Retrospective histopathological analysis of various neoplasms of the female reproductive system (FRS) seen at the Kathmandu University Teaching Hospital, (KUTH) Dhulikhel, Nepal.

OBJECTIVE: To find out the spectrum of various histopathological types of primary neoplasms of different parts/organs of the female reproductive system seen at the Kathmandu University Teaching Hospital (KUTH) as there exists a worldwide wide variation in the distribution of various neoplasms, which appears largely due to exogenous factors rather than due to inherent differences between populations. MATERIAL AND METHOD: This was a retrospective study. It was carried out at KUTH. All neoplasms of the female reproductive system seen at the KUTH during the period of 20 months from 1st January 2004 to 31st August 2005 were included in this study and examined by light microscope (LM). RESULTS: A total number of 60 cases of neoplasms of the female reproductive system were seen. Out of these, 1 (1.7%) was of the vagina (squamous cell carcinoma, papillary variant); 16 (26.7%) were of the cervix of the uterus (all squamous cell carcinoma in advanced stage); none were of the endometrium; 20 (33.3%) were of the body of the uterus/uterine muscle (all liomyomas); 16 (26.7%) were of the ovary, (11 benign, consisting of nine mature cystic tertoma, also known as dermoid cyst, one serous papillary cystdenoma and one mucinous cystadenoma; and, five malignant, consisting of two serous cystadenocarcinoma, two mucinous cystadenocarcinoma and one mixed mucinous and serous cystadenocarcinoma); and, 7 (11.6%) were of the breast (two benign, consisting of fibroadenoma and five malignant, all consisting of infiltrating ductal carcinoma in advanced stage). CONCLUSION: There were relatively a large number of cases of advanced stage of cancer of uterine cervix. All breast cancers seen were also in advanced stage. Endometrial carcinoma was conspicuously absent in our this small series of cases.     

Serum leucine aminopeptidase profile in cancers of gastro-intestinal tract with special reference to hepatic metastasis

Serum leucine aminopeptidase (LAP) was estimated in 30 cases of gastro-intestinal cancers, and compared with 50 age and sex matched controls. Highly significant increase of serum LAP was seen in 7 patients with hepatic metastasis (p less than 0.001) from adenocarcinoma of stomach, colon and rectum. The enzyme values showed a highly significant increase in carcinoma of colon, when compared with different anatomical sites of the gastro-intestinal tract (p less than 0.001). However, in adenocarcinoma of stomach and rectum, significantly increased level of serum LAP was observed (p less than 0.01) which contrasted sharply with the normal enzyme values in squamous cell carcinoma of oesophagus and anal canal.     

Adenocarcinoma of the stomach in a tertiary care hospital in Sri Lanka

OBJECTIVES: Adenocarcinoma of the stomach carries a dismal prognosis when it presents late. Our objective was to describe the location of the tumour, stage at presentation, resectability and survival in a cohort of patients with adenocarcinoma of the stomach, presenting to a tertiary referral centre. DESIGN AND SETTING: Data were collected retrospectively from all patients with gastric neoplasms who presented to the University Surgical Unit, Colombo South Teaching Hospital from May 2000 to October 2006. RESULTS: Ninety three patients presented with malignant gastric neoplasms during this period. Majority (86/93) were adenocarcinomas. Mean age at presentation was 58.3 (range 33-83) years. Male to female ratio was 3.15:1. 52.6% of tumours were in the proximal stomach involving the cardia. Thirty per cent involved the body, and 17.5% the distal stomach. 93% had Stage III or IV disease at presentation. Twenty seven patients (32.5%) had resectable tumours with a mean survival of 25.3 months. Five year survival was less than 5%, in patients who were not offered surgical resection. There were no patients in our series with early gastric cancer. CONCLUSION: All our patients presented with advanced gastric cancer and the majority had unresectable disease. The high proportion of patients having proximal gastric carcinoma is similar to the recent changes seen in the west.     

