Septic arthritis caused by Mycobacterium marinum.

The incidence of infection by Mycobacterium marinum is rising, mainly due to the increasing popularity of home aquariums. The infection typically manifests as skin lesions, with septic arthritis being a rare presentation form. The disease is difficult to diagnose even when there is a high clinical suspicion, as culture in specific media may not yield positive findings.

Simultaneous development of Dieterich disease and Freiberg disease.

Dieterich disease is an uncommon arthropathy of the hand, with few studies published. This lesion shares a similar etiopathogenesis with Freiberg disease, although the association of both conditions has only been described once. We report a 65-year-old man consulting for inflammatory pain in his right hand of 1 month's duration and also in his right foot of 4 months' duration.

Five-year results of implants inserted into freeze-dried block allografts.

Purpose: The purpose of this study was to evaluate the outcome after 5 years of allografts as bone growth material and success of implants inserted in fresh-frozen allograft bone.

Materials And Methods: A total of 20 patients were operated and 41 onlay block freeze-dried allografts (calvarial and iliac crest) were inserted for bone augmentation. A total of 64 dental implants were performed in a two-stage procedure.

Trends in colorectal cancer survival following the 2-week rule.

Objective: The 2-week rule has reduced waiting times for a specialist opinion among patients with a suspected malignancy. We aimed at assessing the effect of this rule on colorectal cancer survival.

Method: Patients diagnosed with colorectal cancer before (group 1) and after (group 2) the introduction of the 2-week rule were identified from a prospective database.

The clinical significance of the circumferential resection margin following preoperative pelvic chemo-radiotherapy in rectal cancer: why we need a common language.

Objective: The presence of microscopic tumour cells within 1 mm of the circumferential surgical resection margin (CRM) is the endpoint most strongly associated with local recurrence in rectal cancer and doubles the risk of developing distant metastases. Reporting on the CRM can monitor surgical quality assurance and over the past two decades has driven advances in surgical technique with the increasing use of total mesorectal excision. The aim of this review was to use the evidence from both phase II and phase III randomized trials of preoperative radiotherapy and chemoradiation in rectal cancer, to assess how often CRM involvement is currently documented and examine its utility as an early predictor of both disease-free and overall survival.

A single common urgent pathway for all colorectal referrals reduces time to diagnosis and treatment.

Objective: Guidelines for the urgent referral of patients with suspected colorectal cancer were introduced in 2000. They aimed to facilitate the prompt diagnosis and treatment of patients with symptoms suggestive of malignant disease. Recent assessment of these guidelines has suggested that although they identify 9-14% of patients with colorectal cancer, they may be used inappropriately and may lead to delays in treatment for those patients with cancers whose symptoms do not fit the guidelines.

Can pathological complete response in the primary tumour following pre-operative pelvic chemoradiotherapy for T3-T4 rectal cancer predict for sterilisation of pelvic lymph nodes, a low risk of local recurrence and the appropriateness of local excision?

Introduction: Local excision is considered inappropriate treatment for T3-T4 rectal adenocarcinomas, as it cannot provide prognostic information regarding lymph node involvement and has a high risk of pelvic recurrence. Preoperative chemoradiation (CRT) studies in rectal cancer suggest that a pathological complete response (pCR) in the primary tumour provides an excellent long-term outcome. If downstaging to stage pT0 predicts a tumour response within the perirectal and pelvic lymph nodes, this may allow local excision to be performed without increased risk of pelvic recurrence.

Long-term outcome after laparoscopic splenectomy related to hematologic diagnosis.

Background: Laparoscopic splenectomy (LS) has been demonstrated as an effective and safe treatment for hematological disorders requiring spleen removal, especially in cases of normal-sized spleens. However, although results are promising, long-term outcome data are lacking. We reviewed our clinical experience with LS in a series of 255 cases, with particular attention to the long-term outcome related to the disease process requiring LS.

Mid term analysis of safety and quality of life after the laparoscopic repair of paraesophageal hiatal hernia.

Background: Initial experience with the laparoscopic repair of paraesophageal and type III mixed hiatal hernias showed that it is safe and feasible, with excellent immediate and short-term results. However, after a longer follow-up, a recurrence rate of < or =40% has been demonstrated. Data related to the outcome of paraesophageal hernia repair and the recurrence rate are still lacking.

Topical glyceryl trinitrate in the treatment of anal fissure.

Aim: the aim of this study was to assess the effectiveness of topical glyceryl trinitrate (GTN) in the treatment of anal fissure.

Patients: eighty consecutive patients were randomized to receive 0.2% GTN gel twice a day during a minimum of 6 weeks.

Referral guidelines for colorectal cancer--do they work?

Aims And Methods: Urgent referral guidelines for patients with suspected colorectal cancer were introduced in 2000. In a district general hospital, we prospectively assessed the effect of these guidelines on the number of urgent referrals received and the number found to have cancer.

