Flutamide in unresectable pancreatic adenocarcinoma: A randomized, double-blind, placebo-controlled trial

Summary Purpose: To evaluate the impact of flutamide on survival of patients with unresectable pancreatic cancer. Methods: This single institution, randomized, double-blind, placebo controlled study compared flutamide in the dose of 250 mg three times daily (n = 23) versus placebo (n = 23) in patients with histologically proven, previously untreated unresectable pancreatic adenocarcinoma. The primary end point was overall survival; secondary endpoints included 6-month and 1-year survival rates, performance status and response rate. Results: Both the groups were well matched with regards to demographic, disease related and treatment variables. This small sample sized study, failed to demonstrate a dramatic effect on survival with the use of flutamide. Median overall survival was 151 days with the use of flutamide as compared to 136 with placebo (p = 0.51). The 6-month survival rate was 39.13% in both arms of study and 1-year survival was 4.35% versus 13.04% for the flutamide group. There was no statistically significant difference in time to deterioration of performance status (flutamide 90 days versus placebo 68 days, p = 0.59) and all patients died as a result of tumor progression. Conclusions: Anti-androgen drug flutamide in the dose of 250 mg three times daily does not appear to prolong overall survival in unresectable pancreatic cancer.     

Reoperative surgery for postcholecystectomy bile duct injuries

BACKGROUND: Surgical repair for a postcholecystectomy bile duct injury can be complicated by the development of an anastomotic stricture which necessitates re-intervention. The authors reviewed their experience with patients requiring re-operation after unsuccessful surgical repair of the bile duct injury, to analyze the possible causes of the failure of the operative procedure and the long-term outcome following revisional surgery. METHODS: Retrospective analysis of the records of 41 patients referred to a tertiary care center for the management of recurrent stricture following surgical repair performed for a postcholecystectomy bile duct injury. RESULTS: Before referral, 69 operative procedures had been performed on these 41 patients. Factors likely to be associated with increased chances of failure of the biliary reconstructive procedures included presentation with cholangitis after the biliary injury, no cholangiographic study before the surgical repair and surgical intervention within 3 weeks of the injury. Thirty-seven (90%) patients were found to have strictures at or above the level of confluence of right and left hepatic ducts, while at the time of the index repair only 12 (29%) patients had an injury at that level. Revisional surgery in all the patients was a Roux-en-Y hepaticojejunostomy. One patient died, 2 patients with multiple previous operations developed recurrence and needed intervention again. Over a mean follow-up period of 4.2 years, 90% patients had a satisfactory outcome. CONCLUSION: Development of recurrent stricture following surgical repair of a postcholecystectomy biliary injury can be related to the technique and timing of the surgical procedure, the complication may therefore be avoidable in some patients. In experienced hands the results of revisional surgery are good but are adversely affected as the number of previous repairs increases.     

Endosonography of the Anal Canal and Rectum

Endosonography has evolved into an effective tool for the accurate preoperative assessment of anorectal pathology, from idiopathic anal pain to malignancy. The published data suggest that endosonography is currently the best method for assessing the structural integrity of the anal sphincter and for staging rectal cancer. The development of new treatment modalities for rectal cancer, including local excision, preoperative radiotherapy, and total mesorectal excision, has increased the importance of accurate preoperative staging to allow the optimum treatment planning. However, there is little information about the impact of endosonographic findings on clinical decision making. Education, training, and quality control in the use of endosonography also require further work. This article aims to evaluate the usefulness and limitations of this technique in clinical practice.     

Coordination complexes constructed from pyrazole–acetamide and pyrazole–quinoxaline: effect of hydrogen bonding on the self-assembly process and antibacterial activity

Two mononuclear coordination complexes of N-(2-aminophenyl)-2-(5-methyl-1H-pyrazol-3-yl)acetamide (L₁), namely [Cd(L₁)₂Cl₂] (C₁) and [Cu(L₁)₂(C₂H₅OH)₂](NO₃)₂ (C₂) and one mononuclear complex [Fe(L₂)₂(H₂O)₂](NO₃)₂·2H₂O (C₃), obtained after in situ oxidation of L₁, have been synthesized and characterized spectroscopically. As revealed by single-crystal X-ray diffraction, each coordination sphere made of two heterocycles is completed either by two chloride anions (in C₁), two ethanol molecules (in C₂) or two water molecules (in C₃). The crystal packing analysis of C₁, C₂ and C₃, revealed 1D and 2D supramolecular architectures, respectively, via various hydrogen bonding interactions, which are discussed in detail. Furthermore, evaluation in vitro of the ligands and their metal complexes for their antibacterial activity against Escherichia coli (ATCC 4157), Pseudomonas aeruginosa (ATCC 27853), Staphylococcus aureus (ATCC 25923) and Streptococcus fasciens (ATCC 29212) strains of bacteria, revealed outstanding results compared to chloramphenicol, a well-known antibiotic, with a normalized minimum inhibitory concentration as low as 5 μg mL⁻¹.

Two mononuclear coordination complexes of N-(2-aminophenyl)-2-(5-methyl-1H-pyrazol-3-yl)acetamide (L₁) and one mononuclear complex, obtained after in situ oxidation of L₁, have been synthesized and characterized spectroscopically.     

Frey’s Procedure Using the Harmonic Scalpel

Freys procedure, which is performed for chronic pancreatitis, principally involves coring of the head of the pancreas and pancreaticojejunostomy. The coring of the inflamed and enlarged pancreatic head is the most difficult and time-consuming part of this operation and is often associated with considerable bleeding. We used the harmonic scalpel to perform Freys procedure in six consecutive patients, which reduced intraoperative bleeding and made the operation technically easier.     

Effect of tractor driving on hearing loss in farmers in India

BACKGROUND: Indian tractor drivers operate their tractors and other implements/equipment in an environment which can have extreme temperatures and high level of suspended particulate matter. In addition, Indian tractors do not have adequate vibration and noise attenuating designs features. This cross-sectional study compares the hearing status of tractor driving farmers (TDFs) (study group) and non-tractor driving farmers (NTDFs) (control group) matched for age, sex, generic/ethnic group, land holding, education levels, and work routines. METHOD: Two groups of 50 experienced tractor-driving farmers and 50 non-driving farmers were selected from 2 villages, 50 km from Delhi. All participants were interviewed for details of work routine and noise exposures. An audiogram was performed and noise measurements taken on tractors and other machines. RESULTS: Self-reported hearing problems were similar (4 cases each) in both the groups of 50 farmers. However, audiogram analysis showed higher prevalence of abnormalities in TDFs. TDFs (24) had more often high frequency hearing loss when compared to NTDFs (14). The noise levels observed on tractors in different operations were in the range of 90-110 dB (A). CONCLUSIONS: Tractor noise levels exceeded the recommended safe limits of OSHA and NIOSH prescribed standards. TDFs had higher high frequency hearing loss than NTDFs. The mechanism of damage and prevention needs to be studied further.