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ORAL CANCER IN RURAL INDIA
1087
Fig 1-Schematic diagram.
Fig 2--Colonoscopic appearance (70cm from and X-ray displayed simultaneously. Space (top right) is for patient’s name.
anus;
diverticular)
In the two-phase TV monitoring system (fig 1) pictures obtained with a TV endoscope (EES-50A) are sent to a video mixer where they can be recorded on video cassette recorder (VCR) and, with time base corrector (TBC), used to provide still pictures if required. A video switching device interchanges previously recorded pictures and X-ray images as required, and the TV monitor displays the current endoscopic image with the stored previous image or X-ray image, and it can do this simultaneously or by providing a synthesised picture. The endoscopic picture from the EES-50A and either the recorded image from the VCR (or the X-ray image) can be simultaneously displayed as main and subordinate pictures or vice versa. Display of the endoscopic image alone is still possible. The biplane TV monitoring system simplified treatment and pennitted accurate evaluation of the effects of laser therapy and scerotherapy for varices. In patients with ulcers detailed evaluation of healing was possible. In the lower digestive tract the system facilitated not only operative procedures accompanying endoscopic examinations but also identification of the sites of multiple polyps during polypectomy, because of the simultaneous display of the endoscopic and X-ray images. The time required for polypectomy was also reduced. Fig 2 illustrates one clinical application. HITOSHI OKANO Third Department of Medicine, TADASHI KODAMA Prefectural of Kyoto University Medicine, TATSURO TAKINO Kamigyo-ku, Kyoto 602, Japan 1. Sivak MV, Fleischer DE. Colonoscopy with a video-endoscope: Preliminary experience. Gastrointestinal Endoscopy 1984; 30: 1-5. 2. Classen M, Phillip J. Electronic endoscopy of the gastrointestinal tract: Initial experience with a new type ofendoscope that has no fiberoptic bundle for imaging.
Endoscopy 1984; 16: 16-19. Riemann JF, Demling L. Initial experience with the new electronic endoscope. Endoscopy 1984; 16: 20-21.
3. Matek W, Lux G,
ORAL CANCER IN RURAL INDIA
SIR,-Where oral cancer is common the mortality from this disease is high. Yet the mouth is easily accessible and oral cancer is detectable at an early stage. Most patients seek medical help only when the disease is advanced. Since high-risk individuals seldom volunteer for oral examination at central screening centres one
suggested approach is for secondary prevention via case-finding in house-to-house surveys.! The incidence of oral cancer, especially palatal cancer, is high in Srikakulam district, Andhra Pradesh, due to the widespread habit of reverse chutta smoking-ie, smoking home-made cheroots with the lighted end inside the mouth.2 In a behavioural intervention study for primary prevention of oral cancer nineteen villages were selected in this district. 12 038 tobacco chewers and smokers aged 15 years and over were examined in a baseline survey and followed-up annually by house-to-house visits. The examination was done by dentists specially trained in the early detection of oral cancer.3 During the baseline examination and eight years of follow-up, 37 oral cancers have been diagnosed ’29 of them palatal cancers. 1 was already advanced at the baseline examination; 1 patient died of oral cancer without a re-examination; and in 2 patients the diagnosis was based on hospital records. The remaining 33 were detected by examining dentists at a reasonably early stage, but of these 33 patients, who might have benefited from early detection, 24 (72 %) refused to attend for treatment despite the best persuasive efforts of the dentists and social scientists on the team. 1 patient claimed that he was sent back from hospital without treatment, and he refused to go again. Of the 24 patients refusing treatment 19 died, most them within two years, and of the 5 survivors 4 have been followed up for one year and 1 for two years. Although poverty was widespread in the area and the study population itself was poor the refusal of treatment was not for financial reasons since patients were reimbursed for travel, treatment, and allied expenses. Ignorance of the seriousness of disease was the main reason. However, it is well-known that in rural India death is not considered as an event that needs to be postponed, especially after middle age-until of course, it becomes imminent, and even then medical assistance is mainly sought to alleviate physical discomfort. We found that oral cancer patients coming to hospital from a rural area constitute only a small, self-selected group of all oral cancer in the population. Thus for research on the incidence and natural history of oral cancer a house-to-house survey should be a preferred approach. Our findings also suggest that the house-to-house approach (even though it can be done by specially trained basic health workers4) may not prove very effective in terms of reducing mortality from oral cancer among the rural populations. Supported by US National Institutes of Health under research agreement 01-022-N. We thank Dr H. T. Shah for field work. Basic Dental Research Unit, Tata Institute of Fundamental Research, Bombay 400 005, India
PRAKASH C. GUIPTA FALI S. MEHTA
Royal Dental College, Copenhagen, Denmark
J. J. PINDBORG
1. World Health Organisation. Control of oral cancer in developing countries: Report ofa
WHO meeting. Bull WHO 1984; 62: 817-30. Pindborg JJ, Mehta FS, Gupta PC, Daftary DK, Smith CJ. Reverse smoking in Andhra Pradesh India: A study of palatal lesions among 10,169 villagers. Br J Cancer 1971; 25: 10-20. 3. Gupta PC, Mehta FS, Pindborg JJ, et al. Intervention study for primary prevention of 2.
