Clinico-mycological study of onychomycosis in a tertiary care hospital—A cross-sectional study

Onychomycosis (OM), has a worldwide prevalence of 5% and 0.5%-5% in India. Trichophyton. rubrum (T rubrum) and T mentagrophytes are the most commonly isolated fungi. As the clinical and mycological characteristics change with time and geographical region; it is important to study the temporal and topographic patterns periodically. The study was conducted to identify the epidemiological and clinico-mycological characteristics of patients with OM attending a tertiary care hospital in Delhi. Hundred patients with clinical diagnosis of OM were recruited. Among these, 88 patients who tested positive for OM on direct microscopy with KOH, culture and/or histopathology with periodic acid-Schiff were included in the study. The clinico-mycological characteristics and risk factors associated with OM were evaluated. OM was more common in males (M:F = 2.5:1). The mean age of patients with OM was 39 ± 15.3 years (SE 1.52) with mean disease duration of 27.6 ± 46.1 months (SE 4.9). Seventeen (19.3%) patients had concomitant diabetes mellitus. The patients displayed mean body mass index (BMI) of 25.67 ± 1.35 kg/sq m. Concurrent dermatophytosis of skin was present in 35 (39.77%) patients. Two feet-one hand syndrome was present in 5 patients. Fingernail involvement without toenail involvement was more common than toenail involvement alone. (43.18% vs 38.63%). Distal and lateral subungual OM (DLSO) was the commonest clinical variant (81.8%). Mycological culture showed growth in 47 (53.40%) patients. Dermatophytes were isolated in majority, that is in 30 (63.82%) patients followed by non-dermatophytic moulds (NDM) in 7 (14.8%) and Candida spp. in the remaining 10 (21.27%) patients.     

Leukocyte telomere length in a population-based case–control study of ovarian cancer: a pilot study

Objectives

Telomeres are structures at chromosome ends that contribute to maintaining genomic integrity. Telomere shortening with repeated cell divisions may lead to genomic instability and carcinogenesis. Studies suggest that shorter telomeres in constitutional DNA are associated with bladder, breast, lung, and renal cancer. Ovarian cancer tissues also have shortened telomeres and increased telomerase activity, suggesting that telomere abnormalities may be related to ovarian cancer.

Methods

We investigated leukocyte telomere length in 99 women with serous ovarian adenocarcinoma and 100 age-matched cancer-free controls enrolled in a population-based case–control study.

Results

Cases tended to have shorter telomeres than controls (P _wilcoxon = 0.002). Compared to subjects with telomere lengths in the longest tertile, those in the middle and shortest tertiles showed respective age-adjusted odds ratios (95% confidence intervals) of 2.69 (1.23–5.88) and 3.39 (1.54–7.46) (P _trend = 0.002). Strongest associations were found for subjects with poorly differentiated carcinomas (OR = 4.89, 95% CI 1.93–12.34).

Conclusions

This study shows that short leukocyte telomeres are associated with serous ovarian adenocarcinoma. These findings should be confirmed in large, prospective studies.     

Benign lesions of larynx—A clinical study

Objective

A climical study was undertaken to analyze the age, sex distribution and symptomatology, sites of involvement and the prognosis of the common types of benign lesions of larynx.

Study Design

A five year retrospective study from 1997 to 2002.

Setting

KMC Hospital Attavar —A tertiary referral hospital.

Patients

A total of 42 patients with benign laryngeal lesions were included based on symptomatology such as hoarseness of voice, foreign body sensation, throat pain, neck mass and cough and with positive clinical findings on indirect laryngoscopy and neck examination. The patients ranged from 7–80 years. All non-operative cases and malignant cases were excluded. Diagnostic hematological and radiological investigations and therapeutic microlyryngoscopic procedures were employed.

Results

A male preponderance with M:F ratio of 3∶1 was observed. Majority of the patients were in the 30–40 age group. Vocal polyps were the commonest type of lesion. In our study, hoarseness of voice, cough, foreign body sensation and throat pain proved to be the commonest symptoms.

