Colorectal Cancer In Adolescents And Young Adults As Compared To Adults With Review Of Literature

INTRODUCTION: Colorectal cancers are relatively uncommon malignancies in India as compared to the western world as here there is less consumption of red and processed meat. According to recent cancer data in India, incidence of colorectal cancer is 4th in men and 3rd in women. Rectal cancers are more common in India[1].Considering such a low incidence in adults, it would be rare to find colorectal cancers in pediatric age group. We present a study on total 46 cases of colorectal cancers, among which 6 cases were in age below 25 years including two cases of adolescents. MATERIALS AND METHODS: A two year retrospective study from June 2016 to May 2018 was done. We came across total 46 cases of colorectal cancers, among which 18 cases were of females and 28 of males. Maximum number of cases were in age group 41- 50 i.e 14 cases. Two very rare cases of age 10 and 14 years were encountered which had very dismal prognosis at diagnosis itself. Other four cases were below 25 years of age and were also in advanced stage. CONCLUSION: Colorectal cancers are generally cancers of 5th to 6th decades. They are less commonly encountered before 30 years of age; being extremely rare in pediatric age group i.e 1 case/ million. If they do so, they usually present in advanced stage and have poor histological stage and grade thus making them inoperable. A high level of suspicion coupled with a digital rectal examination followed by sigmoidoscopy and/or colonoscopy if required can result in early diagnosis which will go a long way in providing effective therapy [2].

Adaptation of 2016 European Society of Cardiology/European Atherosclerosis Society guideline for lipid management to Indian patients – A consensus document

In the year 2016, European Society of Cardiology/European Atherosclerosis Society (ESC/EAS) guidelines provided recommendations on dyslipidemia management. The recommendation from these guidelines are restricted to European subcontinent. To adapt the updated recommendations for Indian subset of dyslipidemia, a panel of experts in management of dyslipidemia provided their expert opinions. This document provides expert consensus on adapting 2016 ESC dyslipidemia guidelines recommendations in Indian setting. The document also discussed India-specific relevant literature to support the consensus opinions provided in management of dyslipidemia.

Role of FNAC in cytological diagnosis of metastatic lymph node.

Background: FNAC not only confirms the presence of metastatic disease, but also gives the clue regarding the nature and origin of primary malignancy Aim and objective: To Assess the usefulness of FNAC in diagnosis of metastatic lymph node. Data were arranged according to lymph node involved and morphological diagnosis. Study design: Study material comprises of 56 lymph node aspirate diagnosed metastatic carcinoma in cytology out of total 383 cases of Lymphnode aspiration in a one year. Method: All FNACs were performed using a 22 gauge needle. An average minimum of 4 slides were made, Slides were routinely stained with both leishmann, Giemsa and Papanicolaou (PAP) stains. Results: Out of total 383 lymph node aspirate 56 cases showed metastasis Lymphnode while 327 cases showed other lesion of lymph node. Cervical lymph node was the commonest group involved. Metastasis from squamous cell carcinoma was the most common diagnosis made on cytology. Conclusion: In our study we feel that FNAC of lymph nodes as a first line of investigation in developing countries. It is not only useful in the diagnosis of suspected or unsuspected metastatic neck nodes, but can also help in starting the specific therapy in time thus reducing mortality and morbidity.

Atypical contents of inguinal hernial sac: A surgical dilemma.

Unusual contents in inguinal hernial sac are uncommon. Appendix, ovary or urinary bladder is more frequent than other abdominal organs. To deal with an unexpected organ during surgery is a surgical dilemma. We present two cases of appendix (Amyand’s Hernia) and third one with ovary in inguinal sac.

Histiocytic necrotising lymphadenitis (kikuchi's disease) [a 5 year histomorphological study].

Background: Kikuchi’s disease is a rare, benign, self-limiting disease, mainly involving the lymph nodes of young people. The disease has unknown etiology. Clinical symptoms and basic investigations in a patient often leads to a misdiagnosis, due to similar findings in other lesions like, lymphomas and chronic granulomatous inflammations of lymph nodes like tuberculosis. Lymph node biopsy shows characteristic diagnostic features. Methods: We studied all lymph node biopsies received in department of pathology & from other private laboratories in Rural and Urban areas, in & around Bareilly region of North India, in 5 years (2006-2010). Relevant clinical data was collected. Findings were correlated with previous studies. A total number of 1015 cases were examined. Results: A total of 15 cases showed histopathological features of Kikuchi’s disease. Most number of cases was seen in females, in the age group of 20-25 years. Patients presented with fever and lymphadenopathy, with a clinical provisional diagnosis of tuberculosis in maximum number of cases.Conclusion: Necrotising lymphadenitis has a striking predilection for cervical lymph nodes of females and is usually accompanied by fever. Most commonly, this disease is mistaken for tuberculosis or Lupus Lymphadenitis. Detailed clinical examination and characteristic histopathological findings help in diagnosing these lesions.