Pattern of poisoning cases in Emergency Department of Kathmandu Medical College Teaching Hospital

Objective: This study was conducted to determine the pattern and severity of poisoning cases in Emergency Department of Kathmandu Medical College Teaching Hospital, Kathmandu, Nepal (KMCTH). Design: Retrospective observational study. Materials and methods: Hospital records of all admissions to the Emergency Department of Kathmandu Medical College Teaching Hospital (KMCTH) following acute poisoning were revised and all data from February 2007 to February 2008 were analyzed retrospectively. Results: This retrospective observational study was performed on 148 cases of poisoning who attended Emergency Department of KMCTH over a period of one year. The overall male to female ratio was 1.05:1. Poisoning was most common in the age group 21-30 years (40.5%). The most common causes of poisoning in adults were organophosphorous compounds and in children was kerosene oil. Oral route (79.05%) was the most common route of administration. 66.2% of cases were intentional poisoning for suicidal attempt. Students (43.9%) and service holders (18.9%) were commonly involved in poisoning. Conclusion: It was seen that adult between 21-30 years of age were more prone to suicidal poisoning with organophosphorous compounds and children of 1-10 years of age were more susceptible to accidental poisoning with kerosene oil. Key words: Organophosphorous; Poisoning; Suicide; Kerosene.     

Oesophageal involvement in mantle cell lymphoma

The stomach and small intestine are common sites for gut lymphomas, but oesophageal lymphomas are very rare. In mantle cell lymphoma (MCL), although multifocal gut involvement is seen, oesophageal involvement is uncommon. Gut involvement may be primary or secondary to systemic involvement. Multiple lymphomatous polyposis (MLP) is the intestinal form of MCL. Most cases of MLP occur in the elderly, usually over 50 years of age, and the presenting symptoms are abdominal pain, melaena, haematochezia and fatigue. In MCL, tumour cells typically express CD5 and cyclin D1 markers. Our patient presented with generalised lymphadenopathy, dysphagia and rapid weight loss. Upper gastrointestinal endoscopy revealed submucosal polypoid lesions in the oesophagus, stomach and duodenum. Histopathology and immunophenotyping confirmed MCL. Although MLP presenting as a primary MCL of the intestine has been described in the literature, our patient also had multiple intestinal polyposis (including the oesophagus) due to secondary involvement from systemic MCL.     

Tonsillar microbial flora: a comparison of infected and non-infected tonsils.

OBJECTIVE: The main objective of this study was to find out the most common organism affecting the tonsils in recurrent tonsillitis. METHODOLOGY: This was a prospective study consisting of total number of 50 patients, conducted in the ENT department of Dhulikhel Hospital, KUTH, Dhulikhel, Nepal. The study period was one year and three months (March 2004 to April 2005). RESULTS: Total numbers of 50 patients were selected, of which 32 were of acute tonsillitis and 18 were taken as control. Among these males were 32 and females were 18. The age group was from 3 years to 64 years. Throat swabs of patients were taken by aseptic method and were sent to the laboratory immediately. Among the infected tonsils the most common organism was Streptococcus viridans followed by Streptococcus pneumoniae and Moraxella catarrhalis. The third most common was Beta haemolytic streptococci whereas Micrococcus was not isolated in any of the infected samples. Likewise in non-infected tonsils, the most common organism isolated was again Streptococcus viridans followed by Micrococcus and Diptheroids. In these specimen no Beta haemolytic streptococci was isolated from the control group. CONCLUSION: Thus, the study is able to put forward the fact that most common organism affecting the tonsils in infected as well as non- infected state is Streptococcus viridans. Where as Beta haemolytic streptococci was not found in non-infected tonsils, likewise Micrococcus was not found in infected tonsils.     

