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Dietary behavior seems to be an important modifiable determinant for the risk of cancer. The evidences from several epidemiological studies suggest that higher intakes of fruits and vegetables have been associated with lower risk of cancer. Dietary phenolic and polyphenolic substances, terpenoids, dietary fibers, fish oils, some micronutrients present in foods of both plant and animal origin, and a reduction of caloric intake appear to inhibit the process of cancer development. Many dietary factors possess antioxidant and anti-inflammatory properties and cause induction of phase II enzymes like glutathione-S-transferases. It has been suggested that cruciferous vegetables play an important role in cancer prevention, and their chemopreventive effects are due to high glucosinolate content which under enzymatic hydrolysis produces bioactive compound isothiocyanates. Further, isothiocyanates of a wide variety of cruciferous vegetables are powerful inhibitors of carcinogenesis in experimental animal models. Several flavonoids present in fruits, tea, soya beans, etc. may be useful as cancer preventive agents. Similarly, ellagic acid, perillyl alcohol and resveratrol found in various fruits may have chemoprotective effect. Moreover, different vanilloids such as curcumin and gingerol have been shown to possess antioxidative properties. Nevertheless, in spite of several studies, still the effects of various ingredients are not clearly distinguished. In human, little convincing evidence has been established for the proposed protective effects of dietary constituents. It is an important future research goal to provide necessary evidences to support the chemopreventive role of different dietary factors, and also to clarify misunderstandings in this perplexing area.

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BACKGROUND : In the absence of an effective cervical cancer screening programme, efforts are being made to explore the feasibility of using the existing infrastructure to develop effective low-cost screening methods. AIMS : To evaluate and compare test performance of visual inspection of the cervix by a doctor and a paramedical worker. SETTING AND DESIGN : Gynaecology outpatient department (OPD), All India Institute of Medical Sciences, New Delhi; cross-sectional study. MATERIAL AND METHODS : One hundred women with complaints of vaginal discharge, irregular bleeding, post coital bleeding or unhealthy cervix underwent visual inspection with acetic acid (VIA) and Lugol's iodine (VILI) by a doctor and nurse, followed by colposcopy and biopsy. STATISTICAL ANALYSIS USED : Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated for each test and compared. Concordance was determined by kappa statistics. RESULTS : VIA by nurse had a higher sensitivity (100% versus 87.5%), but lower specificity (53% versus 63%) when compared with the doctor, but it was not statistically significant. There was moderate agreement between their VIA findings (kappa=0.56). VILI findings were comparable to that of the VIA, both by the doctor and nurse. There was almost perfect agreement (kappa=0.89) between VILI by the doctor and nurse. CONCLUSION : Visual inspection can be performed reliably by trained paramedical workers and doctors and is an effective screening option in low resource settings.

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Positron emission tomography (PET) is a diagnostic imaging technique that has progressed rapidly from being a research technique in laboratories to a routine clinical imaging modality. The most widely used radiotracer in PET is Fluorine18-fluorodeoxyglucose (F18-FDG), which is an analogue of glucose. The FDG uptake in cells is directly proportional to glucose metabolism of cells. Since glucose metabolism is increased many fold in malignant tumors PET has a high sensitivity and a high negative predictive value. PET with FDG is now the standard of care in initial staging, monitoring the response to the therapy, and management of lung cancer, colonic cancer, lymphoma, melanoma, esophageal cancer, head and neck cancer and breast cancer. Other indications of PET like bone tumor, ovarian cancer and cancer of unknown primary (CUP) has also been discussed in brief. The aim of this review article is to review the clinical applications of PET in various malignancies and only limited number of important studies will be discussed for this effort.

