Esophagocutaneous fistula due to tuberculosis is a distinctly rare entity, with only two cases reported over the past 25 years. We report this unusual complication in an 85-year-old, human immunodeficiency virus-negative man and review the relevant literature.

The aim of the study was to investigate the relationship between Gastro-esophageal reflux diseases (GERD) related symptoms and psychological symptomatology, as well as clinically diagnosed generalized anxiety disorder (GAD) or panic disorder (PD) and effectiveness of Sertraline and benzodiazepines in controlling these conditions. Methodology: A 6 months prospective study was conducted in gastroenterology outpatient department of a tertiary care referral hospital. Refractory GERD was diagnosed by assessing proton pump inhibitor failure over 4 week trial of standard doses of PPIs. Therapy with Benzodiazepines and Sertraline was initiated in patients with refractory GERD having panic and anxiety symptoms associated with refractory GERD. Effectiveness of the therapy was measured using panic and agoraphobia scale and Hamilton anxiety scale. Reduction in the severity of GERD symptoms was assessed using GERD-Health related quality of life scale. Results: The occurrence of PD or GAD in patients with refractory GERD in our sample was found to be 68% and 32% respectively. There was a significant decrease in the score of GERD HRQOL after the administration of sertraline and benzodiazepines when compared to the score of GERD HRQOL before administration of interventional drugs (p = 0.001). Conclusion: Our study investigated the role of anxiety and panic in refractory GERD and their effect on quality of life. The results indicated that quality of life of patients were highly improved as indicated by severity scores after administration with sertraline and benzodiazepines. The novel therapy of sertraline and benzodiazepines are highly effective in controlling reflux like symptoms and coexisting anxiety and panic disorder in refractory GERD.

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We reported a case of giant peritoneal loose body in a 53 year old male. Exploratory laparotomy and removal of peritoneal loose body done. Specimen sent for HPE. HPE reveals hyaline mass with dystrophic calcifications.

Pan-hypopituitarism is the inability of the pituitary gland to provide sufficient hormones due to an in sufficient supply of hypothalamic releasing hormones. A46 year old female patient was admitted to the department of gastroenterology with chief complaints history of vomiting since 4 months (5-10 minfollowing feed), weakness and weight preserved. All Endo-crinological work up was not normal. MRI brain (PIT protocol)came with Empty sella with infundibulum central with flattened anterior pituitary.She had attained menopause at age of 30 years 3 -4 years following the birth of her 3 rd female child. She had diagnosed with Empty Sella Syndrome, Anterior Pituitary Hypoplasia,and Sheehan's Syndrome. Finallyshe was treated with prednisone 10mg (5mg at morning and 5mg at evening) and Levothyroxine 50 mcg daily before breakfast. Further workup with DEXA bone scans and plan hormone replacement Serial measurement of hormone assay.