Findings of hiatal hernia on endoscopy were confirmed by manometry; therefore, endoscopy is a good method selleck screening library for screening for hiatal hernia. After 3 months of medical management, 40% patients showed significant improvement in symptoms and quality of life and thus were continued on conservative management. The remaining 60% patients underwent surgery (laparoscopic Toupet’s fundoplication). Both the conservative and the operative groups of patients showed significant improvement in symptoms with treatment. Endoscopy and manometry findings also showed significant improvement in the operative group. Quality of life (evaluated by SF-36 score) also showed significant improvement in both groups. Thus all patients diagnosed to have gastroesophageal reflux disease should be subjected to 3 months of conservative management.

In case of no relief of symptoms, patients need to be subjected to surgery. laparoscopic Toupet’s fundoplication is an effective and feasible surgical treatment option for such patients, associated with minimal side effects. However, the long-term effects of this form of treatment still need to be evaluated further with a larger sample size and a longer followup. Conflict of Interests The authors declare that there is no conflict of interests regarding the publication of this paper.
Multimodality therapy leads to excellent rates of local control in many malignancies. However, it is metastatic disease that usually dictates overall and disease-free survival in cancer patients. The most common sites of metastatic disease include the lung, liver, bone, and brain.

Pain is the most common manifestation of osseous metastasis, whereas lung, liver, and brain metastases can lead to organ dysfunction. Metastasis most commonly arises at the lung bases. Signs and symptoms of metastatic disease to the lung include, but are not limited to, cough, respiratory compromise, hemoptysis, dysphagia, and superior vena cava syndrome. Management is usually conducted with a palliative intent with standard treatment of chemotherapy. Although chemotherapy may lead to considerable response, side effects may be prominent and recurrence is common. Local therapy with surgery can lead to survival rates between 20 and 40% [1]. However, the number and location of metastases, as well as multiple comorbidities, make patients not always amenable to surgical resection.

Bone is the third most common site of metastasis and is a common cause of pain. Each year, it is estimated that over 100,000 patients will develop osseous metastasis, with prostate and breast cancer primaries accounting for 65�C75% Dacomitinib of these patients [2�C4]. Although pain is the most common symptom of osseous metastasis, pathologic fractures secondary to cortical weakening of bone can also lead to increased morbidity with pain and dysfunction [5]. The most common location of pathologic fractures is the femur, followed by the humerus, acetabulum, tibia, and forearm [6].