While colorectal cancer remains one of the most deadly cancers, researchers are making steady progress against this disease. For people living with advanced colorectal cancer and their loved ones, small improvements make a huge difference. We are seeing many patients with metastatic cancer responding well to treatment and living for a longer time. For decades, medications to colorectal cancer were limited to two drugs: 5-Flurouracil and Leucovorin. But in 2004, doctors began to use targeted therapies also. Avastin and Erbitux are mono-clonal antibodies, new generation cancer drugs that can specifically target cancer tumors. The problem with traditional chemotherapy is that it can't be focused--the drug affects both cancer cells and healthy cells alike. Targeted therapies affect the specific mechanisms that allow cancer cells to grow. As a result, they have fewer side effects. Avastin blocks the effect of a substance in the blood that helps tumors to grow new blood vessels. This substance is called Vascular Endothelial Growth Factor (VEGF). By preventing the creation of new blood vessels, the tumor is starved; thus slowing down the tumor growth. Erbitux blocks the effects of a different growth factor called Epidermal Growth Factor (EGF). But these drugs are only used for metastatic colorectal cancers in combination with 5-Flourouracil, Leucovorin and Camptosar. Another turning point in treating colorectal cancer is Adjuvant and Neoadjuvant therapy. Adjuvant therapy is where chemotherapy and radiation are used after surgery. Neoadjuvant therapy is an approach where the treatment is given before surgery to make the tumor smaller and easier to remove. This is more convenient and it gives better results. It is a trend that is gaining momentum around the world. With more drugs to use for colorectal cancers, doctors are now trying them in new combinations and sequences. While new drugs get most attention, surgery remains the standard treatment for people in the early stage of this cancer. People can have inflated ideas about keyhole surgeries, but it is found that for rectal cancer, laproscopic surgery has not shown to be as effective as open surgery. Although these treatment advances are a cause for enthusiasm, we need to keep it in perspective. There are two ways to look at it. You could say that it's great that over the last decade, we have doubled the life expectancy of a person with metastatic colon cancer. On the other hand, you could say that over the last ten years, all we managed to add was about twelve months. Both statements are true. Although the steps might be frustratingly small, we are still moving forward. They may not be flashy, but hopefully with time and research, all of these smaller steps may add up to something big.

Endemic in many developing countries, typhoid fever is a protracted disease that includes bacteremic phase with fever and chills during the first week, widespread reticuloendothelial involvement with rash, abdominal pain and prostration in the second week, ulceration of peyer's patches with intestinal bleeding and perforation during the third week. The infection is caused by bacterium, salmonella typhi. The spread is usually by an oro-fecal route. Contamination of water and edibles are the major source. Infected shellfish can be the source of an outbreak. The incubation period is about 10-15 days. .It is Insidious in onset with fever which rises in a stepladder pattern for 4-5 days , associated with malaise, headache drowsiness and bradycardia .Pulse is often slower than would be expected from the temperature .Complication like perforation of the intestine usually occurs after 10 to14 days of fever.The resulting peritonitis can be rapidly fatal, if not treated promptly and vigorously. It is a challenging surgical emergency in some developing countries. There is a universal consensus that ileal perforations are best treated surgically, contrary to the former belief that they are better managed conservatively. Surgery eliminates the peritoneal soilage and endotoxemia.
After a proper diagnosis is made, perforations are surgically treated depending upon the degree of fecal contamination, general health status of the patient and the number and location of perforations.Surgical techniques are selected on the basis of above factors.Various modalities of surgical options are available, these include primary closure, excision and closure, resection and anastomosis, resection and ileostomy, wedge resection, application of serosal or omental patch, and exteriorization of the perforation.When there is minimum peritoneal contamination with single perforation quite far away from the ileocecal junction and good general health of the patient , the preferred method is primary repair., but in moderate peritoneal contamination with multiple perforations very close to each other, resection anastomosis is usually the choice .Heavily contaminated peritoneal cavity, toxic and moribund patient may require an ileostomy. The mortality and morbidity rate do not depend on surgical techniques, but rather than on the general status of the patient, the virulence of the germs and the duration of the disease before the surgery.Thats why it is very important that the patient gets early initial fluid resuscitation, antibiotic therapy etc for better surgical outcome.
Although there are different methods of cure for typhoid and its complications, it is recommended that every effort be made to prevent the disease in the first place and then to educate the masses to bring the patients to hospital as soon as the symptoms begin. In case where the general condition of the patient is not good, patient has been partially treated and lost many precious hours to seek medical attention, has developed renal shut down, has metabolic and hemodynamic instability, the patients should certainly be managed surgically without delay.

Our body makes it all the time and it plays a major role .It is not exclusively a female hormone nor is it only a sex hormone. It is infact the precursor to the sex hormone , estrogen and testosterone.It regulates blood sugar, develops intelligence, builds bone and brain activities. It is secreted primarily by the ovaries in females and testes in males.There are no great quantitative differences between men and women ( atleast outside the luteal phase).It was not until 1943 that progesterone was made from plant steroid diosgenin .Once it was established that it could be made like this, biochemists began converting it into other hormones like cortisone, testosterone, estrogen and ofcourse the unnatural progestins and progestogens that masquerades as natural progesterone. There is a misconception that the difference between the natural one (made out of plant ) and the altered is just in their spelling. There is much confusion in the minds of many and even the medical field about this.This is not meant as a condemnation. They are just a busy bunch and it is a specialized subject. It is just as a caution to not take everything you hear about these hormones at their face value. Progesterone has a unique molecular structure whereas progestin and progestogens have their structure altered but the latter may look similar to the real thing.Just as ivy and spinach are both green and leafy.(Ivy quiche anyone?) need any other proof? The fact is progestin behave in radically different ways in our body than progesterone. The only similarity is their ability to maintain the endometrial lining.This also means that they can be patented and sold for exhorbitant prices. progestins are potentially toxic because of their altered molecular structure. Some of the side effects are increased risk of abortion and congenital abnormalities if taken by pregnant women, fluid retention, migraine, asthma, epilepsy, cardiac and renal dysfunction, depression, breast tenderness, nausea, insomnia, cancer, and a drop in progesterone levels.There are long term side effects on adrenal glands, liver , ovaries and in uterine function The key messsage is natural progesterone is just like what your body makes and is a unique substance with unique properties that cannot be faked !