Eosinophilic gastritis--an unusual cause of gastric outlet obstruction.

Eosinophilic gastroenteritis is a rare entity. We report a 41-year-old man who presented with features of gastric outlet obstruction due to a submucosal lesion in the distal end of the stomach. Distal gastrectomy with Billroth II reconstruction was done. Histology showed eosinophilic gastritis infiltrating the muscular and serosal layers of the pylorus and antrum.

LIVER RESECTION FOR METASTASES FROM COLORECTAL CANCER.

Five percent of patients with liver secondaries from colorectal carcinoma are potentially resectable and several studies have demonstrated significantly improved survival following resection. Two hundred and ten patients operated for colorectal carcinoma were followed up. Computed tomography confirmed potentially resectable metastasis to the liver in 38. On exploration 18 patients who had 4 or less hepatic metastases and no extrahepatic disease, underwent resection of their secondaries. Fourteen were males and 4 females with a mean age of 43.5 (SD 13.6, range 18-72) years. Ten patients presented with synchronous liver metastasis and 8 had metachronous disease. There was no post-operative mortality. All 18 have been followed up. for a median period of 23.5 (range 12-38) months. Seven patients are alive and well with no evidence of recurrence at a median period of 28 months (survival 39%). Four are alive with local recurrence in the liver. Median time to recurrence was 22 months. Seven patients have died of disseminated disease. The disease free survival at 28 months is 39% and the overall survival 61%. A close follow-up protocol for all patient undergoing curative surgery for colorectal cancer is essential, if such patients are to be selected early.

PAROTOID TUMOURS: A STUDY OF 65 CASES.

Sixty five patients who had undergone surgery for parotid tumours over a period of nine years were studied retrospectively. There were 45 males and 20 females. There were 49 benign and 16 malignant tumours. Age ranged 35-69 years; mean 47 years. Pain (6%) and facial palsy (3%) were unusual features. Size of tumour at presentation varied from 1.5 to 12 cm. Superficial parotidectomy was the commonest operation performed and Total/Radical/Extended parotidectomy was done in selected cases. Postoperative radiotherapy was used in six cases. No recurrences were noted following surgery for benign tumours. However a local recurrence rate of 37% was found for malignancies (6/16 cases). This paper aims to review the experience of managing these tumours in the setting of service hospitals.

INTRAHEPATIC CHOLANGIOJEJUNOSTOMY FOR MALIGNANT HILAR BILIARY OBSTRUCTION: APPROACH TO THE LEFT HEPATIC DUCT.

Biliary enteric anastomosis for relief of biliary obstruction caused by malignancy at the confluence of the bile ducts can be difficult due to non availability of an adequate length of duct for anastomosis. This paper describes an approach to the left hepatic duct to decompress the biliary tree and its successful application in 11 of 12 patients who presented with malignant hilar obstruction.

Adult Wilms' tumour (report of two cases).

Wilms' tumour, an embryonic neoplasm, the most common renal tumour in childhood, had occasionally been reported in adults. Authors report two such cases and have reviewed the relevant literature. While Wilm's tumour in children classically demonstrates the curative potential of combined modality treatment, no such clear guide lines are available for those occurring during adulthood. Pathologic diagnosis of adult Wilm's tumour is difficult because of the multiplicity of undifferentiated adult tumours that must be considered in the differential diagnosis. As no predictive parameters for optimal therapy exist, a combination of surgery, irradiation and chemotherapy probably is indicated for all stages of disease.

Congenital fibrosarcoma. Report of three cases.

Congenital/Infantile Fibrosarcomas are relatively rare soft tissue tumours. Only 238 cases have been reported till 1986 in the world literature of which 60 were truly congenital. A distinction must be made between them and their adult counterparts because of differences in their clinical behaviour. The authors report three cases and highlight their biological behaviour. Despite having an aggressive histological appearance they have a relatively benign course.

ADENOCARCINOMA STOMACH A REVIEW OF 168 CASES.

Medical records of 168 patients with gastric adenocarcinoma treated at Malignant Diseases Treatment Centre, Command Hospital (SC) Pune over a ten year period were analysed. Laparotomy was performed in 146 patients; in 82 patients a gastric resection was done, palliative gastrojejunostomy was done in 42 patients, while in 22 patients only a diagnostic biopsy was done. The resection was considered to be curative in 21 patients. Overall operative mortality was 12.3%. According to the international TNM Classification 16% patients were in Stage I, 13.7% in Stage II, 34.3% in Stage III and 35.8% in Stage IV. A significant correlation was found between five year survival rate and overall stage of disease as well as regional lymph node involvement (p < 0.001). Significantly better survival rates were seen in those who had curative resection as opposed to palliative resection (p < 0.01). Overall survival rate at five years in our patients was 8.3% this poor outcome was probably related to the advanced stage of disease at presentation.