Late onset metastasis from renal cell carcinoma masquerading as a gallbladder polyp.

Renal cell carcinoma (RCC) accounts for approximately 3% of all adult malignancies. A third of people with RCC have metastatic lesions when diagnosed, and another third develop metachronous metastasis during follow-up or after surgical treatment. We report a case of gallbladder metastasis from clear-cell RCC in a 71-year-old woman 13 years after RCC of her right kidney. Preoperative imaging studies showed a suspicious, progressively enlarged gallbladder polyp. The patient underwent open cholecystectomy and lymph node dissection along the hepatoduodenal ligament. The pathology report was compatible with metastatic disease from the kidney that was previously resected. Gallbladder metastasis can occur from RCC several years after initial management. Physicians should be aware of this rare pathology, and intensive follow-up is essential after surgery for RCC.

Minimally invasive oesophagectomy for cancer in patients with HIV/AIDS: considerations and future directions.

The impact of HIV/AIDS on the treatment of oesophageal neoplasms remains undefined due to a lack of adequate data. We present our experience in treating patients with HIV/AIDS who have oesophageal cancer using minimally invasive techniques and discuss important key factors during perioperative management. Two men with HIV/AIDS underwent minimally invasive oesophagectomies in our department, with adequate clinical and oncological outcomes. Minimally invasive oesophagectomy can be safe and has the well-established benefits of minimally invasive techniques, offering good perioperative results and oncological outcomes in patients with HIV/AIDS. Multimodality therapy is crucial.

Cisapride and ranitidine in the treatment of gastro-oesophageal reflux disease--a comparative randomized double-blind trial.

Forty patients with gastro-oesophageal reflux disease and oesophagitis, documented by endoscopy (grades I to III by the Savary-Miller classification) were randomized to participate in a comparative double-blind trial to receive cisapride (10 mg q.d.s.) or ranitidine (150 mg b.d.) for an 8-week period. Upper gastrointestinal endoscopy was performed immediately before the entry to the trial and after the 8-week period at the completion of the trial. The evaluable cohort included 37 patients who completed the trial, 18 in the cisapride group and 19 in the ranitidine group. Three patients were withdrawn from the trial; one on ranitidine developed severe anaphylactic reaction, one on cisapride severe dizziness and one on cisapride did not wish to continue on the trial. The results of the trial, regarding symptomatic and endoscopic improvement were comparable in the two groups. Both drugs were effective in controlling symptoms, such as acid regurgitation, retrosternal pain, retrosternal burning, epigastric fullness and discomfort (pain, burning, sense of pressure) and resulted in endoscopic healing of oesophagitis. With few exceptions, symptoms remained in remission 1 month after treatment in the majority of patients. Globally, both drugs were tolerated comparably, and adverse effects other than those which resulted in the withdrawal from the trial were minimal in both groups. The results of this trial indicate that cisapride and ranitidine, although of different pharmacological action, are comparable in their therapeutic effect in symptomatic improvement and endoscopic healing in patients with mild to moderate gastro-oesophageal reflux disease.