Coexistance of a well differentiated liposarcoma and dedifferentiated low grade myxofibrosarcoma of the scrotum. A rare case and review of the literature.

Liposarcoma is a malignant soft tissue sarcoma usually located in the thigh or the posterior peritoneum in an adult. However, the occurrence of liposarcoma, and indeed a coexistance with scrotal myxofibrosarcoma, is rare. We present an interesting case of a 56-year old male who presented with an inguinal hernia. During the operation a massive fibro-elastic mass located within the left scrotum was noticed which deposited the testicle upward by displacing it into a sack rather than the penis. The mass did not come into contact with the spermatic cord but alongside it the existence of the blood vessels of the mass was found. The histopathological examination revealed a well differentiated liposarcoma along with dedifferentiated low grade myxofibrosarcoma.

Enhancement of gastric emptying of solids by erythromycin in patients with Roux-en-Y gastrojejunostomy.

BACKGROUND: Roux-en-Y reconstruction is sometimes associated with symptoms that suggest food stasis, as a result of dysmotility of either the gastric remnant and/or the efferent jejunal limb. OBJECTIVE: To study the possible effect of intravenous erythromycin lactobionate on gastric emptying of solids in patients who have undergone a Roux-en-Y procedure. PATIENTS: Twenty-four patients with a Roux-en-Y procedure participated in the study. Ten of them had undergone truncal vagotomy with pyloroplasty; the remaining 14 had undergone a Billroth II subtotal gastrectomy as the initial antiulcer procedure. Sixteen healthy subjects served as controls. METHODS: All healthy subjects and patients underwent assessment of gastric emptying of a standard radiolabeled solid meal after administration of placebo or 200 mg of erythromycin lactobionate intravenously. Scanning was done with a gamma camera, and emptying curves were constructed. From these curves the half-time of gastric emptying was calculated. RESULTS: Patients with severe symptoms of gastric stasis had a significantly longer half-time than did patients with mild or no symptoms (P=.002). Patients with a Billroth II subtotal gastrectomy as the initial antiulcer procedure had a significantly worse grade of symptoms (P=.01) and a significantly prolonged half-time (P=.02) compared with patients with a truncal vagotomy with pyloroplasty as the initial antiulcer procedure. Erythromycin significantly reduced the half-time in the controls (P<.001) and all patients after Roux-en-Y procedure (P<.001). CONCLUSION: Erythromycin could be a useful prokinetic drug in patients with Roux stasis syndrome.

Acute pain services in a community hospital.

The development of an acute pain service in a community hospital is described. A plan of operation is proposed, including accurate record maintenance to avoid complications. Results are presented on over 10,000 patients treated by the acute pain service.

Epidural analgesia and its effects on the "normal" progress of labor.

The effects of epidural analgesia on the duration of labor have been a controversal subject since its increased use in recent years. A total of 598 patients receiving this form of analgesia were studied as to progress in labor and eventual outcome. The mean cervical changes during epidural analgesia with a single drug, bupivacaine, 0.125%, with epinephrine, 1:200,000, have been calculated. The labor curves are characterized by constant acceleration in dilatation without deceleration at approximately the same rate for nulliparous and multiparous patients after dilatation of 5 cm. has been reached. Examination of maternal and fetal profiles failed to demonstrate any consistent variables that produce abnormal labor.

Nitinol stents for palliative treatment of malignant obstructive jaundice: should we stent the sphincter of Oddi in every case?

PURPOSE: To evaluate the necessity of metallic stenting of the sphincter of Oddi in malignant obstructive jaundice when the tumor is more than 2 cm from the papilla of Vater. METHODS: Sixty-seven self-expandable biliary stents were used in 60 patients with extrahepatic lesions of the common hepatic or common bile duct and with the distal margin of the tumor located more than 2 cm from the papilla of Vater. Stents were placed above the papilla in 30 cases (group A) and in another 30 with their distal part protruding into the duodenum (group B). RESULTS: The 30-day mortality was 15%, due to the underlying disease. The stent occlusion rate was 17% after a mean period of 4.3 months. No major complications were noted. Average survival was 132 days for group A and 140 days for group B. In group A, 19 patients survived < or = 90 days and in eight of these, cholangitis occurred at least once. Of 11 patients in group A with survival > 90 days, only two developed cholangitis. In group B, 13 patients who survived < or = 90 days had no episodes of cholangitis and in 17 with survival > 90 days, cholangitis occurred in three. There is a statistically significant difference (p < 0.05) regarding the incidence of cholangitis in favor of group A. CONCLUSIONS: In patients with extrahepatic lesions more than 2 cm from the papilla and with a relative poor prognosis (< or = 3 months), due to more advanced disease or to a worse general condition, the sphincter of Oddi should also be stented in order to reduce the postprocedural morbidity.