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   2009| July-September  | Volume 46 | Issue 3  
    Online since June 25, 2009

 
 
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ORIGINAL ARTICLES
Breast self-examination among nurses and midwives in Odemis health district in Turkey
G Ertem, A Kocer
July-September 2009, 46(3):208-213
DOI:10.4103/0019-509X.52955  PMID:19574672
Background The second leading cause of death due to cancer in Turkey is breast cancer, which accounts for 24% of female cancers. Aims: To determine the practices of nurses and midwives and their attitude toward breast self-examination (BSE). Setting and Design: The descriptive survey was conducted to determine the practices of nurses and midwives and their attitude toward BSE. It tried to cover the total population rather than sampling part of it. However, 15 nurses and midwives, where there were errors detected in their data coding papers, and who did not accept to join the study, were excluded from the study. A total of 80 nurses and midwives were included in the study group. Materials and Methods: This survey was carried out at the State Hospital, all Public Health Cabins, and Family Health Centers, in the rural area of Izmir, a city located in the western region of Turkey. The data was collected between 15 March and 1 April 2004. Statistical Analysis: The analysis included descriptive statistics, to examine the association between BSE and medical history, knowledge of BSE, and attitude toward BSE. Results: The results of the study indicated that 52% of the sample performed BSE. Approximately 35% of those who performed BSE reported that they acquired information regarding BSE during their work experience. A significant relationship was found between higher levels of work experience and BSE practice. Except for age, no significant relation was found between the sociodemographic factors and BSE practice. The sample showed a strong belief in the breast lump being the cause of breast cancer and it had a significant correlation with BSE practice. Conclusion: A positive correlation was found between nursing work experience and their practice alongside BSE medical professionals. Almost all the nurses and midwives knew how to conduct BSE, but did not prioritize practicing it.
  11,287 751 21
Mutation pattern of K-ras gene in colorectal cancer patients of Kashmir: A report
AS Sameer, NA Chowdhri, S Abdullah, ZA Shah, MA Siddiqi
July-September 2009, 46(3):219-225
DOI:10.4103/0019-509X.52956  PMID:19574674
Background and Aim: Colorectal cancer (CRC) is one of the leading malignancies worldwide. CRC has been reported to show geographical variation in its incidence, even within areas of ethnic homogeneity. The aim of this study is to identify K-ras gene mutations in CRC patients among the Kashmiri population, and to assess whether they are linked with the clinicopathological parameters. Materials and Methods: Paired tumor and normal tissue samples were collected from a consecutive series of 53 patients undergoing resective surgery for CRC. In addition blood was also collected from all the cases for ruling out germline mutation. Results: Colorectal patients, 22.64% (12 of 53), presented with mutations in K-ras constituting 13 missense mutations out of which 11 were G→A transition, one G→C transversion, and one G→T transversion. 61.5% percent of the mutations occurred in codon 12 and 38.5% in codon 13. One tumor contained missense mutations in both codons. K-ras mutations were significantly associated with advanced Dukes' stage (P < 0.05) and positive lymph node status (P < 0.05). Moreover Codon 12 K-ras mutations were associated with mucinous histotype (P < 0.05). Comparison of the mutation profile with other high-risk areas reflected both mucinous histotype differences and similarities indicating coexposure to a unique set of risk factors. Conclusion: Mutation of the K-ras gene is one of the commonest genetic changes in the development of human CRC, but it occurs in a rather low frequency in Kashmiri population.
  7,653 780 31
Clinical significance of matrix metalloproteinase 2 and 9 in breast cancer
FD Shah, SN Shukla, PM Shah, HK Shukla, PS Patel
July-September 2009, 46(3):194-202
DOI:10.4103/0019-509X.52953  PMID:19574670
Background: Invasion and metastasis are the most strenuous problems in the management of breast cancer. These events require diverse proteolytic enzymes, among which MMP-2 and MMP-9 play a significant role in degradation of type IV collagen, the major component of the basement membrane. Therefore, the major objective of the study is to evaluate the clinical usefulness of MMP-2 and MMP-9 with respect to malignant tumor growth, invasion, and metastasis in breast cancer. Materials and Methods: Gelatin zymography was performed on 157 tissue extracts of malignant and adjacent normal breast tissues as well as negative and positive lymph nodes from 49 breast cancer patients. Statistical analysis was carried out using SPSS statistical software (version 10). Results: ProMMP-2 levels were significantly higher in adjacent normal tissues. Active MMP-2 and MMP-9 levels were higher in malignant breast tissues. Activation ratios of MMP-2 and MMP-9 were significantly higher in malignant breast tissues and in patients with lymph node metastasis. ProMMP-2, active MMP-2, and active MMP-9 could significantly discriminate between malignant and adjacent normal breast tissues. The MMP-2 activation ratio showed significant discriminatory efficacy between patients with and without lymph node metastasis and significant association with increased risk of lymph node metastasis in node-negative patients. Conclusion: The results indicate significant clinical utility of these proteolytic enzymes in malignant tumor growth, invasion, and metastasis in breast cancer.
