Browsing by Author "Hari S. Shukla"

Now showing 1 - 20 of 44

Administration of cancer chemotherapeutic drugs through the enhanced peripheral veins by creating a radiocephalic fistula
(2007) Mallika Tewari; Hari S. Shukla
Background: Administration of chemotherapy through peripheral veins is a morbid procedure. The alternatives include implantable venous ports with associated cost and complication of buried foreign body. Methods: In this pilot study, we created an arteriovenous fistula (AVF) at the wrist of cancer patients due for chemotherapy and then used the resultant enhancement of the peripheral veins of the hand and forearm for administering chemotherapy. The complications of this novel method are compared with our historical controls receiving chemotherapy through the peripheral veins without AVF. Results and Conclusions: Ten patients were offered this new technique after prior informed consent and were followed prospectively for 1 year. Venous accessibility was excellent in the experimental arm with no incident of erythema, thrombophlebitis, or skin necrosis. No significant alteration was found in cardiac parameters at 1, 6, and 12 months post AVF surgery. The procedure proved economical and affordable for a majority of our patients. © 2007 Excerpta Medica Inc. All rights reserved.
An objective assessment of demography of gallbladder cancer
(John Wiley and Sons Inc, 2006) J. Ram Kumar; Mallika Tewari; Arundhati Rai; Rohan Sinha; Sadhu C. Mohapatra; Hari S. Shukla
Background and Objectives: Gallbladder cancer (GBC) is a lethal disease with a wide geographical, ethnic, and cultural variation suggesting major environmental influences such as diet and life style factors in the development of disease. An objective assessment of demographic profile and full implication of these features to recognize the population at risk is needed. This study was therefore undertaken to study the demography of GBC in Varanasi. Methods: A retrospective study as a case-control model comprised 328 cases of GBC and 328 controls with gallstone disease (GSD). The relevant demographic data were collected and analyzed for identification of independent significant features and for the risk of GBC based on these features by calculating odds ratio. Results and Conclusions: GBC predominantly a disease of females belonged to fourth and fifth decade of life. Among 328 cases of GBC only 75 were male and 253 female (M:F= 1:3.37). Majority of GBC patients were above 40 years and multiparous females. Family history of GBC was higher in GBC patients. Majority of GBC patients were of low socioeconomic status and hailed from rural background. This group tends to consume open mustard oil and water from hand pump. This study emphasizes the usefulness of demographic evaluation in diagnosis of GBC and a systematic approach to assessment of demographic features of GBC is recommended. © 2006 Wiley-Liss, Inc.
Association of Helicobacter pylori infection with inflammatory cytokine expression in patients with gallbladder cancer
(2013) Raghvendra Raman Mishra; Mallika Tewari; Hari S. Shukla
Aim: Gallbladder cancer (GBC) may be associated with Helicobacter pylori. The present study was designed to analyze the association of cytokine expression with H. pylori in patients with GBC. Methods: GBC tissue sample and 5 mL blood were collected from each of 54 GBC patients. H. pylori was identified in tissue samples using biochemical tests, histology, culture, nested polymerase chain reaction (PCR), and partial genome sequencing. Tissue samples were categorized as H. pylori-positive (case) and H. pylori-negative groups (control) on the basis of nested PCR of tissue sample. Cytokines interleukin 1-β (IL-1β), tumor necrosis factor-α (TNF-α), interferon-γ (IFN-γ), and interleukin-5 (IL-5) were assayed in blood samples using ELISA. Results: Presence of H. pylori was confirmed in 18 (33 %) of 54 GBC tissue samples. Levels of IL-1β (p = 0.001) and TNF-α (p = 0.01) were significantly elevated in H. pylori-positive GBC compared to the control group. IFN-γ and IL-5 levels did not significantly differ between the two groups. Conclusions: H. pylori DNA was detected in the gallbladder of a third of GBC patients and was associated with higher circulating levels of some cytokines. © 2013 Indian Society of Gastroenterology.
Benign breast disorders in nonwestern populations: Part II-Benign breast disorders in India
(Springer-Verlag, 1989) Hari S. Shukla; Sandeep Kumar
Experience with benign breast disorders has been analyzed in 3 nonwestern populations: Hong Kong, India, and Northern Nigeria. Similarities to and differences from Western experience are found, but of great interest are notable differences between these populations which, as yet, lack explanation. All show "fibroadenosis" and fibroadenoma as common conditions, but the frequency with which phyllodes tumor is diagnosed varies between different centers in India as well as between different racial groups. Tuberculosis is another interesting example-wide differences in the frequency of breast infection are found although tuberculosis itself is common in all 3 countries. The value of prospective studies was shown when mastalgia was studied in this way in India. Often considered a "Western" affliction, these authors have been able to study 112 cases of mastalgia and found it to be twice as common as cancer as a presentation. These differing experiences between populations have been little explored and must hold promise for unravelling some of the enigmas of benign breast disorders in all countries. © 1989 Société Internationale de Chirurgie.
