1 Melanoma’s metastases are usually multiple ulcerated polypoid lesions, either pigmented or amelanotic, and may present at the time of diagnosis or years later.1 Surgical interventions for symptomatic patients with melanoma metastases of selleck chemicals the GI tract may be considered
for both palliation of symptoms and improvement in mortality.4 New therapeutic possibilities were recently developed, such as vemurafenib and ipilimumab, and while they still have limitations, they are the beginning of a new generation of therapies.5 Therapeutic decisions, especially in stage IV patients, should be managed by and interdisciplinary oncology team.4 The authors declare that no experiments were performed on humans or animals for this study. The authors declare that they have followed the protocols of their work centre on the publication of patient data and that all the patients included in the study received sufficient information and gave their written informed consent to participate in the study. The authors declare that no patient data appear in this article. The authors have no conflicts of interest to Selleck PLX 4720 declare. “
“Choledocholithiasis occurs in 8–20% of patients with gallstones.1 The rate of spontaneous migration of bile duct stones through the duodenal papilla is not
well known.1 An impacted bile duct stone at duodenal papilla can be associated with either cholangitis due to the complete obstruction of the bile outflow or acute pancreatitis. Endoscopic retrograde cholangiopanteatography (ERCP) has been established as the standard treatment for impacted bile duct stones. We report a case of a patient with impacted bile duct stone who underwent needle-knife fistulotomy avoiding the papillary orifice followed by standard papillotomy for the removal of the impacted stone. A 61-year-old woman 2-hydroxyphytanoyl-CoA lyase with a past history of diabetes mellitus
type 2, hypertension and laparoscopic cholecystectomy performed one year ago, was admitted in the emergency room with epigastric pain, vomiting and fever. Physical examination showed jaundice and tenderness over the epigastrium. Significant laboratory results included 11,300 × 109/L leukocytes, C-reactive protein 6.8 mg/dL (normal value < 0.5 mg/dL), total bilirubin 3.4 mg/dL (range, 0.2–1.0), aspartate transaminase 89UI/L (range, 5–39) and alanine transaminase 206 UI/L (range, 10–49). An abdominal ultrasound showed extra-hepatic bile duct dilatation (10 mm). A CT scan showed an impacted stone at duodenal papilla. ERCP was performed and the diagnosis of an impacted bile duct stone at duodenal papilla was confirmed. The patient underwent unsuccessfully needle-knife precut papillotomy to achieve deep cannulation.