Browsing by Author "Mallika Tewari"

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A comparative study of transdiscal versus transaortic celiac plexus neurolytic block for upper gastrointestinal cancer patients. A prospective, randomized control study
(BeSARPP, 2021) Amrita Rath; Reena; Anil Kumar Paswan; Mallika Tewari
Aim: To compare transdiscal and transaortic techniques of neurolytic celiac plexus block for upper gastrointestinal cancer patients. Methods: In this prospective randomized study 60 patients with upper gastrointestinal malignancies were included and randomly divided into two groups, group TD and group TA, receiving neurolytic celiac plexus blocks via transdiscal and transaortic techniques, respectively. The primary outcome was quality of life (QoL) as assessed by WHOQOL BREF questionnaire and secondary outcomes were pain relief using visual analogue scale (VAS), and occurrence of complications like hypotension, loose motion, bleeding and discitis. Result: QoL and VAS score were significantly improved in both groups post procedure. Transdiscal approach is more effective in improving VAS score than transaortic approach (1 vs 3) after 1 week and the relief of pain was better in TD group (3 vs 6) at the end of 2 months. Transdiscal approach was found to be more effective in improving QoL (227.00±28.85 vs 191.17±35.78) as compared to transaortic approach. However, postprocedural QoL improved in both groups when compared to pre-procedural QoL (p<0.05). Hypotension, diarrhea and bleeding from aorta were higher in TA group; however, no serious complications were seen in any of the groups. Conclusion: Transdiscal technique is better in terms of adequate pain relief and improving QoL as compared to transaortic technique of NCPB in patients of upper GI malignancies and is associated with lesser incidences of complications. © Acta Anæsthesiologica Belgica, 2021.
A logical approach to trauma - Damage control surgery: Comments [3]
(2005) Mallika Tewari
[No abstract available]
A rare anomaly: An accessory tongue
(2007) Mallika Tewari; H.S. Shukla
[No abstract available]
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.
Altered expression of NKX3.1 has significant prognostic value in gallbladder cancer
(Elsevier Inc, 2019) Deepika Singh; Amisha Bharti; Dipanjan Biswas; Mallika Tewari; Mumtaz Ahmed Ansari; Sunita Singh; Gopeshwar Narayan
Introduction: NKX3.1, an androgen regulated prostate specific transcription factor, inhibits prostate tumorigenesis. However, its role in GBC is not understood. We aimed to investigate NKX3.1 expression profile to define its role in GBC. Methods: We analyzed the expression of NKX3.1 in 52 GBC and 52 paired adjacent control samples at mRNA level through Real time RT-PCR and validated at protein level through Western blotting. The transcript level data was correlated with clinico-pathological parameters. Promoter hypermethylation was analyzed through methylation specific PCR (MSP). Results: NKX3.1 shows down regulation in 55.8%, up regulation in 25% whereas no change in 19.2% of samples. Its mRNA expression is significantly down regulated in late stage tumors (p =0.0103), in tumors with nodal metastasis (p =0 .0036) and in high grade tumors (p =0 .0173). Interestingly, NKX3.1 is significantly higher in male patients than female patients (p =0 .0057). Kaplan-Meyier analysis reveals prolonged median survival of patients with higher level of NKX3.1 expression compared with patients having low or no change in expression. Conclusion: Our findings suggest that loss or lower expression of NKX3.1 may be a critical in determining the phenotype of GBC. Its expression profile may serve as positive prognostic marker for GBC. © 2019 Elsevier Inc.
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.
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.
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.
Assessment of predictive markers of response to neoadjuvant chemotherapy in breast cancer
(2010) Mallika Tewari; Satyajit Pradhan; Usha Singh; Taj Bali Singh; Hari Shankar Shukla
OBJECTIVE: To identify the predictive markers associated with chemotherapy sensitivity, especially those producing pathological complete response (pCR) following neoadjuvant chemotherapy (NACT) in patients with locally advanced breast cancer. METHODS: Core needle biopsy of 50 locally advanced breast cancer patients was analysed for histopathology, grade, oestrogen receptor, progesterone receptor, HER2, Ki-67, p53, Bcl-2, and BAX before starting NACT. This was correlated with response to NACT using Response Evaluation Criteria in Solid Tumours criteria. RESULTS: The mean tumour reduction rate per chemotherapy cycle was significantly higher in BAXpositive (p = 0.01) and Bcl-2-negative (p = 0.04) tumours. BAX expression significantly (p = 0.043) correlated with a response of an at least 30% reduction in tumour size post-NACT on multivariate analysis. A significant relationship was seen between loss of Bcl-2 expression and pCR on univariate (p = 0.048) analysis. Overall, all of the above 12 parameters had 30.4% and 28.5% success in predicting clinical complete response and pCR, respectively, by the Cox and Snell formula. CONCLUSION: Of all parameters examined, only the apoptosis-related genes (Bcl-2 and BAX) seemed to exert some influence on the response to NACT, and neither by itself was sufficient to predict pCR; however, 50 patients is not sufficient to simultaneously analyse several predictive markers. © 2010 Asian Surgical Association.
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.
Authors' reply [2]
(2007) Mallika Tewari; Hari Shukla
[No abstract available]
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.
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.
Carcinoma in-situ in a tiny epidermal cyst [1] (multiple letters)
(2004) Nalini Gupta; G.R. Verma; K. Vaiphei; Mallika Tewari
[No abstract available]
Carcinoma of the Ampulla of Vater Associated with Annular Pancreas
(Springer, 2016) Mallika Tewari; Ashish Verma; Hs Shukla
Carcinoma of the ampulla of Vater associated with annular pancreas is a rare entity. Only seven cases have been reported so far in the English literature. We herein report one such case in a 42-year-lady who presented with progressively increasing jaundice and pain in the upper abdomen for past 2 months. A magnetic resonance cholangiopancreaticography (MRCP) and MRI revealed an annular pancreas with an ampullary mass and a dilated CBD. An upper gastrointestinal endoscopic biopsy from the ampullary mass revealed a moderately differentiated adenocarcinoma. She was diagnosed as having annular pancreas with periampullary cancer that was subsequently confirmed at laparotomy. Histological examination confirmed a complete annular pancreas with a 2 cm × 2 cm moderately differentiated adenocarcinoma of the ampulla of Vater. The management, however, remains as in any case of periampullary malignancy. This highlights the importance that obstructive jaundice in an adult patient presenting with annular pancreas may be associated with a coexisting periampullary malignancy. © 2016, Association of Surgeons of India.
Carcinoma of the fourth part of the duodenum
(2006) Mallika Tewari; Ajay K. Khanna
Primary carcinoma of the duodenum is uncommonly encountered. This is a report of a 45-year-old gentleman who was admitted to our unit with a one-month history of upper abdominal distention. Barium study revealed a narrowed segment of the fourth part of duodenum. A hard stenosing growth was found in the fourth part of duodenum, at laparotomy. He was treated by distal segmental resection and regional lymphadenectomy, that relieved his symptoms. He is asymptomatic and recurrence free at one year follow up.
Centralization of Complex Cancer Surgeries in India: a Difficult Road
(Springer, 2022) Mallika Tewari
[No abstract available]
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.