Breast conservation in locally advanced breast cancer in developing countries: Wise or waste
(2009) Mallika Tewari; Arvind Krishnamurthy; Hari S. Shukla
Breast conservation as an additional benefit was beyond the initial expectations of the investigators who pioneered neoadjuvant chemotherapy (NACT). In recent years an increasing number of patients with locally advanced breast cancer (LABC) are being treated with NACT, followed by breast conservation surgery with axillary dissection and radiation as a part of the multimodality management. Breast conservation has not been the standard of care for women with LABC, owing to concerns of increased chances of local recurrence, and possible survival disadvantage and psychological trauma from experiencing a recurrence of malignancy. LABC is still a common form of presentation of breast cancer in developing countries. Strict adherence to treatment protocols and regular follow-ups for years may not be practical for a large majority of patients hailing from the regions most affected by LABC. Defaulters often thus have a heavy price to pay. Hence lies the importance of carefully selecting LABC patients for a breast conservation approach from others that would have a higher risk of locoregional recurrence. Can we extrapolate the lessons learnt in early breast cancer to LABC and offer selected patients with LABC breast conservation therapy? Would the local control and survival results with conservative therapy be comparable to those obtained using mastectomy, or does the increased tumor burden in LABC necessitate ablative surgery in all women? This review aims to address these important questions. © 2008 Elsevier Ltd. All rights reserved.
Breast tuberculosis: Diagnosis, clinical features & management
(2005) Mallika Tewari; Hari S. Shukla
The significance of breast tuberculosis is due to rare occurrence and mistaken identity with breast cancer and pyogenic breast abscess. Breast tuberculosis was scarcely reported even from endemic areas until lately when several reports have come up from South Africa and India. The incidence of tubercular mastitis although decreasing in the West, could show a resurgence with the global pandemic of AIDS. Breast tuberculosis has no defined clinical features. Radiological imaging is not diagnostic. Diagnosis is based on identification of typical histological features or the tubercle bacilli under microscopy or culture. Antitubercular therapy for 6 months with or without minimal surgical intervention forms the mainstay of treatment today. Over the years since the first description of tubercular mastitis in 1829, the incidence, clinical presentation, diagnostic and treatment methodology of breast tuberculosis has gradually changed. This review discusses the important issues relating to the diagnosis, clinical features, and management of breast tuberculosis.
Cervical epidural anesthesia: A safe alternative to general anesthesia for patients undergoing cancer breast surgery
(2006) A.P. Singh; Mallika Tewari; D.K. Singh; Hari S. Shukla
Background: General anesthesia (GA) is the standard anesthesia for patients undergoing modified radical mastectomy (MRM) for breast cancer. Cervical epidural anesthesia (CEA) is practiced less often because of its reported complications. This prospective study aimed to evaluate the safety and efficacy of CEA as an anesthetic technique for MRM. Patients and Methods: Fifty breast cancer patients with ASA (American Society of Anesthesiologists) grade I or II underwent MRM under CEA from September 2004 to January 2006. Anesthesia was induced with 10 ml of 1% lignocaine; adrenaline was administered through an 18-gauge catheter in C6-C7 or C7-T1 epidural space. Postoperative analgesia was maintained with 0.125% bupivacaine through the epidural catheter. Results: In 49 (98%) patients surgery was conducted smoothly under CEA with good analgesia. 44 patients were awake during surgery. Five patients had to be given intravenous sedation with midazolam, and in one case the procedure was terminated after accidental dura puncture. There were no clinically significant variations in perioperative pulse and respiratory rate, and there was no fall in mean arterial blood pressure during the procedure. The mean preoperative anesthesia time and total cost of the procedure was 20.36 + 2.75 minutes and 12.19 + 2.2£, respectively. All patients were started on a liquid diet and mobilized 4 hours after surgery. Conclusions: Cervical epidural anesthesia is a safe alternative to GA and was preferred by our patients because of its lower cost and reduced perioperative morbidity. © 2006 Société Internationale de Chirurgie.