  6,375 788 36
REVIEW ARTICLES
Economic cost analysis in cancer management and its relevance today
K Sharma, S Das, A Mukhopadhyay, GK Rath, BK Mohanti
July-September 2009, 46(3):184-189
DOI:10.4103/0019-509X.51360  PMID:19574668
The global cancer burden has shown a distinct shift in the last two decades and its financial impact can be large, even among patients living in high resource countries, with comprehensive health insurance policies. It is hard to imagine its impact on patients of developing countries where insurance policies exist infrequently and often cost becomes the greatest barrier in availing cancer treatment. It is recognized that these costs include the direct cost of disease treatment and care, indirect costs accrued by the patient and the family, and economic losses to the society as a whole. Economic cost analysis or cost-effectiveness analysis has emerged as a basic tool in the evaluation of health-care practices. To date, these cost data have been collected only sporadically, even in the most developed countries, and there is a great need for incorporating economic cost assessment practices in developing countries, so that patients and their families can access the care adequately. The current review has been done using pubmed and medline search with keywords like cancer, cost-analysis, cost-effectiveness, economic burden, medical cost, etc.
  6,109 785 4
Screening for human papillomavirus: Is urine useful?
KW D'Hauwers, WA Tjalma
July-September 2009, 46(3):190-193
DOI:10.4103/0019-509X.52952  PMID:19574669
Persistent infection with high-risk Human papillomavirus (hr-HPV 16, 18, 31, 33, and 45) is the main risk factor for developing malignant genital lesions. Screening methods and follow-up schedules for cervical cancer are well known. A golden standard to screen and monitor men does not exist yet, because HPV-related, life threatening malignancies in men are rare. The importance of male HPV screening lies mainly in HPV vaccination. Young females are the target group for HPV, but men are considered to be the reservoir for HPV and to have a role in the perpetuation of the infection in the general population. We looked at the usefulness of urine as a tool for HPV screening. Pubmed was searched with the words ''HPV'', ''Urine,'' and ''HPV-DNA''. The chance of finding HPV-DNA in urine is higher in men with lesions in the urethra than outside the urethra, and in women with abnormal cervical cytology. In general, the results of testing urine for HPV-DNA are better for women than for men, probably because of the anatomical position of the urethra to the vagina, vulva, and cervix. In both genders, urine HPV prevalence is higher in HIV pos patients and in high-risk populations. Urine, to screen asymptomatic low-risk-profile (wo)men seems less useful because their urine samples are often inadequate. If urine proves to be the best medium to screen, a low-risk population remains controversial.
  5,959 740 10
BRIEF REPORT
Benign tumors and tumor-like lesions of the calcaneum: A study of 12 cases
AT Oommen, V Madhuri, NM Walter
July-September 2009, 46(3):234-236
DOI:10.4103/0019-509X.52959  PMID:19574677
Benign tumors of the calcaneum are rare. Cystic lesions such as simple bone cysts and aneurysmal bone cysts are commonly seen. Aims and Objectives: To evaluate tumors of the calcaneum, which were seen over a 12-year period. Materials and Methods: We analyzed noninfectious, noninflammatory, benign lesions of the calcaneum seen in the Orthopedic Out Patient Department from 1991 to 2003. Twelve such tumors were encountered. There were 11 males and one female and their ages varied from 18 to 53 years with a median of 31. Data was collected from the histopathology reports, radiographs, and inpatient and outpatient records. One of the coauthors reviewed the histopathologic findings of all the tumors. Results: Twelve benign lesions were seen in 12 patients. In our series, cysts predominated, with three aneurysmal bone cysts and five simple bone cysts. The other benign tumors were: one fibrous dysplasia, one vascular hamartoma, one osteoblastoma, and one chondromyxoid fibroma. The bone cysts were treated by curettage, with or without bone grafting, except for one large aneurysmal bone cyst, which was treated by excision of the calcaneum. The postoperative function in this patient was good, with modified footwear. Conclusion: The calcaneum is an uncommon site for most bone tumors, and in our series, bone cysts were the most common benign lesions. Curettage and bone grafting or the use of bone substitutes can be effectively used in the treatment of symptomatic bone cysts of the calcaneum.
