Biomedical subjects
K K Dhar
Publications and source records attributed to K K Dhar.
Association of glutathione S-transferase GSTM1 and GSTT1 null genotypes with clinical outcome in epithelial ovarian cancer.
Epithelial ovarian cancer is generally associated with a poor outcome, although the mechanisms that determine survival and progression-free interval (PFI) are unclear. Data from ovarian tumors showing associations between (a) null genotypes at the glutathione S-transferase GSTM1 and GSTT1 loci and expression of p53 protein and (b) outcome and expression of p53 suggest that polymorphism at these loci is a factor determining outcome. Accordingly, we have studied the association between the GSTM1 null and GSTT1 null genotypes and survival and PFI in 148 women with epithelial ovarian cancer. Although we did not find an association between individual genotypes and outcome, women with both GSTM1 null and GSTT1 null genotypes demonstrated poorer survival (P = 0.001) and reduced PFI (P = 0.003). Thus, no cases with both these genotypes survived past 42 months postdiagnosis. In contrast, 43% of the women without this combination survived beyond this time. Because response to chemotherapy is a major factor determining outcome in ovarian cancer, we also examined the data for associations between the glutathione S-transferase genotypes and response to such treatment. Thus, in 78 patients treated with chemotherapy, the combination of GSTM1 null and GSTT1 null was associated with unresponsiveness to primary chemotherapy (P = 0.004); none of the eight patients with both these genotypes responded, compared with 38 of 70 (54%) of patients with other genotype combinations. The effect of the combination of genotypes on survival and PFI was lost in a multivariate model that included response to chemotherapy as a confounding factor. This suggests that the combination of GSTM1 null/GSTT1 null is associated with outcome because of its influence on response to chemotherapy. These preliminary findings may provide a basis for the selection of patients for treatment with chemotherapeutic agents.
Significance of nuchal cord.
Perinatal events of 180 babies with nuchal cord (umbilical cord entanglement around foetal neck) over one year have been studied. The incidence of nuchal cord was 5.74% of all hospital deliveries. More than one third (39%) of them had tight nuchal cord (TNC) and 61% had loose nuchal cord (LNC). Babies with TNC were more frequently met with foetal distress (51%), prolonged second stage (11%), non-toxaemic accidental haemorrhage (7%) and operative delivery (56%) when compared to babies with LNC and controls (without nuchal cord). Nearly one fourth (24%) of the babies with TNC were born as small for date, had birth asphyxia (61%) and 8.5% died during perinatal period. Perinatal outcome was adversely affected by TNC in comparison to LNC and controls.
Leiomyosarcoma of the labium minus.
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Cytologic evaluation of nipple discharge in relation to mammary neoplasia.
Spontaneous nipple discharge as a presenting symptom was seen in 80 patients out of 3500 patients referred for cytologic examination of breast during last 5 years. Gross appearance of nipple discharge was bloody (33), serous (29), milky (16) and yellowish (2). Cytology smears showed 5 cases of carcinoma and 14 cases of intraductal papilloma. One out of two cases of male nipple discharge revealed malignant cells. Bloody nipple discharge was more often associated with carcinoma and intraductal papilloma. Hence it underscored the importance of cytologic evaluation of bloody nipple discharge.
Hydatid cyst causing obstructed labor.
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Single dose tinidazole prophylaxis in vaginal hysterectomy.
OBJECTIVE: To determine the efficacy and side effects of a single dose of tinidazole for infection following vaginal hysterectomy. METHOD: A randomized double-blind placebo-controlled trial using 2 g tinidazole 12 h before vaginal hysterectomy in 50 patients was conducted. No other antibiotic was used until the development of infection. RESULT: There was a significant reduction (P < 0.01) of post-operative vaginal cuff cellulitis (54-16%). A similar reduction (P < 0.05) in febrile morbidity was also observed. The duration of postoperative hospital stay (P < 0.001) and use of additional antibiotics (P < 0.01) were also reduced. No adverse effect of tinidazole was noted. CONCLUSION: A single dose of tinidazole appears to be a safe and effective alternative prevention against infection in vaginal hysterectomy.
Tinidazole prophylaxis in elective abdominal hysterectomy.
OBJECTIVE: To determine whether a single dose (2 g) of tinidazole before abdominal hysterectomy could reduce the incidence of postoperative infection. METHOD: A randomized double-blind placebo-controlled study was undertaken with a single oral dose (2 g) of tinidazole, 12 h before surgery, in 100 patients undergoing abdominal hysterectomy for various benign diseases. Other antibiotic use was withheld until there was no postoperative infection. RESULT: A significant reduction (P < 0.05) of infectious morbidity (28% vs. 8%) as well as a decrease in additional antibiotic use (P < 0.01) and duration of hospital stay (P < 0.001) was observed. Febrile morbidity was also reduced from 36% to 14% (P < 0.05). Tinidazole was tolerated well by all the patients. CONCLUSION: Tinidazole prophylaxis (2 g oral dose) is considered to be a simple, safe and effective way to reduce postoperative infection in abdominal hysterectomy.
Induction of labour in pregnancy complicated by cardiac disease.
Twenty one pregnant patients with cardiac disease had induction of labour for various obstetric reasons with a modified oxytocin infusion method. All of them went into labour and delivered within 20 hours. Twenty patients delivered vaginally. Three neonates had birth asphyxia (Apgar score < 7) and 1 of them died on the 4th day from prematurity. No adverse effect of oxytocin infusion on maternal cardiac status was observed and all of the women went home in good condition. Induction of labour with a modified oxytocin infusion is a safe and effective alternative for selected gravidas with cardiac disease where elective delivery is warranted.
Nonobstetric lower genital tract trauma.
In a 4-year-period there were 31 admissions to Nehru Hospital, because of nonobstetric injuries of the female genital tract. This constituted 0.8% of all gynaecological admissions over this period. The injuries were caused by voluntary coitus, automobile accidents and various types of astride injuries. Seven of the 18 patients with noncoital injuries presented with vulval haematomas and all were managed by evacuation under general anaesthesia. Two of the 13 patients with coital injury were admitted with haemorrhagic shock and required initial resuscitation with blood transfusion. The vaginal vault, especially the right and posterior fornices were the frequent sites of coital injury for parous women; on the other hand lower vaginal and introital injuries were caused by first acts of coitus. Except for trivial superficial lacerations with minimal bleeding, primary definitive surgical repair other than vaginal packing was favoured for better healing and to reduce morbidity.
Prevalence of HBsAg in visceral leishmaniasis (kala-azar)
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Fine needle aspiration biopsy in gynecologic malignancies. Recurrent and metastatic lesions.
This study evaluated the efficacy of fine needle aspiration biopsy (FNAB) in 80 suspected cases of recurrent and metastatic gynecologic malignancies. RNAB was performed at 90 sites in 80 patients; 42 of the sites were deep seated. The cytologic diagnosis correlated well with either histology (7 cases) or clinical follow-up. FNAB diagnosis of deep-seated lesions precluded exploratory laparotomy, and further therapy was administered accordingly. Thus, FNAB in gynecologic malignancies was safe, reliable and cost effective.