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Biomedical subjects

K A Pathak

Publications and source records attributed to K A Pathak.

15 recordsLinked to original sources
PubMed2006

Split therapy: planned neck dissection followed by definitive radiotherapy for a T1, T2 pharyngolaryngeal primary cancer with operable N2, N3 nodal metastases--a prospective study.

BACKGROUND: The management of patients with a small pharyngolaryngeal cancer (T1 and T2) with large nodal metastases is a subject of debate. We present data on the feasibility and outcome of treating these patients with surgery for the nodal metastases followed by definitive radiotherapy. METHODS: Prospective study of 59 patients of small pharyngolaryngeal primary squamous carcinomas with operable (N2/N3) nodal metastasis treated with neck dissection followed by radiotherapy. RESULTS: Complete nodal clearance was achieved in 54 (90%). The mean nodal size was 4 cm and extranodal extension was seen in 88% of patients in the study group. There were no significant postoperative complications. Median interval between surgery and radiotherapy was 23 days. Forty-nine patients (83%) started their RT within 6 weeks of surgery. With a median follow-up of 25 months, the disease free and overall survival was 54% and 60% (5 years). CONCLUSION: The management of patients with a radiocurable pharyngolaryngeal primary with large nodes by this approach is a feasible option with adequate control and survival.

Adult↗
PubMed2005

Simultaneous reconstruction of large skin and mucosal defect following head and neck surgery with a single skin paddle pectoralis major myocutaneous flap.

The pectoralis major myocutaneous (PMMC) flap is commonly used for head and neck reconstruction especially in impoverished nations. PMMC is a sturdy pedicled flap with relatively fewer complications, the learning curve is short and no specialized training in microvascular surgery is needed in order to use this flap. In a defect that requires a large skin and mucosal lining the authors routinely use either a bi-paddle PMMC or a combination of PMMC (for the mucosal lining) and a delto-pectoral flap (for the skin defect). It is indisputable that free tissue transfer is a better way of reconstruction for the majority of most such defects. Unfortunately, not all patients can be offered this form of reconstruction due to the cost, time, expertise and infrastructural constraints in high volume centres such as ours. Bi-paddling of PMMC is hazardous in obese males and most female patients. In such patients the skin defect is reconstructed usually by the delto-pectoral (DP) flap but this, for obvious reasons, is less welcomed by the patients. The authors suggest a technique wherein mucosal lining is created by the myofascial lining (inner surface) of the flap and the skin defect is reconstructed by the skin paddle of the single paddle PMMC. It should be considered wherever a DP flap is unacceptable, or bi-paddling or free tissue transfer is not possible.

Female↗
PubMed2004

Marginal mandibulectomy for lateral sulcus tumours.

OBJECTIVE: To report a retrospective series of marginal mandibulectomy for cancers of oral cavity, with special reference to squamous cancers of gingival buccal complex. METHODS: Retrospective record review of 107 patients who underwent marginal mandibulectomy between 1994 and 2001. RESULTS: Eighty-three marginal mandibulectomies were done for gingivo-buccal complex cancers. Local failure rate was 16%. The 2-year and 5-year disease free survival rates were 69 and 60%, respectively. The local recurrence free survival at the end of 2 and 5 years were 79 and 70%, respectively. CONCLUSION: In carefully selected patients, marginal mandibulectomy is an oncologically safe procedure to achieve good local control.

Carcinoma, Squamous Cell↗
PubMed2004

Upfront submandibular salivary gland transfer in pharyngeal cancers.

Head and neck irradiation results in salivary dysfunction and subsequent xerostomia. Twenty two patients with squamous cancer of oropharynx or hypopharynx underwent contralateral submandibular salivary gland transfer (SMSGT) to submental triangle to shield it from subsequent radiotherapy. Resting salivary outputs of transferred and untransferred gland (control) were measured before and after SMSGT and following radiotherapy, by cannulating individual submandibular duct. They were compared by paired samples t-test. Following radiation therapy transferred gland retained 73% and untransferred gland (control) retained 27% of baseline salivary output. This significant difference in post-radiation salivary outputs suggests preservation of function of transferred salivary gland.

Carcinoma, Squamous Cell↗
PubMed2004

Two- vs three-drug combination chemotherapy in advanced or recurrent head and neck cancer: a single institution experience of 361 patients.

Head and neck squamous cancer is a major concern in India. The proportion of advanced cases is significantly high, and these patients have dismal survival prospects despite aggressive therapy. Often surgical resection and/or radiotherapy are not feasible in these patients. Hence, we decided to explore the option of neoadjuvant chemotherapy using effective agents like ifosfamide and paclitaxel in combination with cisplatin in these patients. A total of 361 patients were evaluable at the end of study. Of these, 207 had received ifosfamide and cisplatin and 154 had received taxanes (paclitaxel or docetaxel) in addition to ifosfamide and cisplatin. The ifosfamide-cisplatin group had an overall response rate of 66.67% (CR, 16.42%; PR, 50.24%) and the median duration of response was 5.5 mo; whereas the group in which taxanes were added, showed an overall response rate of 73.37% (CR, 7.79%; PR, 65.58%) with a median duration of response of 10 mo. The toxicity in both the groups was acceptable and there was no mortality. We conclude that taxane-based combinations have a significant activity in advanced head and neck squamous cancer and warrant further studies.

Adolescent↗
PubMed2003

Transventricular paraganglioma of the larynx.

