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Kalyani N, Upadya VH, Sequeira J. Does Topical Metronidazole-Chlorhexidine Combination Gel Improve Healing of Intraoral Incisions ? A Split-Mouth Comparative Study. J Maxillofac Oral Surg 2023; 22:159-164. [PMID: 36703666 PMCID: PMC9871198 DOI: 10.1007/s12663-022-01706-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 03/02/2022] [Indexed: 01/29/2023] Open
Abstract
Background The oral cavity is a unique environment where wound healing needs to occur in the presence of heavily contaminated oral fluid often leading to infections at the suture site. Topical antimicrobial agents have proven to be effective in controlling intraoral infections. One such antimicrobial combination is Metronidazole-Chlorhexidine which has commonly been used to treat oral ulcers and gingival inflammation; however, there are no studies of its use in the healing of oral incisions. Methodology This split-mouth study comprised of 15 participants who received 30 intraoral incisions. Incisions were placed either simultaneously (Group 1) or at spaced intervals (Group 2) for various minor and major surgical procedures. Metronidazole -Chlorhexidine gel was applied to the study sites while the control sites were allowed to heal naturally. Pain, inflammation, and healing were assessed using visual analogue scale and healing index by Landry et al. Results The study sites showed better wound healing and decreased postoperative inflammation. There was a statistically significant decrease in post-operative pain in the study site in Group 1 but not in Group 2. Conclusion Metronidazole-Chlorhexidine combination gel is a cost-effective, readily available, and safe medicament to improve healing of intraoral incisions and reduce post-operative inflammation and pain.
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Affiliation(s)
- N. Kalyani
- Department of Oral and Maxillofacial Surgery, Yenepoya Dental College and Hospital, Yenepoya (Deemed To Be University), Deralakatte, Mangalore, Karnataka 575018 India
| | - V. H. Upadya
- Department of Oral and Maxillofacial Surgery, Yenepoya Dental College and Hospital, Yenepoya (Deemed To Be University), Deralakatte, Mangalore, Karnataka 575018 India
| | - J. Sequeira
- Department of Oral and Maxillofacial Surgery, Yenepoya Dental College and Hospital, Yenepoya (Deemed To Be University), Deralakatte, Mangalore, Karnataka 575018 India
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Katna R, Naik G, Girkar F, Deshpande A, Chalke S, Bhosale B, Kalyani N. Clinical outcomes for microvascular reconstruction in oral cancers: experience from a single surgical centre. Ann R Coll Surg Engl 2023; 105:247-251. [PMID: 35175143 PMCID: PMC9974342 DOI: 10.1308/rcsann.2021.0295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2021] [Indexed: 12/09/2022] Open
Abstract
INTRODUCTION Reconstruction of a surgical defect is an important part of the management of oral cancers. Microvascular free flap construction provides better functional and cosmetic outcomes. METHODS Between 2014 and 2020, some 524 patients underwent microvascular reconstruction. Comorbidity variables were scored using the Charlson Comorbidity Index (CCI). Complications were recorded using Clavien-Dindo criteria. RESULTS Eighty-three (15.84%), 339 (64.69%) and 102 (19.47%) patients underwent free radial forearm flap, free anterolateral thigh flap and free fibula osteocutaneous flap (FFOCF), respectively. Clavien-Dindo complications of grade III and above were seen in 39 (7.44%) patients. Total flap loss was seen in 18 patients and of these, 16 were salvaged using alternative free flaps or pedicled flaps. On univariate analysis, overall and major complication rates were higher in FFOCF (p=0.171). Major complications significantly more common in patients with a CCI score >4 (p=0.001). Patients aged >65 years had higher rates of complications (p=0.03). CONCLUSION Microvascular free tissue transfer is a reliable, safe and gold standard modality in surgical reconstruction and can be replicated in non-institutional settings.