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BACKGROUND : Data on the clinical profile of early breast cancer (EBC) from India is scant. Due to differences in genetics, environment, lifestyle, socio-demographic structure and ethnicity, the presentation and behavior of breast cancer in India may be different. AIMS : To analyze the clinical presentation and outcome of EBC patients. SETTINGS AND DESIGN : A single center retrospective study. MATERIALS AND METHODS : Data from 487 EBC patients registered and treated at our institute from 1993 through 1999 were analyzed. Cox's multivariate regression test was used to determine prognostic factors for overall and disease-free survival (OS & DFS). RESULTS : The median age was 47 years and 49.7% patients were pre-menopausal. Ninety-six per cent patients presented with a lump. Stages I, IIa, and IIb comprised 7.8%, 38.8%, and 47.6% respectively. Only 11.3% patients opted for breast-conserving surgery (BCS) while the remaining 88.7% underwent modified radical mastectomy (MRM). Adjuvant chemotherapy was administered to 275 (56.5%), and radiotherapy to 146 (29.9%). Estrogen receptor status was known in 173, of whom 93 (53.7%) were positive. Most patients were prescribed Tamoxifen for 5 years. At a median follow-up of 48 months, 126 (25.9%) patients had relapsed (systemic 107, loco-regional 19) and 94 (19.3%) had died. Five-year DFS and OS were 73% and 78%, respectively. On multivariate analysis, four positive nodes adversely influenced survival (P<0.01). CONCLUSIONS : The median age at presentation was 47 years, significantly lower than most Western figures. The majority (86.4%) had a lump size > two cm. BCS was done in only 11% and the rest underwent MRM. Nodal involvement was the significant prognostic factor.

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OBJECTIVES : To obtain baseline information about prevalence of tobacco use among school children in eight states in the North-eastern part of India. MATERIAL AND METHODS : A two-stage probability sample of students in grades 8-10 corresponding to 13 to 15 years of age was selected in each state and surveyed through an anonymous, self-administered questionnaire. RESULTS : Among the sampled schools, the school response rate was 100% in all states except Tripura (92%) and Meghalaya (96%). Among the eligible students, over 80% participated in the survey. Among the respondents, the proportion of boys ranged between 50% to 55%. Ever tobacco users ranged from 75.3% (Mizoram) to 40.1% (Assam). Over 65% of users reported initiation at 10 years of age or earlier in all states except Mizoram (23.1%). The range of current tobacco use (any product) was 63% (Nagaland) to 36.1% (Assam). Current smokeless tobacco use ranged from 49.9% (Nagaland) to 25.3% (Assam). Mizoram reported the highest current smoking (34.5%, mainly cigarette) and Assam reported the lowest (19.7%, again mainly cigarette). Current smoking among girls (8.3% to 28.2%) was also quite high. Over half of current cigarette smokers (53.2% to 96.3%) and a high proportion of current smokeless tobacco users (38.5% to 80.8%) reported feeling like having tobacco first thing in the morning. Only about 20% of students reported having been taught in school about the dangers of tobacco use, except in Mizoram (around 50%). Tobacco use by parents and close friends was positively associated with students' current tobacco use. CONCLUSIONS : Tobacco use including smoking was very high, even among girls, in all eight states in the North-eastern part of India. Signs of tobacco dependency were already visible in these students, more among those who smoked. In general schools did not educate students about the hazards of tobacco use.

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BACKGROUND : Early detection and multimodality therapy has resulted in an overall improvement of survival among breast cancer patients. Despite a significant shift in the treatment approach from radical mastectomy to breast conservation a significant number of patients develop lymphedema. This study was conducted to evaluate the prevalence and risk factors for development of lymphedema. SETTINGS AND DESIGN : Retrospective analysis for prevalence of lymphedema in a tertiary care regional cancer centre. MATERIAL AND METHODS : Three hundred treated breast cancer patients with a minimum follow up of one year were evaluated for the prevalence and risk factors for lymphedema. Lymphedema was assessed using a serial circumferential measurement method. More than 3 cm difference in circumference is considered as clinical significant lymphedema. Univariate and multivariate analysis were performed for evaluating the risk factors by using the Chi square test and Cox logistic regression analysis. RESULTS : The prevalence of clinically significant lymphedema was 33.5 % and 17.2 % had severe lymphedema. The prevalence of lymphedema was 13.4 % in patients treated with surgery only where as the prevalence was 42.4% in patients treated with surgery and radiotherapy. Stage of the disease, body surface area > 1. 5 m2, presence of co-morbid conditions, post operative radiotherapy and anthracycline based chemotherapy were significant risk factors in univariate analysis where as axillary irradiation and presence of co-morbid conditions have emerged as independent risk factors in multivariate analysis (P < 0.001). CONCLUSION : Post treatment lymphedema continues to be a significant problem following breast cancer therapy. Presence of co-morbid conditions and axillary radiation significantly increases the risk of lymphedema. A combination of axillary dissection and axillary radiation should be avoided whenever feasible to avoid lymphedema.

