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Biomedical subjects

R K Deshpande

Publications and source records attributed to R K Deshpande.

11 recordsLinked to original sources
PubMed1992

Dermatofibrosarcoma protuberans metastatic to the lung. A case report.

A case is presented of dermatofibrosarcoma protuberans of the gluteal region with metastasis to the lung appearing 7 years after wide excision of the primary lesion. The world literature is reviewed. The clinical and pathologic features of dermatofibrosarcoma are reviewed and treatment is discussed, with the aim of emphasizing the need for long-term follow-up examination of lymph nodes and for metastases following wide excision of these lesions.

Adult↗
PubMed1992

Cancer of the esophagus: esophagogastric anastomotic leak--a retrospective study of predisposing factors.

An esophagogastric anastomotic leak, especially in the mediastinum or the chest, is a life-threatening complication of surgery for cancer of the esophagus. Of 617 patients who underwent esophageal resection and esophagogastric anastomosis between January 1980 and December 1989, 39 (6.32%) had anastomotic leakage; of these, 25 (64.10%) died. Various biologic parameters, operative techniques, and the management of leaks were analysed. Albumin concentration below 3 gm/dL (chi 2 = 3.9; P = 0.047), neoplastic permeation of the anastomotic cut margin (chi 2 = 4.7; P = 0.04), and cervical anastomosis (chi 2 = 12.32; P = 0.0004) were associated with a higher incidence of anastomotic leakage. Hemoglobin level, type of suture material used for the anastomosis, preoperative radiotherapy, and the experience of the operating surgeon under supervision were found to be statistically insignificant factors and did not influence anastomotic leakage. Mortality due to leak in the first postoperative week was 85% and was statistically significant as compared to the mortality occurring in the second postoperative week (chi 2 = 6.04; P = 0.013). Surgical or conservative management of the leak did not influence mortality (chi 2 = 1.2; P = 0.27). The salvage rates for cervical and intrathoracic anastomotic leakage were 80% and 29.4%, respectively. This difference is statistically significant (chi 2 = 29; P = 0.088).

Anastomosis, Surgical↗
PubMed1992

Cancer of the esophagus in young adults.

Clinicopathological features and survival data of squamous cell carcinoma of the esophagus were analyzed from the viewpoint of age differences in 453 patients treated at the Tata Memorial Hospital, Bombay, India. Two groups were studied: group A, aged 35 years or less; and group B, aged above 35 years. There was no significant difference among the two groups with regard to sex distribution, site and length of the tumor, operability, morphology, histological grade, vascular and lymphatic invasion, and lymph node metastasis. The primary lesion was more advanced and the rate of incomplete resections was higher in younger patients. The incidence of cardiopulmonary complications and postoperative deaths was significantly lower in younger patients. Recurrence of the disease following complete resection was more frequent in the younger age group (chi 2 = 2.61; P = .1063), although the pattern of recurrence remained the same in both groups. Disease-free survival in younger patients following complete resection of the tumor was poorer as compared to the older patients, but the difference is statistically not significant (chi 2 = 1.882; P = .1701). These findings suggest either a delayed diagnosis or a biologically sinister disease in the younger group; further studies of the two groups vis-a-vis their biologic parameters (DNA ploidy, etc.) are in progress and will form the subject of another communication.

Adult↗
PubMed1992

Long-term right atrial catheters in patients with malignancies: an Indian experience.

Ninety-eight single lumen and two double lumen silicone right atrial Hickman/Broviac catheters inserted in 91 patients with various malignancies over a period of 36 months were prospectively studied. The average duration of use for all Hickman/Broviac catheters was 7,460 days with an average of 74.6 days. A total of 41 episodes of catheter-related infections were documented in all patients (0.5 per 100 access days). Catheter related bacteremia was the most frequent type of infection (31 out of 41, 75%). Majority of the bacteremias could be controlled with routine antimicrobial therapy. Exit site infections were seen in 5 Hickman/Broviac catheters. Two catheters had to be removed because of catheter tunnel infections. Gram negative bacteremic infections were the most common, with Pseudomonas aeruginosa being the major pathogen. Silicone rubber Hickman/Broviac catheters proved to be convenient, reliable, and easily manageable devices in our experience.

Adolescent↗
PubMed1992

Choroidal metastasis from primary adenocarcinoma of the esophagus--a case report.