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Affiliation(s)
| | - G Naik
- Vedant Hospital, Thane, India
| | | | | | | | | | - N Kalyani
- Jaslok Hospital and Research Centre, Mumbai, India
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Mukherjee P, Agarwal S, Kalyani N, Roy M, Doshi A, Kommineni S, Patel R. PO-0987 Evaluation of swallowing function using PSS-HN scale for head-neck cancer patients undergoing IMRT. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07438-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Katna R, Singh S, Bhosale B, Deshpande A, Kalyani N. Microvascular reconstruction for head and neck cancers in high risk population: clinical outcomes and complications. Ann R Coll Surg Engl 2021; 103:278-281. [PMID: 33682450 DOI: 10.1308/rcsann.2020.7078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Microvascular reconstruction is the gold standard for reconstruction in oral cavity cancers. Age and comorbidities determine the type of reconstruction. We aimed to analyse the impact of high-risk comorbidities on perioperative morbidity. METHODS This is a retrospective study of 317 patients undergoing microvascular reconstruction from January 2014 to December 2017. High risk patients were based on age, American Society of Anaesthesiologists (ASA) grade (III/IV) and Charlson comorbidity index (CCI) score >4; overall, 73 out of 317 patients were evaluated. RESULTS Median age was 59 years. Five patients (6.8%) had complete flap failures and seven (9.5%) had minor complications (wound breakdown, bleeding, wound dehiscence, partial flap loss). ASA score of IV was significantly associated with morbidity while age >65 years and CCI >4 was not associated. The overall flap success rate was 93.2%. CONCLUSIONS A high-risk population has nearly similar outcomes for microvascular reconstruction as a younger age group. High ASA score adversely affects surgery-related outcomes.
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Affiliation(s)
- R Katna
- Jaslok Hospital and Research Centre, Mumbai, India.,Bombay Hospital and Research Centre, Mumbai, India.,Vedant Hospital, Thane, India
| | - S Singh
- Vedant Hospital, Thane, India
| | - B Bhosale
- Jaslok Hospital and Research Centre, Mumbai, India.,Bombay Hospital and Research Centre, Mumbai, India.,Vedant Hospital, Thane, India
| | - A Deshpande
- Jaslok Hospital and Research Centre, Mumbai, India.,Bombay Hospital and Research Centre, Mumbai, India.,Vedant Hospital, Thane, India
| | - N Kalyani
- Jaslok Hospital and Research Centre, Mumbai, India
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Katna R, Bhosale B, Sharma R, Singh S, Deshpande A, Kalyani N. Oncological outcomes in patients undergoing major glossectomy for advanced carcinoma of the oral tongue. Ann R Coll Surg Engl 2020; 102:514-518. [PMID: 32436723 DOI: 10.1308/rcsann.2020.0100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Major glossectomy is the treatment of choice in locally advanced tongue cancer. It remains the only option in the presence of recurrent or residual disease. The long-term outcomes for patients undergoing major glossectomy have traditionally been poor, with significant morbidity and poor oncological outcomes. The aim of this study was to report on oncological outcomes in patients undergoing major glossectomy. METHODS All patients undergoing major glossectomy between 2014 and 2018 were included in the study. The data of 85 patients with advanced carcinoma of the oral tongue were evaluated. All were under the care of a single surgical and reconstructive team at two hospitals in Mumbai. RESULTS The median patient age was 45 years. At the most recent follow-up, 55 patients (65%) were alive, 47 of whom were disease free. Twenty-nine patients (34%) had locoregional recurrence and twenty-five (29%) had distant metastasis. At a median follow-up of 19 months, rates for 2-year locoregional control, disease free survival (DFS) and overall survival (OS) were 69%, 61% and 62% respectively. Perinodal extension demonstrated a trend towards poor DFS (p=0.060), as did perineural invasion (p=0.055). Node positivity was a significant factor for poor OS, DFS and locoregional control. Multiple node involvement was significantly associated with poor OS on multivariate analysis (p=0.002). CONCLUSIONS Node positivity and multiple node involvement were associated with poor outcomes. Major glossectomy may be offered as a curative option for selected patients with advanced carcinoma of the oral tongue with node negative or limited neck nodal disease (N1).
