Synchronous and Metachronous Malignant tumours expect the un-expected

To evaluate occurrence of synchronous and metachronous malignant tumours, to find tumour types, age group, and relationship to treatment received. Previously diagnosed 1 st primary tumour cases experiencing a synchronous or metachronous tumour, seen at AOI from February 2003 to August 2009 [78 months] were included. The cases were analyzed for morphology/histology of 1st primary tumour, age and gender of patient, treatment received for first tumour, time interval between the 1st and 2nd primary tumour, morphology/histology of second tumour, and the treatment conferred for 2nd tumour. The 2nd synchronous and metachronous tumours were 46/4025 [1.14%], in 18 males and 28 females [M:F 1:1.6]. The age range was 16-75 years [median 43 years]. The follow up time was 24-150 months. The time to 2nd primary tumour was 2-132 months. The 1st primary tumours were breast, ovary, GIT and urinary bladder. The patients received surgery, radiotherapy, chemotherapy, and hormonal therapy alone or as multi-modality treatment for the 1st tumours. The frequent 2nd tumours were breast, ovary and Gastro Intestinal tumours. It is imperative that patients with a primary malignant tumour should be thoroughly, closely, and regularly followed. Genetic counseling, risk estimation, cancer screening and chemoprevention must be emphasized. Every subsequent occurring tumour should be biopsied. The effect of 1st tumour on the 2nd or vice versa are still not fully understood and need exploration. The 2nd primary tumour is usually more aggressive, treatment resistant, and metastasizes early requiring a more aggressive treatment strategy

Role of ursodeoxycholic acid in lowering ALT in chronic liver disease

The objective was to see the efficacy of ursodeoxycholic acid in improving the ALT levels in patients suffering from chronic liver disease. Thirty patients suffering from chronic liver disease [either B or C] were given oral ursodeoxycholic acid in a dose of 250 mg twice a day for 4 months. Their blood biochemistry and haematology were repeated monthly for 7 months i.e. 4 months of therapy and 3 months post therapy to see the response. The mean ALT levels of 30 patients who completed the study was 101+47 IU/L. During therapy 24 cases [80%] showed lowering of their ALT levels while 6 [20%] either showed no response or worsening of ALT levels. Of 24 cases who showed an improvement in their ALT levels; over 25% drop in ALT levels was seen in 217 cases [70%] and less than 25% drop seen in 7 cases [30%]. The mean ALT values during therapy were 75 IU/L showing an overall 25% reduction from the baseline values. Following cessation of therapy the mean ALT levels showed a rise to 90 IU/L which was almost similar to 101 IU/L value in the pre treatment period. The study showed some role of ursodeoxycholic acid in improving the ALT levels in chronic liver disease

Two weeks triple therapy with lansoprazole, amoxycillin and roxythromycin is better than dual therapy with lansoprazole and amoxycillin for h. pylori infection a randomised, clinical trial

AIMS: To compare the efficacy of 2 weeks of dual therapy of Lansoprazole and Amoxycilline with triple therapy of Lansoprazole, Amoxycilline and Roxythromycin for H. pylori eradication. SUBJECTS: Twenty-five suffering from dyspepsia and found H. pylori positive [CLO] during upper GI endoscopy. METHODS: Patients were divided into 2 groups, one group received Lansoprazole [30 mg] once a day, and amoxycilline [500 mg] three times a day [group I], while the second group received Lansoparazole and amoxycillin in similar dosage with the addition of Roxythromycin [150 mg] twice a day [group II]. H. pylori status was confirmed on endoscopy using CLO test at entry to the protocol and then at 4 weeks. H. pylori eradication was 57% in group I and 86% in group II with healing of lesions in all cases. Better response with triple therapy [group II] indicates enhanced eradication of the pathogens with triple therapy while using roxythromycin [JPMA 50:157, 2000]

Frequency of gastrointestinal tumours at a teaching hospital in Karachi

Malignant gastrointestinal tumours are amongst the commonest tumours exhibiting an annual increase globally. There is a change in the morphological site of involvement observed over the years. In this study biopsy proven malignant gastrointestinal tumours seen at Jinnah Postgraduate Medical Centre, Karachi from 1961-1992 were analyzed with reference to age, sex, topography and histology. The study showed an increase in malignant gastrointestinal tumours over the years, from 9% in 1961 to 17% in 1992 with respect to all malignant tumours reported. The tumours affected a much younger age in our population, 74% occurring between 35-64 years of age. Carcinoma oesophagus accounted for 10% of all malignancies [48.7% male and 62.4% female gastrointestinal tumours], while gastric carcinoma remained unchanged [14% male and 9% female GI tumours]. The colorectal carcinoma [25.4% of male and 20.1% of female GI tumours] and carcinoma pancreas [1.2% male and 1.5% female GI tumours] were less frequently seen. It was observed that malignant gastrointestinal tumours have increased significantly over the years in our local population as part of international trend and are occurring at a much younger age as compared to western population. Carcinoma oesophagus was seen more frequently than gastric carcinoma and colorectal carcinoma. A substantially higher number tend to be more anaplastic being seen at an advanced stage of disease at the time of diagnosis