The incidence and patterns of lung cancers in Sri Lanka from 2001 to 2010: Analysis of national cancer registry data.

OBJECTIVES: Epidemiological studies carried out on lung cancer have shown varying incidence patterns in Asia. We aimed to examine the trends in lung cancer incidence and patterns in Sri Lanka. METHODS: All newly diagnosed lung cancer patients in Sri Lanka during 2001-2010 included in the National Cancer Registry were analysed. Trends in incidence were analysed using the Joinpoint regression software. RESULTS: A total of 8482 lung cancer patients (males = 6831, 80.5%, mean age: 60.2 years) were analysed. The WHO age-standardised incidence rate (ASR) has increased from 3.77 per 100,000 in 2001 (95% confidence interval [95% CI]: 3.47-4.07) to 5.74 per 100,000 in 2010 (95% CI: 5.38-6.09; a 1.52-fold increase (p < 0.05 for trend), with an estimated annual percentage change (EAPC) of 5.4 (95% CI: 3.9-7.0). The proportional increase in incidence was higher for females [ASR: 1.2 to 2.3, EAPC = 6.8(95% CI: 4.0-9.7)] than males [ASR: 6.6 to 9.55, EAPC = 5.2(95% CI: 3.8-6.6)] and with similar patterns. CONCLUSIONS: In Sri Lanka, the incidence of lung cancer has shown as increasing trend with a greater proportional rise in females. Although the observed trends could be partly due to better reporting, the greater increase in females who are generally non-smokers is intriguing. Further studies are required to identify reasons for observed incidence trends in lung cancer in Sri Lanka.

Burkholderia pseudomallei peri-prosthetic infection following medial malleolar internal fixation: a case report.

BACKGROUND: Melioidosis-associated peri-prosthetic infection is extremely rare. To date, melioidosis associated septic arthritis of the ankle joint following a medial malleolar internal fixation has not been reported. CASE PRESENTATION: We describe a 49-year-old male with a history of long standing diabetes who presented with fever, constitutional symptoms and right ankle pain for 1 week. Ten years ago, he underwent a medial malleolar screw fixation following a traumatic closed fracture. His initial right ankle radiographs showed no evidence of osteomyelitis. He underwent a wound debridement and washout of the right ankle joint. The peripheral blood and pus from the ankle joint was culture positive for Burkholderia pseudomallei with very high antibody titres. His subsequent radiographs showed features of chronic osteomyelitis. He was treated with a prolonged course of antibiotics and repeated wound debridement. At follow up after 6 months, he had no clinical features of recurrent infection. CONCLUSIONS: Melioidosis should be entertained in the differential diagnosis of peri-prosthetic infections in high risk patients.

Squamous Cell Carcinoma in the Post Tuberculosis Lung after 30 Years of Treatment Completion.

Pulmonary tuberculosis (TB) and lung cancer are becoming increasingly prevalent especially in developing countries. The occurrence of lung cancer after 30 years of completed pulmonary TB treatment is rare. We report a rare occurrence of a squamous cell carcinoma (SCC) in the post TB lung after 30 years of completed pulmonary tuberculosis treatment. A 60-year-old male, an apparently healthy nonsmoker, presented with a community-acquired Klebsiella pneumonia. Imaging revealed a destroyed left lung with cavities with air-fluid levels. An enhancing lesion was noted at the left upper lobe, and a guided biopsy revealed a SCC. He was fit for surgery and underwent an open left pneumonectomy. The left lung was destroyed and cavitatory due to the previous tuberculosis. A peripherally located tumor was noted in the left upper lobe. Histology revealed a moderately differentiated keratinizing type SCC (pT4N0Mx). The negative cultures and histology excluded an active pulmonary tuberculosis. The postsurgical lung function at 1 month showed satisfactory improvement with good functional capacity. He was then referred to the oncologist for adjuvant therapy. The occurrence of post-TB lung cancer after 30 years in an otherwise healthy male without active TB suggests an increased long-term risk of cancer even in the absence of other robust risk factors. Therefore, the chronic inflammatory process in the diseased lung is probably the cause for lung cancer in the absence of active TB. Thus, we suggest long-term surveillance after completed pulmonary TB treatment even in otherwise healthy asymptomatic individuals.

Retrocaval ureter associated with cryptorchidism: A case report and review of literature.

We report an incidentally diagnosed retrocaval ureter in a 14-year-old boy, while evaluating for right-sided hydronephrosis associated with cryptorchidism. Therefore, we suggest that any significant right-sided hydronephrosis associated with cryptorchidism may require investigations to exclude this rare anomaly.

Bilateral rectus sheath haematoma complicating dengue virus infection in a patient on warfarin for mechanical aortic valve replacement: a case report.

BACKGROUND: The management of Dengue virus infection can be challenging. Varied presentations and numerous complications intrinsic to dengue by itself increase the complexity of treatment and potential mortality. When burdened with the presence of additional comorbidities and the need to continue compulsory medications, clear stepwise definitive guidance is lacking and patients tend to have more complex complications and outcomes calling to question the clinical decisions that may have been taken. The use and continuation of warfarin in dengue virus infection is one such example. CASE PRESENTATION: We report a 65 year old South Asian female who presented with dengue fever. She had a history bronchial asthma, a prior abdominal surgery, and was on warfarin and maintained a therapeutically appropriate internationalized normalized ratio for a mechanical aortic valve replacement. Though preemptive decision to stop warfarin was taken with decreasing platelet counts, her clinical course was complicated with the development of bilateral rectus sheath haematoma's requiring resuscitation with blood transfusions. CONCLUSION: Though management of dengue viral fever has seen drastic evolution with recent updated guidance, clinical scenarios seen in the course of the illness still pose challenges to the managing physician. The need to continue obligatory anticoagulation which may seem counterintuitive during a complex disease such as dengue virus infection must be considered after understanding the potential risks versus that of its benefits. Though case by case decisions maybe warranted, a clear protocol would be very helpful in making clinical decisions, as the correct preemptive decision may potentially avert catastrophic and unpredictable bleeding events.