SOMATIC NEUROPATHY IN DIABETES MELLITUS

One hundred patients of Diabetes Mellitus (70 with and 30 without clinical somatic neuropathy) were studied to correlate clinical severity with the magnitude of nerve conduction abnormalities. Age range was 10-79 years (mean 49) with equal number of males and females. Incidence of neuropathy was more in patients over 40 years of age (60 out of 70 patients) with duration of disease over two years (78.33%). The grades of severity were mild in 22 (31.33%), moderate in 25 (35.71%) and severe in 23 (32.86%) patients. Nerve conduction studies were carried out in 48 (27 with and 21 without clinical neuropathy) patients, using the apparatus Dantec (Cantata TM). The nerves (median, peroneal and sural) were stimulated at two points and the recording of latency; amplitude (micro V) and motor and sensory nerve conduction velocities (m/s) were done under identical environmental conditions. Sensory nerve conduction velocity was more affected than motor velocity. In the 21 patients without clinical neuropathy, 14 showed abnormalities indicating early involvement of peripheral nerves. Reduction of motor nerve conduction velocity was more in patients with moderate and severe grades. The reduction was more in lower than in upper limbs. Nerve conduction abnormality helps in diagnosis in diabetic neuropathy even in preclinical state and correlates with severity, in clinical neuropathy.KEY WORDS: Diabetic neuropathy, Nerve conduction abnormality, Peripheral neuropathy     

Five‐year follow up of patients with gastrointestinal stromal tumor: Recurrence‐free survival by risk group

Aim: Gastrointestinal stromal tumor (GIST) is the most common mesenchymal tumor of the gastrointestinal tract. There is limited published data on GIST from the Indian subcontinent. This 5‐year retrospective analysis of 49 patients treated for GIST reports clinical and pathological features and survival outcome by risk stratification. Methods: We reviewed 49 cases of GIST from January 2004 to December 2008. Imatinib was administered after surgery in patients with either high‐risk, residual or metastatic disease and at onset of recurrence or metastatic disease in patients with intermediate risk. Results: The mean age was 50 years (range, 17–80 years). Patients with localized tumor were classified as low (n = 2), intermediate (n = 4) and high risk (n = 32), based on the primary tumor and mitotic index. At a median follow up of 21 months, 2‐year and 3‐year recurrence or progression‐free survival rates were 61 and 39%, respectively, for all patients. The median recurrence‐free survival rate in the intermediate‐risk and high‐risk groups were 7 and 49 months, respectively. The median progression‐free survival in the residual (n = 4) and metastatic disease group (n = 7) was 10 and 29 months, respectively. Conclusion: This study demonstrates the role of imatinib in adjuvant and therapeutic settings. Responses have been durable and most patients tolerate the drug well at clinically effective doses. In view of high recurrence rates in the intermediate‐risk group in our study, it would be better to keep these patients on strict follow up to detect recurrence at the earliest opportunity.