Goblet cell carcinoid of the appendix: laparoscopic appendectomy or right hemicolectomy?

Goblet cell carcinoids are uncommon tumours with histological features of both adenocarcinoma and carcinoid tumour. They occur predominantly in the appendix and although the malignant potential remains unclear, adenocarcinoids appear to be more aggressive than conventional carcinoids. In this case report, we present a goblet cell carcinoid with laparoscopic operative treatment in two stages. A 43-year-old female patient with constant dullness in the right lower quadrant was diagnosed with acute appendicitis and underwent laparoscopic appendectomy. Macroscopically, a diffusely inflamed appendix was found with no sign of perforation. Histopathological examination revealed a goblet cell carcinoid with characteristics of aggressive behaviour, indicating the need for laparoscopic right hemicolectomy in which, however, neither residual tumour nor metastatic lymph nodes could be found. The postoperative course was uneventful. As they may present the same clinical presentation, pathological diagnosis is required to distinguish goblet cell carcinoid from acute appendicitis. Two-stage surgery for goblet cell carcinoid is advocated in the literature, but the debate still continues as to whether the goblet cell carcinoid should be treated by appendectomy alone, as for most carcinoids, or by right hemicolectomy, as for the appendiceal adenocarcinoma.     

Bone turnover during short-term therapy with methylprednisolone or budesonide in Crohn's disease

Background:

Glucocorticosteroids are used frequently for the treatment of relapses of Crohn’s disease.

Aim:

To investigate the influence of the new topically active glucocorticosteroid budesonide in comparison with methylprednisolone on bone turnover in a randomized open trial.

Methods:

Twenty-nine patients received either budesonide (controlled ileal release formulation) 9 mg for 10 weeks, or methylprednisolone 32 mg (equivalent to 40 mg prednisone) orally for 3 weeks with subsequent tapering.

Results:

Patients who completed the trial with methylprednisolone (n = 8) had suppression of serum osteocalcin (30.2 ± 2.6 to 20.4 ± 2.0 ng/mL, P < 0.01), whereas no changes in this parameter of bone synthesis were observed during budesonide treatment (n = 11) (34.8 ± 3.1 to 33.0 ± 3.5 ng/mL). Urinary pyridinolines and deoxypyridinolines, highly sensitive markers of bone degradation, did not change in either group.

Conclusion:

Short-term methylprednisolone therapy impairs osteoblast activity in patients with Crohn’s disease whereas budesonide does not.

     

Bone banking in a community hospital

Major orthopaedic operations are now also performed in community hospitals. Because allografts are sometimes used during these procedures, local bone banking could become an essential tool. We evaluated the indications and results of the allografts from the local bone bank used in our institution. The financial aspect was also examined. Of the 131 allografts stored in our bone bank, only 20 were discarded. Postoperative follow-up showed good ingrowth of the grafts except for one graft failure. There were no superficial or deep postoperative infections. All cultures taken during implantation remained negative. These data suggest that bone banking in a community hospital is a safe and practical alternative to address the ongoing demand of bone grafts in a small orthopaedic practice. Financial costs are reasonable. In our experience, bone banking also broadens the spectrum of orthopaedic operations that can be performed in an orthopaedic unit.     

Symptomatic linea arcuata hernia

Hernias are often associated with congenital defects or incisional breakdown. Even though most of the linea arcuata hernias are asymptomatic, we present a rare case of a symptomatic linea arcuata hernia with associated internal herniation of the colon sigmoideum in a woman without previous abdominal surgery.