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Biomedical subjects

D Behera

Publications and source records attributed to D Behera.

At least 91 records · Page 5Linked to original sources
PubMedDate not supplied

Bronchoendoscopic involvement in patients with carcinoma of middle third of esophagus in absence of respiratory symptoms.

BACKGROUND: Bronchoscopic examination has been advocated as an essential part of evaluation of patients with newly diagnosed esophageal malignancy. The present study describes the role of routine preoperative fibreoptic bronchoscopy in staging disease and assessing resectibility in patients with malignancy involving the middle third of esophagus. METHODS: Preoperative fibreoptic bronchoscopy was performed in 125 patients with carcinoma of the middle third of esophagus. None of the patients had clinical or chest radiographic evidence of extension of disease outside the esophagus. RESULTS: Abnormalities were detected in 33 patients (25.6%), the commonest being external compression over the posterior wall of trachea in 17 (13.6%). Other abnormalities noted were left vocal cord paresis in seven (5.6%); compression over one or both major bronchi in seven (5.6%) and over the left lower lobe bronchus in one (0.8%); infiltration of the left main bronchus in two (1.6%); and growth in trachea in four (3.2%), in left main bronchus in two (1.6%) and over cricoarytenoid area in one (0.8%) patient. CONCLUSIONS: Tracheobronchial involvement, even in the absence of clinical or radiological features, is not uncommon in esophageal cancer. Preoperative bronchoscopy is useful to assess the extent of disease and resectibility in these patients.

Adult↗
PubMedDate not supplied

Lung cancer in India--a perspective.

The epidemiology, aetiopathogenesis, diagnostic methods and management of lung cancer in India have been reviewed based on the published data from this country. Over the years, the incidence has been increasing and the disease is being recognized more often. Smoking is the most important aetiological factor. Beedi smoking which is a common practice in this country is equally, if not more, harmful than cigarette smoking in causing lung cancer. Tremendous improvement has been made in various diagnostic techniques. Cytological methods, fiberoptic bronchoscopy and percutaneous lung aspiration are being used more frequently. At the treatment front, although radiotherapy and chemotherapy are being used, the results are not very encouraging. Except in few cases, surgery is usually not feasible because of advanced disease. Prevention of lung cancer by anti-smoking measures should be the main goal of solving the problem in this country.

Female↗
PubMedDate not supplied

Ifosfamide containing regimen for non-small cell lung cancer.

BACKGROUND: Combination chemotherapy has been demonstrated as one of the best active regimens in patients with non-small cell lung cancer (NSCLC). METHODS: A total of 206 patients with advanced unresectable NSCLC stage III B or stage IV were enrolled to receive combination chemotherapy with mitomycin, ifosfamide and cisplatin. About a third of them (n=63) did not continue therapy after the first course either because of toxicity, lack of affordability, or death. The remaining 143 patients (121 males) received two or more cycles of chemotherapy. RESULTS: Nearly half of all followed-up patients showed a partial or complete radiological response. Overall performance status (Karnofsky scale) worsened in 28 (19.6%) and improved in 44 (30.8%). While 50 patients (35%) gained weight, 65 (45.5%) lost weight during follow-up. Overall median survival was 20 weeks [95% confidence interval (CI), 16 to 24 weeks]. However, overall survival improved progressively with the number of chemotherapy cycles administered. Median survival in patients receiving at least three, four and five chemotherapy cycles was 23 (95% CI, 19-27); 27 (95% CI, 24-30) and 35 (95% CI, 28-42) weeks respectively. Survival at the end of three, six, nine and 12 months was 64.3%, 29.4%, 14.7% and 9.8%) respectively. Survival had no association with age of the patient, but was significantly correlated with baseline performance status (Pearson's correlation coefficient 0.29 p<0.01). The cost of each course of chemotherapy was a little over 100 US dollars. The side effects were minimal and acceptable, and the regimen was tolerated well by all the patients. CONCLUSION: Ifosfamide regimen containing mitomycin and cisplatin is a chemotherapeutic combination for treating patients with advanced NSCLC.

Antineoplastic Combined Chemotherapy Protocols↗
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Re-expansion pulmonary edema and hypotension.

