Sarcoma-like mural nodules in ovarian mucinous cystadenomas--a report of two cases.

Sarcoma-like mural nodule is a very rare occurrence in a mucinous tumour of the ovary. Two such nodules having morphologically benign features with osteoclastic giant cells, in the wall of mucinous cystadenoma are described. In addition, these nodules exhibited reactive vascular proliferations. The sarcoma-like nodules are associated with a favourable outcome and must be distinguished from other malignant nodules composed of sarcoma or anaplastic carcinoma that may also occur in the wall of mucinous ovarian tumours.

Response to low-dose interferon in chronic liver disease due to hepatitis B virus infection.

BACKGROUND: Interferon is at present the only effective therapy for chronic hepatitis B virus (HBV) infection. Data regarding its efficacy in India are scant. The present study was undertaken to assess the efficacy of low-dose interferon in chronic liver disease due to HBV infection. METHODS: Twenty four patients with histologic evidence of chronic hepatitis with or without cirrhosis, and persistent elevation of serum aminotransferases and persistent positivity for HBsAg and HBeAg for more than six months, were included. Fourteen patients were treated with interferon alpha-2b, 3 million units thrice weekly for 16 weeks; ten patients who could not afford the drug were followed up as controls without specific therapy. Patients were examined weekly for the first 4 weeks, followed by two weekly for 12 weeks and then every two months. Blood tests for viral markers and liver biochemistry were done at 0, 4, 8, 12, 16 weeks and then at two-month intervals for at least one year after therapy. Patients who cleared HBeAg were followed up for 2.2 (1-4) years for HBsAg clearance. RESULTS: HBeAg clearance occurred in 9 patients (64%) in the interferon group, and in one control patient (p < 0.01). HBsAg clearance occurred in only one patient in the treatment group during follow up of mean 2.4 years. No patient in the control group cleared HBsAg. Patients having high ALT level at the beginning of treatment had significantly higher HBeAg clearance rate (7 of 7) than patients with low ALT levels (2 of 7; p < 0.05). CONCLUSION: Low-dose interferon therapy is effective in attaining HBeAg, but not HBsAg, clearance in chronic HBV infection.

Natural history of severe duodenal ulcer disease.

BACKGROUND: A subset of patients with chronic duodenal ulcer has severe ulcer diathesis in the form of frequent relapses and complications like perforation and hemorrhage. We observed the effect of drug treatment on the natural history of this subset. METHODS: Of 526 patients diagnosed to have chronic duodenal ulcer by endoscopy, 23 patients with severe diathesis were available for long follow-up (mean period 36 months). Each patient was assessed clinically and endoscopically every 2 months for at least 12 months and then every 3 months or when symptomatic. Helicobacter pylori status was assessed during endoscopy. The effect of antisecretory drugs and anti-H. pylori therapy on natural history was determined. RESULTS: Thirteen of 23 patients (56%) had refractory ulcers; six responded to double dose of H2-receptor antagonists (H2RA) for 8 weeks and six to omeprazole 40 mg daily for 4-8 weeks. Of 20 patients (87%) who were H. pylori-positive, 15 completed triple-drug therapy; of these, 10 patients eradicated H. pylori. These 10 patients were followed up for 24 months; there were no ulcer relapses within the first 12 months but 8 of them relapsed between 12 and 24 months (total number of relapses 8). Reinfection with H. pylori occurred in 3 patients. In the other 10 patients who remained H. pylori-positive, there were 19 episodes of ulcer relapse in 7 patients over 24 months, in spite of maintenance therapy with H2RA (p < 0.05). CONCLUSIONS: Refractoriness in patients with severe ulcer disease is usually episodic and amenable to larger doses of omeprazole or H2RA. Anti-H. pylori therapy improves the natural history but its effect in preventing ulcer relapse is short lasting (less than 12 months). Recurrence of infection is a problem in our population.

Collision tumor of gastrointestinal tract.

A rare combination of multiple adenomatous polyps of the colon and carcinoid tumor of the ileum in a 54-year-old man is reported.