[Gastrointestinal stromal tumor (GIST): a rare case of severe gastric haemorrhage]. / Tumore stromale gastrointestinale: un raro caso di emorragia gastrica severa.

INTRODUCTION: A rare case of gastrointestinal stromal tumor (GIST) provoking a severe gastric bleeding is reported. Case report and results. The Authors report on the case of a 53-year-old male patient who presented with hematemesis, melena and severe acute anemia (Hb: 6 g/dl). EGDS disclosed a protruding lesion centrally ulcerated, of 7 cm in size, localized in the upper half of gastric corpus. Multiple endoscopic biopsies were negative for neoplastic changes. Because of further gastric bleeding, a total gastrectomy with "Roux-en-Y" reconstruction was performed in urgency GIST of smooth muscle was diagnosed by histological and immunohistochemical postoperative examination. DISCUSSION: Gist are neoplasms arising from connective tissue elements of gastrointestinal wall, which represent about 2% of GI-tract malignant tumor. Tumor size of 5 cm or greater, elevated mitotic count, lack of histological differentiation are significantly associated with a shorter recurrence-free survival. GIST-s are rarely cause of an inarrestable gastric bleeding. For gastroenterological surgeons it is critical to select the most suitable surgical procedure. In our case, 9 months after gastrectomy the patient is well, in spite the severe clinical background and the malignancy degree. CONCLUSION: The GIST-s have to be taken into account in the differential diagnosis of GI-tract tumors if endoscopic biopsies are negative for malignancy. In our opinion, total or partial gastrectomy fro gastric should be preferred. Moreover, a close follow up is recommended.

Stress: a self-management approach and nursing care plan for nurses.

Stress is unavoidable but can be controlled to provide the energy for health, growth, and the development of human potential. This article provides a self-management approach and a nursing care plan for nurses.

Factors to consider when choosing long-term care insurance.

New policies regarding long-term care insurance offer access to a variety of care options and services. This information can initiate discussions about long-term care needs and financial options for you and your patient population. This article provides an overview of long-term care and factors to consider when choosing insurance programs and benefits.

[Gallbladder agenesis in the laparoscopic era: report of a case]. / L'agenesia della colecisti nell'era laparoscopica: a proposito di un caso.

The authors report an observed case and re-examine the incidence of this defect; they underline the possibility of the diagnosis during the fetal age and the association with one o more defects, sometimes incompatible with the life; in the adult, on the contrary, may be evidence of an associated litiasic pathology of the ++epato-choledocus or of the stenosis of the oddian sphincter. On the base of the diagnostic previous experiences, they elaborate the proposal of an algorythm and underline the utility of a laparoscopic diagnosis either in the pre-operative doubious cases or in the intra-operative diagnosed cases.

Understanding informed consent.

Understanding and facilitating the informed consent process is our duty as perioperative nurses. Acting as patient advocates, we must determine if our patients have given "informed consent" prior to surgical treatment. When we witness our patients signing consent forms, we must be sure they are competent to sign; that they have spoken with the physician and have discussed the proposed procedure (including the risks, benefits and alternative treatments) and have had their questions answered; and have read the consent form they are being asked to sign. As nurses, we must become aware of our responsibilities related to informed consent. By understanding the concept of informed consent and its legal implications, we will be able not only to the facilitate informed consent process but also to fulfill our legal responsibilities.