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Biomedical subjects

H B Tongaonkar

Publications and source records attributed to H B Tongaonkar.

At least 19 recordsLinked to original sources
PubMed2006

Diagnostic dilemma in an elderly woman with intractable ascites and elevated CA-125 level.

In patients with intractable ascites, careful consideration should be given to the patient's past history with emphasis on cardiac, liver and renal disorders. Ascitic fluid cytology indicating the presence of malignant cells should be unequivocal; cytology should be repeated before embarking on potentially toxic anti-cancer treatment in ambiguous cases. Elevated serum CA-125 levels should not be relied upon to make the diagnosis of ovarian/peritoneal carcinoma. We report a case of tricuspid stenosis with severe ascites in an elderly woman who was initially mis-diagnosed and treated as peritoneal/ovarian carcinoma.

Ascites↗
PubMed2000

Effect of cisplatin-based chemotherapy on emergence of cisplatin resistance, and its correlation with intracellular glutathione levels and accumulation of p53 protein in human ovarian cancer.

Forty-seven ovarian cancer cases in which 20 were previously treated with cisplatin (cisPt) based chemotherapy, were checked for in vitro chemosensitivity using MTT assay. The drugs included in the study were cisPt, adriamycin (ADR), epirubicin (EPR) and etoposide (ETO). The logarithemic concentrations (0.1, 1.0, 10.0 and 100.0 micrograms/ml) of these drugs were used in the MTT assay. The IC50 values for these drugs in the above tumor samples were calculated. The effect of pretreatment with cisPt based chemotherapy on the emergence of drug resistance, expression of p53 protein (detected using immunohistochemical method by employing monoclonal antibody to p53) and intracellular glutathione (GSH) levels was also studied. Our results demonstrated the superiority of EPR in terms of its efficacy as compared to the other drugs used in the study. EPR was effective in both, previously cisPt-exposed and cisPt-unexposed ovarian cancer cases indicating its importance as a second line chemotherapy in the refractory ovarian carcinoma cases. Pre-exposure to cisPt based chemotherapy appears to result in the emergence of cisPt resistance, elevated intracellular GSH levels as well as p53 positivity. A statistically significant correlation was also observed between ADR and EPR resistance and p53 positivity (P < 0.01 and 0.05 respectively).

Antineoplastic Agents↗
PubMed2000

Embryonal rhabdomyosarcoma of prostate in an adult--a diagnostic dilemma.

Embryonal rhabdomyosarcoma of the prostate is a rare. Highly malignant tumour. The median age of occurrence is five years, but sporadic cases have been reported in adults' To the best of our knowledge, till date, fewer than ten cases have been reported of which only two are above the age of sixty years. We report a case of embryonal rhabdomyosarcoma of prostate in a patient more than sixty years of age. If one is not aware of this entity, one can make a mistake in the diagnosis as well as treatment.

Aged↗
PubMed1999

Radical cystoprostatectomy: an extraperitoneal retrograde approach.

PURPOSE: We describe a new technical approach for the surgical management of bladder cancer. MATERIALS AND METHODS: Patients with invasive bladder cancer underwent radical cystoprostatectomy using a technically different approach than the conventional method. The important features of this modification include a small infraumbilical incision, completely extraperitoneal dissection to maintain the bowel loops away from the operating field, urethral dissection performed earlier in the operation rather than at the end to preserve the striated urethral sphincter with the neurovascular bundles, completely retrograde dissection of the rectovesical plane for increased safety and reperitonealization done at completion to isolate the urinary anastomoses from the bowel anastomosis. RESULTS: More than 50 consecutive patients with early bladder cancer underwent this operation during a 2-year period. The technique was safe and satisfactory. CONCLUSIONS: Radical retrograde extraperitoneal cystoprostatectomy is based on a finer knowledge of anatomy. It requires accurate dissection, making it inherently superior to the conventional method.

Cystectomy↗
PubMed1999

Borderline epithelial tumours of the ovary--a retrospective analysis of 31 cases.

