Lower gastrointestinal haemorrhage secondary to an ileal lipoma protruding into the caecum.

We report the case of a patient with lower gastrointestinal haemorrhage. The cause of the haemorrhage was a lipoma of the terminal ileum that protruded into the caecum. The diagnosis was made endoscopically and radiologically. It was surgically treated with local excision.

Effects of acetylsalicylic acid on experimental atherogenesis induced in rabbits.

AIM: Inflammation related processes play a key role in the current etiologic model of atherosclerosis and its acute complications. In addition, platelet-derived growth factors stimulate the neointimal proliferation of restenosis after coronary interventions. Reducing platelet accumulation at treated sites may attenuate restenosis. The purpose of this experimental study was to investigate the effect of acetylsalicylic acid (ASA), a widely used anti-platelet and anti-inflammatory agent on the development and extent of atherosclerosis. METHODS: Fourty-eight male white New Zealand rabbits were separated in 4 groups (12 animals each group). Group I received a diet of 2% cholesterol and 6% corn oil for 3 months. Group II received a diet of 2% cholesterol and 6% corn oil and in addition received 3 mg of ASA/kg daily intramuscular (i.m.) for 3 months. Group III received the same diet, and in addition received 10 mg of ASA/kg daily i.m. for 3 months. Group IV received the same diet and in addition received 50 mg of ASA/kg daily i.m. for 3 months. Animals were sacrificed after 3 months. RESULTS: ASA reduced the serum levels of total cholesterol, total lipids, triglycerides and LDL cholesterol. There was significant difference in the extent of atherosclerotic lesions between animals which received different doses of ASA and that animals which did not received any ASA. High dose ASA treatment resulted in an increase in fasting plasma glucose, associated with a reduction in total cholesterol and triglycerides. CONCLUSION: Our results suggest that there is a protective effect on atherosclerosis development of ASA down stream from where it lowers plasma fatty acid concentrations. However, further studies are required to verify that effect.

Epidural analgesia attenuates the systemic stress response to upper abdominal surgery: a randomized trial.

The effects of combined general anaesthesia and epidural analgesia in various endocrine and metabolic parameters were studied before, during, at the end, and 72 h after upper abdominal surgery, in an effort to further elucidate the role of epidural analgesia in the endocrine and metabolic response. 50 patients were randomly assigned into groups A and B, which received general anaesthesia alone and combined general anaesthesia and epidural analgesia, respectively. The effects of surgical stress in the plasma concentration of ACTH (P <0.001), cortisol (P <0.01), aldosterone (P <0.05), FFA (P <0.05) and glucose (P <0.01) were significantly less pronounced in the group of patients who received combined general anaesthesia and epidural analgesia. However, there were no significant differences between the two groups in regard with plasma TSH, T3, T4, glucagon or Na+ concentration. These results indicate that the combination of general anaesthesia and epidural analgesia attenuate, but does not inhibit, the endocrine and metabolic response to upper abdominal surgery.

Anal lesion resulting from implantation of viable tumour cells in a pre-existing anal fistula. A case report.

Colorectal cancer exfoliates cancer cells into the lumen of the bowel, and possibly, raw bowel mucosa should provide a good medium for the exfoliated cancer cells. We report an extremely rare case of a sigmoid carcinoma metastasizing to a low fistula in ano. The patient was operated on for a fistula in ano. Biopsy demonstrated a moderate differentiated adenocarcinoma. Thereafter, sigmoidoscopy revealed an intraluminal mass at the sigmoid colon. The patient subsequently underwent abdominoperineal resection of the sigmoid colon and rectum. In conclusion, surgeons should be aware of the possibility of cancer spread incidence, distally beyond the initial site by exfoliated cancer cells into the lumen of the bowel.

Changing patterns in advanced gastric carcinoma.

A retrospective study on patients with gastric cancer during the periods 1984-88 (n = 63 patients) and 1989-93 (n = 59 patients) was made. The aim of the study was to assess any changing patterns in tumour distribution, surgical management and survival during the two periods. When the diagnosis was made, the majority of tumours were advanced: 58 were stage IV and 21 were stage IIIB, with 43 tumours at earlier stages. The incidence of proximally located gastric adenocarcinomas increased from 15.9 to 27.1%, while the incidence of carcinomas located in the body decreased from 34.9 to 23.7%. The majority of patients underwent conservative gastrectomy. The proportion of proximal gastrectomies increased from 3.2 to 15.3 per cent (p = 0.02), whereas the proportion of combined resection of adjacent organs decreased from 38.1 to 22.0 per cent (p = 0.04). Perioperative mortality rate decreased from 17.5 to 1.7 per cent (p = 0.003). Prognosis remained unchanged in the two periods; overall 5-year survival is calculated as 12 per cent.

