Biomedical subjects
H S Pandha
Publications and source records attributed to H S Pandha.
Eventration of the diaphragm: an unusual cause of radiation-induced diarrhoea.
We report a patient with carcinoma of the breast who was undergoing postoperative radiotherapy, and who developed transient acute diarrhoea due to the presence of diaphragmatic eventration.
Failure of normalization of alphafetoprotein levels following the successful treatment of teratoma: a diagnostic trap for the unwary.
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Palliation of obstructive nephropathy due to malignancy.
OBJECTIVE: To conduct a prospective study of patients with malignant obstructive uropathy treated actively by percutaneous nephrostomy and J-J ureteric stents. PATIENTS AND METHODS: Forty-two patients (27 men, 15 women, median age 62 years, range 29-83) with obstructive nephropathy secondary to malignancy underwent urinary diversion followed, where appropriate, by active treatment of the underlying cancer. RESULTS: The median survival of all patients was 133 (range 7-712) days. Seventeen patients (40%) survived for > 6 months and five (12%) for < 1 month. Patients who had received no prior therapy and for whom further therapeutic options were available were more likely to benefit from urinary diversion. In nine patients (21%) nephrostomy insertion failed to relieve renal failure. In 20 patients (48%) obstructive nephropathy recurred. The procedure was complicated by urinary tract or nephrostomy site infection in 16 patients, by septicaemia in six patients, by percutaneous urine leak in 13 patients and by pelvi-calyceal perforation in two patients, but not by haemorrhage or death. The median percentage of the patients' remaining life which was spent in hospital was 23.6% (range 2.2-100). CONCLUSIONS: Patients likely to benefit from nephrostomy were those for whom there were therapeutic options available for the treatment of their malignancy. Prolonged survival is possible in obstructive nephropathy secondary to malignancy, which should no longer be cited as an absolute contra-indication to urinary diversion. Patients unlikely to benefit from urinary diversion can also be identified and they should not routinely undergo this intervention.
Ethical and regulatory issues in gene therapy.
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Secretory symptoms from metastatic adrenal cortical carcinoma responding to octreotide.
The prognosis of patients with metastatic adrenal cortical carcinoma is poor, and their disabling symptoms are usually unresponsive to conventional therapy. A patient with Cushing's syndrome secondary to a secretory adrenal cortical carcinoma was treated with octreotide, endocrine therapy and chemotherapy having failed. Treatment led to a dramatic relief of her symptoms with a fall in corticosteroid secretion. Somatostatin analogue therapy for this tumour should be encouraged in view of the lack of alternative palliative treatment.
Tumour markers.
Tumour markers are now used in the diagnosis, anatomical localization, staging, monitoring and definition of prognosis of a wide range of malignancies. The last decade has seen an expansion of our definition of these markers to include oncogenes and oncogene products, and provided us with new possibilities of developing more specific tests to help in the management of cancer.
Gene therapy for urological cancer.
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Multiple primary cancers in association with prostate cancer.
Patients with prostate cancer are at a significant risk of either having a preceding tumour or developing a second malignancy. The precise mechanism by which second cancers develop is not clear but may be the result of exposure to a shared mutagen, abnormalities in oncogene activation or the aberrant expression of tumour suppressor genes. In the recent past, case reports and tumour registry studies on the risk of second cancer development have been important and have alerted the clinician that careful surveillance in this group of patients is required. More prospective hospital based studies are required to delineate the true risk of second malignancies in association with prostate cancer.
An audit of Hickman catheter use in patients with solid tumours.
The purpose of this study was to analyse the use and relative complication rates of Hickman lines inserted by angiographic and surgical routes in patients with solid tumours. Sixty-one patients (median age 55 years; range 21-81) with solid tumours had 71 Hickman catheters inserted. Fifty-three patients had 58 catheters inserted angiographically and eight patients had 13 catheters inserted surgically. Indications were as follows: for administration of infusional chemotherapy (48 patients), poor venous access (nine patients), needle phobia (four patients). The catheters remained in situ for 7981 days (median 105; range 10-750). Immediate complications occurred only in angiographically placed catheters (ten pneumothoraces, one tachydysrhythmia). Pneumothorax was associated with poor nutritional status but not with age, side of insertion or catheter gauge. The median body mass indices (BMIs) were 19.65 kg/m2 and 22.8 kg/m2 in those with and without pneumothorax respectively (P = 0.0045). Five of six patients with BMI < 19 kg/m2 developed a pneumothorax, compared with five of 52 with BMI > 19 kg/m2 (P = 0.0003). The overall sepsis rate was 2.38 per 1000 catheter days. Systemic sepsis was significantly increased for surgically inserted lines (3.94 versus 0.60 per 1000 catheter days; P = 0.001), although there was no significant difference in superficial sepsis (2.36 versus 1.04 per 1000 catheter days; P = 0.22). We conclude that Hickman catheters provide safe, long-term venous access in patients with solid tumours. Angiographic insertion carries a greater risk of acute complications in patients of poor nutritional status but a significantly lower risk of late systemic infective complications.(ABSTRACT TRUNCATED AT 250 WORDS)
Treating acidosis in fulminant hepatic failure: the case against use of bicarbonate solutions.
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Cancer in blacks, whites and Asians in a British hospital.
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Genetic prodrug activation therapy.
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Tumour markers.
The last decade has seen an enormous expansion of the role of tumour markers in the diagnosis, localization, prognosis, staging and monitoring of malignancies. The definition of tumour markers has been broadened to include cytogenetic markers, oncogenes and oncogene products which provide possibilities for developing more specific tests to help diagnose and manage malignant disease.