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Upper GI tract endoscopy findings include adherent clot at the duodenum or infrequently active bleeding. CONTINUING MEDICAL EDUCATION áãÜÔåØÕThÛÔÜÖ ØÑâàØÙÖ ÔÙßÑØ ÔãáÖ ARCHIVES OF HELLENIC MEDICINE 2021, 38(2):278 ÁÑ×ÅÉÁ ÅËËÇÍÉÊÇÓ ÉÁÔÑÉÊÇÓ 2021, 38(2):278 Vascular Diseases Quiz - Case 58 N. Hasemaki, A. Alexandrou, C. Bakogiannis, C. Klonaris First Department of Surgery, Vascular Division, "Laiko" General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece ............................................... Urgent upper gastrointestinal tract (GI) endoscopy revealed adherent clot within the duodenum with no signs of active bleeding. [Extracted from the article]

Purpose: Obturator hernias (OH) are extremely rare hernias, accounting for 0.07–1% of all hernias. This is the first systematic review investigating their presentation, imaging, treatment outcomes, and recurrence rate. Methods: After a detailed search in electronic search engines, 74 studies matched our criteria. A review of these reports was conducted and the full texts were examined. Results: A total of 146 patients with a mean age of 78.8 years were included in our analysis, with 40.1%, 29.9%, and 25.2% of patients suffering from either a right, a left or bilateral OH, respectively. OH were associated with non-specific symptoms and signs; bowel obstruction being the most common. Howship–Romberg sign was present in 56.2% of patients. Computed tomography (CT) scan was the most frequently used diagnostic modality, inversely associated with perioperative mortality. Mesh repair demonstrated a significantly improved perioperative morbidity rate, compared with non-mesh repair. Approximately 30% of patients underwent a laparoscopic operation, which was associated with significantly decreased morbidity and mortality rate as well as length of hospital stay, compared with the open repair. Conclusion: OHs are not associated with specific symptoms and signs; thus, they constitute a diagnostic challenge, requiring a high level of clinical suspicion. Undoubtedly, CT scan of the abdomen is the gold standard diagnostic tool. Their operative repair is mandatory, with the laparoscopic approach demonstrating significant advantages over the open repair. [ABSTRACT FROM AUTHOR]

Esophageal melanoma is a rare and poorly described malignancy. We sought to review all available data on the clinicopathological features, management options, and outcomes of patients with esophageal melanoma to guide clinicians working to treat these uncommon tumors. A systematic literature search of the PubMed, Embase, and Cochrane databases was performed. Exploratory recurrence and survival analyses were performed using previously-validated pooled Cox and logistic regression techniques for case reports and case series. Quality assessment of included studies was performed using the tools developed by the Joanna Briggs and the National Heart, Lung, and Blood Institutes. Fifty-nine studies were reviewed. A total of 93 patients with esophageal melanoma were identified. The mean patient age was 61.2 ± 10.6 years. Esophageal melanoma usually developed at the lower esophagus (48.4%). 90.3% of the patients were symptomatic at presentation, with dysphagia being the most common symptom (72%). Esophagectomy was performed in 91.4% of the patients. Postoperatively, 14 patients (15.1%) received adjuvant chemotherapy. Tumor recurrence was seen in 37 patients (39.8%). The median time to recurrence was 6 months. Disease-specific mortality was 43%. All-cause mortality was 46.1%. On multivariable Cox regression, older patient age (hazard ratio [HR] = 0.91, P  = 0.008) and higher Melan-A expression (HR = 0.21; P  = 0.029) were associated with a significantly lower risk of mortality. Higher S100 levels (HR = 37.4; P  = 0.001) were predictive of poor survival. On logistic regression, large, ulcerated, lower esophageal tumors were significantly more likely to recur (P  = 0.018, P  = 0.013, and P  = 0.027 respectively). Esophageal melanoma is a rare malignancy that tends to present with dysphagia. Most surgically-treated patients undergo esophagectomy. Large, ulcerated, lower esophageal lesions recur more frequently. Immunohistochemistry provides prognostic information regarding survival. [ABSTRACT FROM AUTHOR]