Colonoscopic retrieval of an appendiceal foreign body: prophylaxis for appendicitis?

Management of orally ingested foreign bodies usually consists of endoscopic retrieval while the objects reside within the esophagus or stomach. Although most foreign bodies that pass through the pylorus will be excreted without incident, some may become impacted distally, resulting in obstruction or perforation. Appendiceal foreign bodies have been reported rarely, yet have resulted in the development of acute appendicitis.

Nontraumatic clostridial myonecrosis: an indication for colonoscopy?

Clostridial myonecrosis (CM) is a rare infection that usually arises after traumatic injury. Spontaneous or nontraumatic CM is even more rare and has been described in association with colorectal malignancy. These infections carry a high mortality rate and require urgent surgical intervention and intensive antibiotic therapy.

Laparoscopic endobiliary stenting significantly improves success of postoperative endoscopic retrograde cholangiopancreatography in low-volume centers.

Background: Occult common bile duct stones (CBDS) discovered during laparoscopic cholecystectomy with intraoperative cholangiography are most often managed by postoperative endoscopic retrograde cholangiopancreatography (ERCP). Expert endoscopists at high-volume centers achieve common bile duct cannulation in nearly all patients undergoing ERCP, but cannulation rates of less than 80% have been observed in low-volume centers. As many as 20% of patients with CBDS referred for postoperative ERCP in low-volume centers may require repeated attempts at ERCP, referral to a high-volume center, percutaneous transhepatic techniques, or reoperation for clearance of CBDS when postoperative ERCP fails.

Clarithromycin-induced digoxin toxicity: a case report and a review of the literature.

A 70-year-old woman with a history of atrial fibrillation, on digoxin, presented with nausea, vomiting, and dizziness two days after initiation of clarithromycin therapy. Laboratory results revealed a serum digoxin level of 3.9 ng/ml (normal range 0.

Laparoscopic ventriculoperitoneal shunt placement: a single-trocar technique.

Ventriculoperitoneal shunt (VPS) placement is an important therapeutic technique. Placement of the abdominal portion of VPS can be difficult in the setting of previous abdominal surgery, prior failure of VPS, or obesity. Even under ideal circumstances, standard mini-laparotomy does not allow precision in VPS positioning.

Antibiotic use in the elderly: issues and nonissues.

Despite the well-recognized increase in mortality and morbidity due to infections in the elderly, antibiotics may, in most cases, be used in a manner similar to that in younger patients. The decreased lean body weight and reduced renal function typical of elderly patients, however, require consideration of reduced doses and longer dosing intervals, especially for renally excreted antibiotics. Length of therapy should be conservative because underlying anatomic or functional predispositions to infections tend to complicate treatment.

Diet and risk for breast cancer recurrence and survival.

Dietary factors may influence the risk for breast cancer and also the prognosis following diagnosis and treatment. The aim of this study was to assess whether self-reported prediagnosis diet or other patient factors associated with breast cancer incidence were predictive of recurrence and survival. Patients (n = 149) diagnosed with primary breast cancer between 1989 and 1991 were followed for five or more years.

Secretory villous adenomas that cause depletion syndrome.

Secretory villous adenomas of the colon have been known to cause a depleting syndrome characterized by dehydration, prerenal azotemia, hyponatremia, hypokalemia, metabolic acidosis, obtundation, and, in severe cases, death. We describe 1 case of classic depleting syndrome and review the literature on possible mechanisms. Both cyclic adenosine monophosphate and prostaglandin E2 have been implicated as possible secretagogue compounds in the pathogenesis of this syndrome unique to the secretory variant form of villous adenomas.

Analyte specific reagents: FDA final rule and implications for your clinical flow cytometry laboratory.

In summary, the FDA Final Rule on Analyte Specific Reagents has provided clarity and simplification for manufactures to develop and market products. The burden of establishing performance characteristics is now the responsibility of the clinical flow cytometry laboratory. The FDA now requires a disclaimer to be included in every lab report utilizing these products.

Factor V Leiden and pulmonary embolism in a young woman taking an oral contraceptive.

A 34-year-old woman with a history of asthma and oral contraceptive use died suddenly. Autopsy examination showed chronic pulmonary emboli with an acute pulmonary saddle embolus. An underlying congenital thrombophilic disorder was considered.

Two giant basal cell carcinomas presenting simultaneously in the same patient, one resulting in lower extremity limb loss.

