BackgroundTwo clinically relevant high-risk HPV (HR-HPV) types 16 and 18 are etiologically associated with the development of cervical carcinoma and are also reported to be present in many other carcinomas in extra-genital organ sites. Presence of HPV has been reported in breast carcinoma which is the second most common cancer in India and is showing a fast rising trend in urban population. The two early genes E6 and E7 of HPV type 16 have been shown to immortalize breast epithelial cells in vitro, but the role of HPV infection in breast carcinogenesis is highly controversial. Present study has therefore been undertaken to analyze the prevalence of HPV infection in both breast cancer tissues and blood samples from a large number of Indian women with breast cancer from different geographic regions.MethodsThe presence of all mucosal HPVs and the most common high-risk HPV types 16 and 18 DNA was detected by two different PCR methods - (i) conventional PCR assays using consensus primers (MY09/11, or GP5+/GP6+) or HPV16 E6/E7 primers and (ii) highly sensitive Real-Time PCR. A total of 228 biopsies and corresponding 142 blood samples collected prospectively from 252 patients from four different regions of India with significant socio-cultural, ethnic and demographic variations were tested.ResultsAll biopsies and blood samples of breast cancer patients tested by PCR methods did not show positivity for HPV DNA sequences in conventional PCRs either by MY09/11 or by GP5+/GP6+/HPV16 E6/E7 primers. Further testing of these samples by real time PCR also failed to detect HPV DNA sequences.ConclusionsLack of detection of HPV DNA either in the tumor or in the blood DNA of breast cancer patients by both conventional and real time PCR does not support a role of genital HPV in the pathogenesis of breast cancer in Indian women.
Background Gastric cancer is the second commonest cause of cancer related mortality worldwide. Though its incidence is more in Eastern Asia, it is increasing in the South Asian subcontinent. The diagnosis of early gastric cancer (EGC) confined to the mucosa or submucosa, is an important concern due to a better outcome at this stage where five year survival rates could increase by 90 percent. Though mass screening is done in few countries, it has not been applied in developing countries like Nepal. Preoperative diagnosis of EGC is rare in Nepal. The aim of this study is to analyze the clinico-pathological features of postoperative cases of gastric cancer managed in a tertiary care university hospital of Nepal.Methods All patients with histological diagnosis of gastric cancer admitted in the Department of Surgery, Tribhuvan University Teaching Hospital, Kathmandu, Nepal during the three year period (September 2010 to August 2013) were analyzed retrospectively.Results Ninety two patients with endoscopic diagnosis of gastric cancers were admitted during the past three years. The mean age was 60 years ranging from 28 years to 85 years with the male to female ratio of 2.8:1. Five patients were younger than 40 years and all were in advanced stage. Thirty five percent of the patients belonged to Janajatis (Hill) community though they comprise only 23% of the population and about 65% of them belonged to an area involving 25% of the country.Seventy six cases were operated. Out of 92 patients, 4 patients were diagnosed as early gastric cancer postoperatively. All patients with early gastric cancer were above 50 years with CT Scan abdomen revealing focal thickening without lymphadenopathy.Conclusion Over the years, the incidence of gastric cancer is increasing in Nepal. Though 92% are advance gastric cancers, few have been diagnosed and treated early. A screening program in a country like Nepal with diverse ethnicity and difficult terrain might be helpful if it targets high risk people in high risk areas.Kathmandu University Medical Journal Vol.12(1) 2014: 32-37
High incidence of nasopharyngeal carcinoma (NPC) has been reported from China, Southeast Asia and Northeast (NE) region of India. Populations at geographic regions having higher incidence of NPC display human leukocyte antigen (HLA) distribution patterns different from areas having low incidence. The current study has investigated the contribution of environmental risk factors and ethnic variation of microsatellite markers in HLA region for the high incidence of NPC in NE India. Genotyping of HLA region using 33 microsatellite markers by fragment length analysis was done in 220 study subjects (120 NPC patients and 100 healthy controls). Association analysis showed two adjacent microsatellite markers HL003 (allele 121) and D6S2704 (allele 218) in the HLA class I region having association with high risk of NPC while allele 127 of HL003 and allele 255 of D6S2678 conferred a protective effect. The environmental factors mainly use of firewood (odds ratio (OR) = 3.797385, confidence interval (CI) = 1.97-7.30, P < 0), living in mud house (OR = 3.46, CI = 1.19-10.08, P = 0.022) and consumption of alcohol (OR = 2.11, CI = 1.02-4.37, P = 0.043) were found as major risk factors for NPC. Higher-order interaction showed combination of smoked food consumption and firewood use for cooking in multifactor dimensionality reduction (MDR) analysis and interaction of non-firewood users, non-ventilated houses and residence in mud houses in classification and regression tree (CART) analysis as the significant risk factors for NPC. Expression of Epstein-Barr virus (EBV) RNA was found in 92% (23/25) of NPC cases suggesting its significant role in NPC aetiopathogenesis. This study identified association of NPC with a susceptibility locus in the HLA class I region which has complex interaction with viral DNA and environmental factors.