Thirty one cases of epithelial borderline tumours of the ovary recorded over a period of six years were reviewed. The incidence of borderline tumours was 6% in relation to ovarian epithelial malignancies, with serous and mucinous types comprising three fourth of the lesions. The serous tumours were bilateral in 39%, revealed surface growth in 17% and had peritoneal implants in 11% of cases. The mucinous tumours were bilateral in 11% and had associated pseudomyxoma peritonei in 22% of cases. Nuclear grade appeared to correlate with extraovarian spread and surface growth in the serous borderline tumours, but not in the mucinous borderline tumours. The endometrioid borderline tumours and mixed epithelial borderline tumours were rare lesions. Twenty one patients (68%) presented in Stage-la. Surface growth correlated with recurrences. The prognosis remained good in serous borderline tumours even in the presence of implants as these were non-invasive. The mean disease free survival was 43.03 months. There was no statistical difference in disease free survival of patients with and without implants.

Adenofibroma↗
PubMed1997

Adenocarcinoma of bladder.

Forty-eight patients with adenocarcinoma (21 urachal and 27 non-urachal) of the bladder were treated at the Tata Memorial Hospital between 1976 and 1992. The study group consisted of 32 men and 16 women. The urachal tumours were more common in younger patients (mean age: 49 years) than were non-urachal tumours (mean age: 58 years). The overall 5-year survival in this series was 37%. Stage and grade were powerful predictors of outcome. Patients with non-urachal tumours showed an overall survival rate of 29.9% compared with 45.7% in patients with urachal tumours (P= 0.14). Radical cystectomy was the most common treatment modality in patients with non-urachal tumours and yielded an overall 5-year survival of 35%. Patients with urachal tumours were treated with either partial cystectomy or radical cystectomy. The 5-year survival following partial cystectomy was 56.3% compared with 25.9% following a radical cystectomy and the difference between the two was not statistically significant (P = 0.76).

Adenocarcinoma↗
PubMed1996

Improved management of abdominal undescended testicular tumors with bulky confluent retroperitoneal nodal metastases.

PURPOSE: Germ cell tumors of the abdominal undescended testis associated with confluent bulky retroperitoneal metastases are challenging problems. We report the results of neoadjuvant cisplatin based chemotherapy after diagnosis of germ cell tumors by fine needle aspiration cytology of the abdominal testicular mass. After chemotherapy all patients underwent abdominal orchiectomy with retroperitoneal lymph node dissection for residual nonseminomatous germ cell tumors or radiotherapy for pure seminomas. MATERIALS AND METHODS: Between 1980 and 1991, 57 of 425 patients (13.4%) with germ cell tumors of the testicle had malignancy in an undescended testis, while 39 (68.4%) had tumor in an abdominal testis with confluent bulky metastasis. Metastatic evaluation included tumor marker studies, chest x-ray and computerized tomography of the abdomen. Among the tumors 29 (74.4%) were large volume seminomas (stages IIc, III and IV) and 10 (25.6%) were large volume nonseminomas. All 39 patients received 3 cycles of induction chemotherapy, and orchiectomy was deferred until its completion (14 received vinblastine, actinomycin D and bleomycin-6, and 25 received bleomycin, etoposide and cisplatin). After evaluation of response, the testis was excised. Overall followup was 2 to 12 years (median 4.6). RESULTS: Of 29 seminomas 14 (48.3%) showed a complete and 11 (37.9%) showed a partial response. The latter tumors were treated subsequently with radiotherapy. Four patients with progressive disease died, for an actuarial survival rate of 86%. Of the 10 patients with nonseminomatous germ cell tumor 2 (20%) had a complete response and 4 had a partial response. All patients with a partial response underwent retroperitoneal lymph node dissection. Overall, 4 patients with progression and 2 with a partial response died, for an actuarial survival rate of 39%. Of 39 post-chemotherapy orchiectomy specimens 24 (61.5%) showed viable tumor cells. Furthermore, 16 of 39 patients (41%) had additional ilioinguinal metastases requiring adjuvant radiotherapy or surgery. CONCLUSIONS: Surgical removal of the primary tumor in an undescended testis with bulky metastasis is difficult. We believe that initial chemotherapy followed by 1-stage surgical removal of the primary and residual metastasis is a favorable option to improve compliance and decrease the incidence of loss to followup. Atypically altered ilioinguinal metastases may necessitate a change in radiotherapy ports and/or retroperitoneal lymph node dissection boundaries. The significantly poorer survival with nonseminomatous germ cell tumor could be due to the fact that 50% of the lesions were stage IV at presentation. However, multivariate analysis showed only tumor histology to be the significant parameter and not initial stage at presentation.

