Gastrocolic fistula as a complication after gastrojejunostomy.

Gastrocolic fistula formation is an extremely rare complication of gastric ulcer disease. We report a case of a 55-year-old man who presented with a two-month history of abdominal discomfort, postprandial diarrhea, nausea and faecal vomiting. Upper gastrointestinal endoscopy showed an ulcer in the greater curvature of the stomach. Barium enema examination revealed an obvious gastrocolic fistula between the greater curvature of the stomach and the transverse colon. The involved segment of the colon was excised and truncal vagotomy and antrectomy was performed. The patient was discharged on the 7th postoperative day. It is concluded that cases with postprandial diarrhea and nutritional disturbances after gastric surgery should remind us of the probability of gastrocolic fistula formation.

Effect of meloxicam on postoperative pain relief after inguinal hernia repair with local anaesthesia

Aim: To investigate the effect of the administration of a single dose of meloxicam pre-emptively on postoperative pain management in patients who underwent inguinal hernia repair under local anaesthesia. Subjects and Method: Fifty patients who underwent inguinal hernia repair under local anaesthesia during the period November 2005 to May 2006 were recruited into the study prospectively. The patients were randomized to two groups regarding administration and non-administration of pre-emptivemeloxicam. The postoperative visual analogue pain scale (VAS) values at 4, 8, 12 and 24 hours and analgesic needs of the patients were recorded. Results: No difference was found between the groups in terms of age, gender, hernia localization and type. The VAS values of the patients regarding their pain severity were evaluated at 4, 8, 12 and 24 hours and were significantly lower in the group which received meloxicam pre-emptively (p = 0.001, 0.0001, 0.003 and 0.0001 respectively). The need for non-steroidal anti- inflammatory drug was also found to be significantly lower (p = 0.0001). Conclusion: Postoperative pain severity and hence analgesic requirement were significantly decreased in the patients who received meloxicam pre-emptively. Single dose pre-emptive meloxicam seems to be an effective analgesic therapy for patients undergoing inguinal hernia repair under local anaesthesia.It thereby improves patients comfort and should be considered for use in outpatient surgery.

Objetivo: Investigar el efecto de la administración de una dosis de meloxicam de forma preventiva enel tratamiento del dolor postoperatorio en pacientes sometidos a una reparación quirúrgica de hernia inguinal bajo anestesia local. Sujetos y Métodos: Cincuenta pacientes que tuvieron una reparación de hernia inguinal bajo anestesia local durante el período de noviembre de 2005 a mayo de 2006, fueron reclutados para el estudio demodo prospectivo. Los pacientes fueron divididos aleatoriamente en dos grupos, partiendo del criterio de la administración o no administración de meloxicam de modo preventivo. Se registraron los valores de la escala visual-analógica (EVA) para el dolor postoperatoria a las 4, 8, 12 y 14 horas, así como las necesidades analgésicas de los pacientes. Resultados: No se hallaron diferencias entre los grupos en relación con la edad, el género, lalocalización y el tipo de hernia. Los valores de la EVA de los pacientes con respecto a la severidad de su dolor, fueron evaluados a las 4, 8, 12 y 24 horas, y resultaron ser significativamente más bajos en el grupo que recibió meloxicam de forma preventiva (p = 0.001, 0.0001, 0.003 y 0.0001 respectivamente). También se halló que la necesidad de un medicamento anti-inflamatorio no ester-oidal era significativamente más baja (p = 0.0001). Conclusión: La severidad del dolor postoperatorio y por lo tanto la necesidad de analgésicos, experimentaron una disminución significativa en los pacientes que recibieron meloxicam de forma preventiva. La dosis sencilla de meloxicam de forma preventiva parece ser una terapia analgésica efectiva para pacientes que han sido sometidos a reparación quirúrgica inguinal con anestesia local. Su aplicación mejora el alivio de los pacientes, y debe tenerse en cuenta su uso para la cirugía ambulatoria.

A small bowel fistula extending into a metastatic tumour due to lung carcinoma.

We report the case of a 63-year-old man who presented with an abdominal mass that was subsequently found to be a metastasis of small cell lung carcinoma into which the small bowel had fistulized. After a detailed diagnostic workup, the involved segment of the small bowel was resected along with the mass. The patient is alive and well six months after surgery. Lung carcinoma metastases to the bowel and mesentery are rare. Resection of the metastatic mass gives the best palliation and improves short-term survival.

Effect of meloxicam on postoperative pain relief after inguinal hernia repair with local anaesthesia.

AIM: To investigate the effect of the administration of a single dose of meloxicam pre-emptively on postoperative pain management in patients who underwent inguinal hernia repair under local anaesthesia. SUBJECTS AND METHOD: Fifty patients who underwent inguinal hernia repair under local anaesthesia during the period November 2005 to May 2006 were recruited into the study prospectively. The patients were randomized to two groups regarding administration and non-administration of pre-emptive meloxicam. The postoperative visual analogue pain scale (VAS) values at 4, 8, 12 and 24 hours and analgesic needs of the patients were recorded RESULTS: No difference was found between the groups in terms of age, gender, hernia localization and type. The VAS values of the patients regarding their pain severity were evaluated at 4, 8, 12 and 24 hours and were significantly lower in the group which received meloxicam pre-emptively (p = 0.001, 0.0001, 0.003 and 0.0001 respectively). The need for non-steroidal anti-inflammatory drug was also found to be significantly lower (p = 0.0001). CONCLUSION: Postoperative pain severity and hence analgesic requirement were significantly decreased in the patients who received meloxicam pre-emptively. Single dose pre-emptive meloxicam seems to be an effective analgesic therapy for patients undergoing inguinal hernia repair under local anaesthesia. It thereby improves patients comfort and should be considered for use in outpatient surgery.

