Dysphagia in an 80-Year-Old Woman: A Rare Case of Metastatic Melanoma Presenting in the Small Bowel.

This report discusses the case of an 80-year-old female presenting with non-specific gastrointestinal symptoms and who was ultimately diagnosed as having metastatic melanoma of the jejunum. Notably, on admission, the patient had failed to report a past medical history of melanoma on her back a few years prior, and this significantly impacted the diagnostic process. This case highlights the challenges in diagnosing metastatic melanoma.

Inpatient diabetes management by specialized diabetes team versus primary service team in non-critical care units: impact on 30-day readmission rate and hospital cost.

Objective: We compared the cost-effectiveness of two inpatient diabetes care models: one offered by a specialized diabetes team (SDT) versus a primary service team (PST).

Research Design And Methods: We retrospectively evaluated 756 hospital admissions of patients with diabetes to non-critical care units over 6 months. Out of 392 patients who met the eligibility criteria, 262 were matched 1:1 based on the mean of the initial four blood glucose (BG) values after admission.

Safe ablation of the anal mucosa and perianal skin in rats using Photodynamic Therapy--a promising approach for treating Anal Intraepithelial Neoplasia.

Background: Anal Intraepithelial Neoplasia (AIN), a pre-cursor of anal squamous carcinoma, is increasingly detected in individuals with impaired immune function. However, choices for effective, low morbidity treatment are limited. Photodynamic Therapy (PDT) is promising as it is known to ablate more proximal gastrointestinal mucosa with safe healing, without damage to underlying muscle.

Metastatic insulinoma in a patient with type 2 diabetes mellitus: case report and review of the literature.

Pancreatic neuroendocrine tumors (NETs) are extremely rare, and although insulinomas are the commonest, less than 10% of insulinomas are malignant. Most patients with insulinomas present with neuroglycopenic symptoms and weight gain attributable to insulin excess. Here, we report a case where a 67-year-old lady with a background history of type 2 diabetes mellitus and breakthrough hyperinsulinism who presented with coma.

Midgut pain due to an intussuscepting terminal ileal lipoma: a case report.

Introduction: The occurrence of intussusception in adults is rare. The condition is found in 1 in 1300 abdominal operations and 1 in 100 patients operated for intestinal obstruction. The child to adult ratio is 20:1.

Gastrointestinal manifestations of chronic granulomatous disease.

Objective: Chronic granulomatous disease is a rare clinical entity characterized by recurrent infective and inflammatory complications. Patients are usually assigned to specialist centres, but nonspecialist clinicians may be required to treat these patients in the emergency setting. This review serves as a management guide to those clinicians who are faced with patients presenting with gastrointestinal manifestations of chronic granulomatous disease.

Improving the morbidity of anorectal injury from pelvic radiotherapy.

Objective: Radiation anorectal injury due to pelvic radiotherapy for non intestinal cancer is a significant cause of morbidity which may limit the treatment dose required. Conservative treatment options are of limited value and surgery is reserved only for the most severe complications. This review addresses radioprotection of the anorectum and aims to increase awareness amongst surgeons of the strategies that have been in practice in order to minimize the side-effects of radiotherapy while preserving its therapeutic efficacy.

Anal intraepithelial neoplasia.

Background: Anal intraepithelial neoplasia (AIN) is believed to be a precursor of anal squamous cell cancer and its incidence is rising in high-risk groups, particularly those infected with the human immunodeficiency virus (HIV). The natural history of AIN is unclear and management strategies are lacking.

Methods: This review is based on a literature search (Medline and PubMed) with manual cross-referencing of all articles related to AIN.

Implantation anal metastases after out-patient treatment of haemorrhoids.

Viable exfoliated colorectal cancer cells may be implicated in some cases of suture line recurrence. Whether they can implant and grow on raw surfaces is debatable. Two cases of anal implantation metastases after out-patient haemorrhoidal treatment are described.

Obstructed defecation after undiverted ileoanal pouch reconstruction for ulcerative colitis: pharmacologic approach. Report of a case.

Purpose: Obstructed defecation after ileal pouch construction has been reported only after closure of the diverting loop ileostomy, and biofeedback was an effective treatment modality.

Method: This is a case report of a patient with immediate obstructed defecation after ileal pouch-anal anastomosis without a covering loop ileostomy and its successful pharmacologic management.

Results: A 38-year-old female underwent restorative proctectomy and stapled ileal J-pouch-anal anastomosis without a covering loop ileostomy.

Insertion of self-expanding metal stents for malignant dysphagia: assessment of a simple endoscopic method.

Aim: To assess the efficacy, safety and long-term results of self-expanding metallic prostheses, placed using an entirely endoscopic method, for the relief of dysphagia in oesophageal carcinoma.

Patients And Methods: A consecutive series of 50 patients (30 men, 20 women), aged 43-91 years (median, 75 years) underwent stent placement (Ultraflex Stent, Boston Scientific, Watertown, MA, USA) under general anaesthesia without fluoroscopic control.

Results: Stent placement was successful in all patients.

Necrotising fasciitis in a HIV positive male: an unusual indication for abdomino-perineal resection.

We report a case of necrotising fasciitis of the genitoperineum (Fournier's gangrene) in a HIV positive male following incision and drainage of bilateral ischiorectal fossa abscesses. During surgery to debride the necrotic tissue the rectum was found to be perforated necessitating laparotomy and subsequent abdomino-perineal resection. Although previous reports of Fournier's gangrene in the HIV positive population exist, rectal involvement requiring excision has not previously been reported.

Linear stapled haemorrhoidectomy-an alternative to standard haemorrhoidectomy?

Objective: To evaluate in a pilot study a new haemorrhoidectomy technique involving the use of a linear stapling device.

Patients And Methods: Twenty consecutive unselected patients (12 male, eight female; median age 64 years, range 40-81 years) underwent haemorrhoidectomy using the new technique. Fifteen also underwent pre- and post-operative endoanal ultrasound to assess the anal sphincter complex.

Anal endosonography in patients with anorectal symptoms after haemorrhoidectomy.

Background: Anorectal symptoms after haemorrhoidectomy are common and treatment is often empirical. Because of this, an audit was carried out of the value of anal endosonography in patients with anorectal symptoms after haemorrhoidectomy.

Methods: Between May 1993 and February 1997, 16 patients (ten men and six women of median age 56 (range 35-77) years) were investigated by anal endosonography for anorectal symptoms after haemorrhoidectomy which involved anorectal incontinence (n = 10), anal pain (n = 4) and obstructive defaecation (n = 2).