Sanazole as a sensitizer of hypoxic cells with radical radiation in the treatment of advanced cancer of cervix an Indian experience

AK-2123, is a nitrotriazole with a potential to sensitize hypoxic tissue to radiation. Cancer of cervix in advanced stages are predominantly treated with radiation. These are the tumours which harbour a large hypoxic core. This is an Indian experience of the multicentric trial. Patients were randomized to control and AK-2123 arm. 49 patients were randomized to each group. Patients received external radiation with telecobalt to a dose of 50 Gy in five weeks. Those in the study arm received 600 mg/m2, on alternate days. The patients were further treated with intracavitory radiation a dose of 20 Gy. The total dose of 70 Gy was achieved. Patients in the study arm had a complete response of 71.43% (35 of 49) while only 21 of 49 (42.86%) responded in the control group. The overall survival at two years was 72.2% for the study group and 32.43% for control. Neuropathy, a drug related toxicity was transient except, in one patient, which has persisted. AK-2123, has shown significant radiation sensitizing potential.     

Spontaneous auto-amputation of the foot in a case of diabetes,atherosclerosis and gangrene

Auto-amputation is the spontaneous separation of non-viable tissue from viable tissue, and is usually associated with dry gangrene, occurring in the distal portions of the lower extremities. A 68-year-old female presented with dry gangrene of both feet and subsequent loss of the right foot and digits on the left foot over a period of one and half years. After about six months disarticulation of the right foot from the ankle joint resulted. She gradually lost the digits of the left foot two months later. She had pallor and showed absence of popliteal and distal pulses on both sides. The left foot showed absence of the digits with exposed 3rd and 4th metatarsals and some areas of gangrene and sloughing. Her Hb was 5.4 g/dl and random blood sugar was 340 mg%. Doppler study of the lower limbs showed blockage at the level of the superficial femoral artery on the right side and a patent popliteal artery on the left. She was managed conservatively as she was unwilling for surgical intervention.     

Peripheral venous access ports: Outcomes analysis in 109 patients

Purpose: To perform a retrospective outcomes analysis of central venous catheters with peripheral venous access ports, with comparison to published data. Methods: One hundred and twelve central venous catheters with peripherally placed access ports were placed under sonographic guidance in 109 patients over a 4-year period. Ports were placed for the administration of chemotherapy, hyperalimentation, long-term antibiotic therapy, gamma-globulin therapy, and frequent blood sampling. A vein in the upper arm was accessed in each case and the catheter was passed to the superior vena cava or right atrium. Povidone iodine skin preparation was used in the first 65 port insertions. A combination of Iodophor solution and povidone iodine solution was used in the last 47 port insertions. Forty patients received low-dose (1 mg) warfarin sodium beginning the day after port insertion. Three patients received higher doses of warfarin sodium for preexistent venous thrombosis. Catheter performance and complications were assessed and compared with published data. Results: Access into the basilic or brachial veins was obtained in all cases. Ports remained functional for a total of 28,936 patient days. The port functioned in 50% of patients until completion of therapy, or the patient's expiration. Ports were removed prior to completion of therapy in 18% of patients. Eleven patients (9.9% of ports placed) suffered an infectious complication (0.38 per thousand catheter-days)—in nine, at the port implantation site, in two along the catheter. In all 11 instances the port was removed. Port pocket infection in the early postoperative period occurred in three patients (4.7%) receiving a Betadine prep vs two patients (4.2%) receiving a standard O.R. prep. This difference was not statistically significant (p = 0.9). Venous thrombosis occurred in three patients (6.8%) receiving warfarin sodium and in two patients (3%) not receiving warfarin sodium. This difference was not statistically significant (p = 0.6). Aspiration occlusion occurred in 13 patients (11.7%). Intracatheter urokinase was infused in eight of these patients and successfully restored catheter function in all but two instances. These complication rates are comparable to or better than those reported with chest ports. Conclusion: Peripheral ports for long-term central venous access placed by interventional radiologists in the interventional radiology suite are as safe and as effective as chest ports.     

Stress profile in essential hypertension.

This study was undertaken to test the hypothesis that basal sympathetic activity and sympathetic reactivity to stress are increased in patients with essential hypertension. One hundred and fifteen randomly selected patients with essential hypertension and an equal number of age- and sex-matched normal controls were included in this study. Various parameters, viz., heart rate, respiratory rate, blood pressure, peripheral skin temperature, electromyographic activity of the frontalis muscle, skin conductance (measured by electrodermography), and blood pressure, were measured in the resting state in both groups. These parameters were then measured during the performance of various stressful activities, such as mental arithmetical calculations, thinking of unpleasant thoughts, staring at a fixed point, catching of a dropped object, and reading aloud for 1 min each, and again over a 1-min quiet period following each stressful activity. Changes in various parameters in the two groups were analyzed and compared. Baseline heart rate, respiratory rate, electromyographic activity and peripheral skin temperature were higher-while skin conductance was lower-in the hypertensive group than in the control group. The increases in systolic blood pressure, diastolic blood pressure, heart rate, respiratory rate, electromyographic activity, and peripheral skin temperature in response to stress were greater in hypertensive patients than in controls, while skin conductance showed a higher elevation in controls than in hypertensive patients. In conclusion, sympathetic nervous system activity is increased in patients with essential hypertension. The reduced skin conductance and high peripheral skin temperature in these patients may be due to a possible dermal neurovascular dysfunction.     

Right mini-thoracotomy: an adjunct to left subcostal automatic implantable cardioverter defibrillator implantation

High defibrillation thresholds are encountered in some patients during implantation of the automatic implantable cardioverter defibrillator (AICD). In a consecutive series of 52 patients with AICD implants, 46 had allepicardial implants by left subcostal thoracotomy, and 8 of these patients had thresholds greater than 30 J. Placement of an apicolateral large left ventricular patch and an extrapericardial large right atrial patch electrode through a limited right thoracotomy produced substantial reduction in their thresholds. Especially in patients who have had previous intrapericardial operations, this technique provides a simple solution to the problem of high thresholds.