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Oesophageal adenocarcinoma is the sixth most common cause of cancer death worldwide and Barrett's oesophagus is the biggest risk factor. We aimed to evaluate the efficacy of high-dose esomeprazole proton-pump inhibitor (PPI) and aspirin for improving outcomes in patients with Barrett's oesophagus.

A 69-year-old man, seven years post Ivor-Lewis oesophagectomy for oesophageal adenocarcinoma, was diagnosed to have a moderately differentiated 4 cm, malignant ulcer within the gastric tube remnant on an endoscopic biopsy. His original presentation was with a T1N0 oesophageal adenocarcinoma, histologically intestinal in type with inflammatory features. He presented with anaemia and melena due to a malignant ulcer in the mid body of his gastric tube on an endoscopy which was confirmed to be a gastric neo-adenocarcinoma on biopsy. He underwent right posterolateral thoracotomy and a wedge resection of the gastric tube including the tumour. Pathology confirmed a T3 N0 (0/7 lymph nodes) with clear margins moderately differentiated adenocarcinoma of intestinal phenotype with papillary features and was reported to be a histopathologically new tumour. Proposed surgical treatments in such patients are dependent on patient’s fitness for major resection and may vary from Endoscopic Mucosal Resection to partial resection with preservation of right gastroepiploic vessels or total gastrectomy with intestinal interposition via a retromediastinal route. We suggest that regular endoscopic surveillance may be indicated in such post-oesophagectomy patients as the number of patients developing gastric tube cancers may increase with improve survival of those patients.

False aneurysms of the profunda femoris artery as a complication of orthopaedic operative procedures have been well documented in the past. They have occurred after osteotomy of the proximal femur (Basset & Houck, 1964; Meyer & Slager, 1964; Dumanian & Kelikian, 1969; Mackenzie et al, 1983), intramedullary nailing of the femoral shaft (Dickson, 1968) and nail and plate operations for neck of femur fractures (Dameron, 1964; Fordyce, 1968; Wolfgang et al, 1974). Although usually pulsatile, several examples of nonpulsatile aneurysms have been reported (Mikulin & Walker, 1984; Read, 1984). Ultrasound is routinely used in the diagnosis of aortic aneurysms and, more recently, in the management of peripheral aneurysms (Davis et al, 1977; Gooding & Effeney, 1980). In the case we describe, ultrasound revealed a false aneurysm of the profunda femoris demonstrating its size and site, where clinical examination was inconclusive.An 85-year-old woman fell at home, sustaining a Garden Stage II transcervical fracture of the neck of the right femur.She underwent operative reduction and fixation with a four-hole dynamic hip screw introduced over a guide wire through a lateral approach. approach. Twelve days after the operation she complained of slight tenderness in her right leg and was noted to have mild, non-tender swelling from ankle to thigh. A presumptive diagnosis of deep venous thrombosis was made and she was treated with anti-embolism stockings and mobilisation.