Gallbladder cancer.
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Cholecystectomy, Laparoscopic↗
Biomedical subjects
H S Shukla
Publications and source records attributed to H S Shukla.
CA 125: a potential tumor marker for gallbladder cancer.
BACKGROUND: CA 125 is a glycoprotein and a commonly used tumor marker in ovarian carcinoma. Its use in gallbladder carcinoma (GBC) has not yet been reported. We have henceforth examined for the first time the diagnostic utility of CA 125 in patients with gallbladder diseases. PATIENTS AND METHODS: Serum CA 125 was measured in 64 patients with GBC, 47 Gallstone disease (GSD) and 23 healthy volunteers by ELISA. CA 125 level was compared between different cohorts by non-parametric test (Kruskal Wallis and Mann-Whitney test). Receiver operating characteristic curve (ROC) was constructed to see the diagnostic utility of CA 125. Its level was also correlated with age, sex and clinico-pathological parameters of the patients included in the study. RESULTS: Mean value of CA 125 in patients with GBC, GSD and healthy volunteers was 77.44 +/- 141.31 U/ml, 7.85 +/- 5.40 U/ml, and 8.08 +/- 3.26 U/ml respectively and showed a statistically significant difference (P < 0.001). CA 125 at cut off value of 11 U/ml yielded 64% sensitivity and 90% specificity in differentiating benign from malignant gallbladder disease. CA 125 level increased with stage and grade of the GBC though this was not statistically significant. A higher level of CA 125 was found in presence of gallbladder mass, weight loss, ascites and loss of appetite compared to patients with GSD. No association of CA 125 was apparent with either age or sex of the patients. CONCLUSION: CA 125 has a diagnostic potential for GBC and can differentiate GBC from GSD in light of other clinical details.
Ascites↗
Correlation of nutritional parameters of gallbladder cancer patients.
BACKGROUND AND OBJECTIVE: Gallbladder cancer (GBC) is a highly fatal disease with poor prognosis and 5-year survival <5%. Weight loss and nutritional deterioration are associated with adverse outcomes in terms of cancer prognosis. Protein-calorie malnutrition is the single most common secondary diagnosis in a patient with cancer, and is a direct consequence of the anorexia of malignancy and altered host metabolism induced by the tumor. The present study of nutritional assessment is of particular interest for it helps in better understanding the extent of malnutrition in patients of GBC. PATIENTS AND METHODS: A case-control study was designed comprising of 153 cases of GBC and 153 controls of gallstone disease (GSD). To assess the nutritional status of the GBC patients, anthropometric measurements such as height, weight, mid arm circumference, and skinfold thickness were recorded together with the biochemical parameters and their nutrient intake. RESULTS AND CONCLUSIONS: The present study showed that GBC influences the nutritional status of the patients. Forty-three percent of GBC patients were malnourished with low body mass index (BMI). A significant reduction in all the anthropometric measures was observed for GBC patients compared to those with GSD. GBC patients had significantly low hemoglobin and serum albumin levels compared to the control group. The hemoglobin levels in case and control groups were 10.87 g/dl (+/-1.81 SD) and 11.62 g/dl (+/-1.89 SD), respectively (P < 0.001). Intake of almost all the nutrients was far below the recommendations of Indian Council of Medical Research. GBC patients had anorexia and weight loss.
Anorexia↗
Effect of prevailing local treatment options of breast cancer on survival outside controlled clinical trials: experience of a specialist breast unit in North India.
