Randomized controlled trials in plastic surgery.
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Evidence-Based Medicine↗
Biomedical subjects
Nasir Ali
Publications and source records attributed to Nasir Ali.
Skin metastasis from prostate adenocarcinoma.
We are presenting an interesting case of skin metastasis from adenocarcinoma prostate. Interestingly bone metastasis were absent as documented on radioisotope bone scan and PSA levels were normal. As it was a hormone refractory disease, he was started on mitoxantrone and prednisolone chemotherapy. Lung metastatis appeared after 2 cycles of chemotherapy. He died of progressive disease 4 months later.
Adenocarcinoma↗
Parotid sparing irradiation for the head and neck cancers.
Several authors have shown that xerostomia restricts nutritional intake and limits the ability of patients to maintain normal weight. When both parotids are irradiated, patients never fully regain their normal weight, however if one parotid is irradiated the patients are able to fully recover their weight with in the year. There are certain sites in the head and neck where small and lateralized cancers with diminished risk of contralateral neck metastases can be treated with parotid sparing techniques, i.e., oral cavity, retromolar trigone, anterior tonsillar pillar, tonsillar fossa, and true vocal cord. In these sites it is appropriate to spare the opposite parotid and closely observe the un-irradiated neck. Based on Dr. O' Sullivans long term follow up of patients with cancers of the oral cavity and tonsil, we are encouraged that patients can be irradiated with homo-lateral parotid techniques with out jeopardizing loco-regional control. Hazuka et al and Maesa et al suggested that three dimensional treatment planning may allow the use of parotid sparing techniques in patients who otherwise would not have been considered candidates using conventional radiotherapy techniques.
Head and Neck Neoplasms↗
Resectability rates in locally advanced esophageal carcinoma following neo-adjuvant chemoradiotherapy.
BACKGROUND: Purpose of this study was to assess the resectability rates in un-resectable (Stages III and IV) cancers of the esophagus, to assess the complete pathological response and to compare the efficacy between two chemotherapy regimens. METHODS: From January 1999 to June 2002, medical records of the patients with un-resectable esophageal cancers were reviewed, who received radiation-therapy with concomitant chemotherapy using following regimens:- Arm A:- 5 FU 500 mg/m2 intravenous push (IVP) on first 5 and last 5 days of radiation. Arm B:- 5 FU 1 Gm/m2/Day 96 hour continuous infusion (CIV) and Cisplatin 70 mg/m2 on day one and twenty eight of radiation. At completion of neoadjuvant chemoradiation patients were offered surgery after four to six weeks. RESULTS: 35 patients had unresectable esophageal cancer. Twenty-six received arm A, and 9 arm B treatment. Of 26 patients in arm A, in 13 the disease was made resectable and two of them showed complete pathological response in surgical specimen, thirteen had progressive disease. On the other hand, of 9 patients receiving arm B treatment, in 7 the disease was made resectable and out of them 5 showed complete pathological response in surgical specimen and two had progressive disease. CONCLUSION: Resectability in patients receiving arm B treatment was better than the patients treated arm A. The data is not mature enough to assess the effect on disease free survival or overall survival, this will be seen and published later.
Adenocarcinoma↗
Neoadjuvant chemo-irradiation in un-resectable carcinoma of rectum.
BACKGROUND: Rectal cancer is one of the most frequent gastrointestinal cancers. Conventionally surgery is the mainstay of treatment, however after surgery alone, local recurrence is high especially in locally advanced rectal cancer, i.e. tethered and fixed rectal cancer. This study was conducted to determine the role of neo-adjuvant (pre-operative) chemoirradiation in locally advanced carcinoma of the rectum to improve resectability, local control and survival. METHODS: Study was conducted in Radiation Oncology department of Shaukat Khanum Memorial Cancer Hospital and Research Center from May 97-Oct 99. Thirteen patients with unresectable/locally advanced adenocarcinoma rectum received neo-adjuvant chemoirradiation, 50 Gray to pelvis by box technique on Cobalt-60 machine with concomitant 5-Flurouracil 500 mg/m2 for first three and last three days followed by abdomino-perineal/low anterior resection. RESULTS: Neo-adjuvant chemoirradiation resulted in resectability rate of 92% and clinical down staging in 11/13 (84%) patients and pathological complete response in 2/13 (15%) patients and a local recurrence rate of 2/13 (15.38%). Non hematological toxicity (diarrhea grade 4--15%, erythema grade 3--23%, dysuria grade 1-2--38%) were main problems observed during neo-adjuvant chemoirradition. CONCLUSION: Concomitant preoperative chemoirradiation for locally advanced rectal cancer is associated with considerable clinical and pathological down staging. Tumor resectability is improved with potential for improved local control and is relatively safe with acceptable morbidity.
Adenocarcinoma↗
An index of depression in patients with chronic nonspecific musculoskeletal pain.
BACKGROUND: The present study was undertaken to derive an index of depression in patients with chronic non-specific musculoskeletal pain and to determine correlation between these two parameters. METHOD: The study was carried out at the Shaikh Zayed Hospital Lahore from November 2001 to May 2002 and included 36 patients with pain for at least 4-24 weeks duration; an equal number of healthy people acted as controls. Depression was assessed among subjects by administering the General Health Questionnaire (GHQ) to patients and controls and obtaining their GHQ scores. Pain assessment was performed in patients by scoring the total number of pain sites on digital palpation to provide a Total Pain Score (TPS). RESULTS: Patients differed significantly from controls in their GHQ scores (patients 20.47 +/- 7.19, controls 3.11 +/- 1.89 respectively, p<0.001). The GHQ score and the TPS score correlated significantly in patients (r=0.517, p=0.001). CONCLUSIONS: Patients with chronic non-specific musculoskeletal pain suffer from significant levels of depression, in direct correlation to their pain.
Adult↗