Intussusception of the small bowel secondary to malignant metastases in two 80-year-old people: a case series

<p>Abstract</p> <p>Introduction</p> <p>Small bowel intussusception is rare in adults and accounts for one percent of all bowel obstructions. Malignancy is the etiologic agent in approximately 50 percent of all cases.</p> <p>Case presentation</p> <p>Our first patient was an 80-year-old Caucasian woman with signs and symptoms of intermittent bowel obstruction for the last 12 months. Pre-operative investigation by abdominal computed tomography scanning revealed an obstruction at the ileocecal valve. Exploratory laparotomy revealed an ileocecal intussusception. She underwent an enterectomy. Histological examination showed metastatic breast cancer (lobular carcinoma). Our patient had previously undergone a mastectomy due to carcinoma three years earlier.</p> <p>Our second patient was an 80-year-old Caucasian man with signs and symptoms of acute bowel obstruction. Pre-operative investigation by abdominal computed tomography scanning showed an intussusception in the proximal part of the small bowel. Exploratory laparotomy revealed a jejunojejunal intussusception. He underwent an enterectomy. Histological examination showed metastatic melanoma. Our patient had a prior history of a primary cutaneous melanoma which was excised two years ago.</p> <p>Conclusion</p> <p>Pre-operative determination of the etiologic agent of intussusception in the small bowel in adults is difficult. Although a computed tomography scan is very helpful, the diagnosis of intussusception is made by exploratory laparotomy and histological examination defines the etiologic agent. A prior malignancy in the patient's history must be taken under consideration as a possible cause of intussusception.</p

mmb: Flexible High-Speed Userspace Middleboxes

peer reviewedNowadays, Internet actors have to deal with a strong increase in Internet traffic at many levels. One of their main challenge is building high-speed and efficient networking solutions. In such a context, kernel-bypass I/O frameworks have become their preferred answer to the increasing bandwidth demands. Many works have been achieved, so far, all of them claiming to have succeeded in reaching line-rate for traffic forwarding. However, this claim does not hold for more complex packet processing. In addition, all those solutions share common drawbacks on either deployment flexibility or configurability and user-friendliness. This is exactly what we tackle in this paper by introducing mmb, a VPP middlebox plugin that allows, through an intuitive command-line interface, to easily build stateless and stateful classification and rewriting middleboxes. mmb makes a careful use of instruction caching and memory prefetching, in addition to other techniques used by other high-performance I/O frameworks. We compare mmb performance with other middlebox solutions, such as kernel-bypass framework and kernel-level optimized approach, for enforcing middleboxes policies (firewall, NAT, transport-level engineering). We demonstrate that mmb performs, generally, better than existing solutions, sustaining a line-rate processing while performing large numbers of complex policie

Evaluating the Impact of Path Brokenness on TCP Options

peer reviewedIn-path network functions enforcing policies like firewalls, IDSes, NATs, and TCP enhancing proxies are ubiquitous. They are deployed in various types of networks and bring obvious value to the Internet. Unfortunately, they also break important architectural principles and, consequently, make the Internet less flexible by preventing the use of advanced protocols, features, or options. In some scenarios, feature-disabling middlebox policies can lead to a performance shortfall. Moreover, middleboxes are also prone to enforce policies that disrupt transport control mechanisms, which can also have direct consequences in term of Quality-of-Service (QoS). In this paper, we investigate the impact of the most prevalent in-path impairments on the TCP protocol and its features. Using network experiments in a controlled environment, we quantify the QoS decreases and shortfall induced by feature-breaking middleboxes, and show that even in the presence of a fallback mechanism, TCP QoS remains affected