A case with diagnosis of non-Hodgkin's lymphoma and superior vena cava obstruction on chemotherapy, presented with respiratory distress and massive pleural effusion of right hemithorax. On removal of 3.5 litres of fluid, he developed pulmonary edema of the same side and hypotension.

Adult↗
PubMedDate not supplied

Development of a computer software for easy storage and analysis of fibreoptic bronchoscopy data.

OBJECTIVE: To develop a simple software for management of fibreoptic bronchoscopy records. METHODS: After identification of the specific needs at our hospital, a software was developed. A graphical interface with structured data entry related to patient information and diagnosis, bronchoscopic findings and specimens obtained, and their reports were envisaged. After initial construction, the software was tested over a four-week period. The software was put to routine use after necessary corrections, and validated over the next few months through actual data entry. RESULTS: The software has various modules for input and modification of data, as well as for generation of reports, and can work both on stand-alone personal computers and on networks. With little practice, residents soon became adept at entering details correctly and quickly. The slightly increased time of data entry into the computer was more than made up by uniform and complete report generation. The database component was evaluated by analyzing 1000 consecutive records entered over a 14-month period, and no discrepancies were observed. CONCLUSION: A user-friendly software providing uniform and complete data entry regarding fibreoptic bronchoscopic procedures was developed.

Bronchoscopy↗
PubMedDate not supplied

Lung cancer in India.

BACKGROUND: Lung cancer is one of the commonest malignant neoplasms all over the world. It accounts for more cancer deaths than any other cancer. It is increasingly being recognized in India. METHODS: We did a systematic review of the published studies on epidemiology, diagnosis and treatment of lung cancer in India. Literature from other countries was also reviewed. RESULTS: With increasing prevalence of smoking, lung cancer has reached epidemic proportions in India. It has surpassed the earlier commonest form of cancer, that of oropharynx, and now is the commonest malignancy in males in many hospitals. In addition to smoking, occupational exposure to carcinogens, indoor air pollution and dietary factors have recently been implicated in the causation of lung cancer. Squamous cell carcinoma is still the commonest histological type in India in contrast to the Western countries, although adenocarcinoma is becoming more common. Molecular genetics of lung cancer has opened up new vistas of research in carcinogenesis. Various modalities for early detection through screening are being investigated. Majority of the patients have locally advanced or disseminated disease at presentation and are not candidates for surgery. Chemotherapy applied as an adjunct with radiation improves survival and the quality of life. New anticancer drugs, which have emerged during the last decade, have shown an improved efficacy-toxicity ratio. CONCLUSIONS: In view of our large population, the burden of lung cancer will be quite enormous in India. Drastic measures aimed at discouraging people from smoking must be taken to reduce the morbidity and mortality due to lung cancer.

Air Pollution↗
PubMedDate not supplied

Serum surfactant protein-A levels in chronic bronchitis and its relation to smoking.

BACKGROUND: Surfactant protein-A (SP-A), which is an important constituent of natural surfactant, occurs physiologically in small amounts in blood. Tobacco smoke induces increased alveolo-capillary leakage of surfactant proteins into blood and its level in blood may help in the assessment of lung injury caused by smoke. Little is known on the SP-A levels in patients with chronic obstructive pulmonary disease (COPD). METHODS: Prospective analytical study of 30 patients with clinical diagnosis of chronic bronchitis, which was made on the basis of symptoms, signs and chest radiographic findings. Serum SP-A and serum cotinine levels were measured. RESULTS: Out of 30 patients, 21 were smokers and nine were non-smokers. The serum SP-A level in smokers with chronic bronchitis is significantly higher than the non-smokers. The plasma cotinine levels are also high in smokers. However, there was no correlation between the serum SP-A level and plasma cotinine level (r=0.044). Serum SP-A levels were related to age in smokers (r=0.566, p<0.01) but not in non-smokers with chronic bronchitis (r=0.017, p>0.05). CONCLUSION: The increase in SP-A level in smokers with chronic bronchitis suggests that tobacco smoking causes a chronic increase in permeability of the lung parenchyma. The SP-A, a lung-specific secretory protein, is a potential marker for non-invasive assessment of the integrity of the lung epithelium. Further studies are required to find out whether SP-A can be used as a marker for early identification of smokers who are at risk of COPD.

Age Factors↗
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Profile of repeat fiberoptic bronchoscopy.

