Browsing by Author "H.S. Shukla"

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A comparative study of scalpel and surgical diathermy incision in elective operations of head and neck cancer
(2011) V. Kumar; M. Tewari; H.S. Shukla
Objective: The aim of the study was to assess the outcome of patients following use of scalpel or surgical diathermy in elective skin incision of head and neck cancer. Materials and Methods: 80 patients undergoing surgery for various head and neck cancers were analyzed retrospectively from Jan 2002 to May 2005 and divided into two groups, matched for age, sex, stage and histopathology according to the method used to perform incision, i.e., scalpel or surgical diathermy. Blood loss, total operative time, blood transfusions, wound related complications and cosmetic assessments of the scar were compared. Results: The two groups did not differ significantly in relation to patients or wound characteristics in terms of total operative time and quantity of blood transfusions. There was significantly less blood loss in the diathermy group compared with the scalpel group. There was no difference between the groups in wound complications and cosmetic results before discharge and at 1-month follow-up. Conclusions: There is no change in wound complication rate and scar formation even after application of heat during use of surgical diathermy. Therefore, surgical diathermy is safe and as effective as scalpel during elective skin incision of head and neck cancer.
A discussion on chemoprevention of oral cancer by selective cyclooxygenase-2 (COX-2) inhibitors
(S.C. Virtual Company of Phisics S.R.L, 2010) A.K. Singh; A. Pandey; M. Tewari; Kumar Prakash; H.S. Shukla; H.P. Pandey
Oral cancers are potentially fatal diseases, have a high mortality rate and because of this it is highly challenging for the clinicians. Cyclooxygenase (COX), the key enzyme in prostaglandin cascade, is expressed in two isoform: the constitutive COX-1 and inducible COX-2. COX-2 expression extensively up regulated in oral cancer, oral premalignant lesion and seemed to be enhanced specifically in high-risk oral lesions. In recent studies it has been found that Zinc regulates COX-2 expression in vivo, in animal model may lead to prevention or therapeutic possibilities for upper aerodigestive tract cancer. The data in recent literatures strongly indicate that COX-2 expression is extensively up-regulated in oral cancer and it is believed that COX-2 inhibition strongly suppressed the oral lesion therefore; selective COX-2 inhibitor should be investigated as new chemopreventive agents for patient who are at high risk for developing oral cancer.
A rare anomaly: An accessory tongue
(2007) Mallika Tewari; H.S. Shukla
[No abstract available]
A review of association of dietary factors in gallbladder cancer
(2004) Rai Arundhati; S.C. Mohapatra; H.S. Shukla
Gallbladder cancer (GBC) is the prominent malignancy of hepato-biliary tract, being the fifth most common carcinoma for gastrointestinal tract in United States. Epidemiological studies world wide have implicated dietary factors in the development of gallbladder cancer. The ecological evidences indicate considerable geographic variation in the incidence of gallbladder cancer. However the variations in GBC incidence of different populations might be partly determined by their dietary variations. Higher intake of energy and carbohydrate possibly increase the risk of gallbladder cancer. Obesity plays an important role in the causation of GBC. Adequate intake of fruits and vegetables probably reduce the risk of GBC. This nutritional preventive effect against GBC could be attributed to high content of vitamins, carotenes and fibers. They can not be too emphatically stated as the sole determinants of GBC. It is apparently clear that a variety of essential nutrients can significantly modify the carcinogenic process. Furthermore, an attempt has been made to establish an association between dietary factors and the occurrence of gallbladder cancer.
Aberrant gallbladder situated beneath the left lobe of liver
(2002) A. Dhulkotia; S. Kumar; V. Kabra; H.S. Shukla
Background: Aberrant gallbladder beneath the left liver is a rare congenital anomaly that is found in 0.1-0.7 per cent of the population and causes confusion on imaging and at operation. Two such cases are presented. Case outlines: A man of 83 yr was explored for obstructive jaundice due to a hilar tumour, but the gallbladder was 'missing'. Exploration of a cystic mass to the left of the falciform ligament revealed a gallbladder attached to segment III of the liver. Laparotomy for gallstones in a woman of 70 yr failed to reveal the gallbladder until further dissection was carried out to the left of the falciform ligament. In each of these cases the cystic duct described a hairpin bend before joining the common hepatic duct on its right-hand side. Conclusion: A left-sided gallbladder can be truly ectopic or may just appear so because the falciform ligament is aberrantly placed to the right. In either case preoperative imaging can be misleading, and a careful search is needed at operation. The incidence of disease seems no commoner than in orthotopic gallbladders.
