Laparoscopic rectal resection for deeply infiltrative endometriosis is feasible and safe, and it provides durable symptom control with acceptable recurrence rates.

The risk of harboring occult metastasis in levels I, IV, and V when levels II and III are negative is low. Levels II and III neck dissection is likely to be an effective staging procedure in patients with isolated parotid metastases.

This case demonstrates that lymphangiography can be used as a therapeutic measure in the management of a chylothorax.

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Background: There is increasing evidence that uncomplicated acute diverticulitis (UAD) can be safely and effectively managed as an outpatient. The aim of the current study was to evaluate if an early computed tomography (CT) scan in the emergency department (ED) can reduce the number of hospital admissions when UAD is diagnosed, without compromising patient safety. Methods: A protocol was introduced in 2015, whereby patients with suspected diverticulitis receive a CT scan on presentation to the ED and be considered for discharge home on oral antibiotics if UAD is confirmed. A retrospective analysis of a prospectively collected database was conducted for all patients presenting to the ED with acute diverticulitis over a 4-year period: 2 years prior (May 2013-April 2015; pre-protocol) and 2 years after implementation of the protocol (May 2015-April 2017; post-protocol). Results: A total of 1147 patients presented to the ED, who were diagnosed with diverticulitis, and UAD was confirmed in 552 patients. There was a significant decrease in hospital admissions for UAD in the post-protocol group from 93% to 39% (P < 0.0001) and in the total number of hospital admission days from 602 to 370 (P < 0.0001). There was no increase in representations between both periods (7% versus 6%; P = 0.49). Conclusion: Definitive diagnosis by early CT scan in the ED decreased the admission rate for UAD by more than 50%, and significantly reduced the total number of hospital days without resulting in an increase in representations. UAD can safely and effectively be treated in an outpatient setting leading to a reduction in the burden on the health system.

Both polycyclic aromatic hydrocarbons (PAHs) and legacy organochlorine insecticides (OCPs), including DDT, are dangerous chemical contaminants. The aims of this study were to (i) determine background levels of PAHs and legacy OCPs for wheat samples collected in 2017 and 2018 in Poland, (ii) identify differences between levels in wheat harvested in various regions of Poland, (iii) evaluate differences in contamination sources manifested by the profiles of the identified chemicals, (iv) identify possible correlations between different classes of chemicals present in wheat, and (v) assess the health risks associated with the presence of PAHs and OCPs in Polish wheat. Average concentrations found in the samples were 0.09 ± 0.03 μg kg −1 for benzo[a]pyrene (BaP) (formerly used as a single PAH marker), 0.43 ± 0.16 for the more recently introduced collective PAH 4 marker (benzo[a]anthracene + benzo[a]pyrene + chrysene + benzo[b]fluoranthene), and 1.07 ± 0.68 μg kg −1 for DDT and its metabolites. The PAH profiles indicated contamination from combustion-related emission sources (liquid fossil fuels, coal, biomass). Health risks associated with the presence of PAHs and OCPs in cereals were assessed using the margin of exposure (MOE) approach. The MOE values calculated based on the highest concentrations found in this study exceeded 50,000 for both BaP and PAH 4. The calculated worst-case scenario value for DDT and metabolites was as low as 0.3% of the respective tolerable daily intake (TDI) value. Assessment of dietary risk has shown that the presence of the two contaminant classes in Polish wheat grains is of low concern.

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