Lactulose may reduce -related diarrhea among patients receiving antibiotics.

Background And Aim: Prebiotics are nondigestible oligosaccharides that are metabolized by colonic bacteria, resulting in a change in the pH of the colonic milieu as well as modifying the microbiome of the colon. The purpose of this retrospective study was to determine whether concomitant lactulose administration affected the infection rate among hospitalized adult patients receiving antibiotics.

Methods: We retrospectively reviewed inpatient medical records of patients in a large teaching hospital admitted during a one-year period.

Severe recurrent abdominal pain: an anatomical variant of Chilaiditi's syndrome.

A patient who presented to the emergency department with severe, recurrent abdominal pain demonstrated Chilaiditi's sign, a radiographic term for interposition of the hepatic flexure of the colon between the liver and right hemidiaphragm. Workup of this clinical case revealed anomalous colonic anatomy, which led to successful laparoscopic corrective surgery. We call attention to the potential importance of this sign when associated with clinically recurrent abdominal pain (Chilaiditi's syndrome).

Laparoscopic distal pancreatectomy for inflammatory pseudotumor of the pancreas.

An 82-year-old woman presented with abdominal pain, nausea, emesis, and weight loss of ~25 lb over 6 months. A CT scan and MRI of the abdomen revealed a mass in the tail of the pancreas that was suspicious for malignancy. The patient underwent successful laparoscopic distal pancreatectomy and was discharged home on the 4th postoperative day after an uneventful course.

Risk management in endoscopic practice.

As illustrated, the practice of gastrointestinal endoscopy is not without risks. All physicians who perform endoscopy should be mindful of the tenets of risk management and how they apply to their endoscopic practices. Retrospective review of individual endoscopic practice habits should be performed yearly and modifications made where necessary.

Asymptomatic metachronous metastatic renal cell adenocarcinoma to the gallbladder. Report of a case and guidelines for evaluation of intraluminal polypoid gallbladder masses.

A case of asymptomatic metachronous metastatic unilateral renal cell adenocarcinoma to the gallbladder detected five years after resection of the primary renal neoplasm is reported here. The lesion was diagnosed by contrast enhancement of a gallbladder mass on abdominal computerized tomography scan and by color Doppler sonographic study of the gallbladder, both of which demonstrated the vascular supply to the intraluminal gallbladder mass. The biological behavior of renal cell adenocarcinoma is reviewed.

Acute pharyngoesophageal dysphagia secondary to spontaneous hemorrhage of a parathyroid adenoma.

Spontaneous hemorrhage of a parathyroid adenoma is a rare occurrence which may manifest with a variety of symptoms including cervical pain, hoarseness, respiratory distress, and dysphagia. We report a case of an elderly woman with a parathyroid adenoma diagnosed 10 years ago and for which she had refused surgery. Throughout this period her hypercalcemia was carefully monitored, and she experienced no symptoms or adverse sequelae from her disease.

Rectal prolapse after oral cathartics.

Complete rectal prolapse or procidentia is an uncommon condition long recognized but of uncertain pathogenesis. We report two patients, seen a decade apart, both of whom developed complete rectal prolapse after ingestion of oral cathartics in preparation for diagnostic studies. To our knowledge, cathartic-induced complete rectal prolapse has not been reported previously in the current medical literature, despite the thousands of bowel preparations performed annually.

Percutaneous endoscopic gastrostomy. What are the benefits, what are the risks?

One way to nutritionally support patients who cannot swallow is to administer formula directly into the stomach. Placing a gastrostomy tube percutaneously using endoscopy avoids the risks of general anesthesia and wound healing that accompany surgical gastrostomy. Although certain conditions (eg, sepsis, coagulation disorder, portal hypertension) are contraindications to the procedure, it can be done in patients who have had previous abdominal surgery and in those with severe illness.