BACKGROUND: This study aimed at analyzing different treatments of breast cancer (BC) prevalent in the region, their effect on patients' survival, and discusses the most suitable method within available resources. METHODS: The study was set up at a tertiary care hospital in north India. We retrospectively reviewed data of 473 female BC patients who attended the departments of Surgical Oncology and Radiotherapy from January 1997 to December 1999. Patients with cTNM stage IV and inoperable stage III were included; those who defaulted or were lost to follow-up were excluded. Out of 473 patients, 372 were selected. The selected patients were divided into groups on the basis of place and type of local treatment they received: (1) local excision only, (2) standard breast conservation therapy (BCT), (3) total mastectomy (TM) + axillary lymph node dissection + radiotherapy (RT), and (4) modified radical mastectomy (MRM) + RT. Data regarding recurrence and survival were analyzed in December 2005. Minimum follow-up was 6 years. RESULTS: Overall recurrence rates were significantly higher in patients operated elsewhere (P <0.0001). Of 194 operated at our Breast Unit, 25 (14.6%) of 171 MRM patients and none of 23 BCT had recurrence. Of 178 patients operated elsewhere, 44 (100%), 6 (42.9%), 41 (41%), and 8 (40%) developed recurrence in groups 1, 2, 3, and 4 respectively. Overall survival was significantly better in patients with MRM at our unit versus TM outside (93.6% vs. 80%). CONCLUSIONS: Several types of treatment from improper local excision alone, BCT, TM, to a carefully done MRM are prevalent here. Properly done, MRM yields significant local control with survival benefit and appears to remain the gold standard in management of our BC patients.
Adult↗
Breast tuberculosis: diagnosis, clinical features & management.
The significance of breast tuberculosis is due to rare occurrence and mistaken identity with breast cancer and pyogenic breast abscess. Breast tuberculosis was scarcely reported even from endemic areas until lately when several reports have come up from South Africa and India. The incidence of tubercular mastitis although decreasing in the West, could show a resurgence with the global pandemic of AIDS. Breast tuberculosis has no defined clinical features. Radiological imaging is not diagnostic. Diagnosis is based on identification of typical histological features or the tubercle bacilli under microscopy or culture. Antitubercular therapy for 6 months with or without minimal surgical intervention forms the mainstay of treatment today. Over the years since the first description of tubercular mastitis in 1829, the incidence, clinical presentation, diagnostic and treatment methodology of breast tuberculosis has gradually changed. This review discusses the important issues relating to the diagnosis, clinical features, and management of breast tuberculosis.
Adult↗
Residual breast tissue in the skin flaps after Patey mastectomy.
BACKGROUND & OBJECTIVES: Patey mastectomy implies complete removal of breast tissue. Likely area where residual breast tissue may be left is under the skin flaps. There is no study examining left over breast tissue under the Patey mastectomy skin flap. The present study was undertaken to study the presence of residual breast tissue in skin flaps after Patey mastectomy in patients with breast cancer. METHODS: In 37 patients of breast cancer undergoing Patey mastectomy, biopsy from under the skin flap at central point of 4 quadrants (upper outer, upper inner, lower inner and lower outer), 3 cm from cut margin of skin was taken to examine for residual breast tissue. RESULTS: In 8 of 37 (21.6%) cases residual breast tissue and in 3 of these (37.5%) tumour tissue was found under the skin flap. INTERPRETATION & CONCLUSION: Overall in 21.6 per cent biopsies from under the skin flap revealed information of probable therapeutic importance. This information may in future serve as an additional prognostic factor to consider irradiation to reduce the incidence of local recurrence in flap positive patients.
Adult↗
Tuberculosis of the gallbladder.
Analysis of 5 patients with gallbladder tuberculosis who had open cholecystectomy and review of literature have shown that, although still rare it presents as a part of systemic miliary tuberculosis, abdominal tuberculosis, isolated gallbladder tuberculosis and as a calculus cholecystitis in anergic patients. There are no pathognomonic signs, the diagnosis depends on suspicion of tuberculosis, peroperative findings and histological examination.
Adult↗
In-situ irradiation of keloid scars with Nd:YAG laser.
