A live term intra-abdominal pregnancy in a Field Hospital: a case report.

Abdominal pregnancy is a rare form of ectopic pregnancy with high morbidity and mortality for both the mother and the fetus. Diagnosis can be challenging, especially in a resource-limited setting. We report a case of abdominal pregnancy that presented to Médecins Sans Frontières field hospital in Agok, South Sudan, with abdominal pain. Examination revealed a term pregnancy and a live fetus in transverse lie. The diagnosis of abdominal pregnancy was made intraoperatively, with successful management and delivery of a healthy baby.

Trauma Admission CT as a Road Map for IVC Filters.

The objective of this study was to determine if admission abdominal/pelvic CT on trauma patients can be used as a novel method to evaluate the inferior vena cava (IVC) anatomy and facilitate potential IVC filter placement. Consecutive trauma admission CT's were reviewed. The potential landing zone for filters was determined by the IVC mid portion between the renal and iliac veins. The IVC landmarks were described anatomically using the thoracic and lumbar vertebral bodies as reference points. The IVC diameter and anatomic anomalies which would affect filter placement were also evaluated from the CT. The records of 610 Trauma patients were reviewed. There were 518 (84.9%) that had an admission CT, forming the basis of the study. The CT for 500 of 518 (96.5%) was of sufficient quality to accurately evaluate the IVC. The third lumbar location of the IVC was a safe landing zone in 476 of 500 (95.2%). Anatomic anomalies were present in 47 of 500 (9.4%). We had the following three conclusions. The admission CT in over 96% of trauma patients can be used to determine the IVC filter landing zone. The third lumbar region of the IVC was a safe landing zone in over 95%. Anatomical anomalies affecting IVC filter placement were revealed in 9.4%.

Assessment of criteria and clinical significance of circumferential resection margins in esophageal cancer.

OBJECTIVE: To assess the clinical significance of circumferential resection margins according to current criteria of the College of American Pathologists (CAP) and the Royal College of Pathology (RCP) in esophageal and esophagogastric cancer. DESIGN: Prospective study. SETTING: Single-surgeon database. PATIENTS: One hundred thirty-five patients (mean age, 64 years) with T3 tumors who underwent esophageal resection for cancer between 1991 and 2006. Main Outcome Measure Resection margins criteria and survival. RESULTS: Three hundred seventy-four consecutive patients were prospectively identified from an institutional review board-approved database between 1991 and 2006. All patients with T3 tumors (n = 135) had their original pathologic slides reassessed by a single gastrointestinal pathologist. Operative mortality was 0.7% and mean follow-up was 3.1 years. Follow-up was complete in 81% of patients. Positive margins were identified in 16 cases in the CAP group vs 83 cases in the RCP group. Five-year Kaplan-Meier survival curves in the CAP group demonstrated a significant (P < .001) difference in survival, whereas the RCP group showed no difference (P = .20). In comparisons of negative vs positive margins, respectively, median survival in the CAP group (29.8 months [95% confidence interval (CI), 22.7-36.9] vs 8.33 months [95% CI, 4.4-12.3]) was significantly different from the RCP group (28.47 months [95% CI, 19.7-37.2] vs 22.23 months [95% CI, 13.6-30.8]). At 60-month follow-up, the positive predictive value with respect to survival was 100% in the CAP group vs 81% in the RCP group. Univariate and multivariate analyses identified R1 margins in the CAP group and lymph node ratio as being directly linked to survival. CONCLUSIONS: Positive circumferential resection margins are prognostically important and the CAP criteria provide a more clinically meaningful assessment. Universal adoption of the CAP system can improve interpretation of international clinical trials and allow more accurate comparisons of outcomes.