Alpha 1 (Lns 1/3) is prominent in BM, but is replaced by a laminin matrix rich in alpha3 (Lns 5,6,7) and alpha5 (Lns 10/11) in benign adult prostate glands. In carcinoma, both alpha1 (Lns-1/3) and alpha3 (Lns 5,6,7) are not expressed with persistence of a BM rich in alpha5 (Lns 10/11).

SummaryBackground:Central venous access devices for chemotherapy are being used extensively in patients with cancer. Spontaneous fracture and migration of the catheter is uncommon. We present the uncommon occurrence of a fracture and spontaneous migration of the fragment into the internal jugular vein as a delayed complication of a central venous access catheter implanted for chemotherapy administration.Case Report:A patient with Ewing’s sarcoma of the humerus with metastasis in the lungs underwent placement of a totally implantable venous access device. The port was in place for 1 year. The patient presented with pain in the right side of the neck. A chest X-ray demonstrated complete transection of the catheter and migration of the catheter fragment in the internal jugular vein. Both the migrated catheter fragment and the proximal part of the catheter were retrieved surgically. He had an uneventful recovery.Conclusions:Catheter fracture remains a potential complication, which must be recognized and treated promptly. Periodic chest imaging is recommended for detection and timely removal of the catheter.

ALND is part of primary management of breast cancer.

SummaryBackground:Biliary tract involvement in acute necrotizing pancreatitis is rare.Case Report:We report a case of a 53-year-old man who had a pancreatic choledochal fistula complicating acute necrotizing pancreatitis. The fistula was suspected at computed tomography and confirmed at surgery. The patient underwent necrosectomy, cholecystectomy and proximal biliary diversion. He is well at 1-year follow-up.Conclusions:Simultaneous presence of air in the biliary tree and pancreatic collection is highly suggestive of a pancreaticobiliary fistula. Pancreatic necrosectomy and proximal biliary diversion resulted in closure of the fistula.

Abdominal pain and abnormal coagulation profile in patients on oral anticoagulants should alert the clinician to consider intramural hematoma. Early diagnosis is essential, as patients are successfully managed conservatively with good outcome.

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The purpose of this prospectively collected database is to evaluate the safety of placement of a feeding jejunostomy (FJ) in patients undergoing upper gastrointestinal surgery and evaluating the gastrointestinal (GI) and mechanical complications. A total of 46 consecutive patients who underwent upper gastrointestinal surgery for various benign and malignant diseases were included. All of these patients underwent Witzel feeding jejunostomy at the time of laparotomy. The patients were followed postoperatively to record the gastrointestinal and/or mechanical complications that occurred during the hospital stay of the patients. Feeding jejunostomy could be performed in 100% of the patients and postoperatively, jejunostomy feeds could be started in 97.8% of the patients. 34.8% of the patients underwent an emergency laparotomy; 81.25% of the patients in the emergency group developed a significant postoperative FJ related complications with significant mechanical complications in the emergency group. GI complications were 82.14%; diarrhea was the most frequently encountered (69.5%). GI complications were more frequent and significant in patients with a low preoperative serum albumin (< 3.5 g/dl). No mortalities were recorded as a direct consequence of a FJ. Jejunostomy feeding is an excellent method of providing enteral nutritional support in patients undergoing major abdominal surgery and in patients with upper aero digestive tract pathologies who cannot be fed by mouth. Tube feeding is associated with complications which are minor and self-limiting or can be managed by simple bedside maneuvers. Feeding jejunostomy should be considered in all patients who may require short-or long-term enteral nutrition.