Colorectal liver metastases that are ineligible for resection can be safely and effectively treated with interstitial mTHPBC-based PDT.

Background: Gastro-Intestinal stromal tumours (GISTs) are rare and our understanding of their natural history and optimal treatment are continually evolving. Port site metastasis after laparoscopy for a GIST is an extremely rare phenomenon.

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The growth of 32 untreated colorectal liver metastases and hepatic parenchymal volume in 11 patients were studied using planimetry of computed tomographic images. The median percentage hepatic replacement (PHR) of metastases was 0.49 (range 0.09-18.2). At subsequent assessment a median of 72 (range 14-235) days later, metastases were significantly larger with a median PHR of 1.78 (range 0.10-22.9) (P < 0.001). To compare the growth of metastases with variable PHR, logarithmic changes of PHR over 100 days were studied. This parameter was shown to be reduced in metastases of larger volume. The median (interquartile range) non-neoplastic hepatic parenchymal volume was found to increase from 1839 (1647-1997) to 2200 (1590-2401) cm3 (P = 0.005) as metastatic burden increased. These findings suggest that the growth of colorectal hepatic metastases is more complex than a simple process of hepatic replacement.

The natural history of patients with colorectal hepatic metastases was studied following resection of the primary tumour. Patients were stratified according to the presence of extrahepatic disease and the percentage hepatic replacement (PHR) measured by planimetry of computed tomographic images. The median(semi-interquartile range (s.i.r.)) PHR of patients without extrahepatic disease was 15.0(10.5) and for those with extrahepatic disease 5.4(2.2) (P less than 0.02). The median(s.i.r.) PHR of all patients was 8.7(8.5). The median(s.i.r.) survival of all patients was 125(85.5) days, 92(114) days for patients with extrahepatic disease and 175(133.5) days for patients with disease confined to the liver (P less than 0.02). A linear correlation between the natural logarithm of PHR and survival was demonstrated (p = -0.76, P less than 0.001) for patients without extrahepatic disease. Extrahepatic disease in patients with colorectal hepatic metastases is a major determinant of survival; PHR has a direct association when extrahepatic disease is absent.

A 75-year old lady underwent a routine laparoscopic cholecystectomy during which stones were spilled into the peritoneal cavity. Despite peritoneal lavage the patient developed chronic right upper quadrant discomfort and a pleural effusion over several months. Following the production of a pigmented bilirubin stone in her sputum the patient’s symptoms resolved. Cholelithoptysis is a rare complication of laparoscopic cholecystectomy, the diagnosis should be considered in patients with prolonged chest symptoms after surgery.

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There is a certain volume of urine left within the bladder which cannot be drained by a catheter. A dilutional method was used to calculate this residual volume in 15 men; 10 had acute retention secondary to benign prostatic hyperplasia and 5 had permanent indwelling catheters for neurogenic urinary incontinence. The mean catheterised residual volume was 98.53 ml for patients with acute retention and 14.48 ml for patients with long-term catheters. The explanation for higher post-catheterisation volumes in the acute retention group is probably multifactorial; bladder sacculation and diverticula, detrusor tone and reflux may all play a role.