Study on colorectal cancer presentation, treatment and follow-up.

BACKGROUND: Colorectal carcinoma (CRC) is the second most common cancer in women and men affecting 9.7 % population worldwide. Although CRC mortality has been progressively declining since 1990 at a rate of about 3 % per year, it still remains the third most common cause of cancer deaths. OBJECTIVE: The objective of this study is to evaluate the patterns of clinical presentation, treatment options and follow-up of colorectal carcinoma. METHODOLOGY: Medical records of patients with colorectal carcinoma admitted at St. Luke's Hospital Kilkenny from January 2009 to December 2014 were included in the study. RESULTS: Out of 113, 57 were males and 28 were 75 years or older. Sixty-seven percent presented in the outpatient clinic. The main presentation symptom was bleeding per rectum (40 %), followed by abdominal pain, altered bowel habit, bowel obstruction and weight loss. Mean time delay was 4.79, 6.20 and 4.83 weeks for surgical outpatient department (SOPD), colonoscopy and surgery, respectively. Ninety-eight percent of patients underwent preoperative staging with computed tomography of thorax, abdomen and pelvis (CTTAP) and 78 % had preoperative carcinoembryonic antigen (CEA) measurement. Thirty-four percent of cancers had already metastasized to distant organs. Twenty five percent underwent a right hemicolectomy. Seventy-eight percent received a primary anastomosis. Ninety-five percent achieved a R0 resection. Sixty-two percent were given adjuvant chemotherapy. Seventy-six percent had surgery follow-up and 57 % had excellent follow-up. Cancer recurred in two patients. Thirty day mortality was 2 %. CONCLUSION: Our study shows that the mean age group at risk for colorectal cancer is 65 years (range 54-75). Still, 33 % of patients present to acute surgical assessment units with advanced disease. Though we did well in terms of operative resections, follow-up still remains a challenge.

Deficient cytokine control modulates temporomandibular joint pain in rheumatoid arthritis.

The aim was to investigate how endogenous cytokine control of tumor necrosis factor (TNF) influences temporomandibular joint (TMJ) pain in relation to the role of anti-citrullinated peptide antibodies (ACPA) in patients with rheumatoid arthritis (RA). Twenty-six consecutive patients with TMJ RA were included. Temporomandibular joint pain intensity was assessed at rest, on maximum mouth opening, on chewing, and on palpation. Mandibular movement capacity and degree of anterior open bite (a clinical sign of structural destruction of TMJ tissues) were also assessed. Systemic inflammatory activity was assessed using the Disease Activity Score in 28 joints (DAS28) for rheumatoid arthritis. Samples of TMJ synovial fluid and blood were obtained and analyzed for TNF, its soluble receptor, soluble TNF receptor II (TNFsRII), and ACPA. A high concentration of TNF in relation to the concentration of TNFsRII in TMJ synovial fluid was associated with TMJ pain on posterior palpation on maximum mouth opening. The ACPA concentration correlated significantly to the TNF concentration, but not to the TNFsRII concentration, indicating that increased inflammatory activity is mainly caused by an insufficient increase in anti-inflammatory mediators. This study indicates that TMJ pain on palpation in patients with RA is related to a deficiency in local cytokine control that contributes to increased inflammatory activity, including sensitization to mechanical stimuli over the TMJ.

Tumor necrosis factor mediates temporomandibular joint bone tissue resorption in rheumatoid arthritis.

OBJECTIVE: To investigate if TNF, IL-1 or their endogenous controls, in relation to ACPA, are associated with radiological signs of ongoing temporomandibular joint (TMJ) bone tissue resorption and disc displacement in RA patients. METHODS: Twenty-two consecutive outpatients with TMJ of RA were included. Systemic inflammatory activity was assessed by DAS28. The number of painful regions in the body and ESR, CRP, RF and ACPA were analyzed. TMJ synovial fluid and blood samples were obtained and analyzed for TNF, TNFsRII, IL-1ra, IL-1sRII and ACPA. The ratios between the mediators and their endogenous control receptors were used in the statistical analysis. Magnetic resonance imaging was performed in closed- and open-mouth positions and evaluated regarding disc position and presence of condylar and temporal erosions of the TMJ. RESULTS: A high TNF level in relation to TNFsRII in TMJ synovial fluid correlated to the degree of TMJ condylar erosion. A high IL-1ra level in relation to TNF in TMJ synovial fluid was also correlated to the degree of TMJ condylar erosion. The total degree of TMJ condylar erosion was correlated with the number of painful regions. CONCLUSION: This study indicates that TNF in TMJ synovial fluid mediates TMJ cartilage and bone tissue resorption in RA. The study also suggests that the degree of endogenous cytokine control is of importance for development of bone tissue destruction.

Metastasis from scapular Ewing's sarcoma presenting as sutural diastasis: An unusual presentation.

Ewing's sarcoma is a malignant non-osteogenic primary tumor of the bone. It is one of the most common primary malignant tumors of bone. Peak incidence is noticed in second decade of life with male preponderance of 1.6:1. It occurs most frequently in long bones and flat bones of pelvic girdles. In 30% cases, Ewing's sarcoma is multicentric in origin. In 14-50%, multiple metastases are present at the time of diagnosis. CNS spread is rare and isolated CNS involvement is not seen. Skull metastasis of Ewing's sarcoma is not rare compared to primary Ewing's sarcoma of the skull, but the actual frequency is unknown. We wish to report a case of "Primary Ewing's sarcoma of scapula with metastasis to Skull Vault in a Child resulting in sutural diastasis" diagnosed by clinicoradiological examination and confirmed by histopathology.