Drugs — new, wonderful and effective
By Dr J.D. Wig
CANCER is the name for a group of diseases which have one thing in common: abnormal cells that grow and destroy body tissues. Normally, the healthy cells that make up the body's tissues grow, divide and replace themselves in an orderly way. Sometimes cells lose the ability to control their growth. 

Food for fitness in children
By Seema Gupta
ADEQUATE nutrition is a vital need of every person. However, some age groups are more prone to malnutrition than others because of various factors. Children and adolescents fall in these groups. childhood and adolescence are periods of continuous growth and development. 

A hair-raising problem
By Dr Gurinderjit Singh
THE indication for the new hair pieces treatment seems to consist only of the contraindications to surgical techniques using the patient's own hair, which alone guarantees a definitive and unconstrained result. The patient applying for this treatment must be told of the different possible complications and of the inevitable rejection of the implanted synthetic hair sooner or later.

Drugs — new, wonderful and effective
By Dr J.D. Wig

CANCER is the name for a group of diseases which have one thing in common: abnormal cells that grow and destroy body tissues. Normally, the healthy cells that make up the body's tissues grow, divide and replace themselves in an orderly way. Sometimes cells lose the ability to control their growth. They grow too rapidly and without any order, making too much tissue and become malignant. They spread and kill nearby healthy tissues and organs.

Cancer cells can enter the blood stream and the lymphatic system. This process of their spreading to other parts of the body is called metastasis. Even if cancer is "removed", it may return if the cells had spread before the tumour was removed.

Our models of cancer have been evolving rapidly and with many surprises along the way. We are witnessing an evolving story of the pursuit of the prevention of cancer. From the clinical as well as molecular laboratory perspectives, the optimal treatment of persons at high risk for developing cancer continues to evolve parallelly with new diagnostic, preventive and therapeutic measures.

Cancer, a diagnosis which used to fill the scene with hopelessness and helplessness, is no longer thought to be untreatable. In the war against it, man has acquired a new weapon —chemotherapy (anti-cancer drugs). As the understanding of cancer increases, better and more powerful drugs are being added to the armamentarium of the clinician. The discovery of the cellular theory of biology in 1890 led the way to a more modern approach to the scourge.

Chemotherapy involves drugs to kill cancer cells anywhere in the body. There are different drugs that are used to kill cancer. Often, several drugs are given together. The advantage of chemotherapy is that this treatment can kill any unsuspected cancer cell that has spread to other areas of the body and so cannot be treated with surgery or radiation therapy (killing the cells with special x-ray).

Chemotherapy is used as the only mode of treatment in several cancers and as an adjuvant to surgery and radiotherapy in many others. All cancers are now treated by multi-drug regimens. Usually, a combination of drugs is given by mouth or by injection.

Chemotherapy is systemic because the drug enters the blood stream and travels throughout the body. It is given in cycles, a treatment period followed by a recovery period; then another cycle; and so on.

An explosion at Bari Harbour during World War II and the exposure of seamen to mustard gas led to the observation that alkylating agents caused the suppression of cells in the bone marrow and the lymph glands. These agents were subsequently developed to fight cancer. By the 1950s the rate of the introduction of useful new agents began to accelerate and the subsequent research in tumour cell biology and immunology led to a more rational drug therapy. The progress of drug discovery and effectiveness through clinical trials was demonstrated in the sixties and seventies. The speciality of oncology was created and clinicians coordinated strategies to optimise the treatment. Oncology has the greatest impact on changing the practice of medicine.

Chemotherapy reduces the rate of tumour recurrence and prolongs survival. Pre-operative chemotherapy is now considered a legitimate strategy for inclusion in the multidisciplinary treatment and may be necessary to improve the clinical outcome. One major advantage of this mode of treatment is the possibility of assessing the response to a specific agent so that effective post-operative therapy can be chosen. The main objective is to eliminate distant micrometastases. It is also used as local therapy in patients with inoperable tumours and improves locoregional control.

The delivery of adequate doses is often compromised by the inability of these drugs to differentiate between the malignant and normal cell population. Damage to normal cells compromises the patients quality of life and the delivery of adequate dose-intensive treatment. Significant advances in the reduction of anti-cancer chemotherapy-associated toxicity have occurred in recent years. These include the development of analogues of established cytotoxic agents with improved toxicity profiles and comparable anti-tumour efficacy and improvement in the control of chemotherapy-associated emesis and bone-marrow suppression.

Chemotherapy affects fast-dividing cells such as blood-forming cells and those cells that line the digestive tract. Many patients experience the loss of body hair and appetite, a sore mouth and diarrhoea. Most of them have nausea and vomiting. They are more prone to infections and may have bleeding problems. Almost everyone feels tired. These adverse effects usually go away once chemotherapy is finished. Long-term side-effects are rare.