Cholecystokinin and gastrin receptors targeting in gastrointestinal cancer
(2012) Rajani Rai; Vishal Chandra; Mallika Tewari; Mohan Kumar; Hari S. Shukla
Cholecystokinin and Gastrin are amongst the first gastrointestinal hormone discovered. In addition to classical actions (contraction of gallbladder, growth and secretion in the stomach and pancreas), these also act as growth stimulants for gastrointestinal malignancies and cell lines. Growth of these tumours is inhibited by antagonists of the cholecystokinin and gastrin receptors. These receptors provides most promising approach in clinical oncology and several specific radiolabelled ligands have been synthesized for specific tumour targeting and therapy of tumours overexpressing these receptors. Therefore, definition of the molecular structure of the receptor involved in the autocrine/paracrine loop may contribute to novel therapies for gastrointestinal cancer. Hence, this review tries to focus on the role and distribution of these hormones and their receptors in gastrointestinal cancer with a brief talk about the clinical trial using available agonist and antagonist in gastrointestinal cancers. © 2012 Elsevier Ltd. All rights reserved.
Control of Intra-Operative Hemorrhage during Excision of Carotid Body Tumor
(John Wiley and Sons Inc, 2004) Mallika Tewari; Anurag Dixit; Ritesh Mongha; Hari S. Shukla
[No abstract available]
Correlates between vegetable consumption and gallbladder cancer
(2006) Arundhati Rai; Sadhu C. Mohapatra; Hari S. Shukla
The results of several studies indicate that a diet rich in fresh vegetables protects against several common epithelial neoplasms. This probable effect has been related to specific micronutrients contained in vegetables. In the present case-control study a systematic assessment of the relationship between vegetable intake and the risk of gallbladder cancer has been undertaken. The study is of particular interest in order to better understand the quantifying effect of vegetable consumption with regard to gallbladder cancer. One hundred and fifty-three patients with gallbladder cancer and 153 controls with gallstone disease were included. Each patient's consumption of vegetables was assessed by using a food frequency questionnaire. The frequency of vegetable consumption was divided into three levels: ≥3 days/week, 1-2 days/week and no or rare consumption. Participants were divided into three groups according to the level of vegetable intake. Odds ratios and 95% confidence intervals were computed for subsequent levels of vegetable consumption compared with the high level of consumption. A low consumption of vegetables showed an increase in odds ratio for gallbladder cancer for almost all the vegetables studied. A significant inverse trend was observed for green leafy vegetables and gallbladder cancer. An inverse association was observed for amaranth with an OR of 3.45 for the low vs. high level of consumption. Corresponding values were 2.14 for spinach, 1.86 for bathua, 1.02 for bengalgram leaves, 2.26 for cabbage, 3.06 for fenugreek leaves, 1.95 for mustard leaves and 1.44 for radish leaves. An inverse relationship between the risk of gallbladder cancer and the level of vegetable consumption was observed. © 2006 Lippincott Williams & Wilkins.
Dendritic cell therapy in advanced gastric cancer: A promising new hope?
(2012) Mallika Tewari; Shipra Sahai; Raghvendra R. Mishra; Sunit K. Shukla; Hari S. Shukla
Advanced gastric cancer carries a very poor prognosis when the tumor becomes unresectable. Even with the best currently available chemotherapy regimens the survival rate remains dismal. A recent breakthrough in the treatment paradigm has been the approval of trastuzumab, a monoclonal antibody, in HER2-positive metastatic gastric cancer. A large number of trials are underway using dendritic cells (DCs) in a number of human malignancies and do show a ray of hope in management of these patients. This review attempts to summarize tumor immunology and the current data regarding use of DCs in gastric cancer therapy. © 2012 Elsevier Ltd. All rights reserved.
Epigenetic Changes in Carcinogenesis of Gallbladder
(2013) Mallika Tewari; Amit Agarwal; R.R. Mishra; R.N. Meena; Hari S. Shukla
Gallbladder cancer (GBC) is a lethal and a common malignancy affecting mostly females. There are restricted high incidence pockets across the world and in northern India highest incidence of GBC is reported from the Gangetic belt. The etiology of this disease remains largely unknown though several risk factors have been stated. The genetic aberrations in GBC involving mutations in tumor suppressor genes and oncogenes have been reported in literature. However, there is scarcity of data regarding epigenetic changes that may also be involved in gallbladder carcinogenesis. This review attempts to summarize our current understanding of the epigenetic changes in GBC. © 2013 Indian Association of Surgical Oncology.