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BACKGROUND: The most common and also the most often assayed mtDNA deletion mutation, °mtDNA ⁴⁹⁷⁷ has been demonstrated in various types of human cancer. However, knowledge about °mtDNA ⁴⁹⁷⁷ in lung carcinoma is poor. AIM: To study the 4977 bp deletions of mitochondrial DNA (°mtDNA ⁴⁹⁷⁷) in lung cancer, adjacent histologically normal and normal lung tissue and its potential roles in the development of cancer. MATERIALS AND METHODS: Thirty-seven matched lung cancer/adjacent histologically normal and 20 histologically normal lung tissue samples in subjects without lung cancer were analyzed by PCR technique. RESULTS: °mtDNA ⁴⁹⁷⁷ deletions were detected in 54.1% (20/37) of lung cancers, 59.5% (22/37) of adjacent normal and 30.0% (6/20) of normal lung tissue samples. No significant difference was found in the frequency of °mtDNA ⁴⁹⁷⁷ deletions between the tumor and adjacent normal lung tissues ( P value = 0.815). Moreover, no significant difference was found in the frequency of °mtDNA ⁴⁹⁷⁷ deletions between the tumor and histologically normal lung tissues in subjects without lung cancer ( P value = 0.101). However, the correlation between °mtDNA ⁴⁹⁷⁷ deletion and age and smoking factors was present in our data. STATISTICAL ANALYSIS: Fisher's exact test was used to assess the difference in different groups by the Scientific Package for Social Sciences (SPSS), version 10.0, Statistical analysis software. CONCLUSINS: Mitochondrial DNA 4977 bp deletion, which is not specific to lung cancer, may reflect the environmental and aging process influences operative during tumor progression.

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BACKGROUND: Desmoplastic small round cell tumor (DSRCT) is a rare malignant neoplasm of adolescent males. Current multimodality treatment prolongs life and rarely achieves cure. Aim: To review the presenting features, histopathology and outcome of 18 patients with DSRCT treated at a single institution. Setting and Design: This is a retrospective observational study of patients with DSRCT who presented at the Tata Memorial Hospital between January 1994 to January 2005. Materials and Methods: Eighteen patients of DSRCT seen during this period were evaluated for their clinical presentation, response to chemotherapy and other multimodality treatment and overall survival. The cohort of 18 patients included 11 males (61%) and 7 females (39%) with a mean age of 16 years (Range 1½ - 30 years). Majority (83%) presented with abdomino-pelvic disease. The others, involving chest wall and extremities. There were 6 patients (33%) with metastatic disease at presentation. Results:The treatment primarily included a multimodality approach using a combination of multiagent chemotherapy with adjuvant surgery and radiotherapy as applicable. A response rate of 39% (CR-1, PR-6), with chemotherapy was observed. The overall response rate after multimodality treatment was 39% (CR-5, PR-2). The overall survival was poor except in patients who had complete excision of the tumor. Conclusion: Abdomino-pelvic site was the commonest presentation, the disease can occur at other non-serosal surfaces also. Despite aggressive treatment the outcome was poor. However, complete surgical excision seems to provide a better survival.