A randomized clinical trial of magnesium sulphate as a vehicle for nebulized salbutamol in the treatment of moderate to severe asthma attacks.

Although it is well known that intravenous administration of MgSO4 as an adjunct to conventional therapy is effective in treating asthma attacks, the effect of nebulized MgSO4 as a vehicle for salbutamol has been less evaluated. The aim of this study was to compare the effects of nebulized salbutamol administrated through either MgSO4 or isotonic saline solution on the 'peak expiratory flow rate' (PEFR), other respiratory and clinical parameters, and hospitalization rate of patients suffering from moderate to severe asthma attacks. Twenty-six patients with asthma attack were enrolled in the study in a randomized single blind fashion. After obtaining initial peak expiratory flow measurements (PEFR) and clinical evaluation, all patients received 1mg/kg corticosteroids and oxygen therapy and then either isotonic MgSO4 (2.5 ml, 6.3%)+salbutamol (2.5 ml) or saline (2.5 ml)+salbutamol (2.5 ml) through a jet nebulizer (group 1 (n=14) vs group 2 (n=12), respectively). The nebulizations were repeated every 20 min for the first hour and every hour for the rest of 4 h. The PEFR measurements and clinical assessment were performed after nebulization at 20th, 60th, 120th, 180th and 240th minutes. Patients were discharged when PEFR reached the target level of 70% of predicted. The baseline PEFRs and clinical parameters were similar between groups 1 and 2 (50.2+/-18.5 vs 44.1+/-13.9, respectively, p>0.05). The mean% increase in PEFR at different measurement levels was similar between the groups. When the treatment response was evaluated within the groups, group 2 showed statistically significant increase in PEFR (% of predicted) 1h earlier than group 1 (60th vs 120th minute, p=0.003 vs p=0.007). The mean duration of achieving target-PEFRs was 105.7+/-72.1 min for group 1 and 118.3+/-96.7 min for group 2 (p>0.05). This study suggested that the additional usage of MgSO4 to nebulized salbutamol has no beneficial effect on the treatment of asthma attacks.

Comparison of Shouldice and Lichtenstein repair for treatment of primary inguinal hernia.

PURPOSE: The purpose of this study was to compare the outcome following Lichtenstein open mesh repair or Shouldice repair for the surgical treatment of primary unilateral inguinal hernias. PATIENTS AND METHODS: Patients with primary unilateral inguinal hernia who underwent a Shouldice repair (n: 120) and a Lichtenstein open mesh techniques (n: 121) between 1994 and 1998 were evaluated retrospectively. Operation time, hospital stay, postoperative analgesic consumption and complications, return to work and recurrence after surgery were assessed and compared. RESULTS: The two groups were comparable regarding age, types of hernia and the follow-up interval. There were no significant differences in hospital stay and postoperative complications. The number of recurrences differed significantly between the groups with five in the Shouldice group (4.1%) and one in the Lichtenstein group (0.8%) (p < 0.05). The need of analgesic medication after mesh repair was significantly lower than the Shouldice group (3.9+/-1.4 vs. 4.9+/-1.6 gr. p < 0.05). The operation time was 36+/-14 min. for Lichtenstein repair and 61+/-12 min. for Shouldice repair (p < 0.05). The time for return to work was shorter in Lichtenstein group (17+/-4 days) compared to Shouldice group (25+/-5 days) (p < 0.05). CONCLUSION: Shorter operation time, faster return to work, less need to analgesia and lower recurrence rate, shows the superiority of Lichtenstein repair against Shouldice repair in the surgical repair of primary unilateral inguinal hernia.

No association between serum levels of insulin-like growth factor-I, vascular endothelial growth factor, prolactin and clinicopathological characteristics of breast carcinoma after surgery.

BACKGROUND: Angiogenesis is essential for tumour growth and metastasis. Vascular endothelial growth factor (VEGF) has been suggested as the major angio-genic factor in breast carcinoma. Both insulin-like growth factor-I (IGF-I) and prolactin are involved in the progression of breast cancer at least partly by stimulating angiogenesis. AIM: The aim of the present study was to investigate the association between serum IGF-I, VEGF and prolactin levels and clinicopathological characteristics of breast carcinoma. METHODS: Serum IGF-I, VEGF and prolactin levels were measured in breast cancer patients and controls and these levels were compared with well-known clinicopathological characteristics of breast carcinoma, including tumour size, axillary lymph node and oestrogen/progesterone receptor status, tumour grade and disease stage. RESULTS: Serum prolactin, VEGF and IGF-I levels were found to be similar in breast cancer patients and control subjects (P > 0.05). When the patients were divided into groups according to their tumour size, axillary lymph node status, tumour grade, oestrogen/progesterone receptor status and disease stage, no significant differences in serum prolactin, VEGF and IGF-I levels were found among the groups (P > 0.05). CONCLUSIONS: The present study failed to demonstrate an association between serum levels of VEGF, IGF-I and prolactin and well-known clinicopathological characteristics of breast carcinoma.

Fournier's gangrene after hemorrhoidectomy: association with drug-induced agranulocytosis. Report of a case.

An unusual case of Fournier's gangrene after hemorrhoidectomy and drug-induced agranulocytosis, as the predisposing condition, is described. The patient had severe granulocytopenia that was attributed to the recent use of dipyrone. Together with hemodynamic resuscitation, broad-spectrum antibiotic and recombinant human granulocyte colony-stimulating factor were started. Wide surgical excision of all the gangrenous tissues, in addition to laparoscopic formation of a defunctioning sigmoid loop colostomy, was performed. The white blood cell count rose steadily and the patient experienced a rapid recovery. We emphasize that radical surgery must be accompanied by pharmacologic interventions for a successful outcome in such cases.