Actuarial Analysis↗
PubMed1995

Renal cell carcinoma extending to the renal vein and inferior vena cava: results of surgical treatment and prognostic factors.

Forty-seven patients with renal cell carcinoma with tumor thrombus extension to the renal vein or inferior vena cava (IVC) were treated surgically over a 10-year period. There were 41 males and 6 females with a mean age of 45.7 years. Thirty-three patients had right-sided and 14 had left-sided tumors. Patients with renal vein or infrahepatic IVC thrombus were treated with radical nephrectomy with tumor thrombus excision after achieving conventional vascular control over the IVC and the opposite renal vein. Four patients with retrohepatic IVC thrombus were treated with venacavotomy and thrombectomy after achieving vascular control above the thrombus but below the hepatic veins while two other patients with retrohepatic and one with suprahepatic thrombus required a bifemoroatrial partial venous bypass prior to tumor thrombectomy. There was one postoperative death due to pulmonary embolism. The actuarial 5-year survival for all patients with venous extension was 50% and the median survival was 4.35 years. Perinephric spread and lymph node metastases were significant prognostic factors affecting survival. This suggests that it is the locoregional spread of renal cell carcinoma rather than the level of the thrombus which governs the prognosis of patients with tumor thrombus extension to the renal vein or IVC.

Adult↗
PubMed1995

Partial cystectomy for invasive bladder cancer.

Thirty two patients--23 males and 9 females with a mean age of 52.5 years--underwent planned partial cystectomy for histologically proved muscle invasive bladder cancer. Twenty patients had transitional cell carcinoma and 12 had adenocarcinoma of the bladder. One patient had well-differentiated, 18 had moderately differentiated, and 13 had poorly differentiated tumours. The tumour size was < 2 cm in 7 patients, 2-4 cm in 19 patients, and > 4 cm in 6 patients. Patients with single primary muscle invasive tumours situated in the upper half of the bladder were considered eligible for partial cystectomy. The presence of multicentric urothelial disease, of dysplasia, or carcinoma-in-situ in bladder mucosa away from the tumour on multiple random punch biopsies was considered contraindications to partial cystectomy. All patients underwent partial cystectomy with bilateral pelvic lymphadenectomy. The tumour-free margins of resection were confirmed by intraoperative frozen section examination. The bladder was closed primarily in all patients, although three patients required re-implantation of the ureter. No patient received adjuvant radiation or chemotherapy. Five patients had pathological stage B1 (T2), 18 had B2 (T3A), and 9 had C (T3B) disease. No patient had metastatic pelvic lymph nodes. There was one postoperative death due to unrelated medical cause. Five patients had minor complications that resolved with conservative measures. All patients had adequate bladder capacity of > 250 cc at 6 months after surgery, and none had symptoms attributable to reduced bladder capacity. The overall actuarial survival was 80.1% at 5 years.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenocarcinoma↗
PubMed1995

Is bladder conservation feasible? An Indian experience.