Conclusions

Micro laryngeal surgery and voice rest offer a cost effective, useful and safe method for management of benign laryngeal lesions.     

Myxoma of the jaws—A clinico-pathological study

Myxoma of the jaws is a rare tumour. In India, a few single case reports have appeared, A ten year study of myxomatous tumours of the jaws at the All India Institute of Medical Sciences reveal a total of five cases ; four cases occurred in the maxilla and one arose in the mandible. Two of the cases presented with recurrence after one and half and three years respectively. Surgical excision with cauterisation, and resection for recurrence seam to be an, acceptable mode of treatment.     

Chronic suppurative otitis media—A bacteriological study

A total of 146 cases of chronic suppurative otitis media (CSOM), comprising of 77 males and 69 females in different age groups were studied. A total of 132(77.6%) strains of different bacterial species were isolated as single infecting organism(monobacterial). Two or more bacterial species were obtained from 26 cultures revealing polybacterial growth of 15.3%. Out of total 192 isolates, Pseudomonas sp. ranked highest with 438% incidence followed by staphylococcus pyogenes(18.2%), proteus sp.(12%), Klebsiella sp.(7.3%) and Diphtheroides (6.7%). 86.4% of total bacteria put for antibiotic sensitivity tests showed susceptibility towards gentamycin followed by chloramphenicol(31.3%) and Ampicillin(14.8%).     

Chronic Suppurative Otitis Media — A prospective study

A random selection of 120 cases of Chronic Suppurative otitis Media (CSOM) were investigated for bacterial and fungal isolates at the Department of Microbiology and Parsitology, Benghazi. The specimens were obtained from the out- patient department of Otolaryngology of 28th March Polyclinic. The incidence of CSOM in Benghazi was found to be 23.7%. A total of 145 bacterial isolates were identified and their susceptibility to various antibiotics was tested. Staphylococcus aureus was the predominant pathogen isolated (42.5%), followed by Pseudomonas aeruginosa (21.6%) and proteus species (18.33%). Fungi were isolated from 7.5% of cases, but no growth was observed in 10% of specimens collected. The majority of the bacterial isolates showed multiple drug resistance. Gentamycin still formed the drug of choice in treating the causative strains of either Gram positive or Gram negative bacteria, while tetracycline was found to be the least effective.     

Epidemiological study of primary intracranial tumors: a regional survey in Kumamoto prefecture in southern Japan—20-year study

Background  

The increased use of neuro-imaging techniques, as well as various environmental factors, has been changing the incidence and the proportions of types of intracranial tumors. However, no accurate population-based epidemiological study of intracranial tumors in Japan has been reported. We evaluated recent trends in the occurrence of primary intracranial tumors among residents of Kumamoto prefecture, Japan.     

Phase II study of imatinib mesylate for recurrent meningiomas (North American Brain Tumor Consortium study 01–08)

Platelet-derived growth factor (PDGF) and its receptors (PDGFR) are frequently coexpressed in meningiomas, potentially contributing to their pathogenesis. The North American Brain Tumor Consortium conducted a phase II study to evaluate the therapeutic potential of imatinib mesylate (Gleevec), a PDGFR inhibitor, in patients with recurrent meningiomas. Patients were stratified into benign (WHO grade I) meningiomas or atypical (WHO grade II) and malignant (WHO grade III) meningiomas. The primary end point was 6-month progression-free survival (6M-PFS). Patients requiring enzyme-inducing antiepileptic drugs were ineligible. Patients received imatinib at a dose of 600 mg/day for the first 4-week cycle and then gradually increased to 800 mg/day for subsequent cycles, if there were no unacceptable toxicities. Plasma concentrations of imatinib and its active metabolite, {"type":"entrez-protein","attrs":{"text":"CGP74588","term_id":"875877231","term_text":"CGP74588"}}CGP74588, were assessed. Twenty-three heavily pre-treated patients were enrolled into the study (13 benign, 5 atypical, and 5 malignant meningiomas), of whom 22 were eligible. The study was closed prematurely due to slow accrual. Tissue was available only from a minority of patients, but in these specimens there was uniform distribution of PDGFR, the drug target. Imatinib was generally well tolerated. Of 19 patients evaluable for response, 10 progressed at the first scan, and 9 were stable. There were no complete or partial responses. Overall median PFS was 2 months (range, 0.7–34 months); 6M-PFS was 29.4%. For benign meningiomas, median PFS was 3 months (range, 1.1–34 months); 6M-PFS was 45%. For atypical and malignant meningiomas, median PFS was 2 months (range, 0.7–3.7 months); 6M-PFS was 0%. Cycle 1 trough concentrations of imatinib and {"type":"entrez-protein","attrs":{"text":"CGP74588","term_id":"875877231","term_text":"CGP74588"}}CGP74588 were 2,129 ± 1,600 ng/ml and 517 ± 326 ng/ml, respectively. Single-agent imatinib was well tolerated but had no significant activity in recurrent meningiomas. Trough plasma concentrations of imatinib exceeded those associated with imatinib activity in chronic myelogenous leukemia.     