Primary tuberculosis of the pancreas mimicking a pancreatic tumor.

BACKGROUND: Diagnosis of tuberculosis of the pancreas is often missed, and may present to the clinician as a difficult diagnostic problem. METHODS: We report an extremely rare case of a 35-year-old woman who admitted for acute pain in the right upper quadrant, jaundice, fever 38 degrees C and chills. During the last 8 mo, she developed increasing fatigue and a weight loss of approx 10 kg. RESULTS: Computed tomography (CT) of the abdomen showed a mass in the head of the pancreas, and upper gastrointestinal endoscopy revealed a stenosis of the second part of duodenum and a pancreatico-duodenum fistula. Frozen sections by direct trucut needle biopsy raised suspicions of a malignancy, and a Whipple procedure was performed as a radical procedure. The final histopathology revealed a chronic granulomatous lesion with caseating necrosis. Mycobacterium of tuberculosis was detected using the polymerase chain reaction-based assay. CONCLUSION: This unusual case emphasizes that in suspected cases of pancreatic carcinoma with an atypical presentation, an attempt should be made to confirm the diagnosis by CT-guided needle biopsy, or by ultrasound endoscopic fine-needle aspiration.

An alternative approach for the surgical management of hydatid disease of the liver.

Hydatid disease of the liver still remains a serious medical problem. As a result of increased travelling and immigration, it has also appeared in previously unaffected countries and is now well manifested in countries where the medical personnel lack the experience to treat this problem. We report an alternative method for the surgical management of hydatid disease of the liver, especially that located over the right superior-posterior aspect of the liver. Through a lateral right thoracotomy, we have a better exposure of the cyst and by using the right hemidiaphragm we achieve the same beneficial effect as omentoplasty does.

Cystic dilatations of the common bile duct in adults.

Cystic dilatations of the common bile duct are believed to be of congenital etiology with most cases presenting in childhood. During the last 20 years, 10 patients with cystic dilatations of the bile duct were treated in our Department. There were 5 men and 5 women with an age range of 35-81 years. Clinical presentation consisted of right hypohondrial pain, nausea, vomiting and a history of obstructive jaundice. Diagnosis was established by ultrasound, cholangiography and ERCP in most cases. According to the Todani classification system, 5 patients had type I cysts, 4 had type II and one had type III. At the time of surgery, main associated diseases were choledocholithiasis in 3 cases and cholangitis in 2 cases. One patient (type III) underwent endoscopic sphincterotomy; 4 patients underwent internal drainage and 2 of them developed mild cholangitis postoperatively; 5 patients underwent excision of the cyst and a biliary-enteric bypass and developed no main complications. Patients remained in good health during long-term follow-up. We conclude that cyst excision is the treatment of choice for adults in order to reduce postoperative morbidity and the potential risk of malignancy.

Management of enterochromaffin-like gastric carcinoid tumour metastasized to the liver.

We report the rare case of a patient suffering from pernicious anaemia and a history of flushing and diarrhoea. The patient was found to have microcarcinoids with multiple gastric polyps and a solitary liver metastasis. He was successfully managed with subtotal gastrectomy, while the liver metastasis was cured by Interferon-alpha and octreotide administration.

Massive intraperitoneal hemorrhage caused by a giant exogastric leiomyoblastoma.

Leiomyoblastomas account for a small percentage of smooth muscle tumors of the stomach. Intraperitoneal bleeding is an unusual and unexpected presenting sign. We herein present a 43-year-old woman who was urgently operated on due to signs of collapse. A large hemorrhagic mass measuring 25 x 18 x 15 cm was found arising from the greater curvature of the stomach. A histologic examination demonstrated rounded and spindle cells, and rare mitoses were also seen. Although the number of mitoses was small, the lesion was nevertheless felt to be consistent with malignant leiomyoblastoma because of its large size. Three years later the patient is doing well with no evidence of tumor recurrence. We conclude that intraperitoneal bleeding due to leiomyoblastoma of the gastrointestinal tract is an extremely rare phenomenon and has been described only in a few reports, and only one other previous case presented with signs of collapse.