Comparative approach to non-traumatic acute abdominal pain between elderly and non-elderly in the emergency department: a study in rural Greece.

BACKGROUND: Acute abdominal pain is one of the most common symptoms that emergency department physicians encounter during their practice. The difficult task of early diagnosis and management of abdominal pain becomes more complicated when it involves elderly patients. The aim of this study was to evaluate the presence of age based differences regarding the management of acute non-traumatic abdominal pain in the Emergency Department. METHODS: We retrospectively analyzed the medical records of 933 patients with acute non-traumatic abdominal pain in the emergency department of a regional hospital during one year period. RESULTS: There were no differences between native and foreign elder patients regarding the use of imaging studies and discharge status. Although no differences were detected regarding the clinical presentation and management within the Emergency Department, elder patients with abdominal pain had a higher likelihood of being admitted for further hospitalization and were more often submitted to diagnostic examinations. The elder group had a trend towards lower number of cases of non-specific abdominal pain in comparison with the non-elders. Between male and female elders no statistically significant differences were detected. CONCLUSIONS: A thorough work-up is essential for all patients. The clinician should always be alerted, since elderly patients may require more tests and they should have a low threshold for hospital admission.

Association of helicobacter pylori infection and colon cancer.

BACKGROUND: Gastrin has been shown to exert carcinogenic effect to the epithelium of the colon. This study examines whether hypergastrinemia and H. pylori infection -especially infection by the CagA+ strain- are statistically associated with colorectal cancer and examine possible correlations with the colorectal cancer stage and lymph node metastasis. METHODS: In this prospective case-control study, fasting serum samples from 93 consecutive patients with colorectal cancer treated in a university surgical clinic were preoperatively collected and serum levels of gastrin were measured. A group of 20 age matched hernia patients were used as controls. The pathology report of the specimens was documented and statistical analysis of the data where performed with the spss 17 statistical suite. RESULTS: H. pylori IgG antibodies was reported in 66/93 (71%) in the colorectal cancer group and 13/20 patients in the control group (65%), the difference having non-statistical significance (P = n.s). The prevalence of cagA protein expression in the anti- H. pylori IgG+ patients were higher in the colorectal cancer group (56% positivity), when compared to the control group (38,4% positivity) but the difference was not of statistical significance (P = n.s). The mean levels of serum gastrin levels in the two groups did not significantly differ (Ca group 51.1 ± 36.6 pg/mL vs Control 49.8 ± 17.6 P = n.s.). Patients with lymph node metastasis had higher serum gastrin levels than patients without metastasis and this difference was statistically significant. (53.6 vs 41.06 pg/mL P = 0.025). CONCLUSIONS: Although the serum gastrin levels were not statistically different between the TNM stages of our patient cohort, our data found that serum gastrin levels were significantly higher in patients with lymph node metastasis. Whether gastrin is implicated in the ability of cancer cells to metastasize to the lymph nodes merits further research.

The last place you would expect to find a gallstone.

The increasing use of laparoscopic cholecystectomy has led to an increased frequency of gallbladder perforation and subsequent gallstone spillage in the abdominal cavity. Occasionally unretrieved gallstones can cause infection, adhesions, and obstruction. Furthermore, spilt stones can cause erosion into adjacent organs and can migrate to distant sites, causing a variety of complications. We report the unusual case of a patient who presented with spontaneous erosion of gallstones through Grynfeltt's triangle, 1 year after laparoscopic cholecystectomy and review the current literature.

Emphysematous pyelonephritis, a rare cause of pneumoperitoneum: a case report and review of literature.

INTRODUCTION: Emphysematous pyelonephritis is a gas-producing necrotizing bacterial infection that involves the renal parenchyma and perirenal tissue. CASE PRESENTATION: We report on a case of a 55 year old Caucasian male with no prior medical history presented with left flank pain and malaise. He was diagnosed with emphysematous pyelonephritis, and was successfully treated in our department. The case is presented along with a literature review. CONCLUSION: Prompt diagnosis and early treatment is crucial because of the high rate of mortality. Therapeutic modalities and prognostic factors regarding emphysematous pyelonephritis remain controversial.