Primary melanoma of small intestine masquerading as gastrointestinal stromal tumor: a case report and literature review.

Malignant melanoma of the gastrointestinal tract is a rare entity among intestinal neoplasms. Primary intestinal melanoma is difficult to differentiate from metastatic melanoma, especially given that the primary cutaneous lesion has the potential to regress and disappear. In addition, melanoma by itself is a great mimicker of other neoplastic conditions and may create a major diagnostic challenge when presenting at an intra-abdominal location.

Percutaneous tracheostomy: a cost-effective alternative to standard open tracheostomy.

Percutaneous tracheostomy was initiated as an alternative to open tracheostomy at our institution in December 1993. To assess safety, operative time, and cost, a comparative analysis of percutaneous and open tracheostomies was performed. A retrospective evaluation of all patients who underwent percutaneous tracheostomy (P) from December 1993 to March 1996 was completed.

Polypropylene mesh closure after emergency laparotomy: morbidity and outcome.

Background: Alternative methods for abdominal wall closure may be necessary after emergency laparotomy. The purpose of this study was to determine the morbidity and outcome of emergency fascial closure with polypropylene mesh.

Methods: A retrospective review was performed of all patients undergoing emergency fascial closure with polypropylene mesh from January 1990 to March 1994.

Potential of laparoscopy to reduce non-therapeutic trauma laparotomies.

Standard diagnostic methods used to evaluate patients sustaining abdominal trauma result in non-therapeutic laparotomy rates ranging from 5 to 40 per cent depending upon the clinical situation. The purpose of this study was to assess the safety and efficacy of diagnostic laparoscopy in the identification of intra-abdominal injuries in stable trauma patients. Twenty-one hemodynamically stable adult patients underwent laparoscopy prior to laparotomy for blunt (n = 10) or penetrating (n = 11) trauma, and the findings from each procedure were directly compared.

Value of laparoscopy in trauma ICU patients with suspected acute acalculous cholecystitis.

Patients who require prolonged intensive care following traumatic injuries are at risk for developing acute acalculous cholecystitis (AAC). The diagnosis of AAC is often difficult to establish, resulting in increased morbidity and mortality in this critically ill population. We reasoned that diagnostic laparoscopy might provide a more accurate and timely method of diagnosis.

The management of common bile duct stones in patients undergoing laparoscopic cholecystectomy.

The management of suspected and/or unsuspected common bile duct (CBD) stones in patients undergoing laparoscopic cholecystectomy (LC) is controversial. Decisions on whether to perform an open CBD exploration versus employing therapeutic options such as preoperative/post-operative endoscopic retrograde cholangiography (ERCP) or endoscopic duct exploration are polemic. To determine indications, timing, benefits, and potential morbidity of these approaches, we gathered data on 401 patients undergoing LC within the last 18 months.

[Treatment of hypertension with consideration of metabolism. A challenge for current therapy of essential hypertension].

In the modern therapeutic approach to hypertension, the aspect of "metabolic side effects" is receiving ever more attention. This is the result of the recognition that high blood pressure forms part of a metabolic syndrome known as syndrome X, the components of which are variously influenced by different antihypertensive agents. Of particular importance seems to be the response of an underlying insulin resistance, since resulting hyperinsulinemia has been shown to be a separate risk factor.

Diagnostic laparoscopy in the intensive care patient. Avoiding the nontherapeutic laparotomy.

Evaluation of a potential acute abdomen in patients who require intensive care for concurrent medical/surgical problems is often difficult due to ambiguities in the physical exam and ancillary diagnostic tests. Between August 1990, and February 1992, 25 ICU patients underwent diagnostic laparoscopy to evaluate a suspected acute intraabdominal process. Thirteen laparoscopies were negative, and 12 were positive.