With the introduction of chemotherapy in the treatment of muscle invasive bladder cancers, endeavors at improving disease-free survival/overall survival are ongoing. As high objective response rates were seen with MVAC/CMV regimens (M-methotrexate, V-vinblastine, A-adriamycin, C-cisplatin) organ conservation is being attempted. A phase II protocol was designed using MVAC as the initial therapy. Based on the response to two cycles all patients were evaluated and where possible the bladder was preserved. Twenty-nine patients completed the protocol and had a median follow-up of 24 months. Complete response (CR) was noted in 7/29 (24.1%) of patients, while 11/29 (38%) had partial response (PR) and 11/29 (38%) showed no response (NR). Bladder conservation was possible in 15/29 (51.7%) patients initially with the use of radiation therapy after the initial chemotherapy. Ten of these patients are presently alive with their bladders intact. Three patients died of distant disease, two with normal bladders and one with local relapse. Two of the other patients required salvage cystectomy and are alive and disease-free. All complete responders 7/7 (100%) and 5/11 (45%) partial responders could have their bladders conserved. Three of 11 partial responders who refused radiotherapy and 11/11 non-responders underwent radical cystectomy after initial chemotherapy. Subset analysis indicates that low stage and grade tumours had the highest likelihood of bladder preservation, and there was no difference in overall survival in the groups according to response criteria. As our study consists of a small number of selected patients, it would be improper to draw firm conclusions. However, it seems that initial chemotherapy selects out a subset of patients with a good prognosis and the chance for bladder conservation.

Adult↗
PubMed1995

Superficial bladder cancer. A 10 year experience.

A total of 236 patients - 198 males and 38 females with superficial bladder cancer (stage A(TaT1)) were treated with transurethral resection of the tumours. Intravesical chemotherapy (84 patients) or immunotherapy (27 patients) was added in those patients considered to be at high risk of developing local recurrences or stage progression. The five and ten years survival in the single tumour group (117 patients) were 86 percent and 72.9 percent as compared to 72.5 percent and 70.7 percent respectively in the multiple tumour group (119 patients). The five and ten year survival rates for grade I tumours were 88.3 percent and 86 percent respectively, for grade II tumours 80.8 percent and 64 percent and for grade III tumours 56.9 percent and 46 percent respectively. The impact of tumour grade on survival was found to be independent of the number of tumours. The response rates to intravesical thiotepa was 54.9 percent mitomycin 60 percent and with BCG 71.5 percent. All the three reduced the local recurrence rates and increase the mean interval to recurrence but the stage progression rate was significantly lowered only with intravesical BCG. In our study, we have used the Danish strain of BCG available to us and have found it to yield response rates comparable to other centres using Tice or Pasteur strains.

Adult↗
PubMed1995

Do we need to do comprehensive surgical staging in all cases of clinical early ovarian cancer?

Meticulous staging of ovarian cancer has so far been a prerequisite for treatment planning. However, more than 80% of patients operated by non-oncologists all over the world do not under go a complete staging. Recently there have been reports questioning the need for extensive staging from the point of cervical benefit. We have analysed our data of 64 stage ovarian cancer patients to see if clinical staging was adequate or relaparotomy with restaging is necessary. We conclude that though pathological staging is important for proper reporting of results and evaluation of treatment modalities, in the existing circumstances, a judicious use of clinical methods and taking available pathological factors into account, we can still produce comparable results with restricted use of relaparotomy.

Female↗
PubMed1994

Growing teratoma syndrome.

Growing teratoma syndrome is the term applied to enlarging retroperitoneal or other metastatic masses containing mature teratoma during chemotherapy for nonseminomatous germ cell tumors. Four cases of the growing teratoma syndrome are presented, the metastatic masses being in the retroperitoneal in all the cases. All these patients had enlarging retroperitoneal masses in the presence of normal serum biomarkers following chemotherapy for nonseminomatous tumors. Surgical excision was carried out in all four patients, with disease free survivals ranging from 6 to 24 months after surgery.

Adolescent↗
PubMed1994

Bilateral renal angiomyolipoma.

Bilateral renal angiomyolipoma is a rare entity, usually associated with tuberous sclerosis. Five cases of bilateral renal angiomyolipoma, all females, with a mean age of 34.6 years, are reported. All patients had symptoms attributable to lesions only on one side, with flank pain and mass the commonest symptoms encountered. Only one case had clinical evidence of stigmata of tuberous sclerosis. The mean size of the lesions on the symptomatic side was 17 cm, while that on the asymptomatic side was 2 cm. Three patients were diagnosed correctly as having angiomyolipomas preoperatively with the use of ultrasonography and computed tomography (CT); two of these were treated with total nephrectomy and the third with partial nephrectomy. The other two cases were seen before the availability of CT and were only diagnosed intraoperatively. Both patients were treated with total nephrectomy. The lesions on the asymptomatic side were kept on close surveillance. Two patients developed an increase in the size of the lesions in the contralateral kidney 1 year and 3 1/2 years after the first surgery. Both patients were treated with partial nephrectomy. All patients are alive at 3-14 years (mean 6.6 years) after operation.

