Outcome following radical cystectomy and bladder-preservation therapy in patients with invasive carcinoma of urinary bladder

Background:

Invasive bladder cancer is a lethal disease with a 50% cancer-related mortality even in the best healthcare systems. Optimum combination of surgery, external beam radiotherapy and platinum-based chemotherapy has yet to be determined.

Purpose:

To audit the outcome of multi-modality treatment and compare this with the existing literature in order to set future priorities and re-audit in patients with invasive carcinoma of urinary bladder.

Materials and Methods:

Between January 2001 and December 2004, 97 patients with invasive carcinoma of urinary bladder were analyzed. Radical surgery was done in 18(18%) patients and adjuvant radiation was given to 20(21%) patients. Radical radiation alone, (≥50 Gy) was given to 26(27%) and chemoradiation to 33(34%) patients respectively. Patients in the chemoradiation arm were given the same dose of radiation with weekly concomitant cisplatin at 40 mg/ m² one hour before radiation during the first phase only. At a median follow-up of 32 months the outcome studied included locoregional failure, distant failure, disease-free survival (DFS) and overall survival (OS) using univariate and multivariate analyses. The OS and DFS were calculated according to Kaplan-Meier. Log rank test was used for statistical significance.

Results:

Median age of the patients was 58 years. Males comprised 93% of the total patients. Most (93%) of the patients had transitional cell histology. In patients treated with radiation alone overall response rate was 60%, with a complete response (CR) rate of 42%. The CR in patients treated with chemoradiation was 51%. Bladder was preserved in 61% of patients who received chemoradiation as compared to 42% in patients treated with radical radiation. With radical radiation local recurrence rate was 19% as compared to 22% with surgery and 6% with chemoradiation, respectively. Local recurrence rate was only 5% in patients treated with adjuvant radiation. Distant metastasis rate was least with chemoradiation (9%) as compared to 11.5% in radical radiation: curable dose of radiation and 33% with surgery alone, respectively. Patients with adjuvant radiation had a distant metastases rate of 15%. Median OS was 36 months. Factors affecting OS were histology (P = 0.023) and nodal involvement (P = 0.034). Median DFS was 26 months. Significant factors affecting DFS on univariate analysis were histology (P = 0.046) and nodal involvement (P = 0.004). On multivariate analysis the only factor affecting DFS and OS was nodal involvement (P = 0.01; Hazard Ratio, 0.085-0.719).

Conclusion:

In patients with invasive bladder cancer, combined modality in the form of radical cystectomy followed by radiation give best local control. Radiation alone is not effective to control muscle-invasive local disease; however, Chemoradiation is an effective alternative to radical cystectomy to preserve bladder function.

Effect of incorporation of plantain and chickpea flours on the quality characteristics of biscuits

Blends of plantain and chickpea flours each with concentrations of 0, 10, 20, 30 and 40% along with of refined wheat flour were used for development of biscuits. The flours were evaluated for their chemical and functional properties. Plantain flour had highest crude fiber (3.6%) and carbohydrate content (80.8%), whereas chickpea flour had highest protein content (19.3%) and fat content (4.4%). Plantain flour showed highest water absorption (167.7%) whereas lowest oil absorption capacity (144.6). The chickpea flour showed highest foaming capacity and stability. The thickness and diameter of biscuits did not differ significantly (p < 0.05). The spread ratio and percent spread decreased with the addition of plantain and chickpea flours each up to a concentration of 30%. The fracture strength of biscuits increased significantly (p < 0.05) with addition of plantain and chickpea flours and was highest at 40% concentration (21.1 N). The protein and crude fiber content of biscuits increased significantly (p < 0.05) from 7.1 to 9.2% and 1.1 to 3.6%, respectively with increasing extent of chickpea flour and plantain flours in the blends. The sensory properties of biscuits prepared by replacing refined wheat flour up to 20% each with plantain and chickpea flour were more or less similar to those of control biscuits.

Studies on effect of multiple heating/cooling cycles on the resistant starch formation in cereals, legumes and tubers

'Resistant starch' (RS) is defined as starch and starch degradation products that resist the action of amylolytic enzymes. The effect of multiple heating/cooling treatments on the RS content of legumes, cereals and tubers was studied. The mean RS contents of the freshly cooked legumes, cereals and tubers (4.18%, 1.86% and 1.51% dry matter basis, respectively) increased to 8.16%, 3.25% and 2.51%, respectively, after three heating/cooling cycles (P< or =0.05) with a maximum increase of 114.8% in pea and a minimum of 62.1% in sweet potato (P< or =0.05). Significant positive correlations were observed between the RS content and amylose (y=0.443x-5.993, r=0.829, P< or =0.05, n=9) as well as between the percentage increase in RS and insoluble dietary fiber content (y=2.149x-24.787, r=0.962, P< or =0.05, n=9). A differential scanning calorimeter study showed an increase in the T(0), T(p), T(c) and DeltaH values of the repeatedly autoclaved/cooled starches. The intact granular structure was also observed disappear, as studied using scanning electron microscopy.

Resistant starch content of conventionally boiled and pressure-cooked cereals, legumes and tubers

Resistant starch (RS) content was determined in the conventionally boiled (H1) and pressure-cooked (H2) cereals, legumes and tubers using enzymatic method. Both H1 and H2 legumes contained higher amount of RS as compared to cereals and tubers. H1 and H2 lentils showed highest RS content of 5.0 and 4.9% (dwb), respectively. Higher RS content in legumes can be attributed to the presence of intact tissue/cell structures enclosing starch granules and high level of amylose (26-33%) and high content of viscous soluble dietary fiber components. The decrease in RS content of H2 foods in comparison to H1 counterparts (maximum decrease of 15% in pea) might have occurred due to changes in cell wall integrity of H2 foods and this could result in increased accessibility of starch to amylolytic enzymes.