In-situ coagulation of keloid with Nd:YAG laser irradiation was carried out in in a cohort study of 17 patients, each with one keloid scar situated on either the sternum (six), abdomen (seven), shoulder (two), hip (one), or ear lobe (one). The duration of scarring was three to 17 years and size varied from 3-8 cm long. One to two doses of laser irradiation was required for complete coagulation. At three months, 10 (58.8%) keloids had completely healed; but in seven (41.1%), 25-50% of residual keloid persisted. Intralesional triamcinolone injection, once in four patients and twice in three patients, produced complete resolution in all seven patients. At 18 months to five years follow-up, 14 patients remain keloid-free but in three keloid recurred and was re-treated with laser coagulation with complete resolution. The treatment was carried out as an outpatient procedure under local anaesthesia. There were no complications. The results of this initial study suggest that Nd:YAG laser irradiation coagulation is effective treatment for keloid scarring.
Adolescent↗
What causes cancer gallbladder?: a review.
Gallbladder cancer is a common malignancy of the biliary tract. It is the fifth common malignancy of the gastrointestinal tract in United States and third in Northern India. Despite such high prevalence, there is scanty published literature about this disease in indexed journals. Therefore, this article is intended to provide a brief overview of gallbladder cancer risk factors, based mainly on published evidence from analytical epidemiology and recent research findings of biologists and practising oncologists. Furthermore, an attempt has been made to establish an association between different causative factors and the occurrence of the disease.
Age Distribution↗
Prospective randomized controlled trial comparing Lichtenstein with modified Bassini repair of inguinal hernia.
We present a prospective randomized study of 80 patients with inguinal hernia who underwent either a modified Bassini repair (n = 38) or a Lichtenstein mesh repair (n = 42). Treatment groups were matched for age, side of hernia, type of hernia and ASA grade. There was no difference in the time taken to perform the two operations: the mean time taken to perform Lichtenstein repair was 26.8 min (range 12 to 49), Bassini repair taking a mean of 27.5 min (range 9 to 51), P = 0.76. There was, however, a difference between the operating times with respect to the type of hernia present, direct hernias being the fastest to repair. Pain scores were assessed by a visual analogue scale, and there was significantly less pain in the Lichtenstein group, P = 0.028. Despite this, there was no difference between the analgesic requirements of the two groups, P = 0.073. In order to assess rehabilitation, lengths of time not working and not driving were assessed. There was no difference in either measurement, P = 0.335 and 0.467 respectively. Patients were followed up a mean of 7 weeks post-operatively (range 1 to 13 weeks). There was no significant difference between the two procedures with regard to post-operative urinary complications, wound infection or other complications. All measurements except the time taken to perform the operation were independent of the surgeon involved. The accuracy of the clinical diagnosis was also assessed, and found to be moderate, with 63% of diagnoses being correct.
Adolescent↗
Postoperative intravenous drip infusion is not required after minilaparotomy cholecystectomy.
OBJECTIVE: To determine if drip infusion should be discontinued after full recovery of the patient from anaesthesia after minilaparotomy cholecystectomy in uncomplicated cases. DESIGN: A randomised controlled clinical trial on 60 patients, from the waiting list, of cholelithiasis/cholecystitis operated by minilaparotomy cholecystectomy between November 1995 to March 1996. 30 patients did not receive postoperative i.v. drip infusion and in 30 patients 12-24 hours of standard drip transfusion was continued according to the current practice. SETTING: Single Surgical Unit, SS Hospital, Banaras Hindu University, Varanasi, India. MAIN OUTCOME MEASURE: Recognition of clinical indication for continuation of i.v. drip infusion after full recovery from anaesthesia. RESULTS: In the cohorts of 30 patients each who were or were not given i.v. drip infusion after full recovery from anaesthesia following minilaparotomy cholecystectomy the observations on pulse rate, blood pressure, time to first voiding of urine and time to start first oral intake of fluids were identical. However postoperative urinary retention occurred in 6 (20%) patients in whom the IV drip infusion was given. CONCLUSION: There is no clinical indication to continue IV drip infusion after full recovery from anaesthesia in patients operated for minilaparotomy cholecystectomy.
Adult↗
Visiting registrars in surgery: the trainees' viewpoint.
