A rare presentation of spontaneous splenic rupture from plasma cell leukaemia-a case report.

Spontaneous/atraumatic splenic rupture is rare, and often associated with underlying infectious disease, or haematological malignancy. Plasma cell leukaemia (PCL) is a rare and aggressive subtype of multiple myeloma, with a higher prevalence of hepatosplenomegaly with a bleeding diathesis from secondary to thrombocytopaenia. We report the case of an 82-year-old male presenting to the emergency department with altered mentation and complaints of left abdominal pain.

Sampling frequency optimization of the water quality monitoring network in São Paulo State (Brazil) towards adaptive monitoring in a developing country.

Water quality monitoring networks (WQMNs) that capture both the temporal and spatial dimensions are essential to provide reliable data for assessing water quality trends in surface waters, as well as for supporting initiatives to control anthropogenic activities. Meeting these monitoring goals as efficiently as possible is crucial, especially in developing countries where the financial resources are limited and the water quality degradation is accelerating. Here, we asked if sampling frequency could be reduced while maintaining the same degree of information as with bimonthly sampling in the São Paulo State (Brazil) WQMN.

mucormycosis: a rare and dangerous cause of necrotising fasciitis.

Necrotising fasciitis is a rapidly progressing soft tissue infection requiring early and adequate surgical debridement and appropriate antibiotic cover. The present case highlights bacterial fasciitis associated with fungal () infection with insidious angioinvasive nature () which required amputation, negative-pressure vacuum dressings and amphotericin B for definitive treatment. This demonstrates a relatively rare case of the group IV classification of necrotising fasciitis, which we must consider when there is slowly progressing tissue death despite seemingly adequate treatment.

Spatial optimization of the water quality monitoring network in São Paulo State (Brazil) to improve sampling efficiency and reduce bias in a developing sub-tropical region.

Water quality monitoring networks (WQMNs) are essential to provide good data for management decisions. Nevertheless, some WQMNs may not appropriately reflect the conditions of the water bodies and their temporal/spatial dimensions, more particularly in developing countries. Also, some WQMNs may use more resources to attain management goals than necessary and can be improved.

Characterizing Trophic State in Tropical/Subtropical Reservoirs: Deviations among Indexes in the Lower Latitudes.

Trophic state indexes (TSI) guide management strategies regarding eutrophication control worldwide. Such indexes usually consider chlorophyll-a (Chl-a), total phosphorus (TP), and Secchi disk depth (SDD) as independent variables for estimating aquatic productivity and the degree of impairment. TSIs for each of these components are frequently averaged to produce a single TSI value associated with a trophic state classification (e.

Learning curves and surgical outcomes for proctored adoption of laparoscopic ventral mesh rectopexy: cumulative sum curve analysis.

Background: Laparoscopic ventral mesh rectopexy (VMR) is an effective and well-recognised treatment for symptoms of obstructive defecation in the context of rectal prolapse and recto-rectal intussusception. However, due to the technical complexity of VMR, a significant learning curve has been previously described. This paper examines the effect of proctored adoption of VMR on learning curves, operative times, and outcomes.

Short-term Outcomes of a Randomized Pilot Trial of 2 Treatment Regimens of Transcutaneous Tibial Nerve Stimulation for Fecal Incontinence.

Background: Fecal incontinence is a socially disabling condition that affects ≤15% of adults. Neuromodulatory treatments for fecal incontinence are now well established. Less invasive, cheaper, and more ambulatory forms of neuromodulation are under exploration.

Delayed recurrence of renal cell carcinoma presenting as a haemorrhoid.

Metastatic non-colorectal cancer of the anal canal is a rare entity. To date, only four cases have been described in the literature. We present a 76-year-old man who was referred with an unusual perianal lesion.

A rare case of umbilical hernia containing the pancreas.

We present an extremely rare case of anterior abdominal wall hernia containing multiple viscera and the pancreas in a morbidly obese patient.

Barium proctography vs magnetic resonance proctography for pelvic floor disorders: a comparative study.

Aim: Accurate and reliable imaging of pelvic floor dynamics is important for tailoring treatment in pelvic floor disorders; however, two imaging modalities are available. Barium proctography (BaP) is widely used, but involves a significant radiation dose. Magnetic resonance (MR) proctography allows visualization of all pelvic midline structures but patients are supine.

