Adult intussusception due to a malignant polyp: a case report.

Intussusception is primarily a disease of childhood; only about 5 to 10 per cent of cases occur in adults. In contrast to childhood intussusception 90 per cent of adults have an associated pathologic process, usually a malignant lesion. Adult cases do not have the classical symptoms and diagnosis may be difficult. CT scan and barium studies are the most useful diagnostic methods. We report a very rare case of adult ileocecocolic intussusception caused by a pedunculated malignant polyp of the cecum and review the clinical features of intussusception.

Comparative study of etofenamate and fentanyl for outpatient extracorporeal shockwave lithotripsy.

OBJECTIVE: This study aimed to compare the clinical efficacy and safety of etofenamate (a non-steroidal anti-inflammatory drug) and fentanyl (an opioid analgesic) for outpatient extracorporeal shock wave lithotripsy (ESWL). MATERIAL AND METHODS: 60 non-premedicated patients underwent ESWL for urinary tract calculus with the Multimed 2000 (ELMED Lithotripsy Co.. Turkey) lithotripter. None of patients had previous experience with ESWL treatment. The patients were divided into two groups. A single dose of 1 g etofenamate was given to the patients intramuscularly 25 min before ESWL in group I (n = 30) and 0.1 mg fentanyl was administered intravenously just before ESWL in group II (n = 30). At the end of the treatment a visual analogue score (VAS) of 0 (no pain) to 10 (greatest pain) was used to evaluate the pain. Blood pressure, heart rate and arterial oxygen tension (PaO2) were measured before and during the ESWL. Groups were compared according to the pain scores, stone size, number of shocks, maximum voltage achieved, duration of ESWL and incidence of side-effects of the administered drug. Data were analysed with the Mann-Whitney U-test. RESULTS: No statistical differences were found between the two groups regarding achieved maximal energy levels, pain scores and number of shock waves given (p < 0.01). Satisfactory stone fragmentation was achieved in both groups. There were no changes in blood pressure or heart rate during the ESWL in either group. PaO2 was not affected in the etofenamate group, whereas a transient desaturation in two patients and giddiness in three patients were recorded in the fentanyl group. CONCLUSIONS: Both etofenamate and fentanyl have clinically sufficient effects on pain, and can be used safely for outpatient ESWL procedures.