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Tumours of the head and neck comprise an important group of neoplasia, the incidence of which is increasing in many parts of the world. This increase remains high, despite all the advances in modern medicine. This malignancy is more prevalent in the developing world and unfortunately, has not received satisfactory attention as the more prevalent cancers of the developed world, like lung, breast, or colon cancer. Recent advances in diagnosis and therapeutic techniques of these lesions have yielded novel molecular targets, uncovered signal pathway dominance and advanced early cancer detection. This review covers recent advances in our understanding of the etiology, molecular changes and the possible role that genomic and proteomic research might play in the diagnosis and effective cure of this modern-day scourge.

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BACKGROUND : Glutathione-S-transferases (GSTs) are active in the detoxification of wide variety of endogenous or exogenous carcinogens. The genetic polymorphisms of GSTM1 and GSTT1 genes have been studied earlier to evaluate the relative risk of various cancers. AIM, SETTING AND DESIGN : In the present study, we examined the association of the GSTM1 and GSTT1 gene polymorphisms with sporadic prostate cancer patients in north Indian population. MATERIAL AND METHODS : This case control study was undertaken over a period of 24 months and included 103 prostate cancer patients and 117 controls; both patients and controls originated from northern part of India. The GSTT1 and GSTM1 genotypes were identified by multiplex PCR in peripheral blood DNA samples. STATISTICAL ANALYSIS : Difference in genotype prevalence and association between case and control group were assessed by the Chi square and Fisher Exact tests. RESULTS : Frequencies of null genotypes in GSTT1 and GSTM1, was 11% (13/117) and 30% (35/117) respectively in control individuals. The frequencies of GSTT1 and GSTM1 null genotypes in prostate cancer patients were 34% (35/103) and 53% (55/103) respectively. CONCLUSION : Our study demonstrates that the null genotypes of GSTT1 and GSTM1 are substantially at higher risk for prostate carcinoma as compared to the normal healthy controls. The GSTT1 and GSTM1 null genotypes did not show significant association with tobacco usage in prostate cancer patients. However, the null genotypes were significantly stratified in 50-60 year-old patients when incidence of prostate cancer is high.

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BACKGROUND: Head and neck neoplasia constitute one of the commonest cancers in India. Use of smokeless tobacco (Pan masala, Zarda etc.) is on the increase in North India, especially in Uttar Pradesh, and is responsible for the large majority of these tumours. AIM: To assess the patients' characteristics, yearly prevalence and histopathological subtypes of the head and neck neoplasia (excluding oral cavity) in Allahabad and surrounding regions. SETTINGS AND DESIGN: A retrospective study of 11 years from 1990 to 2000 was designed. Data was collected year-wise using the tumor registry data. MATERIAL AND METHODS: All biopsies submitted for histopathology to the Pathology department were reviewed and analyzed for demographic data, site and diagnosis. STATISTICAL ANALYSIS: The Kolmogorov-Smirnov Two-Sample Test was utilized to determine whether two distributions are the same. RESULTS: A total of 40559 biopsies were examined in the department, of which, lesions of the head and neck region, excluding the oral cavity, constituted 694 biopsies (409 males and 285 females). One hundred and forty-four malignant lesions were reported, 114 being males and 30 females. A comparison of the age-specific prevalence rates of cancer during the study period showed that the prevalence was highest in patients belonging to the 50-59 years age group and squamous cell carcinoma Grade II was the most prevalent type. On an average, 58 new biopsies per annum were received. CONCLUSIONS: Properly structured site-specific data like this can augment the National Cancer Registry Programme and is an essential indicator for the magnitude and the pattern of the cancer problem in India.

