Pancreatic ductal carcinoma continues to be the most lethal malignancy with rising incidence. It is the fourth most common cause of cancer death in the western world due to its low treatment success rate. In addition, because of its rapid growth and silent course, diagnosis is often only established in the advanced stages. As one of the most aggressive malignancies, the treatment of this disease is a great challenge to clinicians. This paper reviewed the natural history of pancreatic cancer, the current clinical practice and the future in pancreatic cancer management.
We present a case of an unsual type of obstructed indirect inguinal hernia with impending strangulation. The operative findings revealed a sliding Maydl's hernia with an ischemic inner ileal loop and an adherent inflamed appendix. This case highlights the importance of intraoperative examination of the intra-abdominal bowel loops proximal to the hernia sac of an incarcerated, obstructed, or strangulated hernia.
Typhoidal salmonellosis and amoebiasis are prevalent in the Buea Health District (BHD) and it is evident that hand hygiene can reduce the transmissibility of these diseases. The barrier measures enforced by the government, in the wake of the corona virus disease 2019 (COVID-19) pandemic has led to behavioural changes which may have had an influence on the positivity rate of these diseases. This study seeks to determine the influence of COVID-19 barrier measures and the implementation of COVID-19 vaccination on the positivity rate of typhoidal salmonellosis and amoebiasis in the BHD. A retrospective study, with purposive and random sampling methods were used to select health facilities in BHD, whose laboratory records were reviewed using a data extraction form to obtain health information of patients who tested for typhoidal salmonella and/or Entamoeba histolytica from June 1, 2018 to December 31, 2021. Chi-square test was used to compare the positivity rate in the pre-and-COVID-19 and in the pre-and-vaccination era. The positivity rate of typhoidal salmonellosis and amoebiasis dropped from 57.8% and 2.7% in the pre-COVID-19 era to 34% and 1.8% in the COVID-19 era respectively, which were significant (χ2 = 945.8; P<0.001 and χ2 = 11.8; P = 0.001 respectively). Within the COVID-19 era, the positivity rate of salmonellosis and amoebiasis decreased from 39% and 2.6% before the implementation of COVID-19 vaccination to 27.7% and 0.8% respectively in the COVID-19 vaccination era and these differences were significant (χ2 = 149.1; P<0.001 and χ2 = 33.8; P<0.001 respectively). However, the positivity rate of salmonellosis between the rainy (43.5%) and the dry (42.8%) seasons and amoebiasis between the rainy (2.2%) and the dry (2%) seasons were not significantly different (χ2 = 0.6; P = 0.429 and χ2 = 0.54; P = 0.463 respectively). A significant decline in the positivity rate of typhoidal salmonellosis and amoebiasis was observed after the implementation of COVID-19 barrier measures and vaccination.
BackgroundFamilial adenomatous polyposis (FAP) is caused by a rare mutation of the adenomatous polyposis coli gene on Chromosome 5q. The risk of colorectal cancer in patients with FAP is nearly 100 % and intensive endoscopic surveillance or prophylactic colectomy are mandatory. If extensive endoscopic surveillance is chosen, there is a cumulative risk of perforation and bleeding especially after polypectomy. We discussed the problems and options in the management of the late diagnosis of an iatrogenic perforation of the splenic flexure complicating endoscopic surveillance in FAP.Case presentationWe present a 35-year-old black African man with FAP who sustained a splenic flexure perforation following a colonoscopic polypectomy of a suspicious lesion. He underwent a splenic flexure resection and primary anastomosis that dehisced and the patient benefited from an emergency definitive colectomy and ileorectal anastomosis.ConclusionsResection with primary anastomosis following iatrogenic perforation of the splenic flexure is not safe because of a high chance of anastomotic dehiscence. Following a late diagnosis in an unstable patient exteriorization of the perforation as a stoma is a better option prior to a definitive prophylactic colectomy.
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