cancer (a considerable increase in risk among smokers) provided evidence of the reliability of the data. In conclusion the results from this study show that diet has a role in lung cancer aetiology, although the association is weak compared to the effects of smoking.

Adult↗
PubMed1994

Use of tobacco and alcoholic beverages by children and teenagers in a low-income coastal community in south India.

To plan and implement cancer control measures, information about the baseline habit patterns of the community is needed. A coastal village near Trivandrum, Kerala, Southern India, supported mainly by the fishing industry, was identified for this study with regard to establishing measures to control oral cancer there. Oral cancer is prevalent in Kerala. Smoking and chewing tobacco and drinking alcoholic beverages are the major risk factors for this cancer. The socioeconomic status of the fishermen of Kerala is low and their literacy rate is low. The adults in coastal Kerala have been found to have a habit pattern of very high levels of tobacco and alcohol use. A survey was conducted to study the tobacco and alcohol use habits of 146 children and teenagers in this village. The percentages of study subjects with pan-tobacco-chewing, smoking, and drinking habits were 29%, 2%, and 3%, respectively. The habit pattern correlated negatively with education and positively with number of children per family. This survey provides information that can be used to plan cancer education efforts, including redesigning the school curriculum and focusing on high-risk groups.

Adolescent↗
PubMed1994

Oesophageal cancer.

The changing pattern of occurrence of oesophageal cancer is reviewed. Major features include marked decreases in rates among Chinese (in whom most oesophageal cancer is seen globally) as lifestyle changes, on migration or more recently in the People's Republic; steady increases among USA blacks; an indication that traditional extremely high rates in central Asia may be declining; a slow decline in many countries as lifestyles change, and diets presumably improve, seen in such diverse areas as Finland, India and parts of Latin America; a recent upturn in certain male populations, parallel to the increase in alcohol consumption.

Adult↗
PubMed1993

Overall survival from breast cancer in Kerala, India, in relation to menstrual, reproductive, and clinical factors.

BACKGROUND: Breast cancer accounts for one-fourth of cancer cases seen in female patients in Kerala, India. Results of a retrospective analysis of breast cancer in Kerala are presented in this article. METHODS: Case records of 449 patients with breast carcinoma treated during 1983-1984 were reviewed. Survival analysis was done by the Kaplan-Meier product limit method. The survival curves were compared by the log-rank test. A forward stepwise procedure with the Cox proportional hazards regression analysis was performed to identify factors influencing survival. RESULTS: The overall 5-year survival rate was 40%. The 5-year survival rates were 85% for patients with T1, 63% for T2, 32% for T3, and 21% for T4 lesions. Those with N0 disease had a 68% 5-year survival rate. The survival rates were 90% for patients with Stage I, 65% for Stage II, 33% for Stage III, and 6% for Stage IV disease. On multivariate analysis, the following factors were found to significantly influence survival: response to treatment (P < 0.001), stage (P < 0.01), and regional nodal involvement (P < 0.05). CONCLUSIONS: Two-thirds of patients with advanced-stage disease on presentation seem to account for the poor overall survival. Early detection of breast cancer by breast self-examination and physician breast examination should be encouraged in developing countries to improve treatment results in breast cancer.

Adult↗
PubMed1993

Evaluation of symptomatology in planning palliative care.

Cross-sectional surveys are a useful tool in planning health care, both in the community and in hospitals. We found that a review of routine case records did not yield sufficient information for planning palliative care services in the hospital environment, and therefore decided to conduct a cross-sectional survey involving random patients attending the outpatient division of the Regional Cancer Centre, Trivandrum, India. Three hundred and twelve patients were interviewed, and pain and weight loss were found to be the most prominent symptoms (> 90%). This study indicates that symptomatology has to be addressed in detail while planning palliative care services in a hospital setting. Even with its selection bias, the study provides valuable clues for the adequate organization and continuation of palliative care services.

Adolescent↗
PubMed1993

Prevention and early detection of oral, breast and cervical cancers: a practical approach in Indian context.

Cancer has emerged as a major killer disease in India. One-third of the total cancer load is constituted by oral, breast and uterine cervix cancers. Considerable knowledge is available on control strategies on these 3 major cancers and this can be transformed into the community through the individual health care practitioners. Oral cancer is preventable and both the precancerous and invasive lesions can be picked up easily by examination of the oral cavity. The occurrence of breast cancer in the country is on the increase. The poor survival rate indicates the impact of the major proportion of advanced cancer. An effective strategy comprising breast self-examination, examination by a physician and a mammography test, is described. Cancer of the uterine cervix is the commonest malignancy among females in several regions in India. An effective and definitive method is available in the form of Pap smear for the control of cervical cancer. An organised community screening programme is not economically viable at present. However, routine per speculum examination should be undertaken and this can result in clinical downstaging of cancer. Women above the age of 40 years should undergo regular Pap smear screening. Broad guidelines are presented for an opportunistic screening.

Adult↗
PubMed1992

Hyperfractionation in advanced carcinoma of the uterine cervix: a preliminary report.

Experience with twice-a-day radiation therapy program for carcinoma of the uterine cervix (FIGO Stages IIB, IIIA & IIIB) is presented. The program consists of delivering 120 cGy per fraction, two fractions a day with 6 hours between fractions. A total of 6000 cGy was delivered in 50 fractions over 5 weeks. A control group was given conventional fractionation 5000 cGy in 25 fractions, 200 cGy per fraction over 5 weeks. This feasibility study enrolled 30 patients, 15 in each group. Normal tissue reactions in skin, mucosa and bowel were recorded. The acute normal tissue reactions were enhanced in the hyperfractionation group. This was significant with regard to the bowel complications. The tumor control rate did not show any significant difference between the two groups. A short follow-up period has revealed complete healing of all acute normal tissue reactions. This study shows that further dose escalation is feasible and a study with large sample size and longer follow-up is required to reach definite conclusions.

