An update on the management of pancreatic neuroendocrine tumors.

Pancreatic neuroendocrine tumors (PNETs) are a rare and heterogeneous group of neoplasia and differ in their clinical presentation, behavior, and prognosis based on both histological features and cancer stage at the time of diagnosis. Although small-sized tumors can be surgically resected, locally advanced and metastatic tumors confer a poor prognosis. In addition, only limited treatment options are available to the latter group of patients with PNETs, such as hormonal analogs, cytotoxic agents, and targeted therapy. In selected patients, liver-directed therapies are also used. As expected, clinicians taking care of these patients are challenged to develop an effective and comprehensive treatment strategy for their patients amid a wide variety of treatment modalities. Targeted therapy for PNETs is limited to sunitinib and everolimus. Presently, a number of clinical studies are ongoing to assess the efficacy of newer targeted agents alone and in combination with previous agents for the treatment of advanced PNETs. The authors reviewed the current treatment and also discussed the emerging agents and emphasized the need to identify biomarkers.

Adult woman with intra-oral epidermoid cyst.

Epidermoid cyst is a rare, slow growing lesion of head and neck region. Its rarest site of presentation is intra-oral. It presents later in life, while taking its time to grow to a significant size, causing other complaints as dyspnoea and dysphagia. We present here a case report of epidermoid cyst at a very rare and unexpected site of presentation. Patient presented in ENT OPD with complaints of large intra-oral midline swelling and associated complaints of dyspnoea and dysphagia. Patient was admitted and operated upon with intra-oral approach, producing good results. It should be kept in mind as one of the differential diagnoses when dealing with long standing intra-oral swellings.

Frequency of otitis media in patients of nasal polypi.

BACKGROUND: Otitis media is a common disease encountered in ENT practice. Its incidence has fallen in the developed world. It is expected that nasal polypi causes Eustachian tube dysfunction which in turn leads to negative middle ear pressure causing to develop otitis media with effusion or recurrent otitis media. The objective of this study was to find the frequency of Otitis Media in patients of nasal polypi. SUBJECTS AND METHODS: It was a cross-sectional study. Seventy patients with bilateral nasal polypi were taken for study from OPD of ENT Department, Fauji Foundation Hospital Rawalpindi. Purposive (non-probability) sampling was done keeping p=4%. There were 24 (34.3%) males and 46 (65.7%) females included in the study. Age range was 26-38 years. Tympanometry was done in every patient to look for signs of Otitis media. Duration of study was from 24th Apr 2008 to 30th Jul 2009. RESULTS: In our study, all patients were having bilateral nasal polypi. Age range was between 26 and 38 years. Frequency of patients having retracted tympanic membrane on right side was 25 (35.7%), and those who developed it on left side was 30 (42.9%). However, 35 (50%) of the 70 patients were having retraction of tympanic membrane whether right or left. This shows frequency of otitis media in patients of nasal polypi was found to be 50%. CONCLUSION: Frequency of developing otitis media in patients of nasal polypi is quite high. Nasal problems lead to development of ear diseases.