  5,960 582 12
LETTERS TO EDITOR
Testicular tuberculosis masquerading as testicular tumor
KS Shahi, G Bhandari, P Rajput, A Singh
July-September 2009, 46(3):250-252
DOI:10.4103/0019-509X.52968  PMID:19574686
  6,122 397 3
A case of leiomyosarcoma of kidney clinically and radiologically misdiagnosed as renal cell carcinoma
M Choudhury, SK Singh, M Pujani, OP Pathania
July-September 2009, 46(3):241-243
DOI:10.4103/0019-509X.52962  PMID:19574680
  4,670 320 4
ORIGINAL ARTICLES
Impact of delay in inguinal lymph node dissection in patients with carcinoma of penis
AK Gulia, A Mandhani, K Muruganandham, R Kapoor, MS Ansari, A Srivastava
July-September 2009, 46(3):214-218
DOI:10.4103/0019-509X.51359  PMID:19574673
Aim: To study the impact of delay in inguinal lymph node dissection (LND) in patients with squamous cell carcinoma of the penis, who have indications for LND at the time of presentation. Materials and Methods: In total, 28 patients (mean age 52.1 12.8 years) with squamous cell carcinoma of the penis, treated from January 2000 to June 2008, were retrospectively studied with regard to clinical presentation, time of LND, and the outcome. The patients were divided into two groups based on the time for LND. Group 1 patients had LND at mean of 1.7 months (range 0-6 months) of treatment of the primary lesion, and group 2 had LND at a mean of 14 months (range 7-24 months) after treatment of the primary lesion. Statistical Analysis: The statistical analysis of survival was done using the Kaplan-Meier method and the Log Rank test, with p < 0.05 considered to be statistically significant. The Mann-Whitney test and Fisher's exact test were used for univariate comparison. Results: Twenty-three of the 28 patients had inguinal LND. In group 1, of 13 patients, 12 were alive, with no recurrence of disease at a mean follow-up of 37 months (8-84) months. In group 2, only two patients were alive and disease-free, at a mean follow-up of 58 months (33-84 months). The five-year cancer-specific survival rates for early and delayed LND were 91 and 13%, respectively, (p = 0.007). Conclusions: When compliance with follow-up is suspect, patients with high grade or T stage (greater than T1) tumor are better treated by inguinal LND during the same hospital admission or within two months of primary treatment.
  4,308 421 11
HPV type 18 is more oncopotent than HPV16 in uterine cervical carcinogenesis although HPV16 is the prevalent type in Chennai, India
VM Berlin Grace
July-September 2009, 46(3):203-207
DOI:10.4103/0019-509X.52954  PMID:19574671
Context: The highest incidence of uterine cervical cancer in India is reported in Chennai. The prevalence and oncopotency are to be considered for the development of vaccines and therapeutic agents. Aims: The aim of the present study is to analyze the prevalence and oncopotency of high risk type HPV16 and 18 in cervical lesions. Settings and Design: This study is designed with 130 study subjects for analysis of selected types of HPV 6/11 and 16/18, in four groups, in a course of three years. The Bethesda system of classification is followed for grouping the samples, using histopathologic examination in biopsies. Materials and Methods: The biopsy samples were collected in 10% buffered formalin and were embedded in paraffin within 24 hours, for long-term preservation. The presence of HPV types were tested by PCR using type-specific primers for HPV16 and HPV18 in the DNA isolated from the subject's biopsies. The stages of cervical lesions were identified by histopathology using the Hematoxylin Eosin stain. Statistical Analysis Used: The data were subjected to statistical analysis, using the SPSS and INSTAT software packages for their associations and risk estimation, respectively. The Graph Pad Prism 2 x 2 contingency table was used for risk estimation and the Kruskel Wallis test was used for analysis of the associations. Results: In the study population, the data indicated a high prevalence of HPV 16. However, during the course of study (1999 - 2003), four (66.6%) dysplasia cases with HPV 18, three (21.4%) dysplasia cases with HPV 16, and none with low-risk HPV6/11, turned into invasive cancer, within one year. Conclusions: The observation of the study implied that HPV16 had a high prevalence in uterine cervical cancer compared with HPV18 cases. However, the development of invasive cancer from precancerous lesions was more for HPV18 infected cases than for HPV16 during the study period, which indicated the higher oncopotency of HPV type 18.
