Background:In the modern era, the major cause of gastric outlet obstruction (GOO) is known to be a malignancy, especially in the developed world. Many books and articles do suggest that the benign causes continue to be the major cause of GOO in the developing world however, there is growing evidence proving the contrary. Males were (more commonly) affected females and individuals in their fifth and sixth decade have been the predominant age group in the majority of studies. There is a minimal data of GOO from South India.Aims:A retrospective analysis of the endoscopic findings of patients presenting with features of GOO to determine the demographic and etiological patterns.Materials and Methods:A retrospective study of the endoscopic findings of patients with GOO from January 2005 to January 2014 was done. The diagnosis of GOO was based on clinical presentation, and an inability during the upper endoscopy to enter the second portion of the duodenum as documented in the endoscopy registers. Patients who have already been diagnosed with malignancy prior to the endoscopy were excluded from the study; so were the patients with gastroparesis.Results:A total of 342 patients with GOO underwent the endoscopy during the study period. The causes for benign obstruction were predominantly peptic ulcer disease. The major cause for malignant obstruction was carcinoma of stomach involving the distal stomach. The male to female ratio was 3.2:1. The patients with malignancy were older than patients with benign disorders. Most of the patients were in the sixth and seventh decade. The risk of malignancy was higher with increasing age, especially in women. A fourth of all carcinoma stomach presented with GOO.Conclusion:The study demonstrates that the cause for GOO in Kerala, South India is predominantly malignancy. The etiological and demographic patterns were similar to the studies conducted in the developed nations.
The thyroid gland or simply, the thyroid in vertebrate anatomy is one of the largest endocrine glands. The thyroid gland is found in the neck, below (inferior to) the thyroid cartilage (which forms the laryngeal prominence, or "Adam's apple"). The isthmus (the bridge between the two lobes of the thyroid) is located inferior to the cricoid cartilage. 1,2 The thyroid gland controls how quickly the body uses energy, makes proteins, and controls how sensitive the body is to other hormones. It participates in these processes by producing thyroid hormones, the principal ones being triiodothyronine (T3) and thyroxine (T4). These hormones regulate the rate of metabolism and affect the growth and rate of function of many other systems in the body. T3 and T4 are synthesized from both iodine and tyrosine. The thyroid also produces calcitonin, which plays a role in calcium homeostasis. 3 Hormonal output from the thyroid is regulated by thyroid-stimulating hormone (TSH) produced by the anterior pituitary, which itself is ABSTRACT Background: The association between thyroid carcinoma and thyroiditis remains controversial in medical bibliography. Therefore, the present study was designed to investigate the incidence of papillary carcinoma in diagnosed cases of thyroiditis patients who underwent surgery and analyze the risk of carcinoma in thyroiditis patients. Methods: Patients of both sexes, age more than 13 with symptomatic thyroid swelling and diagnosed as any sub types of thyroiditis with FNAC/USG/Antibody titer in Government Medical College, Thrissur, India. 41females and 3 male patients were studied to assess risk of carcinoma in thyroiditis cases, analyzing the age, symptoms, clinical presentations and FNAC results. Results: 17 out of 44 cases showed post-operative biopsy as papillary carcinonoma.15 out of 17 papillary carcinoma cases diagnosed were above 36 years, with 6times increased risk, 95% CI = (1.142, 31.532). 10 out of 17 carcinoma cases have rapid increase in size (p=0.00). 82.4% of carcinoma cases have obstructive symptoms (p=0.00). FB sensation is more frequently seen in postoperative benign thyroiditis. 59% of the papillary carcinoma cases were diagnosed pre operatively as colloid with thyroiditis. Conclusions: Females aged more than 36years and all adult males with a rapid increase in size of the thyroid swelling and/or obstructive symptoms like dyspnoea/dysphagia, who's FNAC suggestive of colloid with features of thyroiditis have a high malignant potential for papillary carcinoma, and total/near total thyroidectomy may be considered as an appropriate operative treatment.
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