An improved technique for Soave trans-anal pull-through.

Aim: To describe a new technique for the Soave trans-anal pull-through.

Method: After the mucosectomy during a Soave's procedure, a laparoscopic wound retractor was used to line the distal rectal segment to facilitate delivery of the proximal bowel through a narrow scarred pelvis.

Results: The technique greatly assisted delivery of the proximal bowel and helped prevent mesenteric injury.

Single-incision laparoscopic surgery (SILS) in complex colorectal surgery: a technique offering potential and not just cosmesis.

Aim: Single-incision (or port) laparoscopic surgery (SILS) has recently emerged as a method to improve morbidity and cosmetic benefit of conventional laparoscopic surgery. The literature contains two reports of SILS right hemicolectomy, and we report our experience of this technique.

Method: Seven consecutive, unselected patients underwent SILS retrocaecal appendicectomy, right hemicolectomy, extended right hemicolectomy, colectomy with ileorectal anastomosis, proctocolectomy, anterior resection and restorative proctocolectomy/ileoanal pouch using a single Triport (Olympus Keymed, Southend, UK), conventional instrumentation and nerve block analgesia.

National UK audit of procedure for prolapsing haemorrhoids on behalf of the Association of Coloproctology of Great Britain and Ireland.

Objective: To assess the safety and short term outcomes of the procedure for prolapsing haemorrhoids (PPH), a relatively new procedure for the treatment of symptomatic haemorrhoids.

Method: In 2005, the Association of Coloproctology of Great Britain and Ireland set up an online electronic database to audit the indications and outcomes for patients undergoing a PPH procedure.

Results: During the audit period, 695 patients were entered onto the database by 61 surgeons (range 1-50 patients per surgeon).

Surgery results in significant improvement in growth in children with Crohn's disease refractory to medical therapy.

Inflammatory bowel disease (IBD) in children can cause significant impairment in linear growth, and delay in pubertal onset. The aim of this study was to assess the impact of surgery on linear growth in children with Crohn's disease (CD) who were resistant to medical therapy, and had documented evidence of growth impairment. We performed a retrospective study on eight consecutive patients with refractory disease who had attended the paediatric IBD clinic.

A rare case of adenocarcinoma arising within a duplication cyst of the rectum: curative excision with 9-year follow-up.

This case report is novel in that it describes the successful excision of an adenocarcinoma arising within a rectal duplication cyst without evidence of disease recurrence at 9-years of follow-up.

Acute Abdominal Pain for the General Physician - who, when and how to refer to the on-call surgeon.

Patients with abdominal pain are most frequently referred to the on-call surgical team, but there are occasions when physicians may be required to assess, investigate or treat such patients. This article aims to equip non-surgeons with the skills to undertake an appropriate initial assessment and consider the most appropriate selection, timing and mode of referral to the surgical team.

Serum trypsinogen activation peptide in the assessment of the diagnosis and severity of acute pancreatic damage: a pilot study using a new determination technique.

Objectives: To evaluate the clinical value of a new direct and competitive immunoassay for trypsinogen activation peptide (TAP) determination in acute pancreatitis (AP).

Methods: The subjects were 34 patients with AP (22 mild, 12 severe), 12 patients with nonpancreatic acute abdominal pain (AA), 11 healthy subjects (HS), and 16 consecutive patients who underwent therapeutic ERCP (ERCP). Serum TAP, amylase, and lipase levels were determined in AP, AA, and HS at their initial observation; the AP patients were also studied for 6 consecutive days after admission.

Pharmacological and toxicological aspects of 4-demethoxy-3'-deamino-3'-aziridinyl-4'-methylsulphonyl-daunorubicin (PNU-159548): a novel antineoplastic agent.

4-demethoxy-3'-deamino-3'-aziridinyl-4'-methylsulphonyl-daunorubicin (PNU-159548) belongs to a novel class of antitumor compounds (termed alkycyclines) and is currently undergoing Phase II clinical trial. In the present study, we investigated the in vitro and in vivo antitumor activity, the pharmacokinetics, and the toxicological profile of this compound. PNU-159548 showed good cytotoxic activity in murine and human cancer cells growing in vitro, with an average concentration for 50% growth inhibition of 15.