Epigenetic Silencing of p16INK4a gene in Sporadic Breast Cancer
(Springer, 2023) Satya P. Singh; Mallika Tewari; Alok K. Singh; Raghvendra R. Mishra; Hari S. Shukla
Epigenetic alterations of tumor suppressor genes (TSG) involved in the onset and progression of Breast Cancer (BC) may serve as biomarkers for early detection and prediction of disease prognosis. We have herein tried to determine the methylation status of TSG, p16INK4a, in our 50 BC patients and their association with clinicopathological parameters. The methylation status of the p16INK4a gene in fresh tissue samples from 50 patients with BC was assessed by methylation-specific polymerase chain reaction (MS-PCR). The mean age of BC patients was 49.30 ± 9.75 years. Of 50 BC samples tested, 21 (42%) had methylated p16INK4a gene. p16INK4a gene hypermethylation was significantly associated with age ≤ 50 years, premenopausal status and advanced BC stage. Multivariate analysis revealed a strong association between advanced BC stage (Stage III and Stage IV) and p16INK4a hypermethylation (P = 0.008, RR = 5.996, 95% CI = 1.581—22.739). p16INK4a methylation was significantly associated with Triple Negative BC (TNBC) (P = 0.045, OR = 4.181, 95% CI = 1.030–16.981). These findings indicate that p16INK4a hypermethylation frequently occurs in BC. Hypermethylation of p16INK4a in young, premenopausal, TNBC and with advance stage in BC patients suggests its association with aggressive BC. © 2023, The Author(s), under exclusive licence to Indian Association of Surgical Oncology.
Estrogen and progesterone receptor status in breast cancer: Effect of oral contraceptive pills and hormone replacement therapy
(Churchill Livingstone, 2007) Mallika Tewari; S. Pradhan; Usha Singh; Hari S. Shukla
Background: Higher incidence of hormone receptor positive breast cancer (BC) in White women compared to Blacks and Asians is attributed to different inherent biology. Many of our patients have estrogen receptor (ER) and progesterone receptor (PR) negative tumors. We tried to explore if this is related to low frequency of oral contraceptive pills (OCP) and hormone replacement therapy (HRT) intake. Setting: Breast Unit, Department of Surgical Oncology, Tertiary Care Hospital, India. Methods: Records of female BC patients classified as 'Users' of OCP/HRT for minimum of 1 year and age, stage, histopathology matched 'Non-users' were reviewed retrospectively from January 1990 to October 2006. Results: Analysis of 150 evaluable 'Users' (58/122 premenopausal, 92/178 postmenopausal) and 150 matched 'Non-users' revealed 128 (42.67%) patients had ER and PR-negative, 157 (52.33%) ER and PR-positive, 12(4%) ER-positive/PR-negative, 3(1%) ER-negative/PR-positive tumor. Significantly more ER-positive tumor was found in both premenopausal [62.07% versus 39.06%, p=0.0184, odd's ratio (OR) 2.5527 and 95% confidence interval (CI) 1.2297-5.2993] and postmenopausal (63.04% versus 40.7%, p=0.0046, OR 2.4857 and 95% CI 1.3593-4.5455) 'Users' compared to 'Non-users', respectively. Grade III tumors were significantly less in premenopausal (p=0.0041) and postmenopausal (p=0.0012) 'Users'. Conclusions: These observations suggest that a low incidence of hormone receptor positivity in our patients could be partly due to low prevalence of OCP/HRT intake. © 2007 Elsevier Ltd. All rights reserved.
Expression profle of cholecystokinin type-a receptor in gallbladder cancer and gallstone disease
(Firts Affiliated Hospital, 2011) Rajani Rai; Mallika Tewari; Mohan Kumar; Tej Bali Singh; Hari S. Shukla
BACKGROUND: Regulatory peptide receptors have attracted the interest of oncologists as a new promising approach for cancer pathology, imaging and therapy. Although cholecystokinin (CCK) is a potent modulator of gallbladder contractility and plays a potential role in pancreatic carcinogenesis through CCK type-A receptor (CCKAR), its role in gallbladder cancer (GBC) is still unknown and immuno histo chemical detection of CCKAR in the gallbladder has not yet been reported. This novel case-control study aimed to investigate the expression profile of CCKAR in GBC and gallstone disease (GSD). METHODS: This study included 162 samples of gallbladder: 94 from GBC and 68 from GSD. Expression of CCKAR was analyzed by immunohistochemistry and immunoblotting. The results were statistically correlated with disease history including age, sex, presence of gallstone, stage and differentiation. RESULTS: CCKAR was positive in 30/68 (44.1%) of GSD and 72/94 (76.6%) of GBC samples. Fifty-one of the 72 (70.8%) CCKAR-positive GBC samples showed over-expression. Interestingly, consistent results also appeared in the immunoblotting study. CONCLUSIONS: CCKAR expression was significantly increased in GBC compared to GSD. Moreover, CCKAR expression was associated with the degree of tumor differentiation, i.e., less expression in poorly-differentiated tumors. Thus, it has future prognostic and therapeutic implications in the management of GBC. © 2011, Hepatobiliary Pancreat Dis Int.