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Affiliation(s)
- R Katna
- Jaslok Hospital and Research Centre, Mumbai, India.,Bombay Hospital and Medical Research Centre, Mumbai, India
| | - B Bhosale
- Jaslok Hospital and Research Centre, Mumbai, India.,Bombay Hospital and Medical Research Centre, Mumbai, India
| | - R Sharma
- Bombay Hospital and Medical Research Centre, Mumbai, India
| | - S Singh
- Bombay Hospital and Medical Research Centre, Mumbai, India
| | - A Deshpande
- Jaslok Hospital and Research Centre, Mumbai, India.,Bombay Hospital and Medical Research Centre, Mumbai, India
| | - N Kalyani
- Jaslok Hospital and Research Centre, Mumbai, India
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Katna R, Kalyani N, Agarwal S, Singh S, Deshpande A, Bhosale B. Impact of comorbidities on perioperative outcomes for carcinoma of oral cavity. Ann R Coll Surg Engl 2020; 102:232-235. [PMID: 31841025 PMCID: PMC7027403 DOI: 10.1308/rcsann.2019.0155] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2019] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Surgical management of oral cavity carcinoma involves composite resection with reconstruction. Comorbidities increase the risk of perioperative complications. Objective stratification is important for uneventful recovery. The Charlson Comorbidity Index and the Washington University Head and Neck Comorbidity Index were used to assess perioperative morbidity and mortality. MATERIALS AND METHODS This was a prospective study of 531 patients with head and neck squamous cell carcinoma who were treated between January 2014 and December 2017. Patients' comorbidity scores on the Charlson Comorbidity Index and Washington University Head and Neck Comorbidity Index were recorded. RESULTS The median age of the cohort was 49 years. Median Charlson Comorbidity Index score was 3 and Washington University Head and Neck Comorbidity Index was 0. There were five mortalities with a Charlson Comorbidity Index score of 4 or more. Fifteen patients had either infection, leak or postoperative bleeding. A Charlson Comorbidity Index of 4 or more was associated with higher event rate and poor overall survival (p=0.001). CONCLUSION Higher Charlson Comorbidity Index score is associated with increased incidence of peri-operative morbidity and mortality, while the Washington University Head and Neck Comorbidity Index is a poor predictor of the same.
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Affiliation(s)
- R Katna
- Jaslok Hospital and Research Centre, Mumbai, India
- Bombay Hospital and Research Centre, Mumbai, India
| | - N Kalyani
- Jaslok Hospital and Research Centre, Mumbai, India
| | - S Agarwal
- Bombay Hospital and Research Centre, Mumbai, India
| | - S Singh
- Jaslok Hospital and Research Centre, Mumbai, India
- Bombay Hospital and Research Centre, Mumbai, India
| | - A Deshpande
- Jaslok Hospital and Research Centre, Mumbai, India
- Bombay Hospital and Research Centre, Mumbai, India
| | - B Bhosale
- Jaslok Hospital and Research Centre, Mumbai, India
- Bombay Hospital and Research Centre, Mumbai, India
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Shahid T, Kalyani N, Modak Das S, Mukherjee M, Bhattacharya J, De A, Talukdar R, Samanta A, Ghosh T, Barman D, Sadhukhan S, Vijayaraghavan P, Rajan R. EP-1159 To compare outcome of Intensive nutritional support with standard practise in head ands neck cancer. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31579-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Khanna N, Kalyani N, Godasastry J, Menon H, Sengar M, Khattry N, Dangi U, Arora B, Shet T, Gujral S, Sridhar E, Rangarajan V, Banavali S, Laskar S. PO-0646: Nodular Lymphocyte Predominant Hodgkin’s Lymphoma (NLPHL): Early Outcomes. Radiother Oncol 2017. [DOI: 10.1016/s0167-8140(17)31083-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Agarwal JP, Hotwani C, Prabhash K, Munshi A, Misra S, Mathew A, Kalyani N, Noronha V, Laskar SG, Joshi A, Purandare N, Tandon S, Sharma V. Optimizing treatment and analysis of prognostic factors for locally advanced nonsmall cell lung cancer in resource-limited population. Indian J Cancer 2017; 53:96-101. [PMID: 27146753 DOI: 10.4103/0019-509x.180810] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Lung cancer most commonly presents in advanced stages in developing countries, where combined modality treatment using chemo-radiotherapy (CTRT) is the standard of care. MATERIALS AND METHODS A retrospective audit of patients of nonsmall cell lung cancer (NSCLC) treated at a single Institute from January 2008 to December 2012 was conducted. Various prognostic factors affecting disease-free survival (DFS) and overall survival (OS) were studied by univariate and multivariate analysis. All patients were meticulously followed-up clinically and telephonic contacts. RESULTS Overall 171 patients of NSCLC were treated with definitive CTRT using concurrent chemotherapy in 66% patients and sequential therapy in 28% patients. The actuarial 2 years DFS was 17.5% and 2 years OS was 61.5%. Complete response to treatment resulted in significantly better DFS and OS. Definitive CTRT was very well-tolerated in these patients with good compliance. CONCLUSION Definitive CTRT, sequence being individualized depending on performance status and disease stage at presentation, is a feasible and effective treatment modality for locally advanced NSCLC patients in the developing world. Response to treatment is an important prognostic factor for treatment outcomes.