同时性上消化道多原发癌20例

目的：探讨同时性上消化道多原发癌的诊断及外科治疗。方法：对1990年至2003年间加例上消化道多原发癌的临床资料结合文献进行分析。结果：食管病变以中下段多见,胃部病变多见于贲门。上消化道钡餐造影检查确诊4例(25％),胃镜检查确诊12例(70．6％),8例患者术前漏诊。结论：对食管贲门癌病人,应常规进行上消化道钡餐造影检查及胃镜检查。对早期病变行胃镜下碘染色检查。同时术中进行仔细的手术探查,可提高上消化道多原发癌的诊断率,减少漏诊率。     

94例胃肠道间质瘤临床诊治分析

目的:探讨胃肠道间质瘤(GIST)的诊断与治疗.方法:对1998年1月-2007年12月收治的94例GIST患者病理特点及外科治疗进行回顾性分析.结果:本组GIST发生部位:胃54例(57.4%),小肠22例(23.4%),结肠11例(11.7%),直肠6例(6.4%),肛管1例(1.1%).主要临床表现为消化道出血(56.3%)和腹部肿块(32.1%), 94例均行手术切除.术后1年、 3年、 5年存活率为83.4%、 53.2%、 38.8%,良性及交界性患者均无复发;23例恶性患者中9例复发,其中5例死亡.结论: GIST以胃及小肠最多见,以消化道出血、腹部肿块表现为主.GIST的诊断有赖于病理形态学检查与免疫组化的结合.完整的手术切除是最有效的治疗手段.     

Upper gastrointestinal endoscopy findings in Nigerians: a review of 170 cases in Lagos

BACKGROUND: The advent of flexible endoscopy has made it possible to visualise the mucosa of virtually the entire intestine. This service is yet to be widely available in Nigeria. Existing reports on indications and findings at endoscopies are sometimes conflicting, with some recent reports suggesting a changing pattern of gastrointestinal diseases. OBJECTIVE: The study set out to evaluate the indications, endoscopic findings and their frequencies as well as any adverse outcome from the endoscopic examinations. METHODOLOGY: This was a retrospective study in which we reviewed the endoscopy records of the first one hundred and seventy patients that underwent upper gastrointestinal endoscopy at the Lagos State University Teaching Hospital. The patients' bio data, indications and findings during endoscopic examinations as well as any adverse outcome were documented. Data obtained were analysed using SPSS version 11. RESULTS: The majority of the patients were in the middle to elderly age with a peak in the 5th decade. The commonest indications for upper gastrointestinal endoscopy were; Dyspepsia, upper gastrointestinal haemorrhage, previously diagnosed peptic ulcer unresponsive to treatment and retrosternal discomfort or pain. Endoscopic request for variceal screening were uncommon. The commonest endoscopic findings were; features of gastroesophageal reflux disease, followed by gastroduodenitis (non-ulcer mucosal lesions in stomach and duodenum) and peptic ulcer disease. In 14 patients the endoscopy examination revealed normal findings. CONCLUSION: The role of endoscopy in the diagnosis and management of gastrointestinal disorders cannot be overemphasised. It is hereby recommended that provision of endoscopic facilities and training of necessary personnel be encouraged by all relevant agencies so that the services can be accessible and affordable by all who require it in view of its importance in patient management.     

胃肠道间质瘤的影像诊断价值

目的：探讨胃肠道间质瘤（GIST）的影像学特点及诊断价值。方法：回顾分析53例经手术和病理证实的GIST患者影像及临床资料。结果：病灶分布于食管1例，胃29例，小肠16例，大肠5例，胃肠道外2例。病理分型：良性GIST14例，交界性10例，恶性26例，未确定3例：临床表现为消化道出血占38％（20／53），腹部不适及腹痛占36％（19／53）。主要影像学表现为黏膜下富含血供的肿块，境界清晰光整，外生性为主，肿块内出血、坏死、囊性变明显，局部淋巴结无转移？结论：GIST患者的影像学表现有一定的特征性，对准确定位、良恶性的判断、指导临床治疗和估计预后有重要价值。     

