Browsing by Author "M. Tewari"

Now showing 1 - 13 of 13

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.
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.
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]
Free radicals hasten head and neck cancer risk: A study of total oxidant, total antioxidant, DNA damage, and histological grade
(Medknow Publications, 2016) A.K. Singh; P. Pandey; M. Tewari; H.P. Pandey; I.S. Gambhir; H.S. Shukla
Background: Free radicals such as reactive oxygen species (ROS), which induce oxidative stress, are the main contributors to head and neck carcinogenesis (HNC). The present study was conducted with the aim to assess the oxidant/antioxidant status and DNA damage analysis in head and neck cancer/control patients. Materials and Methods: This prospective study was conducted on 60 patients with biopsy-proven HNC and 17 patients of head and neck disease (HND). The total antioxidant status (TAS), total oxidant status (TOS), and oxidative stress index (OSI) were determined by novel automatic colorimetric methods from tissue homogenate. DNA damage analysis was determined by single cell gel electrophoresis (SCGE). Results: The mean age of the study cohort was 46.65 ± 14.84 years for HNC patients, while it was 49.41 ± 13.00 years for HND patients. There were no significant differences found between the two groups with respect to demographic presentation except tobacco addiction. The association between oxidative stress parameters and DNA damage analysis with study group revealed the following. (A) DNA damage - tissue homogenate TOS and OSI were significantly higher in HNC subjects than in HND (16.06 ± 1.78 AU vs 7.86 ± 5.97 AU, P < 0.001; 53.00 ± 40.61 vs 19.67 ± 21.90, P < 0.01; 7.221 ± 5.80 vs 2.40 ± 2.54, P < 0.01, respectively), while TAS was significantly decreased. (B) Aggressive histological features were identified, more commonly with higher TOS and lower TAS [probability (P) = 0.002, relative risk (RR) = 11.838, 95% confidence interval CI = 2.514-55.730 and P = 0.043, RR = 0.271, 95% CI = 0.077-0.960, respectively]. Conclusion: The increase in free radicals may be the event that led to the reduction of antioxidant status in HNC, thus explaining the oxidative damage of DNA and the severity of disease. Increased OSI represents a general mechanism in its pathogenesis. © 2016 Journal of Postgraduate Medicine Published by Wolters Kluwer - Medknow.
Giant condylomata acuminata vulva in an adolescent girl
(2005) M. Tewari; H.S. Shukla
[No abstract available]
Missed malignancies at laparoscopic cholecystecomy: A new emerging problem
(2006) N. Jain; M. Tewari; H.S. Shukla
Objective: With increase in laparoscopic cholecystectomy (LC) rates the chances of missing a concomitant cancer is high, if the laparoscopic surgeon is focused on gall bladder and does not look around. The aim of the present article therefore is to analyze the unsuspected concomitant cancer, for patients with atypical upper abdominal symptoms and diagnostic delay due to LC. Materials and Methods: This retrospective study evaluates the clinico- pathological data, diagnostic delay and outcome of patients who presented with intra-abdominal malignancy to our unit within 2-8 months of LC for gallstone disease elsewhere, between June 2003 and June 2005. Results: Six such patients were identified (age range 38-62 years). Two patients had carcinoma of the stomach, one each had carcinoma of the caecum, ascending colon and left ovary respectively, while one patient presented with malignant ascitis of unknown origin. Five of these 6 patients underwent a subsequent radical oncological procedure at our unit. Mean diagnostic delay was 4 months. The cTNM of tumor at diagnosis was Stage III/ IV in 5 of these 6 patients. Conclusion: The importance of a good clinical work-up, diagnostic imaging studies and exploration at the time of surgery is re-emphasized. Missing a concomitant lesion is high, if the surgeon focuses only on one organ during an LC.
Pancreatic Cancer: a Challenge to Cure
(Springer, 2015) M. Tewari
Pancreatic ductal adenocarcinoma (PDA) is a challenging disease, as overall survival has not improved over the last several decades. The disease is characterized by late diagnosis, difficult major surgery in resectable patients, and a biologically chemoresistant tumor. Intense research in the field is ongoing to develop biomarkers for early detection and prognostication. Surgery is presently the crux of the management of PDA and has been standardized over the years with high-volume centers reporting <5 % operative mortality. The biggest problem is to overcome the inherent chemoresistance of the tumor that is densely fibrotic and hypoxic and has a tendency to invade surrounding neuronal plexuses. This review attempts to summarize in brief the reasons why PDA is difficult to treat, and provides a glimpse of the ongoing research in the field. © 2015, Association of Surgeons of India.