Carcinoma, Squamous Cell↗
PubMed1992

Primary small intestinal lymphoma.

Gastro-intestinal tract is the most common site of extranodal presentation in non-Hodgkin's lymphoma. Among the subsites the small intestine predominates. This paper presents a review of 21 cases of primary gastro-intestinal lymphoma seen at the Department of Radiation Oncology, Christian Medical College, Vellore, during the period 1979-1986. All patients had laparotomy, and biopsy from the primary site. Histopathological subtypes were done in the International Working Formulation. Stage groupings were done applying the Crowther and Blackledge staging system. Post-laparotomy treatment decision was made depending on the patient's general condition, completeness of surgery and histological subtype. The overall survival rate was 31.5% at 5 years. Early stage disease and high-grade lymphomas have a better prognosis if treated adequately.

Female↗
PubMed1990

Intraocular pressure profile during general anesthesia.

The effect of some anesthetic drugs on intraocular pressure (IOP) was studied in 120 normal healthy patients undergoing non-ophthalmic surgical procedures. IOP rose significantly following the injection of succinylcholine (SCh) alone, or when such injection had been preceded by a pretreatment with a "self-taming" dose of SCh or d-tubocurarine (d-Tc). Though the rise in IOP after diazepam pretreatment was significant, the magnitude was lower than that observed in the groups pretreated with the other two agents. Halothane brought the IOP down faster and lower than ether. SCh is unsafe for intubation for the administration of general anesthesia in cases involving penetrating ocular injuries. It can, however, be used safely for routine ophthalmic surgery, providing that 8 minutes are allowed to elapse between injection and corneal or scleral incision. Halothane is preferred to ether, since the former lowers IOP faster and in a greater amount than the latter.

Anesthesia, General↗
PubMedDate not supplied

Predictors of neck node control in radically irradiated squamous cell carcinoma of the oropharynx and laryngopharynx.

Cases of squamous cell carcinoma (171) of the oropharynx and laryngopharynx with clinically positive neck nodes, treated primarily by radiotherapy, were used for a multivariate analysis of the factors related to the regional outcome. All patients were staged according to the UICC-TNM (1982) classification. Lymph node size (P < 0.01), TNM nodal category (P < 0.05), and stage of the disease (P < 0.05) were significant in univariate analysis. Patient- and disease-related factors (age, sex, and histology) and treatment related factors (radiation dose (5000-6000 rads), radiation schedule, and concurrent chemotherapy) did not reach statistical significance. The stepwise logistic regression resulted in a final model with node size as the most important predictor of neck node control (P < 0.01). Patients with neck nodes up to 1 cm can receive radical radiotherapeutic management for treating the primary as well as nodal disease.

Adult↗
PubMedDate not supplied

Estimating cancer survival in developing countries. Use of reply-paid post cards to augment follow-up information.

Survival from cancer is one of the indices to evaluate cancer control activities. Reliability of survival estimates depends to a large extent on the completeness of follow-up information available for patients in the study group. Loss to follow-up (LFU) is one of the potential problems introduced in follow-up of cancer patients. An attempt is made to improve the follow-up system for reducing the LFU of cancer patients by repeatedly sending reply-paid post cards for the LFU patients. A total of 353 ovarian cancer patients registered at the Regional Cancer Centre, Trivandrum during a three year period and followed-up to a total of five years showed 67 percent loss to follow-up. The five-year survival rate of this group calculated using Kaplan-Meier method under the assumption that the LFU's occurred at random was 75 percent. Efforts to improve the follow-up rate for the study population were made through the simple and cost effective method of postal enquiry which resulted in a reduction of 63 percent of losses to follow-up. Incorporation of this information in the data brought about a revised five-year survival estimate of 55 percent. The reply paid post card system was found to be effective in obtaining useful follow-up data. The result shows that LFU can be reduced by better design of survival study.

Cohort Studies↗
PubMedDate not supplied

Survival in multiple myeloma in Kerala.

BACKGROUND: The reported incidence of multiple myeloma in India ranges from 0.5 to 1.2 per 100,000 but there have been few studies on the effect of treatment of this condition. We, therefore, analysed the clinical profile of patients in Kerala with myeloma, the treatment given and the factors affecting survival. METHODS: Case records of 142 patients with multiple myeloma treated at the Regional Cancer Centre, Trivandrum, between 1984 and 1989 were reviewed and abstracted. Chemotherapy (using melphalan and prednisolone) and radiotherapy were the treatment modalities. Survival analysis was done using the Kaplan-Meier estimates and multivariate analysis of factors affecting survival was performed using Cox's proportional hazards regression model. RESULTS: The mean age of the patients was 61 years and 90 were males. Bone pain and pallor were the most common presenting symptoms and the median survival was 30 months. A combination of melphalan and prednisolone was found to be well tolerated and achieved a survival rate of 62% at 5 years. Hemibody irradiation was beneficial in a small group of patients. On a multivariate analysis, Bence-Jones proteinuria, melphalan and prednisolone combination chemotherapy and response to treatment at 6 months were the most significant factors affecting survival. Socioeconomic status did not seem to influence survival. CONCLUSIONS: Melphalan and prednisolone chemotherapy achieves prolonged survival in myeloma. Radiotherapy can relieve symptoms and in a small group of patients hemibody irradiation can achieve prolonged remission. Further studies are required to identify the subgroups in which certain treatments are most effective in improving survival.

Adult↗