Biomedical subjects
Publications and source records attributed to P P Kumar.
The presenting symptoms of 167 patients with carcinoma of the rectum, sigmoid, and rectosigmoid were reviewed. The earliest symptom was a change in bowel habits and the most frequent symptom was visible blood in the stool followed by a change in bowel habits. The duration of symptoms was not related to survival or the stage of tumor found during surgery.
Since 1979 more than 50 transperineal interstitial implants, both removable and permanent, have been performed at the University of Nebraska Medical Center. The "C" arm of the mobile image-intensifier television unit Siemens Mobile 2 was used to guide the placement of the needles and was found to be useful in achieving accurate implantation.
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Although Iodine-125 seeds for interstitial radiation of prostatic cancer via the retropubic route is an established method of treatment, the retropubic implant technique has disadvantages: inadequate space for proper placement of the needles, possible bleeding from the prostatic venous plexus by the insertion of needles through these veins, and possible wound infection due to inadvertent puncturing of the bladder and/or rectum by the needles. A technique is described whereby Iodine-125 seeds for interstitial radiation are placed into the prostate through the perineum allowing more accurate placement of the seeds, assuring homogenous dose distribution, and decreasing the risk of bleeding and of bacterial contamination.
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Retropubic I-125 implantation of the prostate at the time of suprapubic extraperitoneal pelvic lymphadenectomy is a well-established method of treatment for stages B(2) and early C prostatic cancer. However, there are some technical disadvantages with the retropubic I-125 implant technique, such as inadequate space for proper placement of the needles; bleeding, uncontrollable at times, from the periprostatic venous plexus secondary to insertion of needles into the prostate; and superficial wound infection due to inadvertent puncturing of the bladder and/or rectum by the needles. In this paper the authors describe a new technique which eliminates the technical problems associated with retropubic I-125 implantation of the prostate.
Metastatic carcinoma of the penis is distinctly uncommon and in 80 percent of cases is associated with primary malignancy of the pelvic organs with widespread metastases. Pain and priapism are the most common symptoms at the time of the diagnosis. Both cases presented in this paper responded well to local irradiation, subjectively as well as objectively.
The absence of radiation induced cardiac damage during the orthovoltage era, during which period much lower doses of radiation were delivered for mediastinal malignancies due to severe skin reactions, was misinterpreted as cardiac radioresistance. However, with the advent of supervoltage x-rays with skin sparing effect, much higher doses of irradiation have been given for mediastinal malignancies. This has resulted in higher doses of radiation to the heart resulting in various types of radiation induced cardiac damage. The most common site of damage is to the pericardium, resulting in pericardial effusion. The radiographic evidence of radiation induced pericardial effusion starts one to six months prior to signs and symptoms due to it. Most of the asymptomatic radiation induced pericardial effusions resolve spontaneously. The factors which appear to play a role in the development of radiation induced pericardial effusion are discussed.
Two patients who were treated with therapeutic doses of ionizing radiation for primary carcinoma of the thyroid and cervix developed a second malignancy in the organs included in the field of radiation 10 and 14 years later, respectively. These two patients, whose second malignancies meet all of the criteria to be classified as radiation induced cancer, are presented.
Since October 1975, 41 cancer patients were treated with a remote afterloading device using fractionated high dose-rate intracavitary radiation. Nineteen of these 41 patients were treated for carcinoma of the cervix. Remote afterloading high dose-rate fractionated intracavitary radiation was given in combination with external irradiation. The dose fractionation and rad equivalent therapeutic (RET) values and various points of interest are discussed.
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To a cancer patient, pain is a very distressing symptom and to the physician it heralds advanced nature of the disease. While the mechanisms of initiation of pain are simple, its perception is very complex. In cancer, the tumor growth which results in producing pressure, destruction of tissue, and obstruction is the main cause of pain production. Ionizing radiation, which checks tumor growth and shrinks the tumor most of the time, plays a major role in relieving pain in a cancer patient.
The mortality from carcinoma of the esophagus in the non-white male population of the metropolitan Washington, DC, area is probably the highest in the United States. Data from the National Center for Health Statistics indicates a mortality figure of 27.9/100,000 for the period 1969-1971.(1) Between 1971 and 1976, 114 patients were seen at Howard University Hospital with the diagnosis of carcinoma of the esophagus, of which only 48 were suitable for definitive therapy. All patients were black. The male/female ratio was 4 to 1. Postoperative irradiation appeared to confer benefit on surgically respected patients. In this selected group of patients, treatment had little influence on the natural history of the disease and the adjusted direct five-year survival was 2.1 percent.(*)
The superior vena cava syndrome is among the most important radiotherapeutic emergencies currently known. It is almost always due to malignant disease and therefore no time should be wasted in establishing the histological diagnosis of the malignant tumor which causes the superior vena cava obstruction. The conventional slow, low-dose irradiation is a safe method of treatment. High-dose irradiation in this condition might further compromise the respiratory distress already present thus leading to sudden death.
Low megavoltage electrons, because of their limited penetration, have been found very useful in the treatment of generalized superficial malignancies. However, because of the complexity of the human body contour, it is extremely difficult to achieve uniform dose distribution over the entire body surface. To achieve this, various techniques ranging from two to six fields have been used. In this paper, we discuss the disadvantages of these techniques and describe a new technique, "the rotation technique," which is superior.