Giant basal cell carcinomas are a rare form of the most common malignant neoplasm of the skin. They are commonly found on the trunk and display a more aggressive behavior, resulting in local invasion and metastasis. Giant basal cell carcinomas that reach a critical size of 10 cm in diameter almost always present with metastases.

Stroke following vertebral artery dissection: a case study.

Vertebral artery dissection is an extremely rare but serious precursor to stroke. A case study illustrates how accurate early assessment and diagnosis can permit prompt intervention. Favorable treatment outcomes can occur when such astute management takes place.

Carcinosarcoma of the parotid gland: report of a case with cytohistologic and immunohistochemical findings.

True malignant mixed tumors (carcinosarcomas) of salivary gland origin are exceedingly rare and demonstrate malignant epithelial and stromal components. We report a case of parotid gland carcinosarcoma that showed squamous cell carcinoma and malignant fibrous hystiocytoma without clinical or histologic evidence of a preexisting pleomorphic adenoma. This tumor consisted of 2 histologically different populations of cells without evidence of a common origin from the myoepithelial cell, which is the putative precursor cell of pleomorphic adenoma and its derived carcinosarcoma.

Stereotactic core needle biopsy of nonpalpable breast lesions: initial experience with a promising technique.

Objectives: To evaluate the correlation between the pathological findings of stereotactic core needle biopsy (SCNB) and the prebiopsy mammographic findings, as well as the pathological findings of lesions that were subsequently removed by surgical excision.

Design: A retrospective review of 97 consecutive patients who underwent 100 SCNBs of suspicious nonpalpable mammographic lesions. The criterion standard is surgical excisional biopsy with needle localization.

Laparoscopic endobiliary stenting as an adjunct to common bile duct exploration.

Background: The management of common bile duct stones (CBDS) in the era of operative laparoscopy is evolving. Several minimally invasive techniques to remove CBDS have been described, including preoperative endoscopic retrograde cholangiopancreatography (ERCP), postoperative ERCP, lithotripsy, laparoscopic transcystic common bile duct exploration, and laparoscopic choledochotomy with common bile duct exploration (CBDE). Because of the risks and limitations of these procedures, we utilize laparoscopically placed endobiliary stents as an adjunct to CBDE.

Sudden death due to undetected mediastinal germ cell tumor.

A 32-year old man, apparently asymptomatic, was found dead in his apartment. Autopsy revealed a large necrotic mediastinal mass with liver and occipital brain metastases, the latter having produced acute intraparenchymal and intraventricular hemorrhage with cerebellar tonsillar herniation. Histologically, the mediastinal mass and metastases were consistent with immature extragonadal teratoma, with malignant transformation of the intestinal-type epithelium.

Etiological significance of associations between childhood trauma and borderline personality disorder: conceptual and clinical implications.

Numerous studies over the past decade have pointed to the frequent occurrence of trauma and neglect in the childhood experience of patients with Borderline Personality Disorder (BPD). Advancing research on Posttraumatic Stress Disorder (PTSD) and Dissociative Disorders offers further insight into understanding shared clinical phenomena with BPD. Drawing upon attachment theory, models of learned helplessness, and early primate deprivation, empirical, theoretical and clinical data are integrated to conceptualize the role of trauma and neglect in the etiology of BPD.

Safety of antihistamines in the treatment of allergic rhinitis in elderly patients.

Elderly patients may be more susceptible than younger persons to the sedating and anticholinergic effects of first-generation antihistamines. Second-generation antihistamines, such as loratadine, astemizole, and terfenadine, cause minimal sedation and little if any impairment in cognitive and psychomotor activity in healthy nonelderly patients. Although less extensively studied in elderly patients, it is probable that second-generation antihistamines are also less likely to induce the adverse central nervous system effects in older patients that are characteristic of the first-generation antihistamines.

The effect of living in a nursing home on socialization in elderly people.

The effects of institutionalization on elderly people are of significance both socially and physically. Currently, about 5% of elderly people in the United States live in long-term care institutions, although approximately 33% of all elders will be institutionalized for at least a short period of time. The effects on socialization of living in a nursing home have been studied and commented on from several perspectives.

Addressing the service versus education conflicts created by residency training in ambulatory care settings.

Much of the tension and conflict that result from the competing demands of work and learning during residency training--the service versus education conflict--can be addressed by mutual adherence to fundamental guidelines of fairness and personal responsibility by residents and their employers, mentors, and teachers. Residents should be recognized by their employers as professionals and by their teachers as colleagues. Because residency is postgraduate professional education for medical school graduates, the content of resident education must be primarily determined by the educational needs of maturing physicians.