Advanced stage of breast cancer hoist alkaline phosphatase activity: Risk factor for females in India
(Springer Verlag, 2013) A.K. Singh; A. Pandey; M. Tewari; R. Kumar; A. Sharma; K.A. Singh; H.P. Pandey; H.S. Shukla
Breast cancer is the most common neoplasm affecting women in the western world with an average frequency of 1 in 11, developing the malignancy and it is second most common cancer in India. Variations in serum levels of biochemical parameters especially alkaline phosphatase (ALP) changes may be of great help in diagnosis of breast carcinoma. Serum ALP activity was assayed in 388 histopathologically proven breast cancer patients using spectrophotometric methods and monitored association with cancer stages. Breast cancer is a female-biased disease and our study was conducted in a group of female patients with mean age of 48.67 ± 8.32 years. A significant increase in levels of ALP (809.65 ± 145.97 IU/L) was observed in stage IV of the disease. The logistic regression study gave a significant result (P<0.001) when we compared the group of ALP level (>500 IU/L) with metastatic presentation. The present study besides being cost effective suggested the usefulness of ALP in differentiating breast cancer stages and metastasis. © The Author(s) 2012.
An effective method of drainage of puerperal breast abscess by percutaneous placement of suction drain
(2006) Mallika Tewari; H.S. Shukla
We present a new minimally invasive method of percutaneous placement of suction catheter in patients of puerperal breast abscess (PBA). 30 patients between 18 and 34 years of age were treated by this novel technique from January 1999 to January 2005 after an informed consent. Among them there were primi-para 15, 2nd para 10 and 3rd para 5 lactating mothers. Clinical diagnosis of PBA was based on history and presence of tender fluctuant abscess in the breast. The treatment was carried out on presentation in the outpatient department. Under local, 0.5% lignocaine with adrenaline, infiltration anesthesia 16F suction catheter was placed percutaneously in the abscess cavity for 3-8 days. Results: The abscess healed in 5-8 days time. There was no complication of residual or recurrent breast abscess, fistula or sinus formation, induration or distortion of the breast parenchyma. There was no scar formation. Breast-feeding was not interrupted in any patient.
An evolution of clinical application of inferior pedicle based rectus abdominis myocutaneous flap for repair of perineal defects after radical surgery for cancer
(2010) H.S. Shukla; Mallika Tewari
The inferior epigastric artery based rectus abdominis myocutaneous flap (RAMF) is one of the most versatile flaps used to bridge gaps in the perineum and groin, in the reconstruction of vagina after radical resections for cancer and in selected patients with benign and non-healing perineal lesions. Its use for reconstruction after Abdomino-perineal resection was first described in 1984. This review attempts to summarize the anatomic-technical aspects of inferiorly based RAMF and its applications. © 2010 Wiley-Liss, Inc.
Analysis of wedge resection of gallbladder bed and lymphadenectomy on adequate oncologic clearance for gallbladder cancer
(Medknow Publications, 2016) M. Tewari; S. Kumar; S. Shukla; H.S. Shukla
BACKGROUND: Surgery (R0 resection) is the mainstay of treatment of gallbladder cancer (GBC) as GBC is relatively resistant to currently known chemotherapy and radiotherapy regimens. AIM: To assess if wedge resection of the gallbladder bed achieves an adequate oncological clearance in GBC (namely T1 and T2) and some T3 GBC with minimal liver infiltration. PATIENTS AND METHODS: Patients with GBC who underwent radical cholecystectomy (en bloc cholecystectomy, wedge resection of the gallbladder fossa with a ≥2 cm rim of nonneoplastic liver tissue, and regional lymph node dissection) between October 2012 and June 2015 after obtaining informed consent. RESULTS: Of thirty patients, mean age of 52 years, 5 had T1b, 13 T2, and 12 T3 GBC. R0 resection was achieved in all thirty GBC patients. Hepatic invasion was found in seven patients. The depth of hepatic invasion ranged from 0 to 9 mm. Follow-up ranged from a minimum of 12 to 43 months. Nineteen (63%) patients had N0 and 11 (37%) had N1 GBC. Total lymph node (TLND) count ranged from 1 to 12/patient with a median of 3. There was no local recurrence or systemic relapse of the disease. CONCLUSION: Wedge resection of the gallbladder bed achieves an adequate oncological clearance in early GBC. TLND counts remain poor even after a thorough standard lymph node dissection for resectable GBC. © 2017 Indian Journal of Cancer.
Anterior gastrotomy technique of fashioning pancreaticogastrostomy following pancreatico-duodenectomy for pancreatic head and periampullary cancer
(2005) M. Tewari; H.S. Shukla
[No abstract available]
Assessment of Exocrine Function of Pancreas Following Pancreaticoduodenectomy
(Springer, 2019) Kiran Thogari; Mallika Tewari; S.K. Shukla; S.P. Mishra; H.S. Shukla
Pancreatic exocrine insufficiency (PEI) is a common long-term complication after pancreaticoduodenectomy (PD) and is observed in 23–80% of patients. As the postoperative mortality after PD has substantially decreased, it warrants more attention on the diagnosis and treatment of functional long-term consequences after PD. These include PEI and endocrine insufficiency that can result in significant nutritional impairment and often adversely impacts quality of life (QOL) of the patient. A PubMed search was performed for articles using key words “pancreatic exocrine insufficiency”; “pancreaticoduodenectomy”; “quality of life after pancreaticoduodenectomy”; “stool elastase”; “direct, indirect tests for pancreatic exocrine insufficiency”; “pancreatic enzyme replacement therapy.” Relevant studies were shortlisted and analyzed. This review summarizes relevant studies addressing PEI following PD. We also discuss functional changes after PD, risk factors and predictive factors for postoperative PEI, clinical symptoms, direct and indirect tests for estimation of PEI, pancreatic enzyme replacement therapy (PERT), and QOL after pancreatic resection for malignancy. It was found that significant PEI occurs in most patients following PD. Fecal elastase 1 is an easy indirect test and should be performed routinely in both symptomatic and asymptomatic patients after PD. PERT should be considered in every patient after PD with the aim to improve the QOL and perhaps even their long time survival. © 2019, Indian Association of Surgical Oncology.
CA 125: A potential tumor marker for gallbladder cancer
(2006) Amita Chaube; Mallika Tewari; Usha Singh; H.S. Shukla
Background: CA 125 is a glycoprotein and a commonly used tumor marker in ovarian carcinoma. Its use in gallbladder carcinoma (GBC) has not yet been reported. We have henceforth examined for the first time the diagnostic utility of CA 125 in patients with gallbladder diseases. Patients and Methods: Serum CA 125 was measured in 64 patients with GBC, 47 Gallstone disease (GSD) and 23 healthy volunteers by ELISA. CA 125 level was compared between different cohorts by non-parametric test (Kruskal Wallis and Mann-Whitney test). Receiver operating characteristic curve (ROC) was constructed to see the diagnostic utility of CA 125. Its level was also correlated with age, sex and clinico-pathological parameters of the patients included in the study. Results: Mean value of CA 125 in patients with GBC, GSD and healthy volunteers was 77.44 ± 141.31 U/ml, 7.85 ± 5.40 U/ml, and 8.08 ± 3.26 U/ml respectively and showed a statistically significant difference (P < 0.001). CA 125 at cut off value of 11 U/ml yielded 64% sensitivity and 90% specificity in differentiating benign from malignant gallbladder disease. CA 125 level increased with stage and grade of the GBC though this was not statistically significant. A higher level of CA 125 was found in presence of gallbladder mass, weight loss, ascites and loss of appetite compared to patients with GSD. No association of CA 125 was apparent with either age or sex of the patients. Conclusion: CA 125 has a diagnostic potential for GBC and can differentiate GBC from GSD in light of other clinical details. © 2006 Wiley-Liss, Inc.
Chylous Ascites in Advanced Gallbladder Cancer
(Springer India, 2016) Mallika Tewari; Rupesh Singh; H.S. Shukla
Chylous ascites is a very rare occurrence in a patient with gallbladder cancer (GBC), and only six cases have been reported. We report here one such case in a 55-year-old lady who presented to us with upper abdominal pain for 6 months. A polypoidal gallbladder mass with minimal liver invasion but with multiple subcentimeter pericholedochal, common hepatic, mesenteric, and para-aortic lymph nodes was found on contrast-enhanced computed tomography scan. At laparotomy, the abdomen had milky fluid with engorged beaded lymphatics all over the small intestine. The abdomen was closed over a drain after a lymph node biopsy and collection of the ascetic fluid for analysis. Histopathology confirmed metastatic adenocarcinoma in the lymph node. The triglyceride levels in the ascetic fluid were elevated to 817.00 mg/dl. The patient was put on medium-chain triglyceride diet and a diuretic and recovered well. She was discharged when drain output was nil. Chylous ascites could be a result of abdominal malignancy, post surgery, cirrhosis, and disseminated infections like tuberculosis and filariasis. Treatment is primarily conservative and includes paracentesis/drainage of the peritoneal cavity supplemented by fasting, total parenteral nutrition, and/or diet modification with medium-chain triglyceride diet. © 2016, Association of Surgeons of India.
Correlation of nutritional parameters of gallbladder cancer patients
(2006) Arundhati Rai; Mallika Tewari; S.C. Mohapatra; H.S. Shukla
Background and Objective: Gallbladder cancer (GBC) is a highly fatal disease with poor prognosis and 5-year survival <5%. Weight loss and nutritional deterioration are associated with adverse outcomes in terms of cancer prognosis. Protein-calorie malnutrition is the single most common secondary diagnosis in a patient with cancer, and is a direct consequence of the anorexia of malignancy and altered host metabolism induced by the tumor. The present study of nutritional assessment is of particular interest for it helps in better understanding the extent of malnutrition in patients of GBC. Patients and Methods: A case-control study was designed comprising of 153 cases of GBC and 153 controls of gallstone disease (GSD). To assess the nutritional status of the GBC patients, anthropometric measurements such as height, weight, mid arm circumference, and skinfold thickness were recorded together with the biochemical parameters and their nutrient intake. Results and Conclusions: The present study showed that GBC influences the nutritional status of the patients. Forty-three percent of GBC patients were malnourished with low body mass index (BMI). A significant reduction in all the anthropometric measures was observed for GBC patients compared to those with GSD. GBC patients had significantly low hemoglobin and serum albumin levels compared to the control group. The hemoglobin levels in case and control groups were 10.87 g/dl (± 1.81 SD) and 11.62 g/dl (± 1.89 SD), respectively (P < 0.001). Intake of almost all the nutrients was far below the recommendations of Indian Council of Medical Research. GBC patients had anorexia and weight loss. © 2006 Wiley-Liss, Inc.
Discovery of Helicobacter pylori in gallbladder
(2012) H.S. Shukla; Mallika Tewari
[No abstract available]
Does local therapy affect survival rates in breast cancer?
(1999) H.S. Shukla; J. Melhuish; R.E. Mansel; L.E. Hughes
Background: The goal of this study was to challenge the hypothesis that local recurrence of breast cancer does not affect survival rates, by determining whether survival rates differ for conservative and radical surgical policies. Methods: This study used prospective long-term follow-up monitoring of two contemporaneous groups of patients, within a single unit, who were treated identically except for the one variable of local treatment policy, i.e., conservative or radical. A total of 451 patients with operable breast cancer were chosen from 567 consecutive patients with breast cancer who were treated between 1970 and 1979-in the University Department of Surgery. The rate of survival 132 months after treatment was used as an outcome measure. Results: Two hundred forty-one patients were treated using a conservative approach and 210 were treated using a radical approach. At 132 months, the survival rate (58% vs. 42%) and median survival time (>132 vs. 100 months) were significantly improved for the radically treated group (P < .01). The treatment groups were comparable in terms of age, menopausal status, tumor size, histologic grading, and Nottingham Prognostic Index values. The advantage of the radical policy persisted when examined in relation to each of these prognostic factors. Conclusions: Use of radical local treatment yielded a highly significant survival benefit (comparable to that obtained with adjuvant therapy), compared with a conservative approach. This was related to a reduced locoregional recurrence rate and provides evidence that local therapy influences long-term outcomes for patients with breast cancer. High-quality locoregional control should be emphasized, as is systemic therapy, in management policies. Assessment of surgical techniques, particularly in relation to locoregional recurrence rates, should be included in all studies in which surgery is a component of therapy.
Effect of prevailing local treatment options of breast cancer on survival outside controlled clinical trials: Experience of a specialist breast unit in north India
(2006) Mallika Tewari; S. Pradhan; M. Kumar; H.S. Shukla
Background: This study aimed at analyzing different treatments of breast cancer (BC) prevalent in the region, their effect on patients' survival, and discusses the most suitable method within available resources. Methods: The study was set up at a tertiary care hospital in north India. We retrospectively reviewed data of 473 female BC patients who attended the departments of Surgical Oncology and Radiotherapy from January 1997 to December 1999. Patients with cTNM stage IV and inoperable stage III were included; those who defaulted or were lost to follow-up were excluded. Out of 473 patients, 372 were selected. The selected patients were divided into groups on the basis of place and type of local treatment they received: (1) local excision only, (2) standard breast conservation therapy (BCT), (3) total mastectomy (TM) + axillary lymph node dissection + radiotherapy (RT), and (4) modified radical mastectomy (MRM) + RT. Data regarding recurrence and survival were analyzed in December 2005. Minimum follow-up was 6 years. Results: Overall recurrence rates were significantly higher in patients operated elsewhere (P <0.0001). Of 194 operated at our Breast Unit, 25 (14.6%) of 171 MRM patients and none of 23 BCT had recurrence. Of 178 patients operated elsewhere, 44 (100%), 6 (42.9%), 41 (41%), and 8 (40%) developed recurrence in groups 1, 2, 3, and 4 respectively. Overall survival was significantly better in patients with MRM at our unit versus TM outside (93.6% vs. 80%). Conclusions: Several types of treatment from improper local excision alone, BCT, TM, to a carefully done MRM are prevalent here. Properly done, MRM yields significant local control with survival benefit and appears to remain the gold standard in management of our BC patients. © 2006 Société Internationale de Chirurgie.
Expression Profile of KRAS and p16 in Periampullary Cancer
(Springer, 2024) Mallika Tewari; Jyoti R. Swain; Raghvendra R. Mishra; Vinod K. Dixit; H.S. Shukla
Activating point mutations in codons 12, 13, and 61 of the KRAS gene and loss of p16 expression, a tumor suppressor gene, are common genetic alterations in periampullary cancer (PAC). The present study explores expression profile of KRAS and p16 genes in PAC and its prognostic relevance. A total of 50 patients with PAC who underwent potentially curative pancreaticoduodenectomy were included in the study. Formalin-fixed, paraffin-embedded tissue samples were analyzed for point mutations in codons 12 and 13 of KRAS and codon 9 of p16 using polymerase chain reaction. KRAS mutation in codon 12/13 was found in 32 (64%) and loss of p16 expression in 36 (72%) cases. KRAS mutation was significantly associated with higher grade, higher pathological tumor (pT) stage, lymphovascular invasion (LVI), perineural invasion (PNI), and pathological lymph nodes (pN) involvement on univariate analysis. On multivariate analysis, significant association of KRAS remained with higher grade (p = 0.031), pT stage (p = 0.09), and LVI (p = 0.028). On univariate analysis, loss of p16 expression was significantly associated with higher grade, pN involvement, LVI, PNI, and pT stage whereas on multivariate analysis, statistical significant association of p16 was found with higher grade of tumor only (p = 0.04). Patients with KRAS mutation had significantly (p = 0.018) worse disease-free survival (DFS) whereas no significant association was found in overall survival (OS). Loss of p16 expression had no association with either DFS or OS. The presence of p16 and KRAS alterations in patients with PAC suggests aggressive tumor biology. KRAS mutations confer a significantly poor DFS in PAC. © The Author(s), under exclusive licence to Indian Association of Surgical Oncology 2023.
Familial childhood parathyroid adenoma
(1994) Madhukar Rai; J.K. Agrawal; V. Sasikumar; S.K. Singh; S.K. Saraf; Mohan Kumar; H.S. Shukla
A family in which both the father and son had parathyroid adenoma in childhood is presented, along with a brief review of the literature. © 1994.
Fine needle aspiration cytology in the management of acute suppurative thyroiditis
(Medquest Communications LLC, 1994) S.K. Singh; J.K. Agrawal; M. Kumar; H.S. Shukla
Acute suppurative thyroiditis (AST) is relatively uncommon. We report 11 such cases from a population residing in a goiter endemic zone of Northern India. The important contribution of fine needle aspiration cytology in confirming the diagnosis and management is emphasized.