结肠镜检查人群肛门HPV 感染情况调查及 危险因素分析

目的 旨在研究结肠镜检查人群肛门人类乳头状病毒（HPV）的感染情况，并分析肛门HPV 感染 的相关危险因素。方法 选取2014 年11 月-2016 年11 月新疆医科大学第一附属医院内镜中心行结肠镜检查 的273 例患者行问卷调查，同时采用肛门刷采集脱落上皮细胞，在显微镜下观察病理改变，HC2 法联合基因芯片 法行HPV-DNA 检测及基因分型。结果 在273 例标本中检出HPV-DNA 阳性8 例，总感染率为2.93%，其中4 例为（52+58）型，2 例16 型，1 例35 型，1 例39 型，均属于高危型HPV，显微镜下观察均未见明显的病理改变。 年龄、文化程度、消化道症状是影响肛门HPV 感染的危险因素（P <0.05）。结论 结肠镜检查人群存在着一 定的HPV 感染率。年龄、文化程度、消化道症状是影响肛门HPV 感染的危险因素。     

消化道肿瘤低张CT扫描技术探讨

目的 探讨消化道肿瘤低张ＣＴ扫描的价值。方法 对１８２例消化道肿瘤进行了低张ＣＧＴ扫描。肿瘤ＣＴ扫描用水作对比剂；小肠扫描用１．５％泛影葡胺作为对比剂；结肠扫描用水和泛影葡胺作对比剂。结果 １２９例胃肿瘤、１４例小肠肿瘤和３９例结肠肿瘤的ＣＴ扫描均获得了满意的效果。结论 低张ＣＴ扫描技术对消化道肿瘤的检查效果良好。     

30-year cancer trends in Jamaica. Kingston & St. Andrew (1958-1987)

A total of 19,225 malignant neoplasms were recorded in Kingston & St. Andrew, Jamaica over the 30-year period 1958-1987. The most prevalent cancers in males were those of prostate (12.2%), stomach (10.9%) and lung (10.7%). In females 24.1% of cancers occurred in breast and 20% were recorded for invasive carcinoma of the cervix. There is a steady improvement in the diagnosis of in situ cervical lesions, and a relative decline in the incidence of invasive lesions. Lung cancer in women remains at a low level. A significant decline in cancer of the oesophagus and stomach in both sexes was noted, while neoplasms of colon and rectum maintained a stable pattern. The 30-year trends of lymphomas and leukaemias have shown no increase, although there are changes in classification patterns.     

多原发性胃肠道恶性肿瘤的临床诊治

目的探讨多原发性胃肠道恶性肿瘤的诊断和治疗。方法回顾分析8例患者的临床资料。结果同时癌1例,异时癌7例,癌灶位于胃、十二指肠和大肠。术前正确诊断5例,误诊3例。根治性切除6例,姑息性切除和改道手术各1例。随访1～18年,健在的5例,未见再次异时癌发生。结论通过对多原发性胃肠道恶性肿瘤临床病理特征的认识,有助于提高多原发性胃肠道恶性肿瘤的诊治水平。     

原发性小肠淋巴瘤30例诊治分析

目的:分析总结原发性小肠淋巴瘤,提高诊断及处理水平。方法:回顾性分析我院1991～2004年间30例原发性小肠淋巴瘤的临床病理特点。结果:隐性失血、脐周隐痛、腹部肿物、隐匿消瘦是原发性小肠淋巴瘤的最常见表现。术前确诊为小肠肿瘤43.3%。30例小肠淋巴瘤中66.7%(20/30)行小肠肿瘤根治术,16.7%(5/30)行减瘤荷手术,16.7%(5/30)行姑息手术。术后病理结果均为非霍奇金淋巴瘤,其中B细胞型27例,T细胞型3例,18例发生淋巴转移。术后1年总生存率为66.7%。结论:原发性小肠淋巴瘤是较少见消化道肿瘤,多种检查方法合理应用可提高术前确诊率、手术应行根治性切除术。     

胃肠道小细胞癌诊治体会(附5例报告)

目的探讨胃肠道小细胞癌的诊断、治疗,提高对胃肠道小细胞癌的认识.方法总结我院收治的5例胃肠道小细胞癌的临床资料.结果本组患者中,男2例,女3例,平均年龄为54岁(25～70岁).肿瘤位于胃3例,升结肠1例,直肠1例.4例患者行手术治疗,其中2例给与化疗(或和放疗).全部病人中,1例病人发现肝转移,1例发现脑转移,1例同时伴有肝和脑转移.生存期最短20d,最长16个月,中位生存期5.5个月.结论手术联合化疗有助于改善胃肠道小细胞癌的预后.     