  3,983 562 8
EDITORIAL
Everyone is concerned about costs!
GS Bhattacharyya, H Malhotra, AA Ranade, D Raghunadharao
July-September 2009, 46(3):179-181
DOI:10.4103/0019-509X.52950  PMID:19574666
  4,038 456 -
LETTERS TO EDITOR
Virilizing adrenal carcinoma with inferior vena cava thrombus
P Bansal, A Gupta, R Mongha, AK Kundu
July-September 2009, 46(3):247-249
DOI:10.4103/0019-509X.52966  PMID:19574684
  4,145 259 2
CASE REPORT
Positron emission tomography / computerized tomography evaluation of primary Hodgkin's disease of liver
VS Gota, NC Purandare, S Gujral, S Shah, R Nair, V Rangarajan
July-September 2009, 46(3):237-239
DOI:10.4103/0019-509X.52960  PMID:19574678
Occurrence of primary Hodgkin's lymphoma (PHL) of the liver is extremely rare. We report on a case of a 60-year-old male who presented with liver mass and B-symptomatology. Hepatoma or hepatic metastasis from a gastrointestinal primary was initially suspected. Tumor markers like AFP, CEA, Total PSA, and CA-19.9 were within normal limits. Positron Emission Tomography / Computerized Tomography (PET/CT) revealed a large hepatic lesion and a nodal mass in the porta hepatis. A liver biopsy was consistent with Hodgkin's lymphoma. There was complete regression of the hepatic lesion and evidence of shrinkage of the nodal mass following four cycles of chemotherapy. 18F Fluro -de-oxy Glucose (FDG) PET / CT in this case helped in establishing a primary hepatic lymphoma by demonstrating the absence of pathologically hypermetabolic foci in any other nodes or organs. PET / CT scan is a useful adjunct to conventional imaging and histopathology, not only to establish the initial diagnosis, but also to monitor treatment response in PHL.
  3,801 496 5
LETTERS TO EDITOR
Zoledronic acid induced osteonecrosis of tibia and femur
S Gupta, P Jain, P Kumar, PM Parikh
July-September 2009, 46(3):249-250
DOI:10.4103/0019-509X.52967  PMID:19574685
  3,643 426 8
ORIGINAL ARTICLES
Assessment of gynecologic malignancies: A multi-center study in Tehran (1995-2005)
S Momtahen, M Kadivar, AS Kazzazi, F Gholipour
July-September 2009, 46(3):226-230
DOI:10.4103/0019-509X.52957  PMID:19574675
Objective: The observed differences in cancer incidence are mainly due to different individuals and social risk factors. This study aims to demonstrate the characteristics of female genital malignancies according to the pathological records in Tehran, Iran. Materials and Methods: In this cross-sectional study, all records of pathological specimens categorized as ovarian, uterine corpus or uterine cervix cancers from 1995 to 2005, in five teaching hospitals in Tehran, were studied. Age, marriage, parity, menopausal status, smoking, oral contraceptive usage, pathological staging, and histological grading were reviewed by a trained general practitioner. SPSS 14 was used for statistical analysis. Result: Mean age (SD) at the time of diagnosis was 50 (15). Fifty-nine percent of ovarian, 33.9 and 47.7% of uterine corpus and uterine cervix malignant patients were premenopausal. About 90% of all were nonsmokers and 82.7% were multiparae. Various types of gynecologic malignancies included ovarian (55.5%), uterine corpus (24.9%), and uterine cervical cancers (19.6%) were diagnosed. In tumors of the uterine corpus and uterus cervix, the most frequent stage of diagnosis was stage IIA. Conclusion: Ovarian cancer was the most frequently occurring gynecologic tumor. Although distribution of age in ovarian cancer was similar to that mentioned in the literature, occurrence of the cancer was more frequent in the premenopausal state.
