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HighlightsSubcutaneous metastases from esophageal adenocarcinoma are rare.Associated risk factors have not been clearly elucidated and prognosis is poor.We present three cases of subcutaneous metastases from esophageal adenocarcinoma.These metastases can occur even after resection of early stage disease.They can occur at various intervals of time and various locations.

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It was fortunate that the woman could recognise that she had expelled only a part of the IUCD. If she had missed it she could have had various complications. The transverse limb of the coil could have entered the fallopian tube and caused a tubal perforation. This type of perforation would be possible in a single horizontal smooth arm IUCD (nova T type) and the horizontal arm of the broken IUCD would behave in the same manner. This would also have left the surgeon in a dilemma as to where the vertical limb of the IUCD was. It is important to ensure that IUCD has been expelled intact and no parts are remaining. ReferencesGoldstuck N.D. (1987) Insertion forces with intrauterine devices:implications for uterine perforation.

Background: Gestational diabetes mellitus(GDM) is defined as carbohydrate intolerance of variable severity with onset or first recognition during pregnancy. This study aims at determining the efficacy of the glibenclamide versus insulin in achieving the adequate glycemic control and to analyze the maternal and fetal outcomes and to determine the failure rate of glibenclamide, patient compliance and overall cost of the treatmentMethods: This study was carried out for a period of 22 months at Command Hospital Air Force, Bangalore in Dept. of OBG. Women with GDM whose glycemic control was not achieved with medical nutrition therapy with fasting blood sugar (FBS) values >105mg/dl and 2hour post prandial blood sugar (PP) value >140mg/dl were selected and randomized for treatment either glibenclamide or insulin (50 in each group).Results: The age of the patients in this study ranged from 23 to 33 years. The mean age in glibenclamide group was 27.32 (SD ± 2.84) where as in insulin group was 26.30 (SD ± 3.01). The mean plasma glucose level achieved with glibenclamide was fasting -87.62 mg/dl, post prandial -116.44 mg/dl, before lunch - 95.62mg/dl, after lunch -115.80 mg/dl, before dinner-91.96 mg/dl, after dinner - 116.64 mg/dl, 3AM - 84.42 mg/dl and next day fasting - 86.30mg/dl in comparison with insulin where fasting- 85.54 mg/dl , post prandial -114.14 mg/dl, before lunch - 87.08, after lunch -112.82 mg/dl, before dinner-86.76 mg/dl and after dinner - 114.18 mg/dl, 3AM - 81.16 mg/dl and next day fasting was 86.72mg/dl which is statistically significant. The incidence of maternal and neonatal morbidities was comparable in both the group. 4 % percent of patient treated with glibenclamide had treatment failure. The cost of the treatment and compliance was better with glibenclamide.Conclusions: It has been concluded that glibenclamide is effective as insulin in achieving adequate glycemic control with no significant maternal and fetal morbidity and mortality.

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