无X射线监视内镜下消化道支架置入治疗消化道狭窄的疗效和安全性

目的: 评价无X射线监视内镜下消化道支架置入治疗消化道狭窄的疗效及安全性。方法: 回顾性分析浙江大学医学院附属第一医院2003年3月至2017年11月所有无X射线监视全程内镜直视下消化道支架置入治疗消化道狭窄患者的资料库,详细记录手术经过、疗效、术后并发症及随访情况,比较恶性肿瘤患者与同期未行支架置入的消化道恶性狭窄患者的生存时间。结果: 562例患者中,食管、贲门狭窄310例,胃、十二指肠狭窄40例,结、直肠狭窄212例,其中合并食管气管狭窄、食管纵隔瘘、吻合口瘘共63例。成功置入支架560例（99.64%）,症状缓解有效率达100%。术后胸骨后不适、胸痛、腹痛26例（4.64%）,消化道出血18例（3.21%）,食管支架移位后再调整9例（1.61%）,支架再次狭窄15例（2.68%）,均再次成功放置支架。术后7 d无患者死亡。食管、贲门狭窄组术后胸/腹痛、出血、支架移位的发生率高于结、直肠狭窄组（均P < 0.05）。284例恶性狭窄中,食管、贲门狭窄组,胃、十二指肠狭窄组,结、直肠狭窄组的中位生存时间分别为（13.40±0.71）、（11.00±1.78）、（27.50±1.94）个月,其中直肠恶性狭窄组的中位生存时间明显长于食管、贲门恶性狭窄组及胃、十二指肠恶性狭窄组（均P < 0.05）。与同期未行支架置入术的上消化道恶性狭窄患者比较,食管、贲门狭窄组及胃、十二指肠狭窄组置入支架术后患者生存时间明显提高（均P < 0.05）。结论: 无X射线监视全程内镜直视下消化道支架置入治疗消化道良恶性狭窄及封堵瘘口简便、准确、安全、有效。     

TRAP-ELISA检测消化道肿瘤细胞株端粒酶活性

目的：用TRAP-ELISA法筛选表达端粒酶活性的消化道肿瘤细胞株,探讨端粒酶活性表达在消化道肿瘤中的意义。为进一步研究端粒酶特性提供可靠的方法学保证。方法：对15株消化道肿瘤细胞株（胃癌4株,肝癌6株、胰腺癌2株、结肠癌3株）常规培养后,进行TRAP-ELISA检测,以正常肝细胞为对照,结果：15株肿瘤细胞中,除肝癌BEL-7404和结肠癌LoVo细胞株外,余13株（86.7%)细胞均表达端粒酶活性,而正常肝细胞L-02不表达。结论：绝大多数消化道肿瘤细胞株表达端粒酶活性,提示端粒酶活性检测有潜在的临床应用价值。     

Gastrointestinal Cytomegalovirus infection in non-human immunodeficiency virus infected patients

This is a retrospective study of fourteen patients who had proven Cytomegalovirus (CMV) infection of the gastrointestinal tract with no Human Immunodeficiency virus infection. The median age was 60.5 (Range 28 to 81) years. Eight patients were below (Group 1) and six above sixty five years old (Group 2). Areas of gastro-intestinal involvement were: oesophagus (2), stomach (1), colon (10) and multiple sites (1). Seven patients from Group 1 had received immunosuppressive therapy at the time of presentation and one had diabetes mellitus. We found a high prevalence of co-morbidities such as chronic renal failure and diabetes mellitus in Group 2. At median follow up of 13.9 months, there was a mortality rate of 50%. Only four patients were treated with ganciclovir. Our study concludes that the gastrointestinal CMV diseases in young patients were associated with immunosuppression whereas the older patients had chronic renal failure or diabetes.