Malignant melanoma of the rectum: a case report

<p>Abstract</p> <p>Introduction</p> <p>Anorectal melanoma represents an unusual but important presentation of rectal malignancy. There have only been a few cases reported and the optimum management for this condition is still undecided, however, prompt diagnosis is essential. We have outlined current treatment options.</p> <p>Case presentation</p> <p>We report a case of malignant melanoma of the rectum in a 55-year-old Caucasian man presenting as an emergency with rectal bleeding. Biopsies were taken of the fleshy mass found on digital examination, which confirmed malignant melanoma. No distant metastases were found. He underwent an abdominoperineal resection. We report the surgical management of this rare and aggressive malignancy.</p> <p>Conclusion</p> <p>Treatment options for this condition are divergent. Surgical management varies from wide local excision to abdominoperineal resection. Clinical awareness in both medical and surgical clinics is required for prompt diagnosis and treatment.</p

The introduction of an orthogeriatrician, co-led, collaborative hip fracture pathway within an orthopaedic trauma department

Hip fractures usually occur within the elderly population following minor trauma such as a fall or blow to the side of the body and is primarily caused by the common bone disease osteoporosis. This chronic asymptomatic condition affects both men and women and is frequently referred to as the ‘new epidemic’ (British Orthopaedic Association, 2007 (BOA)). Hip fracture is a prevalent and major global health problem, often leading to untimely death, increased rates of morbidity and reduction in quality of life, (Marks, 2010). It is the most usual reason for admission to an orthopaedic trauma unit (NICE, 2012a) and those who succumb to hip fracture tend to be frail and elderly with multiple co-morbidities leading to prolonged episodes of inpatient care and associated significant inpatient mortality, (Robert et al., 2003). Due to the prevalence of hip fracture, poor clinical outcomes and multiple rehabilitative and social needs of this population of patients, an alliance has been formed between orthopaedic surgeons and geriatrician consultants leading to the application of several models of combined care, adopted internationally to improve the outcome of hip fracture patients, (Fisher et al., 2006). It is clear from the epidemiology of hip fracture and its associated social and healthcare expenditure that a coordinated and collaborative multidisciplinary approach to hip fracture management is imperative in ensuring high quality, cost-effective care, (NICE, 2012a). The purpose of this dissertation is to propose that through replacing the local Trust existing hip fracture pathway ‘traditional model of orthopaedic’ care with a ‘combined orthogeriatric care model’ will result in enhanced standards of care alongside improved patient clinical outcomes whilst ensuring that the organisation also meets local and national best practice standards. This dissertation demonstrates a structured and determinative approach to the implementation of the proposed change through the utilisation of various change models, approaches and tools. It also provides an evaluative account of the change, a fundamental and systematic action of all improvement initiatives, (NHS, 2005) through the utilisation of service evaluation methodology to demonstrating whether the implemented change is able to deliver the intended objectives of the project, including improved patient clinical outcomes and organisational improvement in meeting national best practice standards

Gluten Induces Subtle Histological Changes in Duodenal Mucosa of Patients with Non-Coeliac Gluten Sensitivity: A Multicentre Study

Background: Histological changes induced by gluten in the duodenal mucosa of patients with non-coeliac gluten sensitivity (NCGS) are poorly defined. Objectives: To evaluate the structural and inflammatory features of NCGS compared to controls and coeliac disease (CeD) with milder enteropathy (Marsh I-II). Methods: Well-oriented biopsies of 262 control cases with normal gastroscopy and histologic findings, 261 CeD, and 175 NCGS biopsies from 9 contributing countries were examined. Villus height (VH, in mu m), crypt depth (CrD, in mu m), villus-to-crypt ratios (VCR), IELs (intraepithelial lymphocytes/100 enterocytes), and other relevant histological, serologic, and demographic parameters were quantified. Results: The median VH in NCGS was significantly shorter (600, IQR: 400-705) than controls (900, IQR: 667-1112) (p &lt; 0.001). NCGS patients with Marsh I-II had similar VH and VCR to CeD [465 mu m (IQR: 390-620) vs. 427 mu m (IQR: 348-569, p = 0 center dot 176)]. The VCR in NCGS with Marsh 0 was lower than controls (p &lt; 0.001). The median IEL in NCGS with Marsh 0 was higher than controls (23.0 vs. 13.7, p &lt; 0.001). To distinguish Marsh 0 NCGS from controls, an IEL cut-off of 14 showed 79% sensitivity and 55% specificity. IEL densities in Marsh I-II NCGS and CeD groups were similar. Conclusion: NCGS duodenal mucosa exhibits distinctive changes consistent with an intestinal response to luminal antigens, even at the Marsh 0 stage of villus architecture

Gluten induces subtle histological changes in duodenal mucosa of patients with non-coeliac gluten sensitivity: a multicentre study

Background: Histological changes induced by gluten in the duodenal mucosa of patients with non-coeliac gluten sensitivity (NCGS) are poorly defined. Objectives: To evaluate the structural and inflammatory features of NCGS compared to controls and coeliac disease (CeD) with milder enteropathy (Marsh I-II). Methods: Well-oriented biopsies of 262 control cases with normal gastroscopy and histologic findings, 261 CeD, and 175 NCGS biopsies from 9 contributing countries were examined. Villus height (VH, in μm), crypt depth (CrD, in μm), villus-to-crypt ratios (VCR), IELs (intraepithelial lymphocytes/100 enterocytes), and other relevant histological, serologic, and demographic parameters were quantified. Results: The median VH in NCGS was significantly shorter (600, IQR: 400–705) than controls (900, IQR: 667–1112) (p &lt; 0.001). NCGS patients with Marsh I-II had similar VH and VCR to CeD [465 µm (IQR: 390–620) vs. 427 µm (IQR: 348–569, p = 0·176)]. The VCR in NCGS with Marsh 0 was lower than controls (p &lt; 0.001). The median IEL in NCGS with Marsh 0 was higher than controls (23.0 vs. 13.7, p &lt; 0.001). To distinguish Marsh 0 NCGS from controls, an IEL cut-off of 14 showed 79% sensitivity and 55% specificity. IEL densities in Marsh I-II NCGS and CeD groups were similar. Conclusion: NCGS duodenal mucosa exhibits distinctive changes consistent with an intestinal response to luminal antigens, even at the Marsh 0 stage of villus architectur