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Int Surg. 1998 Oct-Dec;83(4):343-6.
An unusual location of cloacogenic carcinoma.

Indinnimeo M, Cicchini C, Stazi A, Limiti MR, Ghini C.

First Department of Surgery, University of Rome La Sapienza, Roma, Italy.

A 61 year-old female presented with abdominal pain, rectal bleeding, mucus discharge, tenesmus and constipation. Rectal examination and proctoscopy demonstrated rectal stenosis at 5 cm from the anal verge. Transrectal ultrasonography detected a capsulated lesion as a mesenchymal rectal tumor. Computed tomography and endorectal magnetic resonance detected a mesenchymal lesion in the lower-middle rectal thirds. Serum TPA, GICA, SCC and CYFRA were pathological. At surgery the tumour was fixed to the levator ani muscle with rectal folding. Frozen sections of the levator ani muscle biopsies revealed cloacogenic tumour. Abdominoperineal resection was performed. The rectal lesion was cloacogenic carcinoma at 9 cm from the dentate line (pT4 pN0; Ki67 35%; CD31 181 vessels/mm2). Adjuvant radio-chemotherapy was performed. The patient is alive and disease free at 19 months. Extra-anal cloacogenic tumours are an unusual finding. Perhaps cloacal cells were originally present in the rectal wall, but secondary rectal involvement by cloacal remnant from the levator ani muscle cannot be excluded.

online pharmacy ref. source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10096758&dopt=Abstract

Ann Acad Med Singapore. 1998 Nov;27(6):824-9.
A descriptive study of the demography, symptomology, management and outcome of the first 300 patients admitted to an independent hospice in Singapore.

Low JA, Pang WS, Lee A, Shaw RJ.

Department of Geriatric Medicine, Alexandra Hospital, Singapore.

The aims of this study were: 1) to describe the demography, symptomology, investigations conducted, non-pharmacological interventions and outcome of patients admitted to an inpatient hospice and 2) to identify the nursing and medical needs of terminally ill patients. Case-notes of the first 300 patients admitted to Dover Park Hospice were studied retrospectively. There were 159 men and 141 women making up 325 admissions. The racial distribution was: Chinese 95.0%, Malays 3.0%, Indians 1.3% and Others 0.6%. Two-thirds of the men (64.2%) had spouses while 44.7% of the women were widowed. The mean age was 64.7 years. The 3 most common cancers were lung (21.7%), colorectal (14.6%) and hepatobiliary (12.5%). A proportion of patients (39.5%) were not known to have any metastases. Most patients were referred from hospitals and the home-care based Hospice Care Association. The commonest reason for admission was for "terminal care" (57.2%). At admission, only 38% of the patients were aware of their diagnoses and prognosis while 30% did not know either. The average length of stay was 25 days with 7.7% of patients having more than one admission. The most common symptoms were pain, anorexia, breathlessness, insomnia, constipation and dry skin. Non-pharmacological interventions ranged from manual evacuation of the rectum to transfers to tertiary hospitals for surgery and other more invasive interventions. Many patients also attended day-care activities (23.1%). Outcome of the 325 admissions were as follows: went home 20%, died in the hospice 73.2%, went home to die 4.9% and others 1.8%.

online pharmacy ref. source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10101558&dopt=Abstract

J Gynecol Surg. 1993 Fall;9(3):165-8.
The role for laparoscopic presacral neurectomy.

Perry CP, Perez J.

AMI Brookwood Women's Medical Center, Birmingham, Alabama.

This study was carried out to determine the efficacy of laparoscopic presacral neurectomy (LPSN) and to define its role in modern gynecology using a prospective consecutive cohort. One hundred three patients underwent LPSN, and 87 were included in this study. After LPSN, 91% of these 87 patients experienced some decrease in pelvic pain, and a majority of patients had 50% or greater reduction in pain score. There was a highly significant difference among the preoperative and postoperative pain levels (p less than 0.0001). Patients with pain of endometriosis (72), primary dysmenorrhea (5), and chronic pelvic inflammatory disease (10) responded with a decrease in pain score to this procedure. Complications included 1 patient with intraoperative bleeding, 2 with postoperative vaginal dryness, and 1 with constipation. We conclude that LPSN is as effective as that performed by laparotomy and should be offered to patients undergoing operative laparoscopy for central dysmenorrhea and pelvic pain. This procedure should be performed only by expert endoscopists experienced in the anatomy of this region.

online pharmacy ref. source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10171990&dopt=Abstract

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