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BACKGROUND: A population-based registry of endocrine cancer cases in four Iranian provinces, was performed for the years 1996-2000. MATERIALS AND METHODS: Patients in each province were grouped according to age, gender and tumor specifics (site, morphology, behavior) and the data was coded according to the international classification of diseases for oncology. STATISTICAL ANALYSIS USED: Person-years of population at risk were calculated and the results were presented as incidence rates by sex, age, age specific rates and age standard rate (ASR) per 100,000 person-years, using direct method of standardization to the world population. RESULTS: A total of 319 cases of primary endocrine cancer were found and registered, including 313 cases of thyroid carcinoma and 6 cases of adrenal cancer. The thyroid carcinoma group cases consisted of papillary (82.7%), follicular (8.6%), medullary (7.0%) and anaplastic (1.6%) carcinomas. The ASR for thyroid carcinoma was 1.289 (0.627 for men, 1.59 for women), with the highest incidence rate in Kerman (ASR 1.643) and the lowest incidence rate in Golestan (ASR 0.735). For the 6 cases of adrenal cancer, 4 were neuroblastoma and 2 were pheochromocytoma. CONCLUSIONS: Iran was considered as an endemic, iodine-deficient area, until fairly recently. Iodinization of salt has been started about 12 years ago, in the nation. Considering the effect of improvement in the iodine intake in previously deficient communities, which is associated with an increase in the incidence of papillary carcinoma compared to other histologic types, the frequency and distribution of histologic types of thyroid carcinoma was closer to what can be seen in iodine-rich areas.

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Background and Aims: Radiation induced wet desquamation of skin in carcinoma breast patients is a painful condition. In this study topical beclomethasone dipropionate spray was used as prophylaxis with the purpose of reducing risk of the wet desquamation of skin in irradiated field. Materials and methods: Sixty patients of carcinoma breast were planned for postoperative loco regional radiotherapy (50 Gy in 25 fraction over five weeks) were prospectively randomized into two groups (1) steroid group-patients were advised to use beclomethasone dipropionate spray in irradiated axilla from day one of radiotherapy, (2) control group-patients were not allowed to use any topical agent in irradiated area. Radiation induced skin reaction was noted in terms of erythema, dry desquamation and wet desquamation weekly till end of prescribed 50Gy dose of the radiation therapy. Statistical Method: Chi-square test was used to see the statistical significance of the difference in wet desquamation between two arms of the study. Chi-square value and P -value was calculated for the difference of wet desquamation in two study arms. Result: In steroid group 4/30 (13.33%) patients developed wet desquamation of the axillary skin at the end of the radiotherapy. For the control group, this figure was 11/30 (36.66%). The difference in wet desquamation of the axillary skin in the two groups was statistically significant ( P -value= 0.0369). Conclusion: Topical steroid (beclomethasone dipropionate spray) for skin during radiotherapy significantly reduces the risk of wet desquamation of the skin.

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BACKGROUND : The changes in lipid profile have long been associated with cancer because lipids play a key role in maintenance of cell integrity. AIMS : The present study evaluated alterations in plasma lipid profile in untreated head and neck cancer patients as well as patients with oral precancerous conditions (OPC) and its association with habit of tobacco consumption. MATERIAL AND METHODS : This hospital-based case control study included 184 head and neck cancer patients, 153 patients with OPC and 52 controls. Plasma lipids including: (i) Total cholesterol, (ii) LDL cholesterol (LDLC), (iii) HDL cholesterol (HDLC) (iv) VLDL cholesterol (VLDLC) and (v) triglycerides were analysed by spectrophotometric kits. STATISTICAL ANALYSIS USED : Student's t-test was performed to compare mean values of the parameters. RESULTS : A significant decrease in plasma total cholesterol and HDLC was observed in cancer patients (P=0.008 and P=0.000 respectively) as well as in patients with OPC (P=0.014 and P=0.000, respectively) as compared to the controls. The plasma VLDL and triglycerides levels were significantly lower in cancer patients as compared to the patients with OPC (P=0.04) and controls (P=0.059). The tobacco habituates showed lower plasma lipid levels than the non-habituates. Our data strengthen the evidence of an inverse relationship between plasma lipid levels and head and neck malignancies as well as OPC. CONCLUSION :The lower levels of plasma cholesterol and other lipid constituents in patients might be due to their increased utilization by neoplastic cells for new membrane biogenesis. The findings strongly warrant an in-depth study of alterations in plasma lipid profile in head neck cancer patients.