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Affiliation(s)
- J P Agarwal
- Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
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Khanna N, Kalyani N, Goda J, Menon H, Sengar M, Arora B, Shet T, Gujral S, Epari S, Laskar S. PO-0651: Nodular Lymphocyte Predominant Hodgkin Lymphoma (NLPHL): Early outcomes. Radiother Oncol 2014. [DOI: 10.1016/s0167-8140(15)30769-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Engineer R, Kalyani N, Chaudhari S, Dharia T, Shetty N, Goel M, Chopra S, Mehta S, Patil P, Shrivasatava S. PO-0985: Chemoradiation with Brachytherapy for unresectable Klatskin tumours: Promising results from a prospective study. Radiother Oncol 2013. [DOI: 10.1016/s0167-8140(15)33291-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Agarwal JP, Kalyani N, Laskar SG, Kumar P, Pai P, D′cruz AK, Gupta T, Budrukkar A, Murthy V, Narohna V, Chaturvedi P. Cetuximab with radiotherapy in patients with loco-regionally advanced squamous cell carcinoma of head and neck unsuitable or ineligible for concurrent platinum-based chemo-radiotherapy: Ready for routine clinical practice? Indian J Cancer 2011; 48:148-53. [DOI: 10.4103/0019-509x.82872] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Wadasadawala T, Jalali R, Munshi A, Gupta T, Kalyani N, Menon H, Sarin R, Goel A. Five-year survival data in newly diagnosed glioblastoma treated with radiotherapy along with concurrent and adjuvant temozolomide. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.e13009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e13009 Background: We report 5-year survival data in patients with newly diagnosed glioblastoma treated with radiotherapy along with concurrent and adjuvant temozolomide (TMZ). Methods: Between March 2001 to April 2008, 81 patients with newly diagnosed histopathologically proven glioblastoma underwent surgery followed by external radiotherapy to a total dose of 60 Gy in 30 fractions over 6 weeks. Concurrent oral TMZ (75 mg/m2) was given daily with RT followed by adjuvant TMZ for 5 days every 28 days for six cycles (150 mg/m2 for the first cycle and 200 mg/m2 for rest of the cycles). Patients were monitored clinicoradiologically as per standard practice. Results: Patients aged between 11–73 years with a median age of 49 years (60 males, 21 females). Forty per cent of patients underwent a gross total resection of tumour, 44% had partial resection, and 16% an open or stereotactic biopsy only. 79% of the patients had a post-operative Karnofsky Performance Score (KPS) of >80. All six adjuvant cycles were completed in 68%. The 2-, 3-, 4-, and 5-year survival was 34%, 24%, 11%, and 11%, respectively (95% CI 14.03–21.96). The median overall and progression-free survival was 18 (2–92 months) and 16 months (2–72 months), respectively. On multivariate analysis, completion of all six cycles of adjuvant TMZ was associated with significantly better survival (p = 0.000). Neurological performance score (NPS) of 2–3 (p = 0.06) and Recursive Partitioning Analysis class V (p = 0.093) showed a trend towards poorer outcome. Treatment was generally well tolerated with only 2.5% of patients developing grade 3 anemia, leucopoenia, and neutropenia. Grade 3 or 4 thrombocytopenia was seen in 5% patients. Conclusions: Concurrent radiotherapy and TMZ followed by adjuvant TMZ results in encouraging survival even at a long follow-up. No significant financial relationships to disclose.
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Affiliation(s)
- T. Wadasadawala
- Tata Memorial Hospital, Mumbai, India; KEM Hospital, Mumbai, India
| | - R. Jalali
- Tata Memorial Hospital, Mumbai, India; KEM Hospital, Mumbai, India
| | - A. Munshi
- Tata Memorial Hospital, Mumbai, India; KEM Hospital, Mumbai, India
| | - T. Gupta
- Tata Memorial Hospital, Mumbai, India; KEM Hospital, Mumbai, India
| | - N. Kalyani
- Tata Memorial Hospital, Mumbai, India; KEM Hospital, Mumbai, India
| | - H. Menon
- Tata Memorial Hospital, Mumbai, India; KEM Hospital, Mumbai, India
| | - R. Sarin
- Tata Memorial Hospital, Mumbai, India; KEM Hospital, Mumbai, India
| | - A. Goel
- Tata Memorial Hospital, Mumbai, India; KEM Hospital, Mumbai, India
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