Prospects of nano-material in breast cancer management
(2013) A.K. Singh; A. Pandey; M. Tewari; R. Kumar; A. Sharma; H.P. Pandey; H.S. Shukla
Breast cancer evaluation and early diagnosis are core complexity worldwide and an ambiguity for scientists till date. Nano-materials are innovative tools for rapid diagnosis and therapy, which may induce an immense result in the field of oncology. Their exceptional size-dependent properties make them special and superior materials and quite indispensable in several fields of the human activities. The major obstacle in finding cure for malignant breast cancer is to increase in development of resistances for tumors to the therapeutic treatments. The widespread mammo-graph particle is being developed by nations to diagnosis disease in primitive stage to decline the mortality rates caused by breast carcinoma. The advancement of nano-particle based diagnostic tools facilitates in evaluation and provides encouraging development in breast cancer therapeutics. In this compact review, efforts have been made to compose the current advancements in the area of functional nano-particles. Furthermore, in vivo and in vitro applications of nano-materials in breast cancer management are also discussed. © 2013 Arányi Lajos Foundation.
The frequency of live bacteria in gallstones
(Martin Dunitz Ltd, 2004) P. Hazrah; K.T.H. Oahn; M. Tewari; A.K. Pandey; K. Kumar; T.M. Mohapatra; Hari S. Shukla
Background. Septic complications reported from stones and concretions lost in the peritoneal cavity following laparoscopic cholecystectomy reflect the infective potential of gallstones. Although bacteria have been demonstrated in the core of gallstones by scanning electron microscopy and molecular genetic techniques, gallstone culture is the only conclusive proof of whether such bacteria are viable and can cause infection. Methods. Gallstones retrieved from patients undergoing cholecystectomy were decontaminated after surface cleaning with alcohol, and each core was scooped for culture. Results. In this study organisms were cultured from the cores of gallstones in 81% of cases of cholelithiasis and 77% of cases of gallbladder carcinoma, irrespective of stone type and size. Both enteric (57.5%) and non-enteric (20%) organisms were isolated in cholelithiasis, whereas only enteric bacteria could be cultured from cases of gallbladder carcinoma. Long thought to be a causative agent, Salmonella organisms were detected in none of the 14 cases of gallbladder carcinoma. Conclusion. Contrary to the popular belief that bacteria inside gallstones are dead, gallstones from most patients contain live bacteria with the potential to cause infective complications. © 2004 Taylor & Francis.
Tobacco addiction augments obesity and carcinogenesis: Matter of concern for Indian patients
(2013) A.K. Singh; A. Pandey; M. Tewari; B.P. Singh; H.P. Pandey; H.S. Shukla
Purpose: Life-style and tobacco addiction is the major risk factors for cancer progression in all over the world. Knowledge gaps between tobacco addiction, obesity and cancer in Indian patients brought an interdisciplinary group of investigators together to discuss the present study. Patients and Methods: We calculated the body mass index (BMI) of all the patients (N = 927) who were diagnosed with cancer for its treatment. National Institutes of Health (NIH) criteria were used to categorize the patients. All the patients of this disease could be contacted in person to find out the history of the disease. Results: The frequency of addiction in urban cancer patient was found to be about 53.3% and in a rural area it was only 33.7%. Tobacco addiction was independently associated with younger age of cancer patient (odds ratio [OR] 2.242; 95% Confidence interval (CI) 1.653-3.042), obese (OR 7.433; 95% CI 3.746-14.750), overweight (OR 4.676; 95% CI 3.381-6.468) and advanced stage of cancer (OR 11.950; 95% CI 5.283-27.030). Conclusion: Tobacco consumption appears to be a major contributor to cancer in younger age with elevated BMI in India. Rapid changes in diet and life-style, increase in tobacco consumption appear to be strongly associated with the carcinoma in this middle-income country.
Vagal paraganglioma
(2006) M. Tewari; V. Srivastava; H.S. Shukla
Vagal paragangliomas (VP) arise from paraganglia associated with the vagus nerve. Approximately 200 cases have been reported in the medical literature. The management of VP is associated with partial or total loss of vagal function. We report a case of VP in a young boy who presented with neck mass associated with recurrent laryngeal nerve paralysis. Evaluation of the patient was done by laryngoscope and ultrasound examination of the neck. The paraganglioma was excised along with the vagus nerve with ipsilateral loss of vagal function.