Results: Over the first year, 180 urgent referrals were received of whom 95 (55%) fitted the guidelines.

Conservative management of tension pneumoperitoneum.

Tension pneumoperitoneum is characterized by a rapidly increasing intra-abdominal pressure, the haemodynamic and respiratory consequences of which are potentially fatal. Prompt laparotomy, surgical drainage and identification of possible sites of perforation is usually advocated in spite of previous reports of negative laparotomies in the literature. We report the successful non-surgical management of two cases of tension pneumoperitoneum.

Small bowel volvulus resulting in infarction due to an anterior gastropexy band.

Volvulus of the small bowel, although rare, carries a high risk of strangulation and ischemic necrosis. It is usually caused by the rotation of a loop of small intestine around an adhesion band or stoma. We present a case of an anterior gastropexy band, giving rise to a small bowel volvulus, necessitating resection due to infarction.

Laparoscopic management of Spigelian hernia.

Spigelian hernia (SH) is an uncommon abdominal wall hernia. Its clinical symptoms are not characteristic, and the preoperative diagnosis is often difficult because SH can simulate the symptoms of more classical lower quadrant abdominal diseases. We report a case of SH in an 80-year-old woman that was complicated by incarceration and diagnosed by physical examination and ultrasound.

[Pseudoachalasia: a diagnosis to consider in the assessment of dysphagia].

The diagnosis of achalasia is based on the patient's symptoms and on manometric studies although other diseases present similar symptomatology. To present an elderly woman clinically and manometrically diagnosed with achalasia of the cardia who was treated by dilatation. When the patient relapsed and was surgically treated she was found to have and esophageal adenocarcinoma.

Side-to-side stapled anastomosis may delay recurrence in Crohn's disease.

Purpose: Perianastomotic recurrence after resection in Crohn's disease may be related to ischemia and subacute obstruction at the anastomosis. A technique designed to minimize these factors currently is being evaluated.

Methods: From 1984 to 1997 69 patients underwent resection and primary anastomosis for symptomatic Crohn's disease (17 jejunal or ileal, 72 ileocolic, and 7 colocolic resections).

Epirubicin-Lipiodol chemotherapy versus 131iodine-Lipiodol radiotherapy in the treatment of unresectable hepatocellular carcinoma.

Background: Arterially administered iodized oil (Lipiodol) is selectively retained by hepatocellular carcinomas (HCCs), and has been used as a vehicle for delivery of therapeutic agents to these tumors. This study compared the efficacy of Lipiodol-targeted epirubicin chemotherapy with Lipiodol-131I radiotherapy.

Methods: Ninety-five patients with unresectable HCC confined to the liver were administered either Lipiodol-epirubicin emulsion (n = 69; 61 cirrhotics; Okuda tumor Stage I, 14; II, 37; III, 18; epirubicin dose, 75 mg/m2) or Lipiodol-131I (131I) (n = 26; 18 cirrhotics; Okuda tumor Stage I, 6; II, 19; III, 1; dose 750-1050 MBq).

Iodized oil in the treatment of hepatocellular carcinoma.

When injected into the hepatic artery the contrast agent Lipiodol (iodized poppy seed oil) is selectively retained by hepatocellular carcinoma (HCC) for a prolonged period of time. Liver computed tomography (CT) performed after Lipiodol angiography is more sensitive than ordinary CT at imaging HCC. Arterial administration of cytotoxic drugs and radioisotopes conjugated to Lipiodol has been shown to be reasonably safe in patients with irresectable HCC.

Prospective randomized trial of Ivalon sponge versus sutured rectopexy for full-thickness rectal prolapse.

Ivalon sponge rectopexy is a safe reliable procedure in the management of rectal prolapse. Sutured rectopexy is simpler and avoids the use of foreign material. Sutured rectopexy is mandatory if synchronous resection is to be considered.

Selective radionuclide localisation in primary liver tumours (pilot study).

The therapeutic potential of 131I-Lipiodol was investigated in 8 patients with cholangiocarcinoma (CCA) and 15 patients with hepatocellular carcinoma (HCC). Patients received one or two doses of 131I-Lipiodol via hepatic arterial injection. The mean total administered activity was 668 (SD 325) MBq in CCA and 953 (SD 477) MBq in HCC.

Long-term results of large-dose, single-session phenol injection sclerotherapy for hemorrhoids.

Purpose: The aim of our study was to assess the medium to long-term outcome following single session large dose injection sclerotherapy for symptomatic hemorrhoids.

Methods: One hundred eighty-nine patients (male = 106, female = 83, median age, 51; range, 20-85 years) were assessed following single-session, large-dose (3 x 5 ml) phenol injection therapy. The most frequent complaint was bleeding (100 percent).