Squamous cell carcinoma of the pancreas. Report of an unusual case and review of the literature.

Squamous cell carcinoma is an uncommon form of cancer of the pancreas, comprising 0.5-3.5% of cases. We report an unusual case that occurred in a very young woman and showed cystic characteristics. Interesting radiographic features included extensive pancreatic calcifications and pancreatic duct communication to the mass. A literature review of this rare form of pancreatic cancer is also provided.

Ischemic colitis associated with dextroamphetamine use.

Ischemic colitis can be caused by a variety of medications including a number of sympathomimetic agents. We report the case of a 47-year-old narcoleptic man who had abdominal pain and rectal bleeding. The clinical, radiographic, and histologic findings supported the diagnosis of ischemic colitis associated with oral dextroamphetamine use.

Primary small-cell carcinoma of the esophagus. Report of 11 cases and review of the literature.

Primary small-cell carcinoma of the esophagus is an uncommon esophageal malignancy. This report details the clinical and pathologic aspects of 11 cases seen at our institution over 20 years, as well as 123 other cases reported in the literature. Small-cell carcinomas of the esophagus show considerable histologic heterogeneity. Neurosecretory granules can be found in the majority of cases and some show evidence of multidifferentiation. Like primary small-cell cancers of the lung, those in the esophagus are highly aggressive, are usually associated with spread at the time of diagnosis, and have a dismal prognosis regardless of treatment. The possible origin of this interesting variety of esophageal neoplasm is also discussed.

Endoscopic management of retained cystic duct stones.

The finding of residual common bile duct stones after cholecystectomy is a relatively frequently encountered problem for which effective nonoperative therapy exists. Retained stones in a cystic duct remnant are very rare. We present a case of multiple retained stones in a long variant cystic duct remnant following cholecystectomy and common duct exploration, which was successfully managed with endoscopic sphincterotomy and balloon extraction.

Hiccups: esophageal manometric features and relationship to gastroesophageal reflux.

Gastroesophageal reflux (GER) has been reported to be a cause of hiccups. Conversely, some reports state that hiccups cause or adversely affect GER disease. There have been few descriptions in the literature of what hiccups do to esophageal motility. We present a patient with long-standing symptomatic GER and intractable hiccups. Esophageal manometry during hiccups showed absence of LES pressure and absence of peristaltic activity in the esophageal body in response to swallowing, factors which could aggravate GER. Esophageal motility in the absence of hiccups was normal. Antireflux surgery in our patient relieved heartburn but not hiccups. Based on our case and a review of the literature, we believe that clinicians should be cautious in recommending antireflux surgery to treat hiccups in patients with both hiccups and heartburn.

Air-contrast barium enema studies after flexible proctosigmoidoscopy: randomized controlled clinical trial.

The authors performed a randomized clinical trial to determine the effect of flexible proctosigmoidoscopy (FPS) on the quality of air-contrast barium enema (ACBE) studies performed on the same day and whether it mattered if air or carbon dioxide was used for endoscopic insufflation. One hundred twenty-one patients were randomly assigned to one of the following groups: Same-day studies were performed, with air used for insufflation, in group 1; same-day studies, with carbon dioxide, in group 2; and separate-day studies in group 3. Scout images obtained before the ACBE study were graded for the amount of air seen, and ACBE studies were graded for overall quality; each was graded on a scale of 0-3 in a blinded fashion. The air score was significantly greater in group 1 (2.69) than in group 2 (2.01) (P less than .001), which in turn was significantly greater than in group 3 (1.53) (P less than .01). The ACBE quality scores in the three groups were not significantly different. The authors conclude that FPS can be done before ACBE examination without impairing the quality of the ACBE study. Although carbon dioxide insufflation results in less intestinal air after FPS, the quality of the ACBE study is not affected.