Time trends and pathological profile of carcinoma lower oesophagus and gastro-oesophageal junction over the last 20 years--an experience from South India.

There is an upward trend in the incidence of adenocarcinoma lower oesophagus in western countries. However there is only limited comparable data from Asian countries. We conducted a retrospective analysis of our data compiled over a twenty-year period (1985-2004). All lesions diagnosed as either squamous cell carcinoma or adenocarcinoma involving the oesophagus with or without involvement of the gastro-oesophageal junction were included in the study. 476 cases with biopsy proven malignancy (either adeno or squamous) of lower oesophagus were studied. The pattern of change in frequency and histology over twenty years was analysed using the chi square test for trend. There was a consistent increase in the frequency of cancer involving the gastro-oesophageal junction though it did not reach statistical significance (p = 0.15). Out of 476 lower oesophageal cancers, 249 were adeno-carcinomas and 227 were squamous cell carcinomas. Adenocarcinoma involving the gastro-oesophageal junction showed consistent increase even though the p value was not significant (p = 0.09) and this therefore requires further longitudinal studies. There was no change in trend for pattern and frequency of squamous cell carcinoma oesophagus involving different sub-sites during the study period.

Listening to music decreases need for sedative medication during colonoscopy: a randomized, controlled trial.

BACKGROUND: Music played during endoscopic procedures may alleviate anxiety and improve patient acceptance of the procedure. A prospective randomized, controlled trial was undertaken to determine whether music decreases the requirement for midazolam during colonoscopy and makes the procedure more comfortable and acceptable. METHODS: Patients undergoing elective colonoscopy between October 2003 and February 2004 were randomized to either not listen to music (Group 1; n=40) or listen to music of their choice (Group 2; n=38) during the procedure. All patients received intravenous midazolam on demand in aliquots of 2 mg each. The dose of midazolam, duration of procedure, recovery time, pain and discomfort scores and willingness to undergo a repeat procedure using the same sedation protocol were compared. RESULTS: Patients in Group 2 received significantly less midazolam than those in Group 1 (p=0.007). The pain score was similar in the two groups, whereas discomfort score was lower in Group 2 (p=0.001). Patients in the two groups were equally likely to be willing for a repeat procedure. CONCLUSION: Listening to music during colonoscopy helps reduce the dose of sedative medications and decreases discomfort experienced during the procedure.

Pancreatic pseudocyst presenting as odynophagia.

A 40-year-old man presented with abdominal pain and odynophagia. CT scan revealed a pseudocyst in the posterior mediastinum and pleural effusion complicating pancreatitis. He was managed with transpapillary pancreatic duct stenting along with other supportive measures including octreotide, and he improved symptomatically. The stent was removed after four months; there was no pseudocyst on follow up CT scan.

Carbamazepine-induced eosinophilic enteritis.

We describe a 15-year-old boy who was on carbamazepine for the past 8 years for seizure disorder, who developed recurrent episodes of small bowel obstruction. Full-thickness small bowel biopsy obtained at laparotomy was consistent with eosinophilic enteritis. He improved clinically after tapering the drug.