Nasopharyngeal carcinoma (NPC) is an epithelial tumour with a distinctive racial and geographical distribution. High incidence of NPC has been reported from China, Southeast Asia, and northeast (NE) region of India. The immune mechanism plays incredibly role in pathogenesis of NPC. Tumour necrosis factors (TNFs) and heat shock protein 70 (HSP 70) constitute significant components of innate as well as adaptive host immunity. Multi-analytical approaches including logistic regression (LR), classification and regression tree (CART) and multifactor dimensionality reduction (MDR) were applied in 120 NPC cases and 100 controls to explore high order interactions among TNF-α (-308 G>A), TNF β (+252 A>G), HSP 70-1 (+190 G>C), HSP 70-hom (+2437 T>C) genes and environmental risk factors. TNF β was identified as the primary etiological factor by all three analytical approaches. Individual analysis of results showed protective effect of TNF β GG genotype (adjusted odds ratio (OR2) = 0.27, 95 % CI = 0.125-0.611, P = 0.001), HSP 70 (+2437) CC genotype (OR2 = 0.17, 95 % CI = 0.0430.69, P = 0.013), while AG genotype of TNF β was found significantly associated with risk of NPC (OR2 = 1.97, 95 % CI = 1.019-3.83, P = 0.04). Analysis of environmental factors demonstrated association of alcohol consumption, living in mud houses and use of firewood for cooking as major risk factors for NPC. Individual haplotype association analysis showed significant risk associated with GTGA haplotype (OR = 68.61, 95 % CI = 2.47-190.37, P = 0.013) while a protective effect with CCAA and GCGA haplotypes (OR = 0.19, 95 % CI = 0.05-0.75, P = 0.019; OR = 0.01 95 % CI = 0.05-0.30, P = 0.007). The multi-analytical approaches applied in this study helped in identification of distinct gene-gene and gene-environment interactions significant in risk assessment of NPC.
Background and Objectives: The surgical treatment of liver hydatid disease has evolved dramatically and laparoscopic treatment has shown encouraging results with the advantages of minimally invasive surgery. We conducted this study to determine the outcome of laparoscopic management of hydatid disease of the liver.Methods: Consecutive patients with this disease reporting to our department from July 2014 to July 2015 were offered laparoscopic management. All patients received pre- and postoperative albendazole. The laparoscopic technique consisted of aspiration of the cyst fluid, sterilization, suction and drainage of the cavity, deroofing and addition of omentoplasty. Age, sex, duration of surgery, surgical morbidity, hospital stay and evidence of hydatid cyst recurrence were measured.Results: Twenty six patients had laparoscopic treatment for hepatic hydatid cysts. Females were 18 (69.2%) and males were 8 (30.8%). Mean age of patients was 37.46 ± 15.96 years (range 17-74 years). Pain was the commonest presentation occurring in 21 (80.8%).The right lobe of the liver was most commonly involved in 20 patients (76.9%). The mean cyst size was 6.77 cm (range, 5 cm to 12 cm). Minor spillage of cyst contents occurred in 5 patients (19.23%) and major spillage occurred in 1 patient (3.8%). The mean duration of surgery was 84.81 ± 28.93 minutes (range 50 – 150 minutes). Conversion was needed in 2 (7.7%). Complications included portsite infection in 2 (7.7%), bile leak in 3 (11.5 %), fever in 5 (19.2%) and chest infection in 2 (7.7%) cases. Mean hospital stay is 4.58 ± 3.40 days (range 3-16). There was no mortality in the series. The average follow-up period is 7.81 ± 2.57 months. There have been no recurrences to date however 1 patient was lost to follow up.Conclusion: Laparoscopic management of hydatid cysts of the liver is a safe and effective option with advantage of minimally invasive surgery in properly selected patients.
Introduction: Laparoscopic antireflux surgery (LARS) currently represents the gold standard in the surgical management of gastrointestinal reflux disease (GERD) with minimal morbidity and mortality. Routine fundoplication following laparoscopic Heller’s cardiomyotomy is also being recommended to reduce the incidence of pathological gastro-oesophageal reflux after surgery. The aim of the current study was to evaluate patients receiving LARS and to assess their surgical outcomesMethods: Prospective data of all patients admitted in our department with these diseases and undergoing LARS, from May 2014 to November 2015 were reviewed. Patients with Achalasia cardia underwent Laparoscopic Heller’s cardiomyotomy with Dor’s fundoplication and those with GERD with hiatus hernia underwent Laparoscopic Toupet’s fundoplication. Age, sex, duration of surgery, surgical morbidity and hospital stay were recorded. Results: Eleven patients underwent LARS. Females were 5(45.5%) and males were 6 (54.5%). Mean age of patients was 36.18 ± 15.79 years (range 18-68 years). 6 patients (54.5%) underwent Laparoscopic Heller’s cardiomyotomy with Dor’s fundoplication for Achalasia cardia while 5 patients (45.5%) underwent Laparoscopic fundoplication. The median operating room time was 133.64 ± 15.66 minutes (range, 110–160). There were no conversions. The median hospital stay was 3.45±0.522 days (range, 3-4 days). No postoperative complications or preoperative deaths occurred. No patient had a perforation revealed on the postoperative contrast swallow when performed. Gastro esophageal reflux symptoms were significantly improved and severity of dysphagia was also reduced after surgery. The average follow-up period is 5.45 ± 2.67 months (range, 3- 12).Conclusion: LARS is well established technique and becoming more popular over conventional open surgery in view of its equal safety and efficacy with added advantage of less morbidity and mortality. However larger case series and long term follow up would be warranted.
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