Fluoride, boron and nitrate toxicity in ground water of northwest Rajasthan, India

The study was carried out to access the fluoride, boron, and nitrate concentrations in ground water samples of different villages in Indira Gandhi, Bhakra, and Gang canal catchment area of northwest Rajasthan, India. Rural population, in the study site, is using groundwater for drinking and irrigation purposes, without any quality test of water. All water samples (including canal water) were contaminated with fluoride. Fluoride, boron, and nitrate were observed in the ranges of 0.50-8.50, 0.0-7.73, and 0.0-278.68 mg/l, respectively. Most of the water samples were in the categories of fluoride 1.50 mg/l, of boron 2.0-4.0 mg/l, and of nitrate < 45 mg/l. There was no industrial pollution in the study site; hence, availability of these compounds in groundwater was due to natural reasons and by the use of chemical fertilizers.

Fungating scrotal mass: A rare clinical presentation of testicular tumor

A 20-year-old male patient presented with fungating scrotal mass. Investigations revealed yolk sac tumor with lung metastasis. The patient was treated with systemic chemotherapy. There was complete disappearance of the scrotal mass as well as metastatic disease from the lung. Fungating scrotal mass is a rare presentation of testicular tumor. This rare presentation is reported here. This is second such case in the English literature.

Orbital lymphoma: role of radiation

The purpose of this article is to review the literature for clinical presentation, treatment, outcome and complications of using radiotherapy for the treatment of orbital lymphoma. For this, MEDLINE, EMBASE, and the Cochrane Library were searched through January 2007 for published data on primary non-Hodgkin's lymphoma (NHL) of the orbit. The search was conducted in all document types, using the following terms "Non-Hodgkin's lymphoma, MALT (mucosa associated lymphoid tissue) and orbit". Data extracted were based on age, sex, therapeutic methods and outcome of treatment. When full articles were not available, abstracts were used as a source of information. Only those articles whose abstracts or full text were available in English were included in table. The review of reports of NHL of the orbit, in general, served as a source of information about its clinical behavior, treatment and overall prognosis. Fifty-six publications were identified, including six in languages other than English. There was no randomized trial. All the studies were retrospective. The studies were heterogeneous in patient number (3 to 112), histology, disease stage (IE to IV), radiotherapy doses used (4 to 53.8Gy), local control rates (65 to 100%), distant relapse rates (0 to 67%, from low grade to high grade) and five-year survival rates (33 to 100%). Three of the studies with a good number of patients also demonstrated clinical benefit with radiotherapy in terms of superior efficacy or less toxicity. Available data support the acceptance of radiotherapy as a standard therapeutic option in patients with low to intermediate grade orbital lymphoma. Toxicity of radiotherapy is mild if delivered precisely.

Results of letrozole in postmenopausal women after tamoxifen treatment for advanced breast cancer

AIM

To analyze overall and progression-free survival after letrozole in postmenopausal women with advanced breast cancer who failed after tamoxifen therapy.

MATERIALS AND METHODS

This is a retrospective analysis of 95 patients with breast cancer who were postmenopausal and had failed after tamoxifen therapy. Dose of letrozole was 2.5 mg daily until disease progressed. Patients had estrogen receptor- and/or progesterone receptor-positive tumors or both receptors were unknown. One complete course of (6 cycles) chemotherapy for metastatic disease was allowed. The primary end point was time to progression (TTP). Secondary end points included overall objective response rate (ORR), its duration, time to treatment failure (TTF), overall survival and tolerability.

RESULTS

Median TTP was 10 months. ORR was 21% with complete response rate of 9%. Nine patients died of disease during treatment. Median overall survival was 36 months. Median time to response was three months and median duration of response was 13 months. Time to chemotherapy was 13.5 months and TTF was 9.3 months. Treatment failure was seen in 76% of patients. Disease progression was the main cause for treatment failure. Treatment was well-tolerated by all patients.

CONCLUSION

This retrospective analysis shows that letrozole is quite effective as second line therapy in postmenopausal patients with advanced breast cancer who had failed after tamoxifen therapy.

Cardiovascular changes in thyroid disorder

Thyroid hormones have a profound effect on the metabolism. The cardiovascular system is particularly sensitive to this metabolic alteration. Therefore it is not surprising that thyroid dysfunction can produce dramatic cardiovascular effects, often mimicking primary cardiac disease. Both hypothyroidsm and hyperthyroidsm produce a clinical syndrome causing a diagnostic and therapeutic dilemma to the endocrinologist and cardiologist. Furthermore, cardiac disease and amiodarone therapy can also produce thyroid abnormality.

A study of psychiatric comorbidity in alcohol dependence

The diagnosis of comorbid psychiatric conditions have important clinical ramifications as the outcome is poorer with multiple disorders. Various studies have shown that alcohol abuse has severe adverse effects on the course of metal illness and vice versa. Only a little data on the subject are available from our country. We interviewed 30 patients suffering from alcohol dependence using SCID - I & SCID - II. Seventy six percent of the sample had axis - I comorbid diagnosis and 40% had an axis -II diagnoses. Depressive disorder and cluster B personality disorders were the most common comorbid diagnosis.