We present a case of a 25-year-old female with diagnosed familial adenomatous polyposis and elevated carcinoembryonic antigen with negative family history. The suspicion of Gardner's syndrome was raised because extirpation of an osteoma of the left temporo-occipital region was made 10 years ago. Restorative proctocolectomy and ileal pouch anal anastomosis was made but histology delineated adenocarcinoma of the rectum (Dukes C stage). We conclude that cranial osteomas often precede gastrointestinal manifestations of familial adenomatous polyposis or Gardner's syndrome and such patients should be evaluated with genetic testing followed by colonoscopy if results are positive to prevent the development of colorectal carcinoma. If the diagnosis is positive all family members should be evaluated for familial adenomatous polyposis.

The authors report six cases of giant condyloma accuminatum and evaluate the use of mesh-skin grafts in covering the skin defect after radical local excision of perianal giant condyloma acuminatum. Medical records of six patients suffering from the giant condylomata acuminata and treated surgically at the Department of Surgery, Clinical Hospital Center Zagreb, were examined. Use of mesh-skin grafts in covering the skin defect after radical local excision of GCA was compared to other methods of treating the skin defect after radical excision of perianal lesions such as secondary wound healing. Four patients were treated by radical local excision and two patients were treated by abdominoperineal resection. There were partial graft failures (satisfactory result) in all patients and complete healing took about 3 to 4 weeks from time of grafting. A mesh-skin graft was used to cover the skin defect. There were no recurrences, wound infections, wound bleeding, hypertrophic scars, or mesh-like skin appearance of the recipient site. Therefore a good cosmetic and functional result was achieved. Use of mesh-grafts in covering the wounds after radical excision of anorectal giant condylomata acuminata compares favorably to healing by secondary intention in terms of wound healing time, and gives good functional and cosmetic results.

Gastrointestinal duplications are an uncommon congenital abnormality that manifest before the age of two in 80% of cases. Ileal duplication is the most common while colonic duplication, either cystic or tubular, occurs in 10%-15% of cases and remains asymptomatic and undiagnosed in most cases. Mostly occurring in pediatric patients, colonic duplication is encountered in adults in only a few cases. The most common clinical manifestations are abdominal pain and intestinal obstruction. Rarely, duplications present with signs of acute abdomen or acute bleeding. This study reports a case of colonic duplication in an adult who presented with chronic constipation. Complete diagnostic workup was made on several occasions during the previous eight year period, but no pathology was found and chronic constipation was attributed to hypothyroidism caused by long standing Hashimoto thyroiditis. Multislice CT, performed because of abdominal distension, defined colonic pathology but the definite diagnosis of duplication of the transversal colon was made at operation. The cystic duplication and the adjacent part of the ascending and transversal colon were excised en-block. This study implies that colonic duplication, though uncommon, should be included in the differential diagnosis of chronic constipation even when precipitating factors for constipation, such as hypothyroidism are present.

We report a 54-year-old patient with a complaint of weakness, abdominal pain and weight loss. During the clinical examination a palpable tumor resistance in the abdomen was found as well as iron deficiency anemia. Gastroscopy showed an exulcerated, dark brown, fungiform tumor about 4 cm in diameter at the great curve of stomach. Endoscopic biopsy revealed the diagnosis of malignant melanoma by demonstrating the presence of melanin containing tumor cells in gastric mucosa. The patient underwent subtotal gastrectomy, appendectomy and splenectomy. The diagnosis of gastric melanoma with regional lymph node metastases, as well as metastases in appendix adjacent tissue was confirmed by histology and immunohistochemistry. In three years follow up period patient developed cerebral and retroauricular subcutaneous metastases that were treated by surgery, adjuvant chemotherapy and radiotherapy. Finally, an explorative laparotomy was revealed advanced intraabdominal tumor dissemination with dark pigmented ascites. Concerning that all available diagnostic procedures failed to prove other site of melanoma, presented case was considered as primary gastric melanoma as a possible rare site of tumor.

difference between pre-move Barthel score and either first recorded or the final recorded post-move score. One-year mortality ranged from 20% in the EMI control group to 29% in the FE patient group but these differences were not significant. When patients with baseline Barthel scores of >5 were excluded from the analysis, again no significant difference in Barthel and mortality was found.In this study, moving older people was not associated with an increase in mortality or disability following relocation. This contrasts with the results of a number of other studies which we have reviewed in detail elsewhere [2]. However, we took particular care in the planning and organization of the move, and we hope that this had a beneficial influence on postrelocation measures. More UK investigations are needed into the effects of transferring vulnerable older individuals.