Thyroid disease in pregnancy

Objective: aim of the review is to determine the effect of thyroid dysfunction on the course of pregnancy

Material and Methods: Medline, Embase [from 2000 to 2011] and research articles. There was no language restriction for any of these searches. Studies included were randomized clinical trials, cohort and case control studies

Results: there are few prospective population based cohort studies which study the effect of thyroid dysfunction on fetal development. There was a prospective population based cohort study in china. 1017 women with singleton pregnancy participated in this study. The study showed that clinical hypothyroidism was associated with increased fetal loss, low birth weight, and congenital malformations. The sub clinical hypothyroidism was associated with increased fetal distress, preterm delivery, poor vision development, and neurodevelopment delay. The clinical hyperthyroidism was associated with hearing dysplasia. A systemic review and meta-analysis found a strong association between clinical hypothyroidism and preeclampsia, perinatal mortality and lower IQ in the child. They also found an association between thyroid autoimmunity and unexplained subfertlity, miscarriages, recurrent miscarriages and preterm birth

Conclusion: the management of thyroid disease in pregnancy is important as thyroid function undergo changes which can adversely affect pregnancy and the fetus

Hepatocellular carcinoma; characteristics a retrospective study of 34 patients at JHL, Lahore

Hepatocellular carcinoma [HCC] is the commonest primary malignant cancer of the liver in the world. Characteristics of our population suffering from HCC are not known, this study aims to present epidemiological, clinical and laboratory characteristics of HCC patients. A retrospective study. At Jinnah hospital, Lahore. 36 months. HCC was diagnosed according to the guide lines given by EASL-2000. The data was later analyzed by SPSS13. A total of 34 patients were included in the study. Majority patients were male 21[80%] and belonged to urban setting [21]. Pain abdomen 21[61.8%] and Ascites 22[64.7%] were the commonest presentations. 15[44%] patients were suffering from HCV and 12 [35.3%] were negative for both HCV and HBV, while 9 out of these were also not alcoholic. Most of the patients had symptoms present for 1 -6 [76%] months and majority presented in either stage III or IV [91%], none of the patient presented in stage I. Most the patients 25 [73.5%] had tumor size larger than 5 cm at presentation and similarly 20 [59%] had more than one lesions at presentation, stage of tumor was positively associated [p <0.02] with number of tumor lesions. HCC does occur in a cirrhotic background but a good number of patients were not cirrhotic and need to be investigated further for other possible dietary risk factors. Pain and abdominal distension in a cirrhotic patient should be addressed to immediately so as to diagnose HCC at an earlier stage

Colorectal cancer; overall survival and its prognostic factors, a retrospective analysis from 10 year data form JHL

There is paucity of data on epidemiology and survival in colorectal cancer from developing countries. To determine overall survival and its predictive factors. Department of Oncology Jinnah Hospital Lahore. From July 1997 to Dec 2007. 73 patients were analyzed. Patient demographic data including age, sex, socio-economic status, pre-treatment CEA levels, Duke's stage, site of tumor [colon, rectum] and complete tumor resectability were recorded. Univariate analysis by chi-square and multivariate analysis were performed by Cox Regression Model to evaluate the predictors of survival. SPSS v 13.0 was used for statistical analysis. Kaplan-Meier estimate was used to calculate survival. Median age of our patients was 45 years. Male to female ratio was 1:1.2. Complete surgical resection could be performed in only 48 [68.5%] patients. Majority [70%] patients had Duke C and D. Overall survivals at 36 months was 53% and was 90% for Duke A and B, while it was 61% and 26% for Duke's C and D respectively. Females had a better survival rate of 74% as compared to males with a survival of 36%. Patients with proximal colon tumors had survival of 73% as compared to 37% in rectal/rectosigmoid group. Patients with high pre-treatment CEA had poor survival 39%. Only 25% patients with unresectable tumors were alive at 36 months compared to 67% in patients with resectable tumors. Significant predictive factors for improved survival were female gender, early disease, patients with proximal colon tumors, low pre-treatment CEA levels and complete tumor resection

Clinico epidemiological features of colorectal cancer: a retrospective analysis of 10 years data

Objective: There is paucity of data on epidemiology and survival in colorectal cancer from developing countries. The primary objective of this study was to determine the clinicoepidemiological characteristics

Methods: 73 patients presenting to the Department of Oncology, Jinnah Hospital Lahore between July 1997 and December 2007 were analyzed. Patients' demographic data included record of age, sex and socioeconomic status. Clinical features, including both symptoms and signs were recorded. In addition pre-treatment CEA levels, Duke's stage, site of tumor [colon, rectum] and histopathology were recorded as well. SPSS version 13.0 was used for statistical analysis

Results: Median age of our patients was 45 years. Male to female ratio was 1:1.2. Approximately 68.5% patients belonged to a low socioeconomic group. Pain abdomen was the commonest symptom [81 %] followed by altered stool habits [68%]. 46 [63%] patients had a tumor in proximal colon and 27 [37%] patients had rectal/recto-sigmoid junction tumors. Complete surgical resection could be performed in 48 [65.7%] patients. Only 21 [28.8%] patients had Duke's stage and B tumors, 27[37%] had Duke C disease and 22 patients [30.1%] had Duke's stage D. Grade I and II tumors on histopathology were seen in 60 [82.2%] patients. Pre-treatment CEA level was available in 54 patients and 30 [41.3%] had high level prior to initial treatment either surgery or chemotherapy

Conclusion: Colorectal carcinoma is mostly a disease of low socioeconomic group and the major symptoms are pain abdomen and altered bowel habits. The later one is often ignored by the patients and is one of the reasons for late presentation