Accuracy of needle core biopsy in confirming the diagnosis of bone lesions

The material of this study included 30 patients with a provisional diagnosis of a bony lesion which needed confirmation. Their age was 6 - 65 years, average 27.6 years. There were 20 males and 10 females. The affected bones were the femur: 16 cases = 53.3%; the tibia: 4 cases = 13.3%; each of the fibula and iliac bone: 3 cases = 10%; humerus: 2 cases = 6.7%; each of the radius and the fifth metacarpal: 1 case = 3.3%. The provisional diagnosis was reached after clinical examination; imaging and laboratory investigations. It was malignant bone tumour: 12 cases = 40%; giant cell tumour: 4 cases = 13.3%; benign bone tumour: 8 cases = 26.7%; tuberculous osteitis: 2 cases = 6.7%; chronic pyogenic osteomyelitis: 4 cases = 13.3%. To confirm the provisional diagnosis the patient was given general anaesthesia to perform two procedures in the same sitting: first a needle core biopsy [NCB], then an open surgical biopsy after full exposure of the lesion. The biopsy specimens were blinded by being code-numbered differently in each case. The open biopsy was considered as the control. The .NCB gave a correct diagnosis in 27 cases or 90% of the cases of the whole material. The provisional diagnosis was proven by NCB and open biopsy in 26 cases or 86.7% of the whole material. In malignant bone tumours, giant cell bone tumours, tubercuIous osteitis and chronic pyogenic osteomyelitis, the NCB was successful in all cases in accurately confirming the diagnosis. However in benign bone tumours the NCB could give accurate diagnosis only in 5 out of 8 cases [62.5%]. It was concluded that the NCB had the same degree of diagnostic accuracy as the open biopsy in most bony lesions met with in this study, except in benign bone tumours

A single nocturnal dose of famotidine for the treatment of duodenal ulcer: evaluation of efficacy and safety.

The efficacy and safety of a single nocturnal dose of famotidine (40 mg) was evaluated in 30 consecutive patients of duodenal ulcer (DU). Three patients were lost for follow-up and therefore were excluded. The mean age of remaining 27 patients was 34.3 (+/- 9.9) years and male to female ratio was 8:1. The mean size of the DU was 1.21 (+/- 0.79) cm. After a 4-week therapy all patients showed significant improvement and repeat endoscopy in 24 out of 27 patients (89%, 95% confidence interval; 78% to 100%) showed healed ulcer. Clinical assessment of pain relief at 4-week showed significant drop in the mean score of baseline daytime (from 1.85 to 0.13) and baseline nocturnal pain (from 1.70 to 0.10) (p less than 0.0001 and less than 0.0001, respectively). Also shown was the significant decrease in the mean gastrointestinal symptoms score from 5.89 at baseline to only 0.89 at 4-week (p less than 0.0001). Despite that all those who failed to show ulcer healing at 4-week were smokers, logistic regression analysis could not identify smoking or any other risk factors as adverse predictors of ulcer healing. None of the patients experienced significant side effects or adverse reactions. We conclude, that a single nocturnal dose of famotidine is a practical, highly effective and safe approach for the management of DU.

Late relapse of Hodgkin's disease after 25 years.

This short report documents a late relapse of Hodgkin's disease 25 years later after initial complete remission. The case represents the second longest ever reported disease-free survival that was followed by late recurrence. Data about late occurrence in Hodgkin's disease of relapses are reviewed. The biological and clinical significances of those events of late relapses are emphasized.

Malignant bone tumours in pregnancy (a report of two cases and review of literature).

Two cases of malignant bone tumours in pregnancy are reported. The optimum management is not clearly defined due to the rarity of the condition and limited individual experience. Our patients delivered healthy babies without any signs of maternal malignant disease. Cancer chemotherapy was instituted during the postmortem period. Pregnancy did not appear to exacerbate the tumour growth nor in any way affect the ultimate outcome of the patients.

Tuberculosis in patients with malignant disease.

Of 2,143 biopsy proven cancer patients seen at our hospital over a six year period, 4 (0.19%) patients developed active tuberculosis (TB) during anticancer therapy or shortly after its completion. The cancer diagnoses of those patients were non-Hodgkin's lymphoma, breast cancer, chronic myelogenous leukemia, and astrocytoma. Institution of antituberculous therapy was successful in three patients, however, the TB course was rapidly fatal in the fourth patient with non-Hodgkin's lymphoma despite therapy. The association between TB and neoplasia is emphasized. TB complicating malignant disorders represents complex problem regarding its early recognition and its managements.