BACKGROUND: Fiberoptic bronchoscopy (FOB) is invaluable in the diagnosis of a variety of pulmonary diseases, but in many instances the procedure has to be repeated because of an inconclusive initial FOB or for reassessment. METHODS: A retrospective analysis of all the fiberoptic bronchoscopic procedures done between September 2000 and February 2003 was performed and details of patients undergoing repeat FOB abstracted. RESULTS: Of the 2,270 bronchoscopies performed on 2114 patients, 132 procedures were repeated, yielding an over all frequency of repeat FOB of 6.34 percent. Bronchoscopy was done twice in 112 patients, thrice in 16 patients and four times in four patients. The commonest diagnosis in patients undergoing repeat bronchoscopy was bronchogenic carcinoma, followed by non-resolving pneumonia or presence of pulmonary infiltrates in immunocompromised host. The major indications for repeating FOB included obtaining specimens for pathological examination, pre and postoperative evaluation of airways, localization of site of bleeding in patients with hemoptysis, and placement of catheters for intraluminal brachytherapy. Of the 88 cases undergoing repeat bronchoscopy for diagnostic purposes, 41 (46.6%) yielded positive results, either in form of positive histology or localisation of source of hemoptysis. CONCLUSIONS: The frequency of repeat bronchoscopy was low. Commonest indication for a repeat procedure was to obtain repeat/additional diagnostic samples. A repeat procedure can yield positive results even when the initial FOB is nondiagnostic.

Bronchoscopy↗
PubMedDate not supplied

Evaluation of self-care manual in bronchial asthma.

BACKGROUND: Asthma continues to be a substantial cause of morbidity. Various educational programmes have shown an increase in knowledge and self-management skills of asthmatic patients and also revealed a reduction of severe attacks, hospitalisations and days lost from work. METHODS: A self-care manual on bronchial asthma was prepared. A total of 523 bronchial asthma patients were enrolled in the study. Out of these, 260 patients were included in the study group to whom self-care manual was provided and 263 were included in the control group to whom no specific instructions were given. After the initial interview (0 week), follow up of all the patients was carried out at two weeks, six months and at one year. RESULTS: Out of the enrolled patients, 240 (92.31%) and 240 (91.25%), 212 (81.54%) and 210 (79.85%), and 204 (78.46%) and 194 (73.76%) patients completed the follow up at two weeks, six months and one year in the two groups, respectively. Various parameters analysed were knowledge of the patients, their symptomatology, various triggering factors which were inducing and/or precipitating symptoms, the self-care measures they adopted at the time of acute attacks and the indices of asthma morbidity during the last one year. The knowledge scores were significantly higher at all the three follow up visits (F = 633. 98, p < 0.001) as compared to the baseline in the study group patients. In both the groups, the symptom scores decreased at all the follow up visits (F = 71.78, p < 0.001 in the study group and F = 24.19, p < 0.001 in the control group). Multiple logistic regression analysis showed a significant improvement in knowledge and symptoms in the study group as compared to controls after adjusting for various confounding variables (p < 0.001). The number of patients whose symptoms were induced and/or precipitated by exposure to various triggering factors was significantly reduced in study group for all the triggers. There was a statistically significant decrease in the number of severe attacks, number of emergency visits and need of injections during last one year in both the groups, though the differences were more marked in the study group. However, there was a significant decrease in hospital admissions and absence from school/or job in the study group at one year as compared to the control group. CONCLUSION: The self-care manual was effective in self-management of bronchial asthma.

Adult↗
PubMedDate not supplied

Vinblastin and mitomycin-C combination chemotherapy for patients with non small cell lung cancer.

Thirty-four patients with non small cell lung cancer were treated with a combination of vinblastin and mitomycin-C. Major radiological response was observed in 61.5% of cases. Median survival of the treated patients was 6 months and it was 7 months for those showing a major response. Fourteen of the 21 responders survived for 6 months or more, and 4 survived for more than a year. Leucopenia was a common side effect, and it did not produce any major infective complication. We did not find any advantage of this regimen over other less expensive drugs used in our earlier trials.

Adult↗
PubMedDate not supplied

Etoposide (VP-16) containing combination chemotherapy for treatment of patients with small cell lung cancer.