Adult↗
PubMed1994

Intravesical bacillus Calmette-Guerin for superficial bladder cancer: experience with Danish 1331 strain.

A total of 95 patients with stage Ta/T1 superficial bladder cancer was eligible for intravesical bacillus Calmette-Guerin (BCG) immunoprophylaxis according to the standard high risk criteria for tumor recurrence and progression. Of these patients 50 agreed to undergo treatment while the remaining 45 refused any intravesical therapy and served as concurrent nonrandomized controls. The patient and tumor characteristics in the 2 groups of patients were identical. All patients underwent complete transurethral resection of the bladder tumor. Therapy consisted of 120 mg. weekly instillations of BCG (Danish 1331 strain) for 6 weeks. Among the 50 patients 33 received BCG initially while 17 received it after failure of intravesical chemotherapy. Responses were evaluated according to standard criteria. Recurrence was noted in 24 patients (48%) in the BCG group compared to 38 (84.4%) in the control group. The recurrence rates per year and per 100 patient-months were significantly reduced in the BCG arm compared to the control arm. The mean interval to first recurrence and the mean recurrence interval were significantly increased in the BCG arm compared to the control arm. The relative risk of recurrence in the BCG group was 0.62 versus 1.63 in the control group. Subgroup analysis showed significant benefit of BCG for patients with single as well as multiple, stages Ta and T1, and grades II and III tumors. Comparison with pretreatment controls in the BCG group revealed a significant reduction in the recurrence rate in those patients after treatment with BCG, which was not seen in the control group. The benefit of BCG was seen in those who received BCG initially as well as in those who received it after failure of intravesical chemotherapy. Multivariate analysis of prognostic factors showed that this benefit in the BCG group was related only to the treatment, while other prognostic parameters, such as tumor stage, grade, number and so forth were not independent prognostic variables. The rate of progression to muscle invasion was not significantly different in the 2 treatment groups. The relapse-free survival in the BCG group was 35.4% at 60 months compared to 11.2% in the control group (p < 0.001). The side effects of BCG therapy were mild, brief and easily controlled with conservative measures.

Administration, Intravesical↗
PubMed1993

Carcinoma of the penis: the Indian experience.

A total of 150 evaluable patients with carcinoma of the penis were treated at the Tata Memorial Hospital between 1984 and 1987. The majority of patients were in the 4th to 7th decades. All patients presented with a growth on the penis, the biopsy of which revealed squamous carcinoma. The primary lesions were T1 in 34, T2 in 73, T3 in 41, and T4 in 2 patients, respectively. The inguinal nodes were not palpable (N0) in 77 patients, palpable but histologically not metastatic in 39 patients, and metastatic in 34 patients. The treatment of the primary lesion was surgery in 142 patients and radiation therapy in 8 patients. Patients with nonpalpable nodes were kept under surveillance and those with pathologically metastatic nodes were subjected to bilateral ilioinguinal lymphadenectomy. The size related 5 year survivals were 83.3% for T1, 60.4% for T2, and 39.5% for T3 lesions. The 5 year survivals for patients with grade I lesions were 90.3%, for grade II 58.6%, and for grade III 16.7%. The 5 year survival rate for patients for N0 nodes was 75.4% while the 3 year survival rates for patients with N1 and N2 nodes were 40% and 38.8%, respectively. The factors signifying poor survival were perinodal extension and iliac node metastases. There were 8 penile stump recurrences, of which 6 could be salvaged. Metachronous inguinal node metastases developed in 16 patients among whom surgical lymphadenectomy was possible in 12 while 4 had unresectable metastases.

Adult↗