An unusual cause of shoulder pain and weakness.

Shoulder pain and weakness are common presenting Emergency Department complaints. Patients are often diagnosed with fractures, dislocations, bursitis, and muscle strain. Here we present an unusual cause of shoulder pain in an athletic and otherwise healthy young patient that does not respond to typical treatments for musculoskeletal pain.

Late phase TNF-alpha depression in natural orifice translumenal endoscopic surgery (NOTES) peritoneoscopy.

Background: Natural orifice translumenal endoscopic surgery (NOTES) allows access to the peritoneal cavity without skin incisions. Contamination of the peritoneal cavity by enteric contents may render NOTES more physiologically and immunologically invasive than previously thought. Measurement of interleukin-1 (IL-1), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-alpha) is a validated method to quantify surgical stress.