Chemoprotectants have been developed as a means of ameliorating the toxicity associated with cytotoxic agents by providing site-specific protection for normal tissues, without compromising anti-tumour efficacy, and have provided the means to deliver higher cumulative doses of chemotherapy. Further studies are being undertaken to improve patient-response rates and survival.

The escalating cost of healthcare is having a staggering effect on cancer-care. The overall economic cost of cancer treatment in India is very high, and it does not take into consideration the human costs, which are incalculable. Our policy-makers and legislators need to formulate a policy to make these expensive anti-cancer drugs affordable. The need to strengthen the existing cancer centres and create additional ones.

Oncologists doctors whose speciality is cancer treatment are living in an exciting period of drug development. There are more options available for the patient than were imaginable two decades ago. The value of chemotherapy has been established and it reduces the risk of recurrence and death.

Chemotherapy should be administered by trained and experienced clinicians. The impact of side-effects can be minimised by careful management. The cooperation between the government and medicine is crucial to cancer research and treatment. The Government needs to formulate a law which would mandate the provision of the "wonder drugs" to the citizens. Keep cancer on the political agenda. The drugs that are effective are extremely expensive and put a terrible pressure on patients and their families. Some people go into debt. Wonder drugs are just beams of light showing through the door for the majority of our patients.

— Dr Wig, the noted surgeon and creator of public awareness about disease, is based at the PGI, Chandigarh.

Food for fitness in children
By Seema Gupta

ADEQUATE nutrition is a vital need of every person. However, some age groups are more prone to malnutrition than others because of various factors. Children and adolescents fall in these groups. childhood and adolescence are periods of continuous growth and development. An infant grows rapidly, doubling its birth weight by five months and trebling it by one year of age. During the second year, the child not only grows in height by 7-8 cm but also gains four times of its birth weight.

The adolescent period (teenage) is spread almost over a decade. It is characterised by a rapid increase in height and weight, hormonal changes, maturation and wide swings in emotion. The development of the critical bone mass is the hallmark of this age group. All these rapid anabolic changes require more nutrients per unit of the body weight.

Growing children and adolescents require more calcium. Though the recommended dietary allowances for calcium are about 400-600 mg per day only, it is desirable to give higher quantities to adolescents to achieve the peak bone mass.

Calcium is abundantly present in milk, curds, nuts, ragi, green leafy vegetables, dals, etc. Exercise reduces the calcium loss from the bones. Therefore, children should exercise by way of play, cycling, etc.

What type of diet is suitable?

Young children below the age of five years should be given less bulky food, rich in energy and protein (such as legumes, pulses, nuts, edible oil or ghee, sugar, milk and eggs).

* Vegetables, including green leafy ones, and seasonal fruits should be part of their daily menu.

* Very young children should be fed soft cooked food.

* New food options should be introduced one at a time and fed when the child is hungry.

* Food selection should ensure variety in colour, texture and flavour to ensure better acceptance.

* For younger children, the excessive use of fried and spicy food should be avoided.

* Finger food is better accepted by young children eg, sandwiches, cakes and cutlets.

* There should be adequate energy and high-quality protein in the diet.

* Such protein is provided by milk, milk products, eggs, non-vegetarian food and cereal pulse combinations.

* Small but frequent meals should be provided at regular intervals as the pre-school child has a small appetite and a short-attention span for eating.

* For a school-going child, adequate breakfast with sufficient carbohydrates and proteins is essential to ensure a good attention-span. For example flavoured milk with french toast, stuffed parantha, cornflakes, rainbow sandwiches, vegetable puda, pancakes, poha, upma and idli can be given appropriately.

* More food is needed for both sexes during adolescence (12-18 years) but the requirement of boys is higher than that of girls because of the greater lean body mass, and a more intense growth speed. During this period snacking is common. Thus, snacks selected for them should be nutritious and over-dependence on junk food should be discouraged. Boys and girls tend to take snacks between meals. This is partly because they do not take adequate food during regular meals. The snacks they eat are full of fats, carbohydrates and sugar, contributing "empty" calories.

It is, therefore, necessary to train adolescents to eat properly, at regular meal time, in a relaxed manner. They should have wholesome snacks at regular intervals. These snacks should preferably be made from whole grains and dals. Whole wheat, puffed rice, groundnuts and sesame seeds (TIL) are good. Sweets can be had occasionally.

— Seema Gupta is a dietician with considerable experience at Inscol Hospital, Chandigarh.

A hair-raising problem
By Dr Gurinderjit Singh

THE indication for the new hair pieces treatment seems to consist only of the contraindications to surgical techniques using the patient's own hair, which alone guarantees a definitive and unconstrained result. The patient applying for this treatment must be told of the different possible complications and of the inevitable rejection of the implanted synthetic hair sooner or later.

