Uncertain cancer diagnosis: the expanded role of the palliative care consultant.

BACKGROUND: As attending physicians in acute care hospitals consult palliative care services earlier for patients with a life-threatening illness, the role of the palliative care consultant (PCC) may expand, especially when there is diagnostic uncertainty. METHOD: The expanding role of the PCC and the complexities associated with earlier referral are illustrated by describing the case of a patient with an uncertain diagnosis. CONCLUSION: The diagnostic uncertainty that accompanies earlier palliative care consultation may hamper the PCC's ability to establish goals of care and the appropriateness of hospice palliative care unit admission. Attempts at resolving this diagnostic uncertainty may lead to an expanded role for the PCC, which ideally will occur in collaboration with the primary care team.

Enterobius vermicularis infection of the fallopian tube in an infertile female.

Enterobius vermicularis (EV) is the most common nematode to infect humans. It inhabits the intestinal lumen, but rare, ectopic infections have been documented. The female genital tract is the most common ectopic site. We present a unique case of an EV infection of the fallopian tube resulting in inflammation, tubal obstruction, and infertility. A 30-year-old woman presented with infertility. Investigations included a laparoscopy with hydrotubation using methylene blue dye. This showed a left fallopian tube obstruction and extensive pelvic adhesions. A left salpingectomy was performed. Microscopic examination of the fallopian tube revealed numerous calcified and non-calcified ova associated with granulomatous reaction. The microscopic features were compatible with EV infection. Ectopic EV infections of the female genital tract result when the gravid female worm migrates from the perianal area to the vagina and ascends through the uterus and fallopian tubes to the peritoneal cavity. Microscopic examination of these ectopic sites can reveal adult worms or ova with granulomata formation, eosinophilic infiltrate, chronic inflammatory reaction, and fibrosis. The ova have a characteristic asymmetric oval configuration with flattening on one side. We postulate that our patient's salpingitis due to EV with accompanying fibrosis is a cause of her infertility.

Classic Kaposi's sarcoma presenting first with gastrointestinal tract involvement in a HIV-negative Inuit male--a case report and review of the literature.

Kaposi's sarcoma (KS) is a multicentric low-grade vascular malignancy. In North America, it is usually seen in AIDS and solid organ transplant populations. Classic KS is a subtype that traditionally occurs in elderly HIV-negative males of Mediterranean, Eastern European, and Jewish descent. Patients with classic KS characteristically present with skin lesions in the distal extremities. Involvement of the viscera is uncommon in classic KS, but may occur in the late stages of the disease. We report the first case of classic KS presenting in the gastrointestinal tract of an elderly HIV-negative Inuit male from Northern Quebec, Canada.

Post-traveler's diarrhea irritable bowel syndrome: a prospective study.

OBJECTIVE: Anecdotal evidence suggests that irritable bowel syndrome (IBS) can develop after an episode of traveler's diarrhea (TD). This observation supports a contemporary paradigm proposed for the etiology of IBS and may have important implications for public health strategies aimed at preventing TD. This study aimed to determine the incidence of IBS in people experiencing TD. METHODS: A total of 109 healthy adults traveling outside of Canada or the United States were identified and enrolled in a prospective, cohort field study. GI symptoms before and after travel were assessed using the Rome I criteria. Travel diaries and questionnaires were used to assess for TD. RESULTS: The incidence of TD in the study cohort was 44%. Among those experiencing TD, the incidence of IBS was 4.2%. In those not experiencing TD, the incidence of IBS post-travel was 1.6% (relative risk = 2.5, 95% CI = 0.2-27.2, p = 0.41, ns). There was no significant difference in the incidence of IBS between the exposed and nonexposed groups. CONCLUSIONS: This study does not support a large association between TD and an increased risk of developing IBS. A small increase in relative risk may have been undetected because of the size of the study.