The results of our study demonstrate a rising global burden of LC with some significant but uneven trends based on geography, age, and socio-economic status. This information can be used to shape policy and aid strategic targeting of resources to areas with the highest burden.

This study compared the operative case log experience between rotations during General Surgery residency in the United States and an international rotation in India. A resident from the General Surgery residency program at University of Nebraska Medical Center participated in an international rotation in Surgical Oncology at Mehdi Nawaz Jung Institute of Oncology in Hyderabad, India for 3 months in 2009. The operative case log of this resident (INT) was compared to those of another resident (US) on a rotation in surgical oncology at the parent institution during the same time period. Both institutions were tertiary care centers. We noted that the INT resident performed a greater number of cases (132) when compared to the US resident (61). The INT resident also performed cases in a wider variety of disease categories such as: head and neck (26 %), gynecology (19 %), breast (14 %) and urology (4 %). In contrast, abdominal cases accounted for 68 % of the cases performed by the US resident with fewer cases in the other categories. The INT resident performed 98 % of the cases by the open approach, whereas the US resident performed only 81 % of cases by the open approach, with the remaining 19 % of cases performed by the laparoscopic approach. The results demonstrate that the INT resident performed a greater number of operative cases when compared to a resident (US) at the parent institution, and performed cases in more diverse disease categories with an emphasis on the open operative approach.

The aim of this study was to compare the incidence of the different histopathologic types of esophageal carcinoma between the United States of American (US) and India. The Surveillance Epidemiology and End Result (SEER) database was analyzed to determine the incidence of different types of esophageal carcinoma in US. A retrospective review was conducted of all the patients that underwent resection for esophageal carcinoma at a regional oncology center in India from 2001 to 2007. Data relating to histopathologic variables was collected and compared to the patients in the SEER database for the same time period. Esophageal adenocarcinoma accounts for the majority of newly diagnosed cases in the US. Although squamous cell carcinoma is the dominant type of esophageal carcinoma in India, we noted a small but gradual increase (0 % in 2001 to 28 % in 2007) in the incidence of esophageal adenocarcinoma. The results of our study demonstrate a geographic variation in the histopathologic type of esophageal carcinoma. A recent increase in the incidence of esophageal adenocarcinoma in India was also demonstrated. Analysis of risk factors known to be associated with esophageal adenocarcinoma, in the context of India, can provide targets for implementing public health measures.

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BackgroundCurrent literature shows promising data for efficacy of anti-tumor necrosis factor (anti-TNF) biological therapy in Behcet's disease (BD) patients.ObjectivesThe aim was to investigate a cohort of BD patients in Midwest Region of Ireland, current prescription practice for anti TNF biologics in this cohort, patient response & the risk of serious infections or other serious side effects.MethodsAll BD patients attending our rheumatology service & satisfying the ISGBD or ICBD criteria were included in the study. Response was evaluated on patient's new/worsening clinical features & improvement/resolution of clinical symptoms. Management was benchmarked against current European League Against Rheumatism (EULAR) guidelines published in 2009. Serious infection was defined as the requirement for intravenous antimicrobial therapy and hospitalization.ResultsFrom a cohort of 22 patients, 18 (81.9%) received anti-TNF (6 males, 12 females) with mean age 38.9 years. 14 patients (77.8%) achieved complete remission & 4 patients (22.2%) achieved low disease activity on anti-TNF. Among this 3 patients (16.7%) were successfully switched to a different agent due to secondary failure, 6 patients (33.3%) needed 3 different anti-TNFs and one patient required a fourth anti-TNF therapy to achieve remission. Indications to start anti-TNF among our cohort include severe mucocutaneous lesions with significant impact to quality of life (15/18), ocular manifestations (7/18), destructive laryngeal disease (5/18), vascular manifestations (3/18) & resistance or intolerance to conventional treatments (8/18). Anti-TNF was extremely effective in suppressing the mucocutaneous oral & laryngeal manifestations, significantly improving patient's quality of life. However resistant genital ulcers was often a difficult symptom to control with 3 patients achieving partial remission.5 allergic reactions were encountered, all with administration of infliximab. 5 serious infections were documented involving 3 patients (16.7%) and all in patients aged 50 years or above. No other serious side effects were noted.ConclusionsAnti TNF-α biological therapy is an important alternative option for first line therapy in severe BD as many conventional treatments failed to maintain clinical remission and prevention of life-threatening complications. Response rates to anti-TNF-α therapy were excellent and treatment was well tolerated but should be used with caution in patients age 50 or above. BD patients who fail one anti TNF-α due to intolerance, ineffectiveness or secondary failure may still benefit from switching to another drug from this group or even re-trial of a previously administered anti-TNF.ReferencesP.P. Sfikakis, N. Marcomichelakis, E. Alpsoy et al. Anti-TNF therapy in the management of Behçet's disease-review and basis for recommendations. Rheumatology (Oxford), 46 (2007), pp. 736–741Hatemi G, Silman A, Bang D et al. Management of Behçet disease: a systematic literature review for the European League Against Rheumatism evidence-based recommendations fo...