Outcome of Endoscopic Variceal Band Ligation.

INTRODUCTION: Bleeding from esophageal varices in cirrhosis is an emergent condition with high mortality. One of the preferred modality of treating esophageal varices is EVL. We aimed to find out the outcome of EVL in controlling acute esophageal variceal bleeding, prophylactic banding to prevent future bleeding and the number of sessions required for complete eradication of varices. METHODS: This descriptive observational study was carried out in Gastroenterology and Hepatology unit of Bir Hospital, NAMS from June 2016 to May 2017. Consecutive cases who presented in emergency room with acute variceal bleeding due to liver cirrhosis and cases of liver cirrhosis with large varices and red color signs on endoscopic examination were enrolled. They underwent EVL and subsequent re-endoscope at one month interval till the eradication of varices was achieved. RESULTS: Among 83 patients, 15 (18.1%) were of Child Pugh class A, 29 (34.9%) B and 39 (47%) were of C. In 20 (24.1%) cases varices could be eradicated in one session of EVL while 57 (68.7%) required two sessions and in 6 (7.2%) cases it took three sessions. Total average EVL session required for obliteration of esophageal varices was 1.84±0.53. There was only one (1.2%) of early re-bleeding post EVL. CONCLUSIONS: EVL is an effective modality of treatment in controlling acute esophageal variceal bleeding, in preventing future variceal bleeding as well as in eradicating esophageal varices with very few complications.

Colorectal Cancer in Different Age Groups in a Tertiary Hospital in Nepal.

INTRODUCTION: Some studies have suggested that colorectal cancer at a younger age had distinct biological characteristics: different clinical presentations, more advanced stage at time of diagnosis and poorly differentiated carcinoma. The aim of the study is to analyze clinical and histopathological differences between younger (≤40 years of age) and older (>40 years of age) colorectal cancer patients. METHODS: A cross-sectional analysis was conducted amongst the colorectal cancer patients who visited Bir Hospital between July 2015 and April 2017. All colonoscopically diagnosed and histopathologically proven cases of colon cancer were included. Chi-square test and independent t - test was performed to analyze the difference between clinical presentations and histopathological findings among two groups of patients and P value of <0.05 was considered as significant. RESULTS: Thirty younger patients and thirty older patients were enrolled without any differences in gender proportion. There were no statistical differences between clinical presentation and histological grade and type in younger and older patients. The younger patients had more complaints of altered bowel habit (P <0.001) while older patients mostly presented with per rectal bleeding (P< 0.008). CONCLUSIONS: In this study, colorectal cancer at younger ages showed similar characteristics to those of older patients except altered bowel habit was more common in younger patients while per rectal bleeding was more common in older patients. Although colorectal cancer incidence increases with age, younger patients with altered bowel habits, weight loss, anemia and anorexia should also be given due medical attention and undergo evaluation promptly.

Pattern of breast cancer in a tertiary care center.

INTRODUCTION: Breast Cancer is the second commonest cause of cancer death in women. Almost all women survive breast cancer if it is detected before it starts to spread. The aim of the study is to analyze the demographical profile, stage of presentation, histological type, and treatment modalities of breast cancer in a tertiary care setting. METHODS: Total 1141 cases of breast cancer had been followed retrospectively from 1999 to 2006 A.D. in a tertiary care center and their patterns were analyzed. RESULTS: The mean age of presentation of breast cancer was 47.30 +/- 11.57 years in female and 59.03 +/- 14.63 in male, 31 (2.1%) cases of breast cancer were male. There were 123 (10.78%) stage I, 281 (24.62%) stage II, 466 (40.84%) stage III, and 271 (23.75%) stage IV patients. Infiltrating ductal carcinoma was the commonest variety 610 (53.5%). Chemotherapy was the mainstay for treatment of breast cancer 341 (29.9%) followed by surgery 287 (25.2%). CONCLUSIONS: Breast cancer trend is rising with more in late and advanced stages, mostly due to lack of awareness. Infiltrating ductal carcinoma is the commonest variety. Chemotherapy is the most commonly used modality of treatment. Male breast cancer present late and is not so uncommon.

Electrocardiograph and chest X-ray in prediction of left ventricular systolic dysfunction.

INTRODUCTION: Echocardiography is the definitive diagnostic tool for left ventricular systolic dysfunction. But it's expensive and requires trained manpower and thus might not be available in the primary care set up. ECG and Chest X ray, the more basic investigations, may help diagnose LVSD or at least streamline those who absolutely require echocardiography in primary care setup. METHODS: ECG, Chest X ray and Echocardiography along with clinical assessment were performed on 35 patients with some form of complaints related to heart. The inferences on systolic function obtained from ECG, Chest X ray were compared with Echocardiography findings. RESULTS: Out of 35 participants, 25 had left ventricular ejection fraction less than 45%, 28 had abnormal ECG, 30 had cardiomegaly in chest X-ray. A set of pre-selected ECG abnormalities had a sensitivity of 100% (83.4-100), specificity of 70% (35.4-91.9) and a positive predictive value of 89.3% (70.6-97.2) in diagnosing LVSD. Likewise, the figures were 92% (72.5-98.6), 30% (8.1-64.6) and 76.7% (57.3-89.4) respectively for a cardio-thoracic ratio of more than 0.5 in chest X-ray. CONCLUSIONS: Although, ECG and Chest X ray could not replace Echocardiography, they could very well give an idea of the systolic function of an individual and suggest the need or no need for an echo-study in primary care setup.

Effect of acute hepatitis E infection in patients with liver cirrhosis.

INTRODUCTION: Hepatitis E virus is a major cause of enterically transmitted hepatitis. Mortality is very high if it is associated with pregnancy, especially during third trimester. This study was carried out to find out the effects of acute HEV hepatitis on Chronic Liver Disease patients of different etiologies. METHODS: The consecutive patients of liver cirrhosis with definite evidence of recent HEV infection were enrolled in this study. Acute hepatitis was diagnosed by presence of prodromal symptoms and anti-HEV IgM antibody in their serum. The outcomes after superinfection with HEV hepatitis were determined by changes in Child Pugh score, recovery of liver function test, hospital stay and mortality. RESULTS: After exclusion 25 were studied. The etiology of cirrhosis in patients was: alcohol 13, autoimmune hepatitis 3, hepatitis B 2, Budd Chiari syndrome 2, alcohol plus hepatitis B 1, hepatitis C 1, cardiac cirrhosis 1, Wilson's disease 1 and cryptogenic 1. All patients with no recent decompensation showed signs of decompensation during admission. Seven (28%) patients died. The cause of death was either upper gastrointestinal bleeding or hepatorenal syndrome. Remaining patients had prolonged hospital stay with deterioration of Child-Pugh's score. CONCLUSIONS: Superinfection of HEV in cirrhotic patient causes rapid decompensation. The morbidity and mortality is higher compared to those non-infected patients. Development of hepatorenal syndrome and upper GI bleeding was commonest cause of death.