Endometriosis of the appendix presenting as acute appendicitis with unusual appearance.

INTRODUCTION: Endometriosis of the appendix is an uncommon mimicker of acute appendicitis which makes for a diagnostic dilemma. PRESENTATION OF CASE: We present a rare case of a menstruating woman presenting with classic symptoms of appendicitis, without the characteristic inflammatory changes seen on laparoscopy consistent with appendicitis. Instead, the appendix appeared unusually contracted on itself. Pathologic review of the appendix revealed microscopic findings of endometriosis. DISCUSSION: We theorize the growth and shedding of the endometrial tissue during menstruation caused compression of the neural plexi in the wall of the appendix leading to the presentation mimicking acute appendicitis. CONCLUSION: Given the potential for endometrial appendicitis, we propose appendectomy in reproductive age female patients with right lower quadrant pain, regardless of appendix appearance on laparoscopy.

Metastatic deposits of breast lobular carcinoma to small bowel and rectum.

Breast cancer is the most frequent malignancy in women accounting for approximately 32% of all cancers, with a lifetime risk of 1 in 10. It causes considerable morbidity and mortality. Recently, the survival rate has dramatically increased due to early detection of the disease and improvement in the treatment measures. However, more than 30% of the patients develop metastatic diseases following surgical treatment, radiotherapy, hormonal therapy, or chemotherapy. Distant spread is usually found in bones, lungs, liver, brain and skin. Rarely, it spreads to bowel, spleen, gallbladder, pancreas, urinary bladder, and eyes. Breast cancer is the second commonest primary tumour responsible for gastrointestinal metastases after malignant melanoma. We report a case of a Caucasian female who developed an intestinal obstruction secondary to metastatic deposits to the small bowel and later to the rectum from breast lobular carcinoma 2 years after mastectomy, axillary clearance, radiotherapy, hormonal therapy, and transverse rectus abdominis myocutaneous (TRAM) flap for reconstruction.

Squamous cell carcinoma of the bladder presenting as vulvitis and cliteromegaly.

INTRODUCTION: Clitoral metastases are exceptionally rare. We present a case of a squamous cell carcinoma of the bladder presenting with a clitoral metastasis. CASE REPORT: We report the case of an 84-year-old lady with frequency, dysuria and a clitoral mass, which was found to be a poorly differentiated carcinoma on fine needle aspiration cytology. Cystoscopy revealed a moderate to poorly differentiated squamous cell carcinoma of the bladder. CONCLUSION: This is the first reported case of a squamous cell carcinoma of the bladder with clitoral metastasis. Clitoral metastases are exceptionally rare, with only seven previous cases reported in the literature. Although the commonest cause of cliteromegaly is hormonal, a metastatic carcinoma should be considered as part of the differential diagnosis in the elderly female.

Chloride/phosphate ratio in primary hyperparathyroidism.

The chloride/phosphate (Cl:PO4) ratio is known to help distinguish between the hypercalcemia of primary hyperparathyroidism (HPT) and hypercalcemia from other causes. The Cl:PO4 ratio of 106 patients with surgically proven primary HPT was compared with that of 126 normocalcemic healthy outpatients to examine its usefulness as a confirmatory test for primary HPT. The Cl:PO4 ratio was significantly higher in patients with HPT (42.5 +/- 7.0) compared with healthy controls (28.7 +/- 4.6). Patients with HPT and mild renal insufficiency (serum creatinine, 1.5-2.4 mg/dL) also showed a significant increase in the Cl:PO4 ratio (37.3 +/- 6.6) as did those with HPT with borderline elevations in serum calcium (calcium < 11; Cl:PO4, 40.3 +/- 5.6). A Cl:PO4 ratio > or = 33 is a reliable diagnostic test for primary HPT when compared with a normal population. The Cl:PO4 ratio is also of value in the evaluation of the patient with suspected HPT and borderline calcium elevation and those with mild renal impairment. These data suggest that an inexpensive Cl:PO4 ratio might replace serum parathormone assay as a confirmatory test in the evaluation of suspected primary HPT, especially for those patients in whom a localizing study (sestamibi scan) is obtained before neck exploration.

Amyand's hernia: a case report of an incarcerated and perforated appendix within an inguinal hernia and review of the literature.

Appendicitis within an Amyand's hernia is rare; when it occurs it is often misdiagnosed as a strangulated inguinal hernia. We present a case report of such a case and a review of the literature. It is our recommendation that repair should be undertaken without the use of synthetic mesh through a properitoneal incision that gives access to the peritoneal cavity and the inguinal regions.

Isolated popliteal vein entrapment by a fibrous band--a case report.

Popliteal vein entrapment is commonly associated with popliteal artery entrapment, whereas isolated popliteal vein entrapment is a less common entity. The authors present a case of isolated popliteal vein entrapment caused by a fibrous band.

Navigating the seas of caregiving. Allies & ideas for success.

Formal and informal caregivers share an awesome responsibility in caregiving. If they are going to be effective, caregivers must take care of themselves, communicate with each other, and understand the elements of caring. Home care professionals who recognize the interdependence among formal and informal caregivers and their patients can create a supportive caregiving team.