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BACKGROUND : The clinico-pathological characteristics of renal pelvic malignancies associated with stones were retrospectively analyzed. AIMS : The main objective was to define the biological behavior and prognostic factors for these malignancies. SETTINGS & DESIGN : The tumors were classified according to the pathological types. The clinical data, imaging features and pathological features were analyzed with relation to prognosis. MATERIAL AND METHODS : Eighteen cases of malignancies associated with stone disease were retrospectively studied. The institute review board permitted the study. RESULTS : High incidence (15/18) of squamous cell carcinoma (SCC) was noted. The prognosis in this group of patients was uniformly poor. The median survival time was 3.6 months in the SCC group, 7.5 months in the Transitional Cell Carcinoma (TCC) group and 24 months in the Adenocarcinoma (AC) group. Infectious and systemic symptoms were noted in the majority of the patients. Preoperative Imaging techniques revealed tumor in only 2 cases. Both underwent radical extirpation and the median survival is 18 months till date. In the other 16 patients, where the initial diagnosis was made only on histological analysis of incomplete nephrectomy specimens, the survival was 3.56 months. All patients had prolonged history of staghorn stone disease with associated non-functioning kidney. We found that the main prognostic factor was the stage of the disease. CONCLUSIONS : Malignancies associated with stone disease have insidious onset of clinical symptoms and need a high degree of suspicion to identify them pre-operatively. The grave prognosis associated with incomplete excision makes it imperative to diagnose them earlier.

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Background: Increasing numbers of patients with renal cell carcinoma (RCC) are incidentally detected and can be potentially cured by surgery alone. In treating metastatic RCC, worthwhile survival rates are achieved in cases of low burden recurrences. This necessitates a rational follow up protocol, which picks up early recurrences and avoids costly surveillance for those with a favorable prognosis. Aims: We studied the patterns of metastases occurring in patients operated for localized or locally advanced renal cell carcinoma in the Indian setting and try to evolve a suitable follow up protocol. Setting and Design: Institution based, retrospective data. Method and Materials: Records of patients from January 1988 to December 2003, operated for initially localized RCC were reviewed. Follow up was performed using an established protocol. Occurrence of metastases and their patterns were studied. Statistical analysis used: Comparison of the different survival times was performed using the one-way analysis method. Multiple comparisons (post hoc test) were performed using the Bonferroni method. Result: Follow up was available on 209 patients. Mean survival was 43.75 months (SD ? 28.72). Thirty-nine patients developed 59 metastases. Lungs were the commonest site of metastases (37%), followed by bone (22%), liver (19%) and brain (8%). Relapse and survival showed significant correlation with pathological stage (p < 0.001), with higher stage being associated with greater relapses and lesser survival. There was no correlation between site of recurrence and stage of disease. Conclusions: Occurrence of metastases correlate with the pathological stage of the disease at primary presentation. Tailored, stage-based follow up protocols allow adequate surveillance for disease activity and progression without escalating the overall costs.

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Background : Seroma formation after mastectomy typically delays recovery and adds to morbidity. Aims : This retrospective review was undertaken to identify factors which predict development of seroma after mastectomy for breast cancer patients. Setting and Design : 119 consecutive patients intended for mastectomy for the treatment of primary breast cancer were included. Factors taken into consideration were epidemiological, peri-operative in nature and those related to wound drainage output. Materials and Methods : Total mastectomy was performed and axillary sampling was taken. All patients were reviewed within two weeks after leaving hospital, unless seroma formation was detected before discharge. The diagnosis of seroma was made clinically when a collection was detected beneath the skin flaps. Statistical Analysis Used : Student's t test was used with continuous variables and the X ² test for categorical situations. Fisher's exact test was applied when small numbers were encountered. A two-tailed test of P<0.05 was considered significant. Univariate analyses were performed. Results : The incidence of seroma formation was eight per cent. Five factors were identified to be significantly related to seroma formation: i) age over 45 years; ii) hypertension; iii) total drainage output exceeding 500 ml in the first three postoperative days; iv) drainage for more than eight days. Immediate breast reconstruction prevents the formation of seroma. Conclusion : The presence of hypertension in a patient over 45 years should alert the surgeon to possible seroma formation, particularly when the post-operative drainage exceeded 500 ml in the first three days. Appropriate preventive measures should then be implemented.