Plasma matrix metalloproteinases and postmenopausal breast cancer risk: a nested case–control study in the Multiethnic Cohort study

The survival of malignant breast cells depends upon the remodeling of the extracellular matrix, including complex interactions with matrix metalloproteinases (MMPs). It has been hypothesized that circulating MMPs may serve as early indicators of breast cancer development in hospital-based case–control studies. A nested case–control study of the association of pre-diagnostic plasma levels of MMPs with the subsequent risk of postmenopausal breast cancer was conducted within the Multiethnic Cohort. During the follow-up period, 713 women with incident invasive breast cancer were identified and individually (1:1) matched to controls. Four types of MMPs (1, 2, 3, and 7) were analyzed by microsphere immunofluorescence assay. Mean plasma levels of MMPs did not differ significantly between cases and controls; nor were there differences in breast cancer risk by MMP level. No difference in the risk of breast cancer by plasma level of the MMPs was found within strata of age, or ethnicity, although MMP-1 levels were positively associated with breast cancer risk in obese women and women by hormone replacement medications (P values for interaction <0.05). Few significant differences in risk by levels of the MMPs were found by any of the clinical variables. Circulating MMPs were not associated with postmenopausal breast cancer risk.     

Multicentre phase II study of cisplatin–etoposide chemotherapy for advanced large-cell neuroendocrine lung carcinoma: the GFPC 0302 study

BackgroundThe optimal treatment of large-cell neuroendocrine carcinoma (LCNEC) of the lung remains unclear. Here, our primary objective was to assess the efficacy of cisplatin–etoposide doublet chemotherapy in advanced LCNEC. Accuracy of the pathological diagnosis and treatment toxicity were assessed as secondary objectives.Patients and methodsProspective, multicentre, single-arm, phase II study with a centralised review of treatment-response and pathological data. Patients had untreated performance status (PS) 0/1 stage IV/IIIB LCNEC and received cisplatin (80 mg/m22 d1) and etoposide (100 mg/m22 d1-3) every 21 days.ResultsEighteen centres included 42 patients (mean age, 59 ± 9 years; 69% men; median of four cycles/patient). At least one grade-3/4 toxicity occurred in 59% of patients (neutropaenia, thrombocytopaenia, and anaemia in 32%, 17%, and 12%, respectively). The median progression-free survival (PFS) and overall survival (OS) were 5.2 months (95% confidence interval, CI, 3.1–6.6) and 7.7 months (95% CI, 6.0–9.6), respectively. The centralised pathologist review reclassified 11 of 40 (27.5%) patients: 9 as small-cell lung cancer, 1 as undifferentiated non-small-cell lung cancer, and 1 as atypical carcinoid. Survival data were not significantly changed by excluding the reclassified patients.ConclusionsThe pathological diagnosis of LCNEC is difficult. The outcomes of advanced LCNEC treated with cisplatin–etoposide doublets are poor, similar to those of patients with advanced small-cell lung carcinoma (SCLC).     