Overseas Doctors have been coming for higher surgical training to the UK for many years. Little is known about the reasons they choose to come here, what their expectations are and if the training they receive fulfils these expectations and prepares them for a career back home. The aim of this study was to address these questions and to see what changes could be suggested to make training more meaningful to visiting registrars. Questionnaires were sent to 26 trainees who were part of the 3 year surgical registrar rotation in Wales from 1992. 23 completed questionnaires were available for analysis as the others were not traceable. 83% came to the UK to obtain the FRCS and train in a specific aspect of general surgery (74%). The period of training was felt to be inadequate by 79% of trainees. 65% felt that of the total period of training, less than 75% was useful. On return to their own countries 96% were to be either solely or largely responsible for patients in their care. In conclusion, if surgical training is to remain meaningful to visiting trainees, changes would have to be made to the Calman system to enable them to continue to do the FRCS and avenues made available for them to train in their stated areas of interest with adequate supervision, regular assessment and certification.
Attitude of Health Personnel↗
Keeping chewing tobacco in the cheek pouch overnight (night quid) increases risk of cheek carcinoma.
Chewing Chewable Indian Tobacco (CIT) is a popular addiction in India. Some of the addicts keep the bolus of chewed tobacco tucked in the gingivo-labial sulcus (cheek pouch) overnight. This is known as the habit of the night quid. To assess the influence of night quid on the development of oral cancer we carried out this case control observational study in the Out Patient Department of Surgery, Sir Sunder Lai Hospital, Varanasi, India. A total of 105 consecutive oral cancer patients (epidermoid carcinoma) and 71 sex- and age-matched CIT addicts of the same duration of addiction were investigated for the habit of the night quid. The habit increased the risk of development of cheek carcinoma significantly at Odd's Ratio of 12.5. Simply giving up the habit of night quid could help in the reduction of oral cancer in CIT addicts.
Adult↗
Familial childhood parathyroid adenoma.
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Adenoma↗
Fine needle aspiration cytology in the management of acute suppurative thyroiditis.
Acute suppurative thyroiditis (AST) is relatively uncommon. We report 11 such cases from a population residing in a goiter endemic zone of Northern India. The important contribution of fine needle aspiration cytology in confirming the diagnosis and management is emphasized.
Acute Disease↗
Role of rapid imprint cytology in the diagnosis of skin cancer and assessment of adequacy of excision.
Imprint cytotechnique was employed in 20 cases of maligant skin tumours (11 squamous cell carcinoma, 4 basal cell carcinoma and 5 malignant melanoma) to evaluate the reliability of the technique by comparing the results with histologic diagnosis. In ten cases margins of the excised tumours were also subjected to imprint and histopathologic studies to assess the clearance of malignancy. All the tumours were correctly diagnosed in imprint smears. Similarly 100% cytohistopathologic correlation was also obtained in the assessment of excisional margins of the tumours. The technique of imprint cytology may be employed for quick diagnosis of skin cancers and in assessment of clearance of surgical field during surgery.
Basal Cell Carcinoma↗
Acute abdominal complications of tuberculous psoas abscesses.
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Adult↗
Pre-cancerous lesions of stomach.
Total 39 cases of carcinoma stomach were noticed out of 142 malignant tumours of GIT (27.46 percent). Histologically maximum cases were of diffuse type (56.41 percent) followed by intestinal type (35.89 percent) and indolent mucoid carcinoma (7.69 percent) of the stomach. The surrounding epithelium showed lot of changes in the intestinal type of carcinoma stomach. About 78.57 percent showed intestinal metaplasia, 14.28 percent of these cases showed chronic gastric ulcer and severe dysplasia (carcinoma in situ) and another 14.28 percent revealed villous adenoma with carcinoma in situ. In contrast to this, in diffuse variety, only 13.63 percent cases revealed intestinal metaplasia, 27.27 percent showed basal cell hyperplasia, stratification of the epithelium of crypts and diffuse infiltration of mucosa by malignant cells and 4.54 percent showed atrophic gastritis also. In mucoid carcinoma all cases had basal cell hyperplasia and stratification of crypts. Hence these conditions should be taken as premalignant lesions of stomach and should be cured in proper time.
Adenocarcinoma, Mucinous↗