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We reported a case of 79-year old woman with known large bowel diverticulosis presenting with small bowel obstruction due to stone impaction - found on plain abdominal X-ray. Contrast studies demonstrated small bowel diverticulosis. At laparotomy, the gall bladder was normal with no stones and no abnormal communication with small bowel - excluding the possibility of a gallstone ileus. Analysis of the stone revealed a composition of bile pigments and calcium oxalate. This was a rare case of small bowel obstruction due to enterolith formation - made distinctive by calcification (previously unreported in the proximal small bowel).

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The purpose of this study was to examine a previous increase in male gallstone disease and to consider the burden of gallstones in a necropsy study with matched controls over a decade. Gallstone prevalence in 5,050 males fell from 20.2% to 19.1% (P=0.022) and in 4,125 females fell from 30.4% to 29.0% (P=0.03). Female gallstone subjects had a higher BMI than controls 24.5 vs. 23.3 (P<0.01), but males did not. Gallstones were twice as common in diabetics, but not with coronary heart disease (CHD). A third of elderly patients of both sexes had gallstones, but cholecystectomy was more common in females, 17:10%. Gallstone-related mortality was 0.7%. The prevalence of gallstones fell slightly. The association between gallstones and diabetes was confirmed, but not for CHD, and for BMI this was confined to females. Gallstones are very common in the elderly, but most are unoperated and seldom cause death.

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Hormone replacement therapy (HRT)-related breast cancer may carry a better prognosis since there is no increase in breast cancer deaths. We looked at the prognostic risk factors and outcome inpatients who had ever taken HRT compared to those who had not, in a case control study. Subgroups of recent-users and those using HRT for >5 years were also compared to controls. Tumor size, grade, vascular invasion, lymph node, and estrogen receptor status as well as median Nottingham Prognostic Indicator (NPI) were compared between cases and controls. Absolute survival between ever-users and never-users was compared by life table analysis. There was no difference between all the cases and their controls for the five prognostic factors. NPI in each group was also similar. Absolute survival between ever-users and never-users was not significantly different either (p = 0.678). There was no evidence that HRT-related breast cancer has a more favorable outcome.

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