A histomorphological study of resected mediastinal tumors.

Background: The numerous structures within the mediastinum, make it prone for development of various congenital cysts, benign & malignant neoplasms. Cystic lesions and small tumors are asymptomatic in half of the patients and symptoms develop as a result of compression or invasion. These tumors are thus discovered at very late stages, which proves fatal, or, are diagnosed incidently. Methods: We analysed all resected mediastinal tumor specimens received in Department of Pathology & from few other private laboratories in Rural and Urban areas, in & around Bareilly region of North India. In 10 years duration, a total number of 38 cases were examined. Information was collected from detailed gross & microscopic examination and correlated with that of previous studies. Results: Mediastinal tumors occur more in males, with higher frequency of malignant lesions than benign. Predominant tumors are thymomas occurring in middle age group(20-29yrs), followed closely by neurogenic tumors. Conclusion: This study stresses upon the importance of early screening of all patients with suspicion, with help of radiological modalities along with FNAC & mediastinoscopy. Possible causes of increasing incidence of thymomas in children younger than 16yrs age should be further evaluated.

Wilson's disease in Eastern India.

INTRODUCTION: Wilson's disease is an inherited autosomal recessive (AR) disorder of copper metabolism transmitted by a mutant gene on chromosome 13q14-21 and results in abnormal accumulation of copper giving rise to protean manifestations. AIM: The aim is to study the clinical features, biochemical and radiological abnormalities of this disorder in Eastern India and the effect of treatment. RESULTS: Forty nine (n = 49) cases were studied over a period of 10 years. Majority of patients were male with mean age of onset being 11.13 years. They commonly presented with dysarthria, dystonia or drooling. The clinical features were dystonia (96%), silly smile (92%), dysarthria (80%), cognitive decline (71%), tremors (47%), bradykinesia (45%), etc. Family history suggested an autosomal recessive pattern. Sibling screening revealed that 4/8 (50%) were presymptomatic. All but one had presence of Keyser Fleischer (KF) ring in their cornea. Serum copper was reduced in 77% while ceruloplasmin was less in 94% of cases. The commonest abnormality seen in CT/MRI were in basal ganglia (74%) followed by white matter changes (59%) and brain stem changes (20.5%). The response to treatment was not as good and there was an initial deterioration in 50% of cases. Only five patients could go back to their school. CONCLUSION: Wilson's disease have protean manifestations. All children with slowly progressive extrapyramidal syndrome should be investigated for it. Screening of all asymptomatic siblings for Wilson's disease must be carried out. Early institution of proper treatment and life long continuation is indicated in all. In the present series, an earlier age of onset of neurological signs and symptoms were seen; there was initial deterioration in 50% of cases and the response to treatment was not as good.

Management of esophagorespiratory fistula due to carcinoma esophagus with palliative intubation, gastric decompression and transgastric feeding jejunostomy.

BACKGROUND: Carcinoma esophagus with esophagorespiratory fistula has a poor prognosis. Water and food intake suffers and pulmonary contamination leads to lung infection. Treatment is essentially palliative. METHODS: Thirty-five patients with esophagorespiratory fistula secondary to esophageal carcinoma were treated with palliative esophageal intubation, gastrostomy and transgastric feeding jejunostomy. RESULTS: Esophageal prosthesis could be implanted in 34 patients. One patient died in the postoperative period. Twenty-nine patients were able to swallow saliva without leakage into the lungs. Only four patients were able to take full diet orally for any significant length of time. An 18-G needle inserted in the gastrostomy Malecot's catheter provided outlet for air in the stomach and prevented rise in intragastric pressure and gastroesophageal reflux. Transgastric feeding jejunostomy functioned satisfactory. Twenty patients were followed up; the average survival was 58 days (range 9-337 days). CONCLUSION: Esophageal intubation, gastrostomy and transgastric feeding jejunostomy provide satisfactory palliation for patients with esophagorespiratory fistula secondary to carcinoma esophagus.

Volvulus and gangrene in intra-abdominal colon after colonoplasty for esophageal stricture.

Ten years after colonoplasty using the left colon for impassable corrosive stricture of the esophagus, a 27-year-old woman developed volvulus and gangrene of the remaining intra-abdominal colon. It was resected and colostomy was done. In the second stage, after 3 months, the ascending colon and cecum were mobilized and anastomosed to the rectal stump. Eight years later, the patient is asymptomatic.

Primary intrapulmonary teratoma presenting as pyothorax.

A female patient presented with empyema thoracis and was planned for decortication. Peroperatively a cystic mass was found in the left lower lobe which was resected and diagnosed as a case of teratoma of lung on histopathological examination. This unusual case of primary intrapulmonary teratoma is being reported here.

A new physiological approach to control essential hypertension.

