Fifteen patients with lymphoid blast crisis of chronic myelogenous leukemia (LyBC-CML) and five patients with acute lymphoblastic leukemia converting to Philadelphia-positive (Ph+) chronic myeloid leukemia (ALL Ph + CML) were followed. Seven of 15 (46.7%) LyBC-CML patients developed meningeal leukemia within a median period of 6 months (range 2-11 months), while there was no medullary relapse. Five of these responded well to triple intrathecal therapy. In the ALL Ph + CML patients, in spite of central nervous system (CNS) prophylaxis with IT MTX and 18 Gy cranial radiation, two of five patients (40%) experienced meningeal leukemia, one isolated and the other with medullary relapse. The data confirm that LyBC-CML patients experience a high incidence of meningeal leukemia. The role of CNS prophylaxis is not very clear, but its use may delay development and reduce morbidity due to CNS disease.

BACKGROUNDPerforation peritonitis is one of the commonest surgical emergency encountered by surgeons. The aim of the study is to provide an overview of aetiological factors causing peptic ulcer perforation and the factors affecting the outcome of management.

Persistent mesocolon is a rare embryological anomaly that occurs when the primitive dorsal mesocolon fails to fuse with the posterior lateral parietal peritoneum allowing for volvulus of the cecum and colon. In malrotation of the gut, the normal rotation of the embryonic gut is arrested or disturbed during in-utero development.To our knowledge, this is the first case of isolated colon gangrene with persistent ascending mesocolon to be reported, although earlier studies have documented cases of persistent mesocolon of both ascending and descending mesocolon. This case had signs of acute intestinal obstruction and peritonitis, and preoperative imaging was suggestive of sigmoid volvulus. Explorative laparotomy revealed a hugely dilated and gangrenous ascending colon; the fixed part of the small intestine was found in the subhepatic space, and the hepatic flexure was at a level below the transpyloric plane in the midclavicular line. Findings were suggestive of isolated colon gangrene with persistent ascending mesocolon and malrotation of the gut. Right hemicolectomy with terminal ileostomy was performed and postoperative follow-up showed no complications.For a young patient with no prior co-morbidities, a volvulus of ascending mesocolon diagnosis was deemed unlikely because ascending colon is a retroperitoneal organ. The medial position of ascending mesocolon and small bowel loops to the right side was a crucial intra-operative clue for diagnosis. Such cases are difficult to diagnose pre-operatively through imaging alone, hence explorative laparotomy becomes necessary. Intra-operative findings led to performing a right hemicolectomy and ileostomy to relieve the obstruction. Therefore, among other congenital reasons for intestinal obstruction, surgeons should consider persistent mesocolon and volvulus as differential diagnoses when evaluating young patients. Emergent surgery is the only approach to address this.

BACKGROUND Soft tissue sarcomas are a heterogeneous group of tumours arising from primitive multipotent mesenchymal cells undergoing differentiation into one or more cell lines. They constitute 1% of human cancers. [1] Most cases of soft tissue sarcoma are sporadic and the cause is unknown. Soft tissue sarcomas are one of the most common radiation associated tumours [2] and they develop from any site and have more than 50 histological types and subtypes. The aim of this study is to provide an overview of its distribution and to emphasise the recent trends in the management of soft tissue sarcoma with considerable change towards limb and organ saving attitude. [3]

BACKGROUNDCarcinoma oesophagus is the 6 th most common cancer in the world. Overall, a 5-year survival rate with treated tumour is 5 to 20% only. But still most patients with carcinoma oesophagus could not be diagnosed earlier because of late presentation. The aim of this study is to know the regional incidence, common histological types, clinical features and investigations to aid diagnosis, to know the common site and to know operability of carcinoma oesophagus.