ABSTRACT
Cholangiocarcinoma (CCA) is a heterogeneous group of aggressive malignancies emerging from the canals of Hering to the CBD. CCA are rare tumours accounting for 3% of gastrointestinal tumours with an incidence of <2/100000, with an increased incidence in Asia. They present late and have a grave prognosis. The only curative option is surgical resection. The aim was to study the demographic and clinical spectrum of CCA with special emphasis on practicable diagnostic modalities, treatment strategies and their outcome at our rural tertiary setup.METHODSThis was a single centre observational study with a longitudinal design conducted over a period of 2 years. 30 patients presenting with features or diagnosis of CCA to the Department of General Surgery and the Department of Radiotherapy of North Bengal Medical College and Hospital, were studied with special reference to treatment and outcome. Data was collected, compiled on Excel sheet and analysed using GraphPad QuickCalcs 2018 (San Diego, CA).RESULTSMean age of the patients was 52.36 years with a female: male ratio 1.5:1. They presented mainly with jaundice (90%), clay coloured stool (83.3%), pruritus (66.6%), anaemia (56.6%), abdominal lump (43.3%) and pain abdomen (33.6%) reflecting a late presentation. Diagnosis and staging were done by blood parameters and available imaging studies in our setup (abdominal ultrasound, CECT and MRCP). The most common type was Distal CCA (60%) followed by Perihilar CCA (33.3%) and Intra-hepatic CCA (6.6%). Pancreaticoduodenectomy was done in 26.6% of patients and resection with hepaticojejunostomy in 10% of patients; surgical biliary bypass in 20% of patients, chemotherapy in 6.6% and PTBD followed by chemotherapy in 36.6%. After 1 year 72.7% of those who underwent curative surgery were having disease free life and 26.3% of those who underwent palliative treatment were having improved quality of life.
ABSTRACT
Wild animal related injury is a serious health problem for people living in the foothills of the sub Himalayan terrain. Geographically the foothills are proximal to the tea gardens and the dense forests which in turn are in close proximity to human habitation. Thus, the tea garden workers and labourers as well as others are always at imminent threat from the abundant wildlife. The type of injury could be quite serious, sometimes grotesque and even life threatening. Though we regularly face various kinds of such injuries inflicted from wild animals, there are no studies regarding this very pertinent problem at hand. We wanted to evaluate the causes and treatment outcomes of wild animal injuries in the foothills of sub Himalayan terrain.METHODSThis is a descriptive study conducted for a period of two years. We reviewed the medical records of about 103 patients with wild animal related injuries in North Bengal Medical College and Hospital, between July 2017 to May 2019. Data was collected and compiled in Excel sheet followed by analysis using software Epi Info and Epi Calc 2000.RESULTSThe medical records of about 103 patients with wild animal related injuries in a rural tertiary medical college and hospital of North Bengal between July 2017 to May 2019 were reviewed. Demographic and etiological characteristics of patients and injury and outcome data were analysed. 80% were males and 20% females. The mean age was 33 years (13-77 years). 80% were inflicted by elephants. However, a wide array of animals like rhinos, leopards, bison and leopards were responsible. There were eleven deaths, elephant trampling accounting for nine of them. Interestingly there were urban victims too.CONCLUSIONSWild animal related injuries constitute an important public health problem for people living in this sub-Himalayan belt which needs to be addressed with proper environmental and health measures.