A combination chemotherapy consisting of VP-16, vincristine, cyclophosphamide and CCNU was used to treat 24 patients of small cell lung cancer (extensive stage disease - 15 and limited stage - 9). In addition, radiotherapy of 1000 to 4000 cGys was given to primary disease in chest in 16 patients. The overall response rate was 95.8% with complete response (CR) in 9 (37.5%) and partial (PR) in 14 (58.3%) cases. The overall median survival was 24 weeks. In patients with CR, it was 39 weeks and in those with PR this was 22.5 weeks. The lone non-responder survived for only 8 weeks. The drugs were well tolerated.

Adult↗
PubMedDate not supplied

Worsening of steroid dependent asthma : A possible role of rifampicin.

A 40-year-old male patient with chronic steroid dependent asthma developed pulmonary tuberculosis. After administration of antituberculosis therapy with rifampicin, isoniazid and pyrazinamide his asthma worsened. Omission of rifampicin from the drug regimen successfully controlled bronchospasm.

Adult↗
PubMedDate not supplied

Ultrasound guided aspiration biopsy of peripheral pulmonary lesions.

Forty-six patients with peripheral lung lesions underwent ultrasound-guided percutaneous needle aspiration biopsy. Aspirates were sent for cytological and/or microbiological examination. Confirmative diagnosis was obtained in 40 patients (86.9%). Twenty-eight patients had positive cytology for malignancy and 12 patients with benign lesions had diagnosis made by cytologic and microbiologic examination. None of the lesions could be diagnosed by sputum cytology and fibreoptic bronchoscopy with biopsy or brushings. No complication was observed in any patient. We conclude that ultrasound guided aspiration biopsy is a useful and safe method for the diagnosis of peripheral pulmonary masses. The diagnostic yield far exceeds that which can be obtained by sputum cytology and fibreoptic bronchoscopy with biopsy.

Adolescent↗
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Correlation of smoking behaviour and blood carboxyhaemoglobin in bidi and cigarette smokers.

Effects of different variables (amount, number of puffs, depth of inhalation, length and timing of sampling) of smoking on the blood carboxyhaemoglobin (COHb) levels were studied. There were 27 bidi smokers, 25 cigarette smokers, 25 mixed smokers (all asymptomatic) and 20 symptomatic cigarette smokers. Fifty-eight healthy non-smokers served as controls. The mean COHb levels in all the smokers were nearly 5-7 times higher than that in non-smokers. The blood COHb levels correlated well with the self assessed degree of inhalation by the individual smokers in each of the groups. There was no significant correlation between the COHb levels and number smoked on the test day, number of puffs per cigarette or bidi, and the length of smoking material. There was a good inverse correlation between the time interval and COHb level. The smoking index (amount smoked) did not bear any relationship with blood COHb levels.

Adult↗
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Massive pleural effusion, pseudocysts and pancreatico-pleural fistula with asymptomatic pancreatic disease.

A case of chronic pancreatitis with multiple pseudocysts of the pancreas and a pancreatico-pleural fistula causing massive left sided pleural effusion is reported, being a rare and an unusual cause of pleural effusion. This case illustrates the importance of pleural fluid amylase estimation in the diagnosis and the role of endoscopic retrograde cholangio pancreatography to elucidate the pathogenesis of such an effusion. The role of medical management is also emphasized.

Adult↗
PubMedDate not supplied

Tracheo-bronchial stenosis--report of 3 cases.

Three cases of large airway stenosis of different aetiologies are reported. In the first case, tracheal stenosis occurred after endotracheal intubation. The second case developed bronchial stenosis as a sequelae to pulmonary tuberculosis. The third case had localized stenosis of the left main bronchus for which no cause could be found. The first case responded completely to dilatation while the 2nd case demonstrated only partial response. Third case did not improve significantly with dilatation.

Adolescent↗
PubMedDate not supplied

Effect of radiation on pulmonary functions in patients with breast cancer.

There is no systematic study available from our country regarding pulmonary function tests in patients of breast cancer who receive postoperative radiotherapy. Therefore, we planned a prospective study to find out the effect of radiation on pulmonary functions in patients with breast cancer; who had undergone surgery in the form of simple mastectomy and axillary clearance. Transient radiological changes were seen in two cases and one patient had fibrosis at 9 months.

Breast Neoplasms↗