Isopod parasite, Nerocila depressa Milne Edwards, 1840 infestation in Thryssa stenosoma Wongratana, 1983, as a first record from Narmada estuary, West Coast of India.

The study reported Thryssa stenosoma, as a new host of isopod Nerocila depressa infestation. Furthermore, the record of Nerocila depressa from the Narmada estuary is of first kind in the West Coast of India. Thryssa stenosoma, commonly known as slender thryssa forms an important commercial fish species at Bhadbhut, a part of the Narmada estuary. The prevalence of N. depressa infestation was 17.39% with a mean intensity of 2.8. in T. stenosoma, showing a low rate of infestation. The present information would form a new addition of isopod infestation to the list of parasitic diseases of estuarine fishes in India.

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.

NATURAL HISTORY OF CARCINOMA OF THE GALLBLADDER AND ITS INFLUENCES ON MANAGEMENT.

There were 45 patients (8.8%) of carcinoma of the gall bladder among 506 patients of gall bladder disease admitted during January 1993 to June 1995. Female to male ratio was 4:1 and average age at detection was 52 years. Pain right hypochondrium and jaundice were prominent clinical features. Ultrasonography accurately diagnosed 33 (73.3%) cases while computed tomography was correct in 15/22 (75%) of cases. Cholelithiasis was present in 37 (80%) patients. Sixteen patients were not offered surgery due to either widespread disease or due to poor general health. Cholecystectomy with wedge or segmental resection of liver and lymphadenectomy was performed in 18 out of 29 patients. In 6 patients segmental resection of the contiguous involved organ was performed. Perioperative mortality was 8 per cent. Two patients were alive for more than 24 months, 7 for more than 12 months and 11 were being followed-up for 1 to 12 months. All patients not offered surgery died within 4 months.

AN EXPERIENCE IN MANAGEMENT OF SURGICAL OBSTRUCTIVE JAUNDICE.

One hundred and five patients of surgical obstructive jaundice were admitted to Army Hospital, Delhi from July 1991 to June 1994. Patients were investigated as per the diagnostic protocol. The causes of obstruction were choledocholithiasis (24 patients), periampullary carcinoma and carcinoma head of pancreas (32 patients), carcinoma gall bladder and cholangiocarcinoma (11 patients each). The procedures performed to relieve obstructive jaundice in 89 cases included choledochojejunostomy (17), pancreato-duodenectomy (15), hepaticojejunostomy (15), choledocholithotomy (12) and choledochoduodenostomy (12). Mortality was 7 per cent in pancreatoduodenectomy and 8 per cent in palliative procedures.

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.