  3,573 478 4
LETTERS TO EDITOR
Lack of awareness about breast cancer and its screening in developing countries
MM Rizwan, M Saadullah
July-September 2009, 46(3):252-253
DOI:10.4103/0019-509X.52969  PMID:19574687
  3,614 417 15
Marine life: New hope for cancer drugs
R Jain
July-September 2009, 46(3):243-244
DOI:10.4103/0019-509X.52963  PMID:19574681
  3,455 424 4
ORIGINAL ARTICLES
Gnathic osteosarcomas: A 10-year multi-center demographic study
T Azizi, MHK Motamedi, SM Jafari
July-September 2009, 46(3):231-233
DOI:10.4103/0019-509X.52958  PMID:19574676
Background: Osteosarcomas (OS) of the jaws are uncommon lesions representing 6-8% of skeletal OS. We assessed the characteristics, demographics, prevalence clinical and histopathological findings and distribution of gnathic OS relative to non-gnathic OS in four major treatment centers. Materials and Methods: This study assessed 13 gnathic OS patients of 98 OS patients from four major referral centers during 1996-2007. The age distribution, gender, involved site, clinical findings, signs, symptoms, grade and sub-types were assessed. Hematoxylin-eosin, Picrosirius red, Ponceau trichrome, Masson trichrome and osteoid staining methods were used. Results: Of the 98 OS lesions, 85 (86.8%) involved the skeleton, the youngest patient was 6 and the oldest 60 years old; 13 lesions (13.2%) involved the jaws (seven mandibular and six maxillary) and the youngest and oldest patients were 15 and 50 years-old, respectively. Non-gnathic OS was more prevalent between the ages of 11 and 20 years (avg. 15 years) and was common in the distal femur and proximal tibia, presenting most frequently with pain and swelling. OS of the jaws, however, presented more than 10 years later than non-gnathic OS, being more prevalent between the ages of 20 and 30 years (avg. 27 years). OS of the jaws most frequently involved the mandibular body and the posterior maxillary alveolar ridge, presenting frequently with pain, swelling and loosening of teeth. Two patients with gnathic OS died during the 10-year follow-up period (15.3%). Conclusion: Prevalence of OS of the jaws was about twice as high as that reported in other studies and presented later than non-gnathic cases. Pain and swelling were common signs and symptoms in this disease. The mixed sub-type was the most common sub-type of gnathic OS.
  3,214 429 8
LETTERS TO EDITOR
Anaplastic large cell lymphoma presenting as liver abscess and portal vein thrombosis
SB Chalamalasetty, K Madan, S Javvaji, KK Singh, M Vijayaraghavan, S Mathur, L Kumar, S Paul, SK Acharya
July-September 2009, 46(3):240-241
DOI:10.4103/0019-509X.52961  PMID:19574679
  3,212 318 2
Infiltrating duct carcinoma within a fibroadenoma
KR Iyengar, SC Peh, CH Yip, A Vijayananthan
July-September 2009, 46(3):244-246
DOI:10.4103/0019-509X.52964  PMID:19574682
  3,109 371 8
Alpha-fetoprotein production by non-hepatocellular carcinoma, malignant liver tumor
V Saini, K Madan, VV Mittal, P Sakhuja, SK Sarin
July-September 2009, 46(3):253-254
DOI:10.4103/0019-509X.52970  PMID:19574688
  3,025 358 1
GUEST EDITORIAL
Delayed lymphadenectomy in patients with carcinoma of penis
PK Hegarty
July-September 2009, 46(3):182-183
DOI:10.4103/0019-509X.52951  PMID:19574667
  2,673 388 -
LETTERS TO EDITOR
Enterocolic fistula associated with a gastrointestinal stromal tumor
A Shamsaeefar, S Mohammad Vahid Hosseini, N Motazedian, T Razmi
July-September 2009, 46(3):246-247
DOI:10.4103/0019-509X.52965  PMID:19574683
  2,725 261 3
Adverse drug reactions
V Gajula, S Bogu, A Vutukuru
July-September 2009, 46(3):255-256
DOI:10.4103/0019-509X.52973  PMID:19574690
  2,136 366 -
Authorship criteria and the role of reviewers and the editor
SA Pai
July-September 2009, 46(3):254-255
DOI:10.4103/0019-509X.52971  PMID:19574689
  1,925 254 -
Editor's comments

July-September 2009, 46(3):255-255
DOI:10.4103/0019-509X.52972  
  1,362 176 -
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