Distal Metastasis of Colorectal Cancer (CRC) mostly spread to the lymph node, liver, peritoneum and lung. The kidney metastasis from colorectal cancer considered to be unusual and rare sites of metastasis. The most important factor which affects the prognosis of colorectal cancer is distal metastasis. The present study reported the case of a 70-yr-old Saudi man metastatic mucinous adenocarcinoma of the colon in the right kidney at the time of initial presentation.

Background: Symptomatic gallstones and inflammatory disorder of the gastro duodenum are common causes of upper abdominal pain. It’s a great challenge to differentiate between gastrointestinal symptoms due to gall stones or any other causes. These gastrointestinal symptoms may be related to gallstones but underlying correlation has not been established yet, which is extremely disappointing for the operating surgeon.

Aim: To find out role of preoperative endoscopy in symptomatic gall stones.

Methods: Prospective observational multicentre study of 382 patients undergoing Laparoscopic cholecystectomy from July 2014 to December 2015. All patients diagnosed with gallstones based on ultrasound abdomen, irrespective of age and sex. All patients were subjected to Upper Gastrointestinal Endoscopy 24 to 48 hours before cholecystectomy biopsy were obtained for histopathology if required. Those patients not keen for surgery, pregnant ladies due to risk of foetal loss, CBD stone, obstructive jaundice, carcinoma of gall bladder, was excluded

Results: During this period, 382 patients. The female to male ratio 4.78:1 (316 versus 66), and the mean patient age was 46.10 ± 6.31 years (22 to 65 years). 146 (38.21%) Patients were present with typical pain and 236 (61.78%) atypical pain. Ultrasound revealed single stone in 83 (21.72%), multiple stones in 299 (78.27%), impacted stone at the neck of gallbladder was found in 68 (17.80%) patients, Thick wall gallbladder was seen in 221 (57.85%) patients and contracted gallbladder 44 (11.51%) patients. Pre-operative upper gastrointestinal endoscopy findings revealed Esophagitis in 22 (5.75%) cases, GERD in 26 (6.80%) cases, gastritis in 88 (23.03%), gastric ulcer 49 (12.82%), duodenal ulcer in 39 (10.20%), polyps 21(5.49%) and carcinoma of stomach 9 (2.35%). In all patients with typical pain complete relief of symptoms were observed within 15days post- operatively. Out of 236(61.78%) cases with atypical pain had persistence of symptoms in 141 (59.74%) cases up to four months.

Conclusion: Upper Gastrointestinal Endoscopy should be performed preoperatively for gallstone disease to evaluate atypical symptoms and a patient is fully informed in addition treated for associated conditions.

Adverse Drug Reactions (ADRs) are a prime cause and a major concern especially for chemotherapy receiving patients due to their suppressed immunity to combat other subsidiary malfunctions of the body. The findings of the study include accumulation of ADRs induced by chemotherapy in colorectal cancer patients ranging between 19 to above 70 years. One hundred eighty CRC patients were included in this study. Mild to moderate ADRs were observed in all age groups with the maximum being observed in the elderly. Mild reactions were observed in 35.3% males and 37.1% females while 16.8% males and 10.8% females showed moderate reactions. Higher tumor stage and grade (p<0.05) play a crucial role in ADR. Among CRC patients most commonly found ADRs were Nausea and vomiting (16.17%) followed by anorexia (14.97%), blurred vision (13.77%) etc. Results provide an insight that DNA modifying agents and topoisomerase inhibitors have an impact on mortality rate and moderate ADR (p<0.01). Both WHO causality assessment scale and Naranjo’s algorithm revealed similar grade in ADR, except for nausea & vomiting and stool incontinence due to non-specific reaction. This study helps to correlate the mutual association of clinicopathological parameters and chemo-induced ADR and also emphasized on the need of pharmacovigilance to increase the quality life of cancer patients.