oral cancer among 36 000 Indian tobacco users. Lancet 1986; i: 1235-38. 4. Mehta FS, Gupta PC, Bhonsle RB, Murti PR, Daftary DK, Pindborg JJ. Detection of cancer using basic health workers in an area of high oral India. Cancer Detect Prevent 1986; 9: 219-25.
oral
cancer
incidence in
CLOBETASOL PROPIONATE OINTMENT AS FIRST-AID FOR BURNS
SIR,-Clobetasol propionate ointment 0.05% (’Dermovate’; Glaxo) has been used to prevent burns from ultraviolet A (UVA) overdose in psoralen UVA (PUVA) regimens and in PUVA
therapy of chronic actinic dermatitis.’ It also reduces inflammation and oedema after cryotherapy.2 Anecdotal reports have been made of clobetasol’s efficacy in the prevention of thermal injury. We report a case of scalding in our department. A secretary spilt boiling coffee over the whole of the back of her left hand. Clobetasol ointment was applied liberally within 2 min of scalding and a non-adhesive dressing and gauze bandage was applied. She continued to work. Erythema and pain subsided in 2 h,
Fig 1-Schematic diagram.
Fig 2--Colonoscopic appearance (70cm from and X-ray displayed simultaneously. Space (top right) is for patient’s name.
anus;
diverticular)
In the two-phase TV monitoring system (fig 1) pictures obtained with a TV endoscope (EES-50A) are sent to a video mixer where they can be recorded on video cassette recorder (VCR) and, with time base corrector (TBC), used to provide still pictures if required. A video switching device interchanges previously recorded pictures and X-ray images as required, and the TV monitor displays the current endoscopic image with the stored previous image or X-ray image, and it can do this simultaneously or by providing a synthesised picture. The endoscopic picture from the EES-50A and either the recorded image from the VCR (or the X-ray image) can be simultaneously displayed as main and subordinate pictures or vice versa. Display of the endoscopic image alone is still possible. The biplane TV monitoring system simplified treatment and pennitted accurate evaluation of the effects of laser therapy and scerotherapy for varices. In patients with ulcers detailed evaluation of healing was possible. In the lower digestive tract the system facilitated not only operative procedures accompanying endoscopic examinations but also identification of the sites of multiple polyps during polypectomy, because of the simultaneous display of the endoscopic and X-ray images. The time required for polypectomy was also reduced. Fig 2 illustrates one clinical application. HITOSHI OKANO Third Department of Medicine, TADASHI KODAMA Prefectural of Kyoto University Medicine, TATSURO TAKINO Kamigyo-ku, Kyoto 602, Japan 1. Sivak MV, Fleischer DE. Colonoscopy with a video-endoscope: Preliminary experience. Gastrointestinal Endoscopy 1984; 30: 1-5. 2. Classen M, Phillip J. Electronic endoscopy of the gastrointestinal tract: Initial experience with a new type ofendoscope that has no fiberoptic bundle for imaging.
Endoscopy 1984; 16: 16-19. Riemann JF, Demling L. Initial experience with the new electronic endoscope. Endoscopy 1984; 16: 20-21.