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Gallbladder cancer (GBC) is the prominent malignancy of hepato-biliary tract, being the fifth most common carcinoma for gastrointestinal tract in United States. Epidemiological studies world wide have implicated dietary factors in the development of gallbladder cancer. The ecological evidences indicate considerable geographic variation in the incidence of gallbladder cancer. However the variations in GBC incidence of different populations might be partly determined by their dietary variations. Higher intake of energy and carbohydrate possibly increase the risk of gallbladder cancer. Obesity plays an important role in the causation of GBC. Adequate intake of fruits and vegetables probably reduce the risk of GBC. This nutritional preventive effect against GBC could be attributed to high content of vitamins, carotenes and fibers. They can not be too emphatically stated as the sole determinants of GBC. It is apparently clear that a variety of essential nutrients can significantly modify the carcinogenic process. Furthermore, an attempt has been made to establish an association between dietary factors and the occurrence of gallbladder cancer.

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BACKGROUND : Juvenile nasopharyngeal angiofibroma (JNA) is a rare tumor of adolescent males and there is a paucity of Indian studies on this subject. AIMS : To present the experience of management of JNA at a single institution. SETTING AND DESIGN : This is a retrospective observational study of patients with JNA who presented at the Tata Memorial Hospital between May 1988 and August 2001. MATERIALS AND METHODS : Thirty-two patients with JNA were treated in the study period. Since the time period was prolonged and diagnostic and therapeutic protocols had undergone many changes, the patients were divided into two groups, namely 1988-1996 and 1997-2001. The age distribution, disease patterns, management approaches and treatment outcomes of patients in the two groups were recorded. Statistical analyses were done using students 't' test and test for proportion. RESULTS : The mean age at presentation was 16 years and more than 90% of the patients had Stage III or IV disease. Preoperative embolization was carried out in 19 patients. The surgical approaches used were median maxillectomy, infratemporal fossa, transpalatal, maxillary swing and craniofacial approach. The recurrence rate, complete resection rate and cure rates were 12.5%, 41% and 63% respectively. CONCLUSION : Surgery is the mainstay of treatment of JNA. Preoperative embolization and newer surgical approaches result in less blood loss and complete resection. Aggressive re-resection should be done for resectable recurrences reserving radiotherapy for unresectable, recurrent/ residual disease.

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BACKGROUND : Brainstem tumors represent 10% of central nervous system tumors, accounting for 30% of pediatric posterior fossa tumors. AIMS : The aim of this study was to clinicopathologically correlate 45 cases of brain stem gliomas and determine the occurrence and prognostic significance of p53 expression. MATERIALS AND METHOD : 45 cases of brain stem gliomas encountered during a 19-year period. 30 were diagnosed by surgical biopsy and 15 at autopsy. In 25 cases p53 immunohistochemistry (Avidin Biotinylated technique) was performed. The WHO brain tumor classification and Stroink’s CT classification were applied. STATISTICAL ANALYSIS USED : Chi square test. RESULTS AND CONCLUSIONS : 51 % of gliomas were observed in the first decade of life. The female to male ratio was 1.04: 1. The commonest presenting features were cranial nerve palsies (33%) and cerebellar signs (29.8%). 55.55% of cases were located in the pons, 31.01% in the medulla and 13.33% in the midbrain. Diffuse astrocytomas were seen in 40 cases (5% were Grade I, 47.5%Grade II, 32.5% Grade III and 15% Grade IV) and pilocytic astrocytomas in 5 cases. Grade IV patients had 2- 3 mitoses /10 high power fields and had a poorer survival rate.Grade II astrocytomas were treated with excision and radiotherapy, while grade III and IV tumors were treated with radiotherapy and chemotherapy (CCNU). Improvement was noted in 20% of patients postoperatively. The outcome was better in patients who were treated surgically. p53 is a frequently mutated gene in brain stem astrocytomas. It was found in 50 % of glioblastoma multiforme, 28.57% of grade III astrocytoma and 12.5% of grade II astrocytoma, while grade 1 astrocytomas failed to express p53 protein. p53 positivity was more in high grade lesions, decreasing significantly in lower grade lesions.