Hair pieces: The use of hair-pieces is a non-surgical procedure, which supplies the patient with additional hair. A hair-piece often constitutes an alternative to the various surgical solutions. Enormous progress has been made in recent years in the field of hair-pieces as regards their composition and their conception. Very many hair-pieces are currently commercially available.

Their main differences relate to:

* The type of hair used.

* The base on which the hair is implanted.

* The mode of the fixation of the hair-piece.

Natural hair: The main advantage of using natural hair is the natural appearance and the fact that waving is as easy as with normal hair. This allows the use of shampoos and hair-dryer. However, there is one great disadvantage, which is rapid deterioration with time. The hair becomes discoloured in sunlight and requires dyeing after 6-12 months. The hair splits at its ends and loses its natural laxity. To obtain the desired colour, it is usually necessary to dye it, which makes it even more brittle.

Artificial hair: Many kinds of fibres are used in artificial hair. They often permit a natural appearance after waving and conditioning but in practice frequent conditioning is necessary and should be done by a professional. Waving remains stable for about a month, even after shampooing. The fibres always retain their original colour. They deteriorate with time but less rapidly than the natural hair. The chief flaw is the fact that few fibres give the textural feel of natural hair.

The bases for implantation

Wide-meshed net: The hair is sewn on a wide-meshed net after having previously been fixed on a thread. The advantage is that the prosthesis is very aerated and the scalp can easily be washed without removing the hair-piece. The disadvantage is that when the hair is somewhat dirty and greasy, it becomes raised in ridges by the effect of the wind and acquires an unnatural appearance.

Close-meshed net: Close-meshed nets often have the aspect of a tulle on which the hair is attached one by one. They can be fastened, stuck on, or fastened and stuck. The tulle usually has a nylon base.The aeration of the scalp is relative and its washing may require complete or partial removal of the hair-piece, but the distribution of the hair is more uniform.

"Microskin": "Microskin" is a very thin and transparent sheet of nylon on which the hair is fixed, usually by gluing. The distribution of the hair is very uniform. When a bunch is raised, the aspect of the base is very similar to that of the normal scalp, which is seen by transparency. However, aeration of the scalp is very poor and even promotes a certain maceration. Washing must therefore be very frequent and the hair-piece has to be completely removed each time.

Adhesives: The oldest method of fixing hair-pieces is by gluing, the hair-piece having several adhesive patches on its inner aspect. The procedure is easy but allergies are common. The glues or gums can be replaced by a double-sided adhesive, with the same risks of allergy. These two types of fixation have a disadvantage of being relatively precarious and do not allow the wearer to take part in sports or sea or pool-bathing.

Weaving: The prosthesis may be sewn on a thread, which is itself fixed to the patient's hairs by means of a braid. This braid is made of three linen threads, which are braided, taking a lock of hair as the fourth thread. A lock of hair is thus caught every centimetre and ensconced in the weave. The fixation of the hair-piece is very firm, but it is necessary to perform a tightening up about every month, since the hair grows and the hair-piece then becomes loose. This procedure has the disadvantage of provoking in the long term a progressive peripheral traction alopecia, and this alopecia, which is transient to begin with, may become permanent with time.

Microspots: The hair-piece may be fixed by microspots; several locks of hair are knotted to the hair-piece and fixed in place by a spot of glue. The glue may provoke allergies and the retightening necessary every month requires cutting the hair to which the glue has been applied since there is no solvent capable of dissolving it. Again, this procedure presents the same risks of traction alopecia as the previous method.

Grips: The fixation by hair grips has the disadvantage of being too precarious. The small grips are flat and 1 cm long, and six or seven are needed to keep a hair-piece in place.

Surgical fixation: Surgical fixation has now been virtually abandoned by most surgeons because of the large number of infections it causes. The surgeon fixes a thread on the scalp, a thread of nylon, steel or gold wire, and the hair-piece is then sewn on this thread. This procedure is very attractive, but the fixation thread always ends up by becoming infected or by cutting the hair because of the permanent traction it exerts. This procedure is, therefore, contraindicated. Another procedure has been described, which consists of making tunnels 2 or 3 cm long under the scalp and lining their inner aspect with a split skin graft. The results in practice are disappointing.

Advantages of hair-pieces: Hair-pieces have, of course, the value of not requiring surgical intervention. Apart from artificial implants, to which we shall return, it is also the only procedure which allows the augmentation of the number of hair. To this extent, it is the sole treatment possible for major baldness where the crown height is less than 8 cm.

Disadvantages of the procedure: The chief blank of this procedure is the careful and permanent maintenance of the hair-piece, which moreover has to be changed quite often. In particular, there is the worry of having properly styled hair so as to ensure that the hair-piece is not conspicuous. Specifically, the meshes must always mask the anterior frontal line.