ABSTRACT
Portal vein thrombosis is considered a relative contraindication for transarterial chemoembolization [TACE] in hepatocellular carcinoma. The purpose of our study was to evaluate the efficacy of TACE treatment in patients with hepatocellular carcinoma with portal vein [PV] thrombosis. From April 2011 to June 2013, 17 patients with unresectable hepatocellular carcinoma with PV thrombosis were studied. Patients were assessed for tumor response by imaging at regular intervals and the data compared with the baseline laboratory and imaging characteristics obtained before treatment. Univariate analysis was used to assess the treatments impact on patient survival. Survival analysis was performed using Kaplan-Meier estimations. Overall survival rates at three, six and 12 months were 82%, 71%, and 47%, respectively, with a median of 10 months. Patients in Child-Pugh class A had a median survival of 15 months compared to five months for those patients in Child-Pugh class B. The median survival period of patients responsive to treatment was 13 months while that of non-responders was five months. Patients with ascites at the time of presentation had median survival period of six months while those who did not had a median survival period of 13 months. In univariate analysis, response to chemoembolization [p < 0.001], ascites [p < 0.050] and Child-Pugh class at diagnosis [p < 0.050] were found to be significant prognostic factors. TACE is a promising procedure in unresectable hepatocellular carcinoma with PV thrombosis. Response to chemoembolization, ascites and Child-Pugh class were the most important determining factors of survival
ABSTRACT
Adenosquamous carcinoma (ASC) of the stomach is a very rare tumor comprising less than 0.5% of all stomach malignancies. Here, we report a case of a 37-year-old male, who presented with upper gastrointestinal bleeding in the form of hematemesis and malena. A subtotal gastrectomy was done in view of massive uncontrolled bleed. Histology showed evidence of ASC of the body and antrum with metastasis to the liver, perigastric lymph nodes and peritoneal and pleural cavity.
ABSTRACT
Introduction: This study examines the perspective of senior orthopaedic faculty and infectious disease experts from the Indian subcontinent and other countries on the appropriate duration of multi drug antitubercular chemotherapy in osteoarticular tuberculosis. Material and methods: A questionnaire regarding what antitubercular drugs, their dosage and for how long was asked to attending faculty in an International Conference on musculoskeletal infections. Results: Thirty different prescriptions were obtained from a total of 52 respondents. Forty-two respondents voted against short course (6 months) regimen. The mode value for duration of treatment with isoniazid and rifampicin treatment in the study was 12 months; for pyrazinamide, it was three months. There was almost no consensus over the duration of treatment with ethambutol. Conclusion: There is a strong need to assess long term impact of DOTS in osteoarticular tuberculosis to facilitate the National Tuberculosis Programme planning, uniform training, wider acceptance, drug ordering and distribution. An effective communication between those planning national tuberculosis programmes and experts in osteoarticular tuberculosis is essential for universal acceptance of the management protocols.
ABSTRACT
Patients with chronic pancreatitis may have varied complications including common bile duct stenosis, cholangitis, pseudocyst or fistula formation and secondary biliary cirrhosis. Common bile duct obstruction due to disimpaction of a pancreatic calculus into the ampulla of Vater leading to severe cholangitis and septic shock is a rare phenomenon. We are reporting such a case here.