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Totally implantable venous devices (TIVD) are increasingly being utilized for venous access for chemotherapy of oncological patients. These devices considerably improve the quality of life of patients requiring long-term chemotherapy. However, despite the great usefulness of TIVDs, their insertion and maintenance is not free of complications. Many early as well as late complications associated with these devices have been reported. We report an unusual, silent, but potentially hazardous complication of catheter fracture and cardiac migration in a 16-year-old girl, in whom the port had been unused for 9 months before presentation. Percutaneous retrieval was unsuccessful as the catheter end was embedded in the myocardium. The catheter was removed via a midline sternotomy without any further complications. We have also reviewed the literature about the possible mechanism of this complication and discussed methods to recognize and avoid it.

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Objectives: The objectives of the present study were to study the pattern of tobacco use among rural adolescents (15-19 years) and to find out reasons for use and non use of tobacco products. Materials and Methods : In the present community-based research, triangulation of qualitative (free list, focus group discussions) and quantitative methods (survey) was undertaken. The study was carried out in surrounding 11 villages of the Kasturba Rural Health Training Centre, Anji during January 2008 where 385 adolescents were selected by simple random sampling and interviewed by house to house visits. After survey, six focus group discussions were undertaken with adolescent boys. Results: About 68.3% boys and 12.4% girls had consumed any tobacco products in last 30 days. Out of boys who had consumed tobacco, 79.2% consumed kharra, and 46.4% consumed gutka. Among boys, 51.2% consumed it due to peer pressure, 35.2% consumed tobacco as they felt better, and five percent consumed tobacco to ease abdominal complaints and dental problem. Among girls, 72% used dry snuff for teeth cleaning, 32% and 20% consumed tobacco in the form of gutka and tobacco & lime respectively. The reasons for non use of tobacco among girls were fear of cancer (59%), poor oral health (37.9%). Among non consuming boys it was fear of cancer (58.6%), poor oral health (44.8%) and fear of getting addiction (29.3%). According to FGD respondents, few adolescent boys taste tobacco by 8-10 years of age, while girls do it by 12-13 years. Peer pressure acts as a pro tobacco influence among boys who are outgoing and spend more time with their friends. They prefer to consume freshly prepared kharra which was supposed to be less strong (tej) than gutka. Tobacco is being used in treatment of some health problems. Tobacco is chewed after meals for better digestion, given to ease toothache, pain in abdomen and to induce vomiting in suicidal insecticide poisoning. Conclusion: The current consumption of any tobacco products among rural adolescents was found very high. Hence, the multi-pronged intervention strategy is needed to tackle the problem.

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Background: Breast cancer accounts for 19-34% of all cancer cases among women in India. There is a high mortality due to late stage diagnosis as patients usually present at an advanced stage because of lack of awareness and non-existent breast cancer screening programs. Aim : To determine the awareness about breast cancer among women in an urban resettlement colony in Delhi. Settings and Design: A community based, cross-sectional study carried out in a resettlement colony in South Delhi. Materials and Methods: Semi-structured interview schedule was used to collect information regarding breast cancer. Modified Kuppuswamy scale was used for assessing the socio-economic status. Results and Conclusions: A total of 333 women were included. The mean age was 36 years±15.1 and 46% were illiterate. Only 185 (56%) women were aware of breast cancer; among them, 51% knew about at least one of the signs /symptoms, 53% were aware that breast cancer can be detected early, and only 35% mentioned about risk factors. Thus, awareness about breast cancer is low amongst women in this community. There is a need for awareness generation programs to educate women about breast cancer, propagation of correct messages and promote early detection of breast cancer.

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