Laryngeal paragangliomas are rare neuroendocrine tumours. Most laryngeal paragangliomas are supraglottic in location, with only 3% reported to be glottic in location. We present a rare case of transventricular paraganglioma with fixation of the hemilarynx that presented a diagnostic and therapeutic challenge.

Female↗
PubMed2003

Neoadjuvant chemotherapy with ifosfamide and cisplatin combination in advanced head and neck cancer: a retrospective analysis of 519 patients: a single institution experience.

Advanced head and neck cancer is a major therapeutic problem in India. Ifosfamide has shown significant activity as a single agent in head and neck squamous carcinoma. In this study, we present our experience with two cycles of ifosfamide and cisplatin in the neoadjuvant setting given to a total of 519 patients. The complete response rate was 20% and the overall response rate was 80%. The treatment was well tolerated, there was no need for dose reduction, and there were no life-threatening side effects. We feel that this high response rate is sufficient to warrant more studies using ifosfamide-based combinations in a neoadjuvant setting for squamous carcinoma of the head and neck.

Adolescent↗
PubMed1999

Lateral thyrotomy for neurilemmoma of the larynx.

We present a rare case of neurilemmoma of the larynx, which was excised through a lateral thyrotomy approach with resulting restoration of laryngeal function. The advantage of the lateral thyrotomy approach for submucous tumours of the larynx is discussed.

Humans↗
PubMed1997

Penile tourniquet: an invaluable technique.

In 72 cases of minor penile surgeries, including circumcision (42), meatotomy (18), meatoplasty (8) and chordee correction (4), a ring cut from a surgical glove finger was used as a tourniquet at the base of the penis after infiltrating the skin and the glans with plain 1% xylocaine. The usual surgical procedures were performed and the tourniquet was released after securing the probable bleeding points. The postoperative results were excellent, with oedema of the penis being the only complication. There was no incidence of skin necrosis, sensory impairment, wound infection, erectile dysfunction or postoperative oozing. This bloodless technique not only curtailed the operating time and made the procedure simpler, but it also prevented the washout of xylocaine by impeding venous drainage.

Adult↗
PubMedDate not supplied

Situs inversus with cholelithiasis.

Situs inversus totalis is a form of heterotaxia which is usually detected accidentally while investigating for any associated condition. If undetected, this condition can create a diagnostic puzzle. We report one such case in which situs inversus was associated with cholelithiasis.

Adult↗
PubMedDate not supplied

Mesenteric fibromatosis: a report of three cases and literature review.

Fibromatosis is a group of relatively uncommon benign diseases showing proliferation of fibrous tissues and is liable to be confused with fibrosarcoma, thereby causing diagnostic as well as therapeutic dilemmas. Even after the correct diagnosis is made, one is not sure about the most effective treatment is in a given setting. Surgery seems to provide the best results but is not feasible at many times due to the extent of the disease, hence the need for non-surgical modalities for unresectable and incompletely resected tumors. Mesenteric fibromatosis is one of the rarer forms of fibromatosis. Three such cases are being presented here with a brief review of the literature.

Adolescent↗
PubMedDate not supplied

Quality of life of head and neck cancer patient: validation of the European organization for research and treatment of cancer QLQ-C30 and European organization for research and treatment of cancer QLQ-H&N 35 in Indian patients.

AIMS: To present the first cross-culture validation of the European organization for research and treatment of cancer (EORTC) quality of life questionnaires, the EORTC-QLQ-C30, and the QLQ-H&N 35 in India. SETTINGS AND DESIGN: These questionnaires were translated into two vernacular languages and pilot test was done on 15 patients. Two hundred head and neck cancer patients completed the QLQ-C30 and the QLQ-H&N 35 at two time points during their treatment. Psychometric evaluation of the structure, reliability, and validity of the questionnaire was undertaken. RESULTS: The data supports the reliability of the scales. Validity was tested by item-scale, scale--scale correlation and by performing known group comparisons. The results demonstrated that the items correlated with their respective scale and no significant correlation was found between scales. The questionnaire was responsive to change over a period of time. SUMMARY: This data suggests that the EORTC QLO-C30 and the QLQ-H&N 35 are reliable and valid questionnaires when applied to a sample of head and neck cancer patients in India.

Combined Modality Therapy↗
PubMedDate not supplied

Carcinoembryonic antigen: an invaluable marker for advanced breast cancer.

Serial serum Carcinoembryonic antigen (CEA) levels were measured in 150 individuals (50 patients with breast cancer, 50 benign breast diseases and 50 other controls). These levels were correlated with clinicopathological parameters and follow-up information. Serum CEA levels were independent of the primary tumor status, their histology, lymphoreticular response and the patients' characteristics as well as the age, sex and the menstrual status. However, the nodal status, number of involved nodes and the grade of the tumors had significant influence on the level of serum CEA. Breast cancer patients especially those with metastasis had significantly higher serum CEA levels as compared to the controls and those with localised disease, irrespective of the site of metastasis. These levels were lowered appreciably by the disease regression and were raised or stable during the disease progression. Receiver operating characteristic (ROC) curve showed metastasis to be more frequent in patients with pretreatment serum CEA levels above 25 ng/ml and persistent post treatment CEA levels above 15 ng/ml. Serum CEA level was found to be a valuable prognostic indicator for advanced breast cancer and serial serum CEA levels provided an average lead time of about 3.9 months before the clinical appearance of metastasis.

Adult↗