This study was conducted on 20 male patients of Essential Hypertension (EH) in order to explore the possible role of baroreflex mechanism in the etiology of EH and also to find out whether by restoration of baroreflex sensitivity to normal level either by postural tilt stimulus on a tilt table or by the equivalent yogic postural exercise (Yogic asanas), the EH could be cured or controlled. Patients on therapeutic regime were gradually withdrawn from drug therapy, and later divided into two groups of 10 each. Group-I (age 34 +/- 1.7 years) was subjected to a 3 week course of 70 degrees head-up tilt for 30 min daily, while in group-II (age 50 +/- 3.3 years), specific yogic exercises equivalent to head-up or head-down tilt were administered for the same duration. The progressive autonomic readjustments were assessed by a battery of tests including cardiovascular responses to head up tilt, cold pressor response at 4 degrees C water (CPR), alpha index of EEG (AI), level of blood catecholamines (CA) and plasma renin activity (PRA). At the end of 3 weeks, there was a significant reduction (P < 0.001) in blood pressure in both the groups. Progressive changes in BP and HR response to tilt during 3 weeks course of tilt and yogic exercise clearly indicated gradual improvement in baroreflex sensitivity. Likewise, changes in other indices like CPR, AI, CA and PRA indicated progressive attenuation of sypatho-adrenal and renin-angiotensin activity. All these changes together with the reduction in BP strongly suggest a close link between the etiology of EH and baroreflexes on the one hand and controlling influence of the latter on sympatho-adrenal and renin-angiotensin systems on the other. It also throws light on the physiological mechanism underlying the effects of selected yogic exercises in the treatment of EH.

An experimental study on cardiotoxicity of aluminium phosphide.

Aluminium phosphide(AlP), a grain fumigant pesticide, was studied for its cardiotoxicity in anaesthetised rats. The hemodynamic and cardiac biochemical changes were investigated following intragastric administration of different doses of AlP (10, 20 and 40 mg). With 10 and 20 mg dose of AlP an immediate fall in BP was observed which recovered partially and stabilized for 10 minutes followed by a gradual fall till the animal died. However, with a higher dose (40 mg) there was no recovery in BP, instead the initial fall continued till the death of the animal. An increase in the heart rate was observed with 10 and 20 mg dose of AlP for 15 minutes which was followed by a marked fall till cardiac arrest ensued. On the other hand, 40 mg dose produced only a transient tachycardia followed by a prolonged bradycardia. ECG changes at all dose levels included initial tachycardia and ST segment elevation progressing to QRS broadening. However, marked conduction defects as evidenced by the ventricular ectopics were noticed only with 40 mg. The mean survival time dose dependently decreased with 10 mg(55 +/- 3 min), 20 mg(35 +/- 2 min) and 40 mg(18 +/- 2 min) of AlP. The cardiac glycogen, ATP and CP levels were significantly lowered in animals treated with 10, 20 and 40 mg of AlP. Higher levels of MDA in the cardiac tissue were observed with 10, 20 and 40 mg of AlP. Thus it is suggested that the deleterious effect of AlP on heart is mediated by both declined cellular metabolism of the myocardium as well as by necrosis of the cardiac tissue resulting in the release of reactive oxygen intermediates.

Foley catheter self dilatation for strictures of the upper end of oesophagus.

Three patients having corrosive stricture of the upper end of oesophagus and two patients of impassable corrosive stricture of oesophagus who were subjected to coloplasty using descending colon and who developed stricture at the site of upper anastomosis were being treated by antegrade dilatations with oesophageal bougies under general anaesthesia. These patients were put on controlled, progressive, self, domiciliary, dilatation with foley catheter. Four patients became asymptomatic and did not require any other type of dilatation. One patient initially was not able to do the dilatations properly so she required re-training, after which she remained asymptomatic. Foley catheter dilatation of the strictures of the upper end of oesophagus was found to be simple, effective, easy to carry out, comfortable for the patient and economical.

Late bronchoplasty for missed traumatic rupture of bronchus.

Two patients of traumatic rupture of main bronchus are reported here. One patient presented 2 years after blunt chest trauma while the other patient presented 9 weeks after trauma. Lesion in both patients were missed in the immediate post-trauma period. In both patients pulmonary angiogram demonstrated normal vasculature in the atelectatic lung, while intraoperatively good compliance and elasticity were found. Bronchoplasty done in both patients had good postoperative results.

Bilateral morgagni hernia masquerading as mediastinal mass.

Bilateral Morgagni hernia is a rare entity. A patient of bilateral Morgagni hernia presenting as mediastinal mass is being reported. The hernial contents included transverse colon so the diagnosis could be confirmed preoperatively by barium enema. Surgery was curative.

A case of bilateral pulmonary hydatid cysts.

A case of bilateral hydatid lung disease is reported who presented with a history of short duration and large opacities in both lung fields. A trial of medical treatment with albendazole 400 mg BD for 6 weeks failed. The patient was managed by surgical intervention which also ultimately established the diagnosis of hydatid disease.