Primary adenocarcinoma of the esophagus is uncommon and the incidence in the middle third is rare, accounting for about 0.7 percent to 1.5 percent. Metastasis of carcinoma to the eye is a rare occurrence. We report here a case of primary adenocarcinoma of the middle third of the esophagus with choroidal metastasis.

Adenocarcinoma↗
PubMed1992

Indigenous silicone rubber endoprosthesis for malignant esophago-pulmonary fistula.

Endoscopic placement of an esophageal endoprosthesis is the most rational therapy for relieving the distress of malignant esophago-pulmonary fistula. The commercial prostheses are very expensive for widespread use in India. We have indigenously prepared silicone rubber endoprostheses. The wall of the prosthesis was hardened in a graded manner until the desired resistance to compression with flexibility is achieved. This prosthesis was placed successfully in five patients with malignant esophago-pulmonary fistula. Dysphagia and aspiration were relieved in all the patients. One patient had delayed esophageal perforation and died of massive bleeding 3 weeks after the placement of prosthesis. The indigenous endoprosthesis is cost-effective and safe.

Adult↗
PubMed1991

Epiphrenic diverticulum of the esophagus.

Esophageal diverticula are rarely found at the terminal portion, where they are called supradiaphragmatic or epiphrenic diverticula and occur in association with motility disorders of the terminal esophagus. We present here two cases of epiphrenic esophageal diverticulum, one of which was treated surgically.

Aged↗
PubMed1991

Giant gall bladder diverticulum.

Diverticula of the gall bladder are very rare. We present here a patient with a giant diverticulum of the gall bladder with features of cholecystitis and cholelithiasis.

Cholecystectomy↗
PubMed1989

Current status of surgical treatment of cancer of the esophagus.

Treatment modalities for cancer of the esophagus continue to encourage a healthy debate amongst surgeons, radiotherapists, and chemotherapists. This is because overall results by current treatment methods are generally unsatisfactory, though an all-round steady gain is now being reported by many authors. With increasing sophistication in radiotherapy techniques (external and intracavitary) and more effective combination chemotherapy, it is likely that surgical treatment of this cancer may be reexamined. There is little doubt, however, that despite the advent of radiotherapy and chemotherapy, surgery is still the most important treatment method in providing lasting relief of dysphagia and maximum survival. While increasingly low surgical mortality and a high cure rate are now being reported, the type and extent of surgery are still contentious issues. Alternatives ranging from a very radical excision (monobloc total esophagectomy with mediastinal dissection) to a blunt transhiatal esophagectomy are now being advocated. Radiotherapists and chemotherapists are now investigating the feasibility of a nonsurgical treatment for cancer of the esophagus.

Combined Modality Therapy↗
PubMed1989

Combined treatment modalities in esophageal cancer.

Esophageal cancer has been conventionally treated with surgery and radiotherapy for many years. The overall results for all cancers are poor because the majority of patients present late for therapy. The advent of increasingly effective chemotherapeutic drugs--used as single agents and in combination--for squamous cancer has added one more modality in the management of esophageal cancer. Previous publications from this institution and in the literature have indicated the palliative efficacy of such chemotherapy management along with surgery and radiotherapy, particularly for advanced disease. The selection of an individual patient likely to respond to chemotherapy, the number of cycles to be given, and their exact timing in relation to radiotherapy and/or surgery still remains a matter of debate. With appropriate endoscopic and imaging techniques, chemotherapy responsive and non-responsive lesions can be generally identified; even radiotherapy responses can be predicted with appropriate evaluation in a majority of cases. This assessment avoids delay in instituting the most appropriate type of treatment for a given patient with esophageal cancer. Cisplatinum-based front-loading (anterior) chemotherapy was used in 75 patients of locally advanced esophageal cancer (greater than 7.5 cm on esophagogram) with a 76% (57/75) overall response rate and 10% (8/75) showing complete responses as judged by esophagogram, endoscopy; and surgical resection in 7. Patients evaluable for 2- and 3-year survivals show a control rate of 35% and 24%, respectively, which is better than hitherto reported for advanced esophageal cancer. Similar reports are now available in the literature, and further studies with combined therapy should be pursued to improve the salvage rates in the usual advanced case of esophageal cancer.

Antineoplastic Combined Chemotherapy Protocols↗