We studied analgesic effect of ethylmorphine in 150 patients suffering from advanced malignancy. All patients were referred to us in pain and palliative care clinic. Maximum number of patients i.e. were suffering from cancer of cervix and 24 percent from head and neck malignancy. All patients were taking medications irregularly in form of non-steroidal anti-inflammatory drugs (NSAIDs) acetaminophen and/or benzodiazepines. We discontinued the drugs, which the patients were taking and started with tablet ethylmorphine 32 mg every 4 hours. On follow up after one week, all except 10 patients had 70 to 100 percent pain relief. Side effects like dryness of mouth, nausea, vomiting, constipation etc. were treated as needed. 100 patients attended OPD for more than 2 months and 70 patients were followed for more than 3 months. We conclude that ethylmorphine is an effective analgesic for moderate to severe cancer pain, if assessed and given systematically.

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Capecitabin is an oral 5-Fluorouracil (5-FU) prodrug, tumour activated carbamate. It provide higher concentration of 5-FU in tumour and so also the response rate. The federal drug administration in USA has approved it for treatment of Taxane-refractory metastatic cancer of breast. Regarding the colorectal cancer, the best outcome that can be anticipated for the oral fluoropyrimidine are unlikely to be equivalent to 5-FU these agents are unlikely to enhance the response rate or duration of survival that can be achieved by 5-FU. Additionally, it is uncertain that at present how compliant patients will be using oral medications that may be associated with toxic side effects. Nonetheless, the development of the oral fluoropyrimidine represents a creative pharmacological advance and the compound merits additional studies to better define its place in treatment regimens for patients with advanced colorectal cancer.

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Primary undifferentiated (embryonal) sarcomas of the liver are rare. We report a child who presented with such a tumour. The child was operated and received post-operative chemotherapy. The child is well with the follow-up of 24 months post-treatment having fully regenerated hepatic tissue (ultrasonographic documentation).

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Acute lymphoblastic leukemia (ALL) is a rare disease in the elderly, aged over 60 years. ALL in the elderly carries a poor prognosis. Associated medical conditions limit the use of intensive chemotherapy protocols in this subset of patients. It is well documented that infectious complications remain the predominant cause of morbidity and are largely responsible for age related mortality rates of 3-20 percent during induction therapy of adult ALL. Possible approaches to improve the outcome should be by better understanding of the biology of the disease and use of intensive curative chemotherapy protocols with prophylactic use of growth factors.

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Non-germ cell malignancy occurs in approximately 3-4 percent of germ cell tumours in adults, but the incidence of the same is considerably lower in children. Sarcoma is the most commonly encountered non-germ cell malignancy. Neuroblastoma arising within a germ cell tumour is a rare occurrence. Review of literature showed only 3 reported cases of neuroblastoma arising within teratoma and all the three patients were adults. A very unusual case of a 10-year-old female child having neuroblastoma arising within a teratoma is reported here.

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