Metastatic mediastinal hepatoid adenocarcinoma.

Hepatoid adenocarcinoma (HAC) of the mediastinum is a rare extrahepatic tumour that pathologically and morphologically resembles hepatocellular carcinoma. Extrahepatic HACs primarily occur in the stomach, ovaries, lung, gallbladder, pancreas and uterus. Patients with mediastinal HAC tend to be male smokers over forty years of age. Clinical symptoms of HAC are non-specific and varied in nature; therefore, diagnosis can be challenging and often delayed. Diagnostic investigations encompass haematological, radiological and histological assessment. Surgical resection is reserved for early-stage patients; however, since diagnosis may be delayed, most patients present with metastatic disease, for which the treatment of choice is platinum-based chemotherapy.

The management of cryptoglandular fistula-in-ano.

Idiopathic cryptoglandular fistula-in-ano is a common pathological condition. Fistula-in-ano has been managed by a number of surgical techniques, and there is still no consensus regarding the management of this condition. Surgical techniques aim to treat and cure the fistula-in-ano with minimal risk of recurrence or complications, and to maintain patient continence. This article discusses the evidence available to inform the management of idiopathic cryptoglandular fistula-in-ano, and problems that surgeons face because of the lack of high-quality evidence.

Unusual site for primary arterio-enteric fistula resulting in massive upper gastrointestinal bleeding - A case report on presentation and management.

INTRODUCTION: Communications between an artery and the bowel are termed arterio-enteric fistulae. These are uncommon and mainly involve the aorta and duodenum. They can cause fatal haemorrhage. A primary aorto-enteric fistula has several aetiologies, one of which is post-radiotherapy. CASE REPORT: 75-year old gentleman presented with acute upper gastrointestinal bleeding and haemorrhagic shock. He had a past history of right colonic cancer treated by resection and radiotherapy. At emergency gastroscopy he became critically unstable and the procedure was unsuccessful to achieve haemostasis. After resuscitation, a CT angiogram confirmed a right ilio-duodenal fistula between the right common iliac artery and duodenum. Interventional radiology was performed and a covered stent was inserted in the right common iliac artery. The patient recovered and was subsequently discharged from hospital. Three months later, he presented once again with similar massive haematemesis. Despite all efforts to stabilise him, he passed away a few hours after this second admission. DISCUSSION: This case highlights what could possibly be a limitation of interventional radiology in providing definitive treatment for such a presentation. There are no set guidelines for the management of bleeding aorto-duodenal fistulae and literature is scarce. This makes it difficult to treat and the outcome is relatively unpredictable. CONCLUSION: While minimally invasive radiological techniques are invaluable in many areas and life-saving in countless emergency bleeds, cases like these should ideally not be treated by stenting alone. It would be wise to follow arterio-enteric fisula bleeds by definitive open surgical repair.

The benefits of being a video gamer in laparoscopic surgery.

INTRODUCTION: Video games are mainly considered to be of entertainment value in our society. Laparoscopic surgery and video games are activities similarly requiring eye-hand and visual-spatial skills. Previous studies have not conclusively shown a positive correlation between video game experience and improved ability to accomplish visual-spatial tasks in laparoscopic surgery. This study was an attempt to investigate this relationship. AIM: The aim of the study was to investigate whether previous video gaming experience affects the baseline performance on a laparoscopic simulator trainer. MATERIALS AND METHODS: Newly qualified medical officers with minimal experience in laparoscopic surgery were invited to participate in the study and assigned to the following groups: gamers (n = 20) and non-gamers (n = 20). Analysis included participants' demographic data and baseline video gaming experience. Laparoscopic skills were assessed using a laparoscopic simulator trainer. RESULTS: There were no significant demographic differences between the two groups. Each participant performed three laparoscopic tasks and mean scores between the two groups were compared. The gamer group had statistically significant better results in maintaining the laparoscopic camera horizon ± 15° (p value = 0.009), in the complex ball manipulation accuracy rates (p value = 0.024) and completed the complex laparoscopic simulator task in a significantly shorter time period (p value = 0.001). Although prior video gaming experience correlated with better results, there were no significant differences for camera accuracy rates (p value = 0.074) and in a two-handed laparoscopic exercise task accuracy rates (p value = 0.092). CONCLUSION: The results show that previous video-gaming experience improved the baseline performance in laparoscopic simulator skills.