[Sigmoid occlusion due to endometriosis. A case report]. / Occlusione del sigma da endometriosi. Presentazione di un caso.

The Authors report a case of sigmoid obstruction due to endometriosis and review the literature about. Unusual localisation and difficult preoperative differential diagnosis with IBD and bowel carcinoma are stressed. A 45-years old woman with previous history of oophorectomy was admitted at the hospital with symptomatic bowel obstruction. A barium enema showed a sigmoid stenosis thought to a carcinoma of bowel. A laparoscopic approach confirmed the diagnosis and a laparotomy was performed with a subsequent anterior resection (end-to-end anastomosis with stapler) plus myomectomy. The Authors do believed, during surgery, to be treating a carcinoma which disappeared with opening the specimen. The mucosa were intact and muscular layers so think to form a strong ring to be able to invaginate the upper colon for 3-4 cm. A stromal tumor was supposed and the definite diagnosis of endometriosis was very surprisingly. Intestinal resection to be necessary, with associated salpingo-oophorectomy and hysterectomy in older patients and treatment with oral contraceptive in younger female. Laparoscopy may be helpful in the diagnosis showing pelvic endometriosis with bowel wall involvement. Laparoscopic treatment in our opinion must be confirmed to particular situation and to well experience of surgeons.

Occupational risk factors for cancer of the central nervous system: a case-control study on death certificates from 24 U.S. states.

The risk of cancer of the central nervous system (CNS) by industry and occupation was investigated with a case-control analysis of the death certificates of 28,416 cases and 113,664 controls, selected from over 4.5 million deaths in 24 U.S. states between 1984 and 1992. Industries showing consistent increases in risk by gender and race included textile mills, paper mills, printing and publishing industries, petroleum refining, motor vehicles manufacturing, telephone and electric utilities, department stores, health care services, elementary and secondary schools, and colleges and universities. CNS cancer risk was increased for administrators in education and related fields, secondary school teachers, and other education- and health-related occupations. The application of job-exposure matrices to the industry/occupation combinations revealed a modest increase in risk for potential contact with the public at work and exposure to solvents. Occupational exposure to electromagnetic fields (EMF) was not associated with CNS cancer, although an association was observed with a few EMF-related occupations and industries. Agricultural exposures were associated with significant risk increases among white women and white men. Further work is required to investigate in more detail specific occupational exposures or possible confounders responsible for the observed associations.