Small bowel volvulus resulting from a congenital band treated laparoscopically

In recent years, laparoscopy has dramatically changed the approach to the patient with acute abdominal pain. We report the case of a patient with small bowel volvulus caused by a congenital band binding the greater omentum to the mesentery, which was promptly diagnosed and treated using laparoscopy. Early intervention averted irreversible ischemic lesions of the intestine and the need for bowel resection. With the routine use of laparoscopy in the setting of acute abdominal pain, rare affections can be easily diagnosed and effectively treated.     

Adjuvant chemotherapy after resection in elderly Medicare and Medicaid patients with colon cancer

BACKGROUND: This study investigated the influence of Medicaid enrollment on the receipt and completion of adjuvant chemotherapy and the likelihood of evaluation by an oncologist for those patients who do not initiate chemotherapy. METHODS: Medicaid and Medicare administrative data were merged with the Michigan Tumor Registry to extract a sample of patients who had resection for a first primary colon tumor diagnosed between January 1, 1997, and December 31, 2000 (n = 4765). We used unadjusted and adjusted logistic regression to assess the relationship between Medicaid enrollment and the outcomes of interest. RESULTS: Relative to Medicare patients, Medicaid patients were less likely to initiate chemotherapy (odds ratio, 0.50; 95% confidence interval, 0.39-0.65) or complete chemotherapy (odds ratio, 0.52; 95% confidence interval, 0.31-0.85). When the sample was restricted to patients with TNM-staged disease, Medicaid patients were less likely to initiate chemotherapy. Older patients and patients with comorbidities were also less likely to initiate or, in some cases, to complete chemotherapy. CONCLUSION: Medicaid enrollment is associated with disparate colon cancer treatment, which likely compromises the long-term survival of these patients.     

The Utility of the State Buy-In Variable in the Medicare Denominator File to Identify Dually Eligible Medicare-Medicaid Beneficiaries: A Validation Study

Objective. To compare the adequacy of the state buy-in variable (SBI) in the Medicare denominator file to identify dually eligible patients.
Data Source/Study Settings. We used linked Medicare and Medicaid data from Michigan and Ohio for elders diagnosed with incident breast, prostate, or colorectal cancer between 1996 and 2001.
Study Design. Using the Medicaid enrollment file as the "gold standard," we assessed the number of duals from Medicare files in cross-sectional and longitudinal analyses.
Data Collection/Extraction Methods. Data for the study population were linked with Medicare and Medicaid files using patient identifiers.
Principal Findings. Sensitivity was low (74.2 percent, 95 percent confidence interval [CI]: 72.7, 75.6 and 80.8 percent, 79.7, 81.9, in Michigan and Ohio, respectively). PPV was above 95 percent in Michigan and 88.8 percent in Ohio. Both sensitivity and PPV varied between and within the states. Both in Michigan and in Ohio, we observed limited agreement on the length of enrollment in Medicaid between the two data sources.
Conclusions. Except to examine disparities by dual status at a very broad level, the SBI variable alone may be inadequate to identify duals. The findings call for improvements in Medicare and Medicaid information management systems and for uniformity in database linking strategies.     

Time away from work: employed husbands of women treated for breast cancer

Purpose

We estimated the effect of cancer and its treatment on employment and weekly hours worked for employed men whose wives were newly diagnosed with breast cancer.

Methods

We collected employment data on 373 married, insured, and employed men from 2007 to 2011. The outcomes were employment, any decrease in weekly hours worked, and change in weekly hours worked from pre-diagnosis to 2 and 9 months following treatment initiation relative to a non-cancer control group (N?=?451 for the 2-month survey and N?=?328 for the 9-month survey) extracted from the Current Population Survey. We also stratified the cancer sample by those undergoing chemotherapy and radiation treatment at the time of the interviews and repeated the analysis.

Results

Men whose wives were newly diagnosed with cancer were more likely to decrease weekly hours worked (p?<?0.05) 2 months following treatment initiation than men in the control group. However, the change in weekly hours worked was not statistically significantly different from the change experienced by men in the control group. No differences between the two groups were observed at the 9-month interview.

Conclusions

Breast cancer treatment had a small, negative effect on work outcomes in employed husbands of affected women.

Implications for cancer survivors

While the results were generally favorable, more research is needed to understand the extent to which caregiving needs are met in an employed cancer population.     

Ovarian metastasis from choroidal melanoma

Ocular melanoma has a strong tendency to metastasize often several years after its initial diagnosis was made. We report on the case of a 50-year-old woman who was treated 20 years earlier for an ocular melanoma and currently seen regularly in our institute for liver metastases that were treated by chemotherapy. After three treatments, a check-up with computed tomography demonstrated the presence of a right ovarian mass. An ovariectomy was performed, and the pathological examination confirmed the diagnosis of an ovarian metastasis from an ocular melanoma. This is the fourth case of metastasis to the ovary from an ocular melanoma reported in the medical literature.     

Laparoscopic fenestration for a symptomatic simple cyst of the spleen

Benign nonparasitic cysts of the spleen are a rare entity. Surgical treatment is indicated when they become symptomatic. Splenic conservative techniques are preferred, given the important immunologic role of the spleen. Laparoscopy has been used in the treatment of different splenic diseases with favorable results in terms of reduced postoperative discomfort, duration of hospital stay, and better cosmetic results. We report the case of a 35-year-old woman with a symptomatic simple cyst of the spleen that underwent a laparoscopic fenestration. The diagnostic and therapeutic implications are discussed focusing on the role of laparoscopy.     

Vaginal evisceration. Report of a new case

Vaginal evisceration is rare and most commonly found in postmenopausal women. We report the case of a postmenopausal woman due to ruptured enterocele. Surgical treatment was done through a midline laparotomy and consisted of bowel resection with primary anastomosis and vaginal vault suture repair. Risk factors for this rare clinical entity are discussed along with the different therapeutic options.