Ferritin above 100 mcg/L could rule out colon cancer, but not gastric or rectal cancer in patients with involuntary weight loss

ABSTRACT: BACKGROUND: A tenth of patients with involuntary weight loss (IWL) have gastrointestinal cancer. Ferritin is the first parameter to be modified during the process leading to iron deficiency anaemia, therefore it should be the most sensitive. The aim of this study was to assess the ability of ferritin to rule out gastrointestinal cancer in patients with involuntary weight loss. METHODS: All consecutive patients with IWL admitted in a secondary care university hospital were prospectively studied. Ferritin, haemoglobin with erythrocyte indices and serum iron were recorded for all patients. The reference standard was bidirectional endoscopy and/or 6 months follow-up. RESULTS: 290 patients were included, a quarter had cancer, of which 22 (7.6%) had gastrointestinal cancer (8 gastric cancer, 1 ileum cancer, 13 colorectal cancer). Ferritin had the best area under the curve (AUC), both for gastrointestinal cancer (0.746, CI: 0.691-0.794), and colorectal cancer (0.765, CI: 0.713-0.813), compared to the other parameters of iron deficiency. In the diagnosis of colorectal cancer, ferritin with a cut-off value of 100 mcg/L had a sensitivity of 93% (CI: 69-100%), and negative likelihood ratio of 0.13, with a negative predictive value of 99% (96-100%), while for gastrointestinal cancer, the sensitivity was lower (89%, CI: 67-95%), with a negative likelihood ratio of 0.24. There were three false negative patients, two with gastric cancer, and one with rectal cancer. CONCLUSION: In patients with involuntary weight loss, a ferritin above 100mcg/L could rule out colon cancer, but not gastric or rectal cancer.     

Cauda Equina Intradural Extramedullary Cavernous Haemangioma: Case Report and Review of the Literature

Cavernous haemangioma (cavernoma) is a benign vascular lesion, exceptionally located in cauda equina. We report a case, diagnosed and operated in the Department of Neurosurgery from Pitesti County Emergency Hospital, of a 60-year-old woman with history of lumbar region distress, who presented with low back pain, paravertebral muscle contracture, and bilateral lumbar radiculopathy, with sudden onset after lifting effort. The preoperative diagnosis was done using computed tomography (CT) and magnetic resonance imaging (MRI), and the patient underwent surgery—two level laminectomy, dural incision, and tumor dissection from the cauda equina nerve roots under operatory microscope. Histopathological examination confirmed the positive diagnosis of cavernoma of cauda equina. The patient''s outcome was favorable, without postoperative neurological deficits.     

Acute complications after laparoscopic bariatric procedures: update for the general surgeon

Background

Development and widespread use of laparoscopic bariatric surgery exposes emergency room physicians and general surgeons to face acute or chronic surgical complications of bariatric surgery.

Methods

The most common surgical emergencies after bariatric surgery are examined based on an extensive review of bariatric surgery literature and on the personal experience of the authors' practice in four high-volume bariatric surgery centers.

Results

An orderly stepwise approach to the bariatric patient with an emergency condition is advisable. Resuscitation should follow the same protocol adopted for the non-bariatric patients. Consultation with the bariatric surgeon should be obtained early, and referral to the bariatric center should be considered whenever possible. The identification of the surgical procedure to which the patient was submitted will orient in the diagnosis of the acute condition. Procedure-specific complication should always be taken into consideration in the differential diagnosis. Acute slippage is the most frequent complication that needs emergency treatment in a laparoscopic gastric banding. Sleeve gastrectomy and gastric bypasses may present with life-threatening suture leaks or suture line bleeding. Gastric greater curvature plication (investigational restrictive procedure) can present early complications related to prolonged postoperative vomiting. Both gastric bypass and bilio-pancreatic diversion may cause anastomotic marginal ulcer, bleeding, or rarely perforation and severe stenosis, while small bowel obstruction due to internal hernia represents a surgical emergency, also caused by trocar site hernia, intussusceptions, adhesions, strictures, kinking, or blood clots. Rapid weight loss after bariatric surgery can cause cholecystitis or choledocholithiasis, which are difficult to treat after bypass procedures.

Conclusions

The general surgeon should be informed about modern bariatric procedures, their potential acute complications, and emergency management.     

An unusual case of congenital scoliosis associated with rib agenesis in the upper part of the concavity treated by VEPTR vertebra to vertebra

Background contextRib agenesis in congenital scoliosis is rarely encountered, and its disposal in the application area of the proximal vertical expandable prosthetic titanium rib (VEPTR) module is a challenge to the orthopedic surgeon.PurposeTo present a case in which known treatment methods in early-onset scoliosis were not possible to apply.Study designCase report.MethodsA patient aged 1 year and 10 months, presenting a congenital scoliosis with the following characteristics: left T3 hemisegmented hemivertebra, T5–T6–T7 hemivertebral segment, T9, T10 trapezoidal vertebrae, right side I–IV rib agenesis with T1–T2–T4 hemivertebral hypoplasia (T3 agenesis) and bilateral XIIth rib agenesis, and V–VI and VII–VIII–IX fused ribs on the right side. We applied a standard VEPTR in a new construct, vertebra to vertebra.ResultsThe VEPTR vertebra to vertebra proved to be an efficient and stabile construct after 1.5 years of follow-up and three device distractions in a row. The curve corrected from 100 to 58 Cobb degrees.ConclusionsWe believe that the vertebra-to-vertebra construct with eventual modifications may be a solution in the treatment of early-onset scoliosis needing surgery, which associate rib agenesis in the area where the proximal module has to be applied.     

Efficacy of osteopathy and other manual treatment approaches for malocclusion – A systematic review of evidence

Backgroundand objectivesThe osteopathic literature often underlines the need for manual treatment of malocclusion. This literature review will investigate the efficacy of osteopathic and other manual treatment approaches for malocclusion.Data sourcesA systematic literature review was undertaken by searching medical and osteopathic databases (Pubmed, DIMDI, Osteopathic Research Digital Repository, Physiotherapy Evidence Database (PEDro), www.chiroindex.org, www.osteopathic-research.com). Other relevant osteopathic journals that are not indexed (e.g. Osteopathische Medizin, Osteopathic Medicine and Primary Care) were also searched. The keywords ‘dental occlusion’ and ‘malocclusion’ were combined with keywords for various manual treatment approaches.Study selection and data extractionAs few hits were anticipated, the inclusion criteria were fairly wide and not too strict in terms of quality. Identified studies were categorized according to Sacketts' levels of evidence, and assessed using Downs and Black's quality checklist for healthcare interventions.ResultsOf 30 articles that met the inclusion criteria, 13 were experts' opinions with hardly any evidence. As such, this review focused on the remaining 17 studies: 12 case series, three case–control studies, one systematic review of case–control studies, and one methodologically weak randomized controlled trial. Most of the studies in this review were of poor quality. By applying Downs and Black's quality assessment tool problems with internal and external validity could be identified. Most of the studies had confounding or selection bias. Only three studies attained more than half of the maximum score on the Downs and Black's quality assessment tool.ConclusionsA few studies reported some changes in malocclusion associated with osteopathy and other manual treatment approaches. As such, there is a need for high-quality research in this area.