3. Matek W, Lux G,
ORAL CANCER IN RURAL INDIA
SIR,-Where oral cancer is common the mortality from this disease is high. Yet the mouth is easily accessible and oral cancer is detectable at an early stage. Most patients seek medical help only when the disease is advanced. Since high-risk individuals seldom volunteer for oral examination at central screening centres one
suggested approach is for secondary prevention via case-finding in house-to-house surveys.! The incidence of oral cancer, especially palatal cancer, is high in Srikakulam district, Andhra Pradesh, due to the widespread habit of reverse chutta smoking-ie, smoking home-made cheroots with the lighted end inside the mouth.2 In a behavioural intervention study for primary prevention of oral cancer nineteen villages were selected in this district. 12 038 tobacco chewers and smokers aged 15 years and over were examined in a baseline survey and followed-up annually by house-to-house visits. The examination was done by dentists specially trained in the early detection of oral cancer.3 During the baseline examination and eight years of follow-up, 37 oral cancers have been diagnosed ’29 of them palatal cancers. 1 was already advanced at the baseline examination; 1 patient died of oral cancer without a re-examination; and in 2 patients the diagnosis was based on hospital records. The remaining 33 were detected by examining dentists at a reasonably early stage, but of these 33 patients, who might have benefited from early detection, 24 (72 %) refused to attend for treatment despite the best persuasive efforts of the dentists and social scientists on the team. 1 patient claimed that he was sent back from hospital without treatment, and he refused to go again. Of the 24 patients refusing treatment 19 died, most them within two years, and of the 5 survivors 4 have been followed up for one year and 1 for two years. Although poverty was widespread in the area and the study population itself was poor the refusal of treatment was not for financial reasons since patients were reimbursed for travel, treatment, and allied expenses. Ignorance of the seriousness of disease was the main reason. However, it is well-known that in rural India death is not considered as an event that needs to be postponed, especially after middle age-until of course, it becomes imminent, and even then medical assistance is mainly sought to alleviate physical discomfort. We found that oral cancer patients coming to hospital from a rural area constitute only a small, self-selected group of all oral cancer in the population. Thus for research on the incidence and natural history of oral cancer a house-to-house survey should be a preferred approach. Our findings also suggest that the house-to-house approach (even though it can be done by specially trained basic health workers4) may not prove very effective in terms of reducing mortality from oral cancer among the rural populations. Supported by US National Institutes of Health under research agreement 01-022-N. We thank Dr H. T. Shah for field work. Basic Dental Research Unit, Tata Institute of Fundamental Research, Bombay 400 005, India
PRAKASH C. GUIPTA FALI S. MEHTA
Royal Dental College, Copenhagen, Denmark
J. J. PINDBORG
1. World Health Organisation. Control of oral cancer in developing countries: Report ofa
WHO meeting. Bull WHO 1984; 62: 817-30. Pindborg JJ, Mehta FS, Gupta PC, Daftary DK, Smith CJ. Reverse smoking in Andhra Pradesh India: A study of palatal lesions among 10,169 villagers. Br J Cancer 1971; 25: 10-20. 3. Gupta PC, Mehta FS, Pindborg JJ, et al. Intervention study for primary prevention of 2.
oral cancer among 36 000 Indian tobacco users. Lancet 1986; i: 1235-38. 4. Mehta FS, Gupta PC, Bhonsle RB, Murti PR, Daftary DK, Pindborg JJ. Detection of cancer using basic health workers in an area of high oral India. Cancer Detect Prevent 1986; 9: 219-25.
oral
cancer
incidence in
CLOBETASOL PROPIONATE OINTMENT AS FIRST-AID FOR BURNS
SIR,-Clobetasol propionate ointment 0.05% (’Dermovate’; Glaxo) has been used to prevent burns from ultraviolet A (UVA) overdose in psoralen UVA (PUVA) regimens and in PUVA
therapy of chronic actinic dermatitis.’ It also reduces inflammation and oedema after cryotherapy.2 Anecdotal reports have been made of clobetasol’s efficacy in the prevention of thermal injury. We report a case of scalding in our department. A secretary spilt boiling coffee over the whole of the back of her left hand. Clobetasol ointment was applied liberally within 2 min of scalding and a non-adhesive dressing and gauze bandage was applied. She continued to work. Erythema and pain subsided in 2 h,