A case–control study of childhood brain tumors and fathers’ hobbies: a Children’s Oncology Group study

Objective  A comprehensive case–control study was conducted to evaluate parental risk factors for medulloblastoma (MB) and primitive neuroectodermal tumor (PNET). This analysis was conducted to evaluate associations between fathers’ hobbies and risk of their children developing MB/PNET. The hobbies chosen for study were those with similar exposures as occupations associated with childhood cancers. Methods  Cases were 318 subjects under six years of age at diagnosis between 1991 and 1997 and registered with the Children’s Cancer Group. An equal number of controls were selected through random digit dialing and individually matched to cases. Results  In multivariate analyses, a significant association was seen for lawn care with pesticides [during pregnancy: odds ratio (OR) = 1.6, 95% confidence interval (CI): 1.0, 2.5; after birth: OR = 1.8, 95% CI: 1.2, 2.8] and a weak association was seen for stripping paint [during pregnancy: OR = 1.4, 95% CI: 0.8, 2.6; after birth: OR = 1.4, 95% CI: 0.7, 2.6]. Conclusions  This study suggests that household exposures from hobbies, particularly pesticides, may increase risk of MB/PNET in children; previous research has been mostly limited to occupational exposures.     

Malignant melanoma of the jaws—A clinicopathological study

Malignant melanoma of the oral cavity is rare and only 1.5% of all melanoma occurs in the oral cavity. Two cases of malignant melanoma of the jaw are reported because of its rarity. Various aspects of the cases are discussed.     

Peritoneal metastases from extra-abdominal cancer – A population-based study

Introduction

Peritoneal metastases (PM) are predominantly seen as a manifestation of intra-abdominal malignancy such as colorectal or ovarian cancer. However, extra-abdominal primary cancer can also metastasise to the peritoneum. Population-based data on the incidence of PM from extra-abdominal cancer is lacking. This study aims to assess the patterns and survival of patients in Ireland with PM from extra-abdominal cancers.

Case–control study of smoking and non-melanoma skin cancer

Objective  

To investigate the association between cigarette smoking and basal and squamous cell carcinomas (BCC and SCC) of the skin, a clinic-based case–control study was conducted in Tampa, FL.     

Survival of cancer patients in europe—The EUROCARE study

Book Review

Survival of cancer patients in europe—The EUROCARE studyEdited by F. Berrino, M. Sant, A. Verdecchia, R. Capocaccia, T. Hakulinen, J. Estève International Agency for Research on Cancer, Lyon (France), 1995; IARC Scientific Publication No. 132; 463 pp. ISBN 92 832 2132 X; ISSN 0300-5085     

Incidence and mortality of second sarcomas – A population-based study

BackgroundStudies on second sarcoma in unselected populations of cancer survivors have not previously been published.MethodsSecond sarcoma was defined as a sarcoma following a previous invasive cancer. Patients with this malignancy were retrieved from the Cancer Registry in Norway for the period 1960–2007 among a total of 728 874 cancer patients including 11 612 with a sarcoma. Changes in incidence and average annual percent change (AAPC) were studied with join-point analyses. Overall and sarcoma-related mortalities were assessed using the Kaplan–Meier and competing risk methods, respectively.ResultsA total of 900 second sarcomas were identified comprising 7.5% of all sarcomas. The AAPC of second sarcoma incidence was 6.2 (95% CI = 5.7–6.7) as compared to 2.5 (95% CI = 2.1–2.8) for all sarcomas and 2.5 (95% CI = 2.4–2.6) for cancer in general. The annual incidence of second sarcomas doubled during the last decade of the study period. The distribution of histological subtypes was significantly different between second and sporadic sarcomas. The overall mortality was significantly higher and sarcoma-related mortality was significantly lower for patients with a second sarcoma compared to sporadic sarcoma.ConclusionsThere is an increasing incidence of second sarcomas among cancer survivors, and one may speculate a relation to the intensified use of cytotoxic treatment of the preceding malignancy. Sarcoma–related mortality after second sarcomas is significantly below that of sporadic sarcoma.