Gallbladder carcinoid masquerading as gallbladder carcinoma
(2009) Mallika Tewari; Vinay Kumar; Raghvendra Raman Mishra; Hari S. Shukla
BACKGROUND: Carcinoid of the gallbladder is rare. Since it often presents as a gallbladder mass it may be confused with gallbladder carcinoma. METHODS: A 35-year-old lady presented with pain in the right upper abdomen, and was radiologically found to have a gallbladder mass. A provisional diagnosis of gaUbladder carcinoma was made. Laparotomy revealed a 20x20 cm, exophytic, friable growth arising from the fundus of the gaUbladder. It was excised with segment IVb and V of the liver and regional lymphadenectomy. RESULT: Histopathological examination revealed it was a neuroendocrine carcinoma, atypical carcinoid of the gaUbladder. CONCLUSION: Gallbladder carcinoid has a poor outcome, requires aggressive treatment, and should be considered as one of the rare but possible gallbladder lesions. © 2009, Hepatobiliary Pancreat Dis Int. All rights reserved.
Gallbladder carcinoma: High rate of mitochondrial D-loop mutations
(2013) Sanjeev K. Maurya; Mallika Tewari; Hari S. Shukla
The molecular mechanisms leading to gallbladder carcinoma (GBC) are poorly understood. Different molecular disorders, including nuclear and mitochondrial genomic alteration, are associated with different cancers. The frequency of mitochondrial genome mutation has remained completely unexplored. In GBC, this is the first report of a mutation analysis in the mitochondrial genome, especially in the D-loop region. For a comprehensive D-loop view in GBC in humans, we sequenced the mitochondrial genome of 35 GBC patients and matched germ-line DNA. A wide range of point mutations and polymorphisms was observed. These variations in the D-loop sequence of human GBC represent good evidence of the mitochondrial role in GB carcinogenesis and may be used as a marker for GBC. Copyright © 2013 by Lippincott Williams & Wilkins.
Gastrointestinal stromal tumor
(2008) Puneet Gupta; Mallika Tewari; Hari S. Shukla
Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract. These form a distinct category of tumors characterized by oncogenic mutations of the KIT receptor tyrosine kinase in a majority of patients. KIT is used not only for diagnosis but also for targeted therapy of GISTs. Imatinib, a tyrosine kinase inhibitor, is widely used in the treatment of advanced and metastatic GISTs and has been recently employed in the neo adjuvant and adjuvant set-up with encouraging results. Certain specific mutations in an exon (such as in exon 9) of the KIT gene result in GISTs that are relatively unresponsive to the Imatinib treatment. New therapeutic agents like Sunitinib have now been approved for the treatment of Imatinib-resistant GIST. This review summarizes the salient features of GIST along with a detailed review of targeted multi-disciplinary approach to the treatment of these special tumors. © 2007 Elsevier Ltd. All rights reserved.
Genetic abberations in gallbladder cancer
(2012) Sanjeev K. Maurya; Mallika Tewari; Raghvendra R. Mishra; Hari S. Shukla
Gallbladder carcinoma (GBC) is the most common type of biliary tract carcinoma and the third commonest digestive tract malignancy in our region. Studies available in literature do not clearly define the molecular genetic mechanisms involved in the pathogenesis of GBC. Most of these studies are limited to protein expression analysis by immunohistochemistry and western blotting, and only a few have been done on mRNA (messenger RNA) and mutation analysis. This review aims to critically analyze all the available evidence on genetic aberrations in gallbladder carcinoma. © 2010 Elsevier Ltd. All rights reserved.
Genomic profiling of breast cancer
(2009) Anjita Pandey; Alok Kumar Singh; Sanjeev Kumar Maurya; Rajani Rai; Mallika Tewari; Mohan Kumar; Hari S. Shukla
Genome study provides significant changes in the advancement of molecular diagnosis and treatment in Breast cancer. Several recent critical advances and high-throughput techniques identified the genomic trouble and dramatically accelerated the pace of research in preventing and curing this malignancy. Tumor-suppressor genes, Proto-oncogenes, DNA-repair genes, Carcinogen-metabolism genes are critically involved in progression of breast cancer. We reviewed imperative finding in breast genetics, ongoing work to segregate further susceptible genes, and preliminary studies on molecular profiling. © 2009 Wiley-Liss, Inc.