Transanal resection: a novel approach.

Due to the increase in screening programs, more rectal polyps and early rectal cancers are detected. Transanal resection of these lesions is less invasive than a transabdominal approach. Transanal endoscopic microsurgery (TEM) has gained a lot of interest, but the technique has several drawbacks such as the expensive instrumentation and considerable learning curve. With the evolution of single incision laparoscopic surgery (SILS), laparo-endoscopic single-site surgery (LESS) and natural orifice transluminal endoscopic surgery (NOTES), new devices have become available. This led to the development of a hybrid technique of transanal surgery. The technique combines a transanal approach, a SILS port and standard laparoscopic instruments. We used this technique in 2 cases.

Case report: a gastric lipoma in a morbid obese man.

We report a case of a 54-year-old, morbid obese man who presented with melena, hematemesis and fatigue over the last two days. The cause of this upper gastrointestinal bleeding was found on endoscopy which revealed an ulcerated submucosal mass in the gastric antrum. The haemorrhagia could not be stopped with injection of Aethoxysclerol. The mass was resected by an antrectomy with Roux-en-Y reconstruction. Histologic examination showed a lipoma. No further treatment was necessary. In this case report, we would like to stress the need for histologic diagnosis to differentiate a benign gastric lesion from a malign.

Terminal Complement Pathway Deficiency in an Adult Patient with Meningococcal Sepsis.

The complement system is an essential part of our innate immune system. Three enzymatic activation pathways are described, all converging into a common terminal pathway which causes lysis of the target cell. Late complement deficiencies (LCDs) are typically diagnosed in children or adolescents with invasive meningococcal disease (IMD). However, IMD can also be a first manifestation in adulthood and should prompt for the evaluation of the LCD. We report the case of a young adult with IMD who was found to have a LCD, caused by a compound heterozygous mutation in C6. His vaccination status was optimized and prophylactic antibiotic treatment was initiated. By means of this case, we would like to raise awareness of underlying LCD in (young) adults presenting with IMD by N. meningitidis. Screening for complement deficiencies after IMD, followed by genetic testing, can be lifesaving and allows for genetic counselling. In addition, we discuss the diagnosis and treatment of LCD.

Gastrointestinal bleeding caused by a GIST of Meckel's diverticulum--a case report.

Meckel's diverticulum is a common congenital anomaly of the small intestine, affecting 2% of the population. Neoplastic transformation is infrequent and gastrointestinal stromal tumours are exceptional in this location. We report a case of gastrointestinal bleeding caused by a gastrointestinal stromal tumour of Meckel's diverticulum.

[Personality traits of patients who have recovered completely from depression]. / Persoonlijkheidskenmerken bij patiënten die volledig hersteld zijn van een depressieve stoornis.

BACKGROUND: The psychobiological model of personality developed by Cloninger includes four dimensions of temperament and three dimensions of character. Studies have indicated that the personality dimensions of patients with depression differ from those of control subjects without depression. AIM: To assess whether the personality traits of persons who have experienced one or more depressive episodes in the past and have made full recovery differ from the personality traits of persons who have never suffered from depression. METHOD: The personality dimensions for 40 persons in remission but with a previous history of depression and for 49 healthy controls were determined by means of a Dutch version of the Temperament and Character Inventory (tci) questionnaire. results Compared to the control subjects, patients in remission showed a significant increase on the temperament scale Harm Avoidance and a statistically significant decrease on the character scale Self-Directedness. The increase also applied to all subscales of Harm Avoidance and the decrease applied to four of the five subscales of Self-Directedness. CONCLUSION: Compared to healthy control subjects, patients in remission showed a distinctly different personality profile. None of these differences can therefore be regarded merely as a transient phenomenon during a depressive episode ('state effect'). However, it cannot be concluded from the current study whether the altered personality profile is a consequence of having had a depression or whether it is a 'scarring effect' of a pre-existing vulnerability factor.

Classic biphasic pulmonary blastoma: a case report and review of the literature.

Pulmonary blastomas are rare malignant tumors, comprising only 0.25-0.5% of all malignant lung neoplasms. Pulmonary blastomas are subdivided in three categories: well-differentiated fetal adenocarcinoma (WDFA), classic biphasic pulmonary blastoma (CBPB) and pleuropulmonary blastoma (PPB), which is currently regarded as a separate entity. The majority of patients with CBPB and WDFA are adults with an average age of 43 years. Tobacco use is identified as a causative agent. Symptomatology varies from asymptomatic (40%) to symptoms of a non-specific pulmonary disease. The most common roentgenologic pattern is a large peripheral nodule. The treatment of choice is surgical excision. The efficacy of adjuvant chemotherapy and radiotherapy is not yet established. The prognosis of pulmonary blastoma is very poor; overall five-year survival is 16%. WDFA appears to have a better prognosis. Adverse prognostic factors are biphasic type, tumor recurrence, metastasis at initial presentation, gross size of the tumor (>5 cm) and lymph node metastasis. On the basis of the available literature, an initial aggressive treatment that includes surgery and, wherever possible, postoperative chemotherapy and radiotherapy could be useful to prolong survival in patients with this rare lung neoplasm. We present